Electronic health record analysis via deep poisson factor models

DOE PAGES

Henao, Ricardo; Lu, James T.; Lucas, Joseph E.; ...

2016-01-01

Electronic Health Record (EHR) phenotyping utilizes patient data captured through normal medical practice, to identify features that may represent computational medical phenotypes. These features may be used to identify at-risk patients and improve prediction of patient morbidity and mortality. We present a novel deep multi-modality architecture for EHR analysis (applicable to joint analysis of multiple forms of EHR data), based on Poisson Factor Analysis (PFA) modules. Each modality, composed of observed counts, is represented as a Poisson distribution, parameterized in terms of hidden binary units. In-formation from different modalities is shared via a deep hierarchy of common hidden units. Activationmore » of these binary units occurs with probability characterized as Bernoulli-Poisson link functions, instead of more traditional logistic link functions. In addition, we demon-strate that PFA modules can be adapted to discriminative modalities. To compute model parameters, we derive efficient Markov Chain Monte Carlo (MCMC) inference that scales efficiently, with significant computational gains when compared to related models based on logistic link functions. To explore the utility of these models, we apply them to a subset of patients from the Duke-Durham patient cohort. We identified a cohort of over 12,000 patients with Type 2 Diabetes Mellitus (T2DM) based on diagnosis codes and laboratory tests out of our patient population of over 240,000. Examining the common hidden units uniting the PFA modules, we identify patient features that represent medical concepts. Experiments indicate that our learned features are better able to predict mortality and morbidity than clinical features identified previously in a large-scale clinical trial.« less

Interrogation of bimetallic particle oxidation in three dimensions at the nanoscale

DOE PAGES

Han, Lili; Meng, Qingping; Wang, Deli; ...

2016-12-08

An understanding of bimetallic alloy oxidation is key to the design of hollow-structured binary oxides and the optimization of their catalytic performance. However, one roadblock encountered in studying these binary oxide systems is the difficulty in describing the heterogeneities that occur in both structure and chemistry as a function of reaction coordinate. This is due to the complexity of the three-dimensional mosaic patterns that occur in these heterogeneous binary systems. By combining real-time imaging and chemical-sensitive electron tomography, we show that it is possible to characterize these systems with simultaneous nanoscale and chemical detail. We find that there is oxidation-inducedmore » chemical segregation occurring on both external and internal surfaces. Additionally, there is another layer of complexity that occurs during the oxidation, namely that the morphology of the initial oxide surface can change the oxidation modality. As a result, this work characterizes the pathways that can control the morphology in binary oxide materials.« less

Toxic effect of single and binary treatments of synthetic and plant-derived molluscicides against Achatina fulica.

PubMed

Rao, I G; Singh, D K

2002-01-01

The toxic effect of single and binary treatments of synthetic and plant-derived molluscicides was studied against the harmful terrestrial snail Achatina fulica. In single treatments, among the synthetic molluscicides Snail Kill and cypermethrin were potent, whereas Cedrus deodara oil was more toxic among molluscicides of plant origin against A. fulica. In binary treatments, a combination of Cedrusdeodara + Alliumsativum was more toxic. The toxicities of these single and binary treatments of synthetic and plant-derived molluscicides were dose and time dependent. Copyright 2002 John Wiley & Sons, Ltd.

Topology of Awareness: Therapeutic Implications of Logical Modalities of Multiple Levels of Awareness.

ERIC Educational Resources Information Center

Levine, Shellie

2000-01-01

Describes a theory of a topology of awareness, in which higher levels organize reality through dialectical logic, whereas lower levels construct reality based on Aristotelian logic, binary oppositions, and experiencing entities as discreet and independent. Argues that metaphor, poetry, and narrative are linguistic tools that enable clients to…

Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals.

PubMed

Koehler, Andreas; Eyssel, Jana; Nieder, Timo O

2018-01-01

Health care for transgender and transsexual (ie, trans) individuals has long been based on a binary understanding of gender (ie, feminine vs masculine). However, the existence of non-binary or genderqueer (NBGQ) genders is increasingly recognized by academic and/or health care professionals. To gain insight into the individual health care experiences and needs of binary and NBGQ individuals to improve their health care outcomes and experience. Data were collected using an online survey study on experiences with trans health care. The non-clinical sample consisted of 415 trans individuals. An individual treatment progress score was calculated to report and compare participants' individual progress toward treatment completion and consider the individual treatment needs and definitions of completed treatment (ie, amount and types of different treatments needed to complete one's medical transition). Main outcome measures were (i) general and trans-related sociodemographic data and (ii) received and planned treatments. Participants reported binary (81.7%) and different NBGQ (18.3%) genders. The 2 groups differed significantly in basic demographic data (eg, mean age; P < .05). NBGQ participants reported significantly fewer received treatments compared with binary participants. For planned treatments, binary participants reported more treatments related to primary sex characteristics only. Binary participants required more treatments for a completed treatment than NBGQ participants (6.0 vs 4.0). There were no differences with regard to individual treatment progress score. Because traditional binary-focused treatment practice could have hindered NBGQ individuals from accessing trans health care or sufficiently articulating their needs, health care professionals are encouraged to provide a holistic and individual treatment approach and acknowledge genders outside the gender binary to address their needs appropriately. Because the study was made inclusive for non-patients and individuals who decided against trans health care, bias from a participant-patient double role was prevented, which is the reason the results are likely to have a higher level of validity than a clinical sample. However, because of the anonymity of an online survey, it remains unclear whether NBGQ individuals live according to their gender identity in their everyday life. The study highlights the broad spectrum of genders in trans-individuals and associated health care needs and provides a novel approach to measure individual treatment progress in trans individuals. Koehler A, Eyssel J, Nieder TO. Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals. J Sex Med 2018;15:102-113. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Context-Aware Local Binary Feature Learning for Face Recognition.

PubMed

Duan, Yueqi; Lu, Jiwen; Feng, Jianjiang; Zhou, Jie

2018-05-01

In this paper, we propose a context-aware local binary feature learning (CA-LBFL) method for face recognition. Unlike existing learning-based local face descriptors such as discriminant face descriptor (DFD) and compact binary face descriptor (CBFD) which learn each feature code individually, our CA-LBFL exploits the contextual information of adjacent bits by constraining the number of shifts from different binary bits, so that more robust information can be exploited for face representation. Given a face image, we first extract pixel difference vectors (PDV) in local patches, and learn a discriminative mapping in an unsupervised manner to project each pixel difference vector into a context-aware binary vector. Then, we perform clustering on the learned binary codes to construct a codebook, and extract a histogram feature for each face image with the learned codebook as the final representation. In order to exploit local information from different scales, we propose a context-aware local binary multi-scale feature learning (CA-LBMFL) method to jointly learn multiple projection matrices for face representation. To make the proposed methods applicable for heterogeneous face recognition, we present a coupled CA-LBFL (C-CA-LBFL) method and a coupled CA-LBMFL (C-CA-LBMFL) method to reduce the modality gap of corresponding heterogeneous faces in the feature level, respectively. Extensive experimental results on four widely used face datasets clearly show that our methods outperform most state-of-the-art face descriptors.

Slip speed feedback for grip force control.

PubMed

Damian, D D; Arita, A H; Martinez, H; Pfeifer, R

2012-08-01

Grasp stability in the human hand has been resolved by means of an intricate network of mechanoreceptors integrating numerous cues about mechanical events, through an ontogenetic grasp practice. An engineered prosthetic interface introduces considerable perturbation risks in grasping, calling for feedback modalities that address the underlying slip phenomenon. In this study, we propose an enhanced slip feedback modality, with potential for myoelectric-based prosthetic applications, that relays information regarding slip events, particularly slip occurrence and slip speed. The proposed feedback modality, implemented using electrotactile stimulation, was evaluated in psychophysical studies of slip control in a simplified setup. The obtained results were compared with vision and a binary slip feedback that transmits on-off information about slip detection. The slip control efficiency of the slip speed display is comparable to that obtained with vision feedback, and it clearly outperforms the efficiency of the on-off slip modality in such tasks. These results suggest that the proposed tactile feedback is a promising sensory method for the restoration of stable grasp in prosthetic applications.

Potential Influence of Metro on Bus: A Case Study

NASA Astrophysics Data System (ADS)

Selvakumar, M.; Abishek Reddy, M.; Sathish, V.; Venkatesh, R.

2018-03-01

A modal shift occurs when one mode of transport has a comparative advantage in a similar market over another. The present work concerns with the development of modal shift model for urban travel in Chennai, India. The modal shift model was calibrated using binary logit technique and validated using hold-out sample method. The validated model was used to predict the probability of shift in selected corridor. The recent introduction of metro rail in Chennai has lead to an increasing competition among public transport modes. To study the influence of metro on bus transport, a Stated Preference (SP) survey was conducted among express bus travellers. Using the SP survey data, a modal shift model was calibrated to estimate the plausible shift from bus to metro. Results indicate that variables like fare-difference, age, and income play an important role in the shift behaviour. When metro fare increases with respect to express bus fare, bus passengers are less willing to use metro and vice-versa.

Potential Influence of Metro on Bus: A Case Study

NASA Astrophysics Data System (ADS)

Selvakumar, M.; Abishek Reddy, M.; Sathish, V.; Venkatesh, R.

2018-06-01

A modal shift occurs when one mode of transport has a comparative advantage in a similar market over another. The present work concerns with the development of modal shift model for urban travel in Chennai, India. The modal shift model was calibrated using binary logit technique and validated using hold-out sample method. The validated model was used to predict the probability of shift in selected corridor. The recent introduction of metro rail in Chennai has lead to an increasing competition among public transport modes. To study the influence of metro on bus transport, a Stated Preference (SP) survey was conducted among express bus travellers. Using the SP survey data, a modal shift model was calibrated to estimate the plausible shift from bus to metro. Results indicate that variables like fare- difference, age, and income play an important role in the shift behaviour. When metro fare increases with respect to express bus fare, bus passengers are less willing to use metro and vice-versa.

Treatment of sentence comprehension and production in aphasia: is there cross-modal generalisation?

PubMed

Adelt, Anne; Hanne, Sandra; Stadie, Nicole

2016-09-09

Exploring generalisation following treatment of language deficits in aphasia can provide insights into the functional relation of the cognitive processing systems involved. In the present study, we first review treatment outcomes of interventions targeting sentence processing deficits and, second report a treatment study examining the occurrence of practice effects and generalisation in sentence comprehension and production. In order to explore the potential linkage between processing systems involved in comprehending and producing sentences, we investigated whether improvements generalise within (i.e., uni-modal generalisation in comprehension or in production) and/or across modalities (i.e., cross-modal generalisation from comprehension to production or vice versa). Two individuals with aphasia displaying co-occurring deficits in sentence comprehension and production were trained on complex, non-canonical sentences in both modalities. Two evidence-based treatment protocols were applied in a crossover intervention study with sequence of treatment phases being randomly allocated. Both participants benefited significantly from treatment, leading to uni-modal generalisation in both comprehension and production. However, cross-modal generalisation did not occur. The magnitude of uni-modal generalisation in sentence production was related to participants' sentence comprehension performance prior to treatment. These findings support the assumption of modality-specific sub-systems for sentence comprehension and production, being linked uni-directionally from comprehension to production.

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

ERIC Educational Resources Information Center

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

2007-01-01

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

Array design considerations for exploitation of stable weakly dispersive modal pulses in the deep ocean

NASA Astrophysics Data System (ADS)

Udovydchenkov, Ilya A.

2017-07-01

Modal pulses are broadband contributions to an acoustic wave field with fixed mode number. Stable weakly dispersive modal pulses (SWDMPs) are special modal pulses that are characterized by weak dispersion and weak scattering-induced broadening and are thus suitable for communications applications. This paper investigates, using numerical simulations, receiver array requirements for recovering information carried by SWDMPs under various signal-to-noise ratio conditions without performing channel equalization. Two groups of weakly dispersive modal pulses are common in typical mid-latitude deep ocean environments: the lowest order modes (typically modes 1-3 at 75 Hz), and intermediate order modes whose waveguide invariant is near-zero (often around mode 20 at 75 Hz). Information loss is quantified by the bit error rate (BER) of a recovered binary phase-coded signal. With fixed receiver depths, low BERs (less than 1%) are achieved at ranges up to 400 km with three hydrophones for mode 1 with 90% probability and with 34 hydrophones for mode 20 with 80% probability. With optimal receiver depths, depending on propagation range, only a few, sometimes only two, hydrophones are often sufficient for low BERs, even with intermediate mode numbers. Full modal resolution is unnecessary to achieve low BERs. Thus, a flexible receiver array of autonomous vehicles can outperform a cabled array.

Large-scale Cross-modality Search via Collective Matrix Factorization Hashing.

PubMed

Ding, Guiguang; Guo, Yuchen; Zhou, Jile; Gao, Yue

2016-09-08

By transforming data into binary representation, i.e., Hashing, we can perform high-speed search with low storage cost, and thus Hashing has collected increasing research interest in the recent years. Recently, how to generate Hashcode for multimodal data (e.g., images with textual tags, documents with photos, etc) for large-scale cross-modality search (e.g., searching semantically related images in database for a document query) is an important research issue because of the fast growth of multimodal data in the Web. To address this issue, a novel framework for multimodal Hashing is proposed, termed as Collective Matrix Factorization Hashing (CMFH). The key idea of CMFH is to learn unified Hashcodes for different modalities of one multimodal instance in the shared latent semantic space in which different modalities can be effectively connected. Therefore, accurate cross-modality search is supported. Based on the general framework, we extend it in the unsupervised scenario where it tries to preserve the Euclidean structure, and in the supervised scenario where it fully exploits the label information of data. The corresponding theoretical analysis and the optimization algorithms are given. We conducted comprehensive experiments on three benchmark datasets for cross-modality search. The experimental results demonstrate that CMFH can significantly outperform several state-of-the-art cross-modality Hashing methods, which validates the effectiveness of the proposed CMFH.

Predictions about Bisymmetry and Cross-Modal Matches from Global Theories of Subjective Intensities

ERIC Educational Resources Information Center

Luce, R. Duncan

2012-01-01

The article first summarizes the assumptions of Luce (2004, 2008) for inherently binary (2-D) stimuli (e.g., the ears and eyes) that lead to a "p-additive," order-preserving psychophysical representation. Next, a somewhat parallel theory for unary (1-D) signals is developed for intensity attributes such as linear extent, vibration to finger, and…

Linear Subspace Ranking Hashing for Cross-Modal Retrieval.

PubMed

Li, Kai; Qi, Guo-Jun; Ye, Jun; Hua, Kien A

2017-09-01

Hashing has attracted a great deal of research in recent years due to its effectiveness for the retrieval and indexing of large-scale high-dimensional multimedia data. In this paper, we propose a novel ranking-based hashing framework that maps data from different modalities into a common Hamming space where the cross-modal similarity can be measured using Hamming distance. Unlike existing cross-modal hashing algorithms where the learned hash functions are binary space partitioning functions, such as the sign and threshold function, the proposed hashing scheme takes advantage of a new class of hash functions closely related to rank correlation measures which are known to be scale-invariant, numerically stable, and highly nonlinear. Specifically, we jointly learn two groups of linear subspaces, one for each modality, so that features' ranking orders in different linear subspaces maximally preserve the cross-modal similarities. We show that the ranking-based hash function has a natural probabilistic approximation which transforms the original highly discontinuous optimization problem into one that can be efficiently solved using simple gradient descent algorithms. The proposed hashing framework is also flexible in the sense that the optimization procedures are not tied up to any specific form of loss function, which is typical for existing cross-modal hashing methods, but rather we can flexibly accommodate different loss functions with minimal changes to the learning steps. We demonstrate through extensive experiments on four widely-used real-world multimodal datasets that the proposed cross-modal hashing method can achieve competitive performance against several state-of-the-arts with only moderate training and testing time.

Low Complexity Track Initialization and Fusion for Multi-Modal Sensor Networks

DTIC Science & Technology

2012-11-08

feature was demonstrated via the simulations. Aerospace 2011work further documents our investigation of multiple target tracking filters in...bounds that determine how well a sensor network can resolve and localize multiple targets as a function of the operating parameters such as sensor...probability density (PHD) filter for binary measurements using proximity sensors. 15. SUBJECT TERMS proximity sensors, PHD filter, multiple

Comparative Effectiveness Study of Patient-Reported Outcomes following Proton Therapy or IMRT for Prostate Cancer

PubMed Central

Hoppe, Bradford S.; Michalski, Jeff M.; Mendenhall, Nancy P.; Morris, Christopher G.; Henderson, Randal H.; Nichols, Romaine C.; Mendenhall, William M.; Williams, Christopher; Regan, Meredith M.; Chipman, Jonathan; Crociani, Catrina; Sandler, Howard M.; Sanda, Martin G.; Hamstra, Daniel A.

2014-01-01

Background Data continues to emerge on the relative merits of different treatment modalities for prostate cancer. The purpose of this study is to compare patient-reported quality-of-life outcomes (QOL) after proton therapy (PT) and intensity-modulated radiation therapy (IMRT) for prostate cancer. Methods A comparison was performed of prospectively collected QOL data using the expanded prostate cancer index (EPIC) questionnaire. QOL data was collected during the first 2 years following treatment for men treated with PT and IMRT. PT was delivered to 1,243 men at a single center to 76-82Gy. IMRT was delivered to 204 men included in the Prostate Cancer Quality Assurance Study (PROSTQA) in doses of 75.6-79.4Gy.The Wilcoxon rank sum test was used to compare EPIC outcomes by modality using baseline-adjusted scores at different time points. Individual questions were assessed by converting to binary outcomes and testing with generalized estimating equations. Results No differences in changes in summary scores for bowel, urinary incontinence, urinary irritative/obstructive, and sexual domains were seen between the two cohorts. However, more men treated with IMRT reported moderate/big problems with rectal urgency (p=0.02) and frequent bowel movements (p=0.05) than men treated with PT. Conclusions There were no differences in QOL summary scores between the IMRT and PT cohorts during early follow-up up to 2-years. Response to individual questions suggests possible differences in specific bowel symptoms between the two cohorts. These outcomes highlight the need for further comparative studies of PT and IMRT. PMID:24382757

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities.

PubMed

Horn, Eva K; Bartak, Anna; Meerman, Anke M M A; Rossum, Bert V; Ziegler, Uli M; Thunnissen, Moniek; Soons, Mirjam; Andrea, Helene; Hamers, Elisabeth F M; Emmelkamp, Paul M G; Stijnen, Theo; Busschbach, Jan J V; Verheul, Roel

2015-01-01

Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy. A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups. All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished. Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. Copyright © 2014 John Wiley & Sons, Ltd.

Development of the "Treatment beliefs in knee and hip OsteoArthritis (TOA)" questionnaire.

PubMed

Selten, Ellen M H; Vriezekolk, Johanna E; Schers, Henk J; Nijhof, Marc W; van der Laan, Willemijn H; van der Meulen-Dilling, Roelien G; Geenen, Rinie; van den Ende, Cornelia H M

2017-09-19

Use of conservative treatment modalities in osteoarthritis (OA) is suboptimal, which appears to be partly due to patients' beliefs about treatments. The aim of this study was to develop a research instrument assessing patients' beliefs about various treatment modalities of hip and knee OA: the 'Treatment beliefs in OA (TOA) questionnaire'. The item pool that was retrieved from interviews with patients and healthcare providers comprised beliefs regarding five treatment modalities: physical activity, pain medication, physiotherapy, injections and arthroplasty. After an extensive selection procedure, a draft questionnaire with 200 items was constructed. Descriptive analyses and exploratory factor analyses with oblique rotation were conducted for each treatment modality separately to decide upon the final questionnaire. Internal consistency and test-retest reliability were determined. The final questionnaire comprised 60 items. It was completed by 351 patients with knee or hip OA. Each of the five treatment modalities yielded a two factor solution with 37% to 51% explained variance and high face validity. Factor I included 'positive treatment beliefs' and factor II 'negative treatment beliefs'. Internal consistency (Cronbach α's from 0.72 to 0.87) and test-retest reliability (i.e. intraclass correlation coefficient from 0.66-0.88; standard error of measurement from 0.06-0.11) were satisfactory to good. The TOA questionnaire is the first questionnaire assessing positive and negative treatment beliefs regarding five treatment modalities for knee and hip OA. The instrument will help to understand whether and to what extent treatment beliefs influence treatment choices.

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps, challenges, and insights

PubMed Central

Li, Jin; Kros, Johan M

2017-01-01

Abstract To date, five cancer treatment modalities have been defined. The three traditional modalities of cancer treatment are surgery, radiotherapy, and conventional chemotherapy, and the two modern modalities include molecularly targeted therapy (the fourth modality) and immunotherapy (the fifth modality). The cardiotoxicity associated with conventional chemotherapy and radiotherapy is well known. Similar adverse cardiac events are resurging with the fourth modality. Aside from the conventional and newer targeted agents, even the most newly developed, immune‐based therapeutic modalities of anticancer treatment (the fifth modality), e.g., immune checkpoint inhibitors and chimeric antigen receptor (CAR) T‐cell therapy, have unfortunately led to potentially lethal cardiotoxicity in patients. Cardiac complications represent unresolved and potentially life‐threatening conditions in cancer survivors, while effective clinical management remains quite challenging. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some favorable benefits of modern cancer treatments in cancer‐related survival, regardless of the oncologic prognosis. This review focuses on identifying critical research‐practice gaps, addressing real‐world challenges and pinpointing real‐time insights in general terms under the context of clinical cardiotoxicity induced by the fourth and fifth modalities of cancer treatment. The information ranges from basic science to clinical management in the field of cardio‐oncology and crosses the interface between oncology and onco‐pharmacology. The complexity of the ongoing clinical problem is addressed at different levels. A better understanding of these research‐practice gaps may advance research initiatives on the development of mechanism‐based diagnoses and treatments for the effective clinical management of cardiotoxicity. PMID:28862319

A Multi-Modal Face Recognition Method Using Complete Local Derivative Patterns and Depth Maps

PubMed Central

Yin, Shouyi; Dai, Xu; Ouyang, Peng; Liu, Leibo; Wei, Shaojun

2014-01-01

In this paper, we propose a multi-modal 2D + 3D face recognition method for a smart city application based on a Wireless Sensor Network (WSN) and various kinds of sensors. Depth maps are exploited for the 3D face representation. As for feature extraction, we propose a new feature called Complete Local Derivative Pattern (CLDP). It adopts the idea of layering and has four layers. In the whole system, we apply CLDP separately on Gabor features extracted from a 2D image and depth map. Then, we obtain two features: CLDP-Gabor and CLDP-Depth. The two features weighted by the corresponding coefficients are combined together in the decision level to compute the total classification distance. At last, the probe face is assigned the identity with the smallest classification distance. Extensive experiments are conducted on three different databases. The results demonstrate the robustness and superiority of the new approach. The experimental results also prove that the proposed multi-modal 2D + 3D method is superior to other multi-modal ones and CLDP performs better than other Local Binary Pattern (LBP) based features. PMID:25333290

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

PubMed Central

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

2014-01-01

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

Optimal sensor placement for spatial lattice structure based on genetic algorithms

NASA Astrophysics Data System (ADS)

Liu, Wei; Gao, Wei-cheng; Sun, Yi; Xu, Min-jian

2008-10-01

Optimal sensor placement technique plays a key role in structural health monitoring of spatial lattice structures. This paper considers the problem of locating sensors on a spatial lattice structure with the aim of maximizing the data information so that structural dynamic behavior can be fully characterized. Based on the criterion of optimal sensor placement for modal test, an improved genetic algorithm is introduced to find the optimal placement of sensors. The modal strain energy (MSE) and the modal assurance criterion (MAC) have been taken as the fitness function, respectively, so that three placement designs were produced. The decimal two-dimension array coding method instead of binary coding method is proposed to code the solution. Forced mutation operator is introduced when the identical genes appear via the crossover procedure. A computational simulation of a 12-bay plain truss model has been implemented to demonstrate the feasibility of the three optimal algorithms above. The obtained optimal sensor placements using the improved genetic algorithm are compared with those gained by exiting genetic algorithm using the binary coding method. Further the comparison criterion based on the mean square error between the finite element method (FEM) mode shapes and the Guyan expansion mode shapes identified by data-driven stochastic subspace identification (SSI-DATA) method are employed to demonstrate the advantage of the different fitness function. The results showed that some innovations in genetic algorithm proposed in this paper can enlarge the genes storage and improve the convergence of the algorithm. More importantly, the three optimal sensor placement methods can all provide the reliable results and identify the vibration characteristics of the 12-bay plain truss model accurately.

Effect of single and binary combinations of plant-derived molluscicides on different enzyme activities in the nervous tissue of Achatina fulica.

PubMed

Rao, I G; Singh, Amrita; Singh, V K; Singh, D K

2003-01-01

Effect of single and binary treatments of plant-derived molluscicides on different enzymes--acetylcholinesterase (AChE), lactic dehydrogenase (LDH) and acid/alkaline phosphatase (ACP/ALP)--in the nervous tissue of the harmful terrestrial snail Achatina fulica were studied. Sublethal in vivo 24-h exposure to 40% and 80% LC(50) of Azadirachta indica oil, Cedrus deodara oil, Allium sativum bulb powder, Nerium indicum bark powder and binary combinations of A. sativum (AS) + C. deodara (CD) and CD + A. indica (AI) oils significantly altered the activity of these enzymes in the nervous tissue of Achatina fulica. The binary treatment of AS + CD was more effective against AChE, LDH, and ALP than the single ones. However, binary treatment of AI + CD was more effective against ALP. Copyright 2003 John Wiley & Sons, Ltd.

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma.

PubMed

Song, Do Seon; Nam, Soon Woo; Bae, Si Hyun; Kim, Jin Dong; Jang, Jeong Won; Song, Myeong Jun; Lee, Sung Won; Kim, Hee Yeon; Lee, Young Joon; Chun, Ho Jong; You, Young Kyoung; Choi, Jong Young; Yoon, Seung Kew

2015-02-28

To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC). A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively. In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P<0.001) and objective tumor response (P=0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P=0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P<0.001). Multivariate analysis identified tumor stage (P<0.001) and tumor type (P=0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P<0.001), surgical treatment (P=0.009), and multi-modal treatment (P=0.002) were identified as independent post-treatment prognostic factors. TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

PubMed Central

Song, Do Seon; Nam, Soon Woo; Bae, Si Hyun; Kim, Jin Dong; Jang, Jeong Won; Song, Myeong Jun; Lee, Sung Won; Kim, Hee Yeon; Lee, Young Joon; Chun, Ho Jong; You, Young Kyoung; Choi, Jong Young; Yoon, Seung Kew

2015-01-01

AIM: To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC). METHODS: A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively. RESULTS: In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P < 0.001) and objective tumor response (P = 0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P = 0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P < 0.001). Multivariate analysis identified tumor stage (P < 0.001) and tumor type (P = 0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P < 0.001), surgical treatment (P = 0.009), and multi-modal treatment (P = 0.002) were identified as independent post-treatment prognostic factors. CONCLUSION: TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC. PMID:25741147

Electric field encephalography for brain activity monitoring.

PubMed

Versek, Craig William; Frasca, Tyler; Zhou, Jianlin; Chowdhury, Kaushik; Sridhar, Srinivas

2018-05-11

Objective - We describe an early-stage prototype of a new wireless electrophysiological sensor system, called NeuroDot, which can measure neuroelectric potentials and fields at the scalp in a new modality called Electric Field Encephalography (EFEG). We aim to establish the physical validity of the EFEG modality, and examine some of its properties and relative merits compared to EEG. Approach - We designed a wireless neuroelectric measurement device based on the Texas Instrument ADS1299 Analog Front End platform and a sensor montage, using custom electrodes, to simultaneously measure EFEG and spatially averaged EEG over a localized patch of the scalp (2cm x 2cm). The signal properties of each modality were compared across tests of noise floor, Berger effect, steady-state Visually Evoked Potential (ssVEP), signal-to-noise ratio (SNR), and others. In order to compare EFEG to EEG modalities in the frequency domain, we use a novel technique to compute spectral power densities and derive narrow-band SNR estimates for ssVEP signals. A simple binary choice brain-computer-interface (BCI) concept based on ssVEP is evaluated. Also, we present examples of high quality recording of transient Visually Evoked Potentials and Fields (tVEPF) that could be used for neurological studies. Main results - We demonstrate the capability of the NeuroDot system to record high quality EEG signals comparable to some recent clinical and research grade systems on the market. We show that the locally-referenced EFEG metric is resistant to certain types of movement artifacts. In some ssVEP based measurements, the EFEG modality shows promising results, demonstrating superior signal to noise ratios than the same recording processed as an analogous EEG signal. We show that by using EFEG based ssVEP SNR estimates to perform a binary classification in a model BCI, the optimal information transfer rate (ITR) can be raised from 15 to 30 bits per minute - though these preliminary results are likely sensitive to inter-subject variations and choice of scalp locations, so require further investigation. Significance - Enhancement of ssVEP SNR using EFEG has the potential to improve visually based BCIs and diagnostic paradigms. The time domain analysis of tVEPF signals shows robust features in the electric field components that might have clinical relevance beyond classical VEP approaches. . © 2018 IOP Publishing Ltd.

Predictors of treatment with dialysis modalities in observational studies for comparative effectiveness research*

PubMed Central

Kuttykrishnan, Sooraj; Kalantar-Zadeh, Kamyar; Arah, Onyebuchi A.; Cheung, Alfred K.; Brunelli, Steve; Heagerty, Patrick J.; Katz, Ronit; Molnar, Miklos Z.; Nissenson, Allen; Ravel, Vanessa; Streja, Elani; Himmelfarb, Jonathan; Mehrotra, Rajnish

2015-01-01

Background The Institute of Medicine has identified the comparative effectiveness of renal replacement therapies as a kidney-related topic among the top 100 national priorities. Given the importance of ensuring internal and external validity, the goal of this study was to identify potential sources of bias in observational studies that compare outcomes with different dialysis modalities. Methods This observational cohort study used data from the electronic medical records of all patients that started maintenance dialysis in the calendar years 2007–2011 and underwent treatment for at least 60 days in any of the 2217 facilities operated by DaVita Inc. Each patient was assigned one of six dialysis modalities for each 91-day period from the date of first dialysis (thrice weekly in-center hemodialysis (HD), peritoneal dialysis (PD), less-frequent HD, home HD, frequent HD and nocturnal in-center HD). Results Of the 162 644 patients, 18% underwent treatment with a modality other than HD for at least one 91-day period. Except for PD, patients started treatment with alternative modalities after variable lengths of treatment with HD; the time until a change in modality was shortest for less-frequent HD (median time = 6 months) and longest for frequent HD (median time = 15 months). Between 30 and 78% of patients transferred to another dialysis facility prior to change in modality. Finally, there were significant differences in baseline and time-varying clinical characteristics associated with dialysis modality. Conclusions This analysis identified numerous potential sources of bias in studies of the comparative effectiveness of dialysis modalities. PMID:25883196

A geriatrician's guide to the use of the physical modalities in the treatment of pain and dysfunction.

PubMed

Perret, Danielle Marie; Rim, Josephine; Cristian, Adrian

2006-05-01

The use of the physical modalities in the treatment of musculoskeletal conditions has a long and rich history. This article explores the various physical modalities and their indications, precautions, and contraindications, especially in their applied use in pain management. It also highlights the role of the physical modalities as agents for the management of pain in the geriatric population.

The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner.

PubMed

Nadler, Scott F; Weingand, Kurt; Kruse, Roger J

2004-07-01

Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculoskeletal injuries. Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Through a better understanding of these modalities, clinicians can optimize their present treatment strategies. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Continuous low-level cryotherapy and thermotherapy are newer concepts in therapeutic modalities. Both modalities provide significant pain relief with a low side-effect profile. Contrast therapy, which alternates between hot and cold treatment modalities, provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone. Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing. With thermotherapy, skin burns may occur, especially in patients with diabetes mellitus, multiple sclerosis, poor circulation, and spinal cord injuries. In individuals with rheumatoid arthritis, deep-heating modalities should be used with caution because increased inflammation may occur. Whirlpool and other types of hydrotherapy have caused infections of the skin, urogenital, and pulmonary systems. Additionally, ultrasound should not be used in patients with joint prostheses.

"Sequential” Boron Neutron Capture Therapy (BNCT): A Novel Approach to BNCT for the Treatment of Oral Cancer in the Hamster Cheek Pouch Model

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

Ana J. Molinari; Andrea Monti Hughes; Elisa M. Heber

2011-04-01

Boron Neutron Capture Therapy (BNCT) is a binary treatment modality that involves the selective accumulation of 10B carriers in tumors followed by irradiation with a thermal or epithermal neutron beam. The minor abundance stable isotope of boron, 10B, interacts with low energy (thermal) neutrons to produce high linear energy transfer (LET) a-particles and 7Li ions. These disintegration products are known to have a high relative biological effectiveness (RBE). Their short range (<10 {micro}m) would limit the damage to cells containing 10B (1,2). Thus, BNCT would target tumor tissue selectively, sparing normal tissue. Clinical trials of BNCT for the treatment ofmore » glioblastoma multiforme and/or melanoma and, more recently, head and neck tumors and liver metastases, using boronophenylalanine (BPA) or sodium mercaptoundecahydrododecaborane (BSH) as the 10B carriers, have been performed or are underway in Argentina, Japan, the US and Europe (e.g. 3-8). To date, the clinical results have shown a potential, albeit inconclusive, therapeutic advantage for this technique. Contributory translational studies have been carried out employing a variety of experimental models based on the implantation of tumor cells in normal tissue (e.g. 5).« less

2SLS versus 2SRI: Appropriate methods for rare outcomes and/or rare exposures.

PubMed

Basu, Anirban; Coe, Norma B; Chapman, Cole G

2018-06-01

This study used Monte Carlo simulations to examine the ability of the two-stage least squares (2SLS) estimator and two-stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment was varied across simulation scenarios. Results showed that 2SLS generated consistent estimates of the local average treatment effects (LATE) and biased estimates of the average treatment effects (ATE) across all scenarios. 2SRI approaches, in general, produced biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimized the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long-term care insurance on a variety of binary health care utilization outcomes among the near-elderly using the Health and Retirement Study. Copyright © 2018 John Wiley & Sons, Ltd.

Effectiveness and Cost-effectiveness of Four Treatment Modalities for Substance Disorders: A Propensity Score Analysis

PubMed Central

Mojtabai, Ramin; Graff Zivin, Joshua

2003-01-01

Objective To assess the effectiveness and cost-effectiveness of four treatment modalities for substance abuse. Data Sources The study used data from the Services Research Outcomes Study (SROS), a survey of 3,047 clients in a random sample of 99 drug treatment facilities across the United States. Detailed sociodemographic, substance use, and clinical data were abstracted from treatment records. Substance abuse outcome and treatment history following discharge from index facilities were assessed using a comprehensive interview with 1,799 of these individuals five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use. Study Design Effectiveness and cost-effectiveness of four modalities were compared: inpatient, residential, outpatient detox/methadone, and outpatient drug-free. Clients were stratified based on propensity scores and analyses were conducted within these strata. Sensitivity analyses examined the impact of future substance abuse treatment on effectiveness and cost-effectiveness estimates. Principal Findings Treatment of substance disorders appears to be cost-effective compared to other health interventions. The cost per successfully treated abstinent case in the least costly modality, the outpatient drug-free programs, was $6,300 (95 percent confidence intervals: $5,200–$7,900) in 1990 dollars. There were only minor differences between various modalities of treatment with regard to effectiveness. However, modalities varied considerably with regard to cost-effectiveness. Outpatient drug-free programs were the most cost-effective. There was little evidence that relative effectiveness or cost-effectiveness of programs varied according to factors that were associated with selection into different programs. Conclusions Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment. PMID:12650390

The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence.

PubMed

Martin, Garth W; Rehm, Jürgen

2012-06-01

Our objectives were to review the effectiveness of psychosocial modalities in the treatment of alcohol use disorders and problems, and to examine the impact of therapists on treatment outcome, the evidence on best practices for comorbid conditions, and the evidence on treatment matching. We based our review on published systematic reviews of this topic after 2000. There is strong evidence that some, but not all, psychosocial treatments are effective in treating alcohol problems. Those with the strongest empirical support are motivational enhancement therapy, various cognitive-behavioural interventions, and brief interventions. Meta-analyses for several of these modalities suggest typical effect sizes in the low-to-moderate range. When these modalities have been compared with one another in well-designed clinical trials, they have been shown to be of comparable effectiveness. There is little basis on which to recommend one of these modalities over another but good reason to select from among them.

Predictors of treatment with dialysis modalities in observational studies for comparative effectiveness research.

PubMed

Kuttykrishnan, Sooraj; Kalantar-Zadeh, Kamyar; Arah, Onyebuchi A; Cheung, Alfred K; Brunelli, Steve; Heagerty, Patrick J; Katz, Ronit; Molnar, Miklos Z; Nissenson, Allen; Ravel, Vanessa; Streja, Elani; Himmelfarb, Jonathan; Mehrotra, Rajnish

2015-07-01

The Institute of Medicine has identified the comparative effectiveness of renal replacement therapies as a kidney-related topic among the top 100 national priorities. Given the importance of ensuring internal and external validity, the goal of this study was to identify potential sources of bias in observational studies that compare outcomes with different dialysis modalities. This observational cohort study used data from the electronic medical records of all patients that started maintenance dialysis in the calendar years 2007-2011 and underwent treatment for at least 60 days in any of the 2217 facilities operated by DaVita Inc. Each patient was assigned one of six dialysis modalities for each 91-day period from the date of first dialysis (thrice weekly in-center hemodialysis (HD), peritoneal dialysis (PD), less-frequent HD, home HD, frequent HD and nocturnal in-center HD). Of the 162 644 patients, 18% underwent treatment with a modality other than HD for at least one 91-day period. Except for PD, patients started treatment with alternative modalities after variable lengths of treatment with HD; the time until a change in modality was shortest for less-frequent HD (median time = 6 months) and longest for frequent HD (median time = 15 months). Between 30 and 78% of patients transferred to another dialysis facility prior to change in modality. Finally, there were significant differences in baseline and time-varying clinical characteristics associated with dialysis modality. This analysis identified numerous potential sources of bias in studies of the comparative effectiveness of dialysis modalities. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

New approaches in clinical application of laser-driven ionizing radiation

NASA Astrophysics Data System (ADS)

Hideghéty, Katalin; Szabó, Rita Emilia; Polanek, Róbert; Szabó, Zoltán.; Brunner, Szilvia; Tőkés, Tünde

2017-05-01

The planned laser-driven ionizing beams (photon, very high energy electron, proton, carbon ion) at laser facilities have the unique property of ultra-high dose rate (>Gy/s-10), short pulses, and at ELI-ALPS high repetition rate, carry the potential to develop novel laser-driven methods towards compact hospital-based clinical application. The enhanced flexibility in particle and energy selection, the high spatial and time resolution and extreme dose rate could be highly beneficial in radiotherapy. These approaches may increase significantly the therapeutic index over the currently available advanced radiation oncology methods. We highlight two nuclear reactionbased binary modalities and the planned radiobiology research. Boron Neutron Capture Therapy is an advanced cell targeted modality requiring 10B enriched boron carrier and appropriate neutron beam. The development of laser-based thermal and epithermal neutron source with as high as 1010 fluence rate could enhance the research activity in this promising field. Boron-Proton Fusion reaction is as well as a binary approach, where 11B containing compounds are accumulated into the cells, and the tumour selectively irradiated with protons. Due to additional high linear energy transfer alpha particle release of the BPFR and the maximum point of the Bragg-peak is increased, which result in significant biological effect enhancement. Research at ELI-ALPS on detection of biological effect differences of modified or different quality radiation will be presented using recently developed zebrafish embryo and rodent models.

A Comparison of Therapeutic Factors in Two Group Treatment Modalities: Verbal and Art Therapy.

ERIC Educational Resources Information Center

Shechtman, Zipora; Perl-Dekel, Ofra

2000-01-01

Compares therapeutic factors in verbal and art group psychotherapy in a psychiatric day-treatment clinic in Israel. Results only partly support the differences between modalities, but do reveal significant differences between participants with only a few interactions between participants and modalities. All therapeutic factors appear in both…

Physician perceptions of the value of physical modalities in the treatment of musculoskeletal disease.

PubMed

Rush, P J; Shore, A

1994-06-01

We randomly surveyed 100 specialists in rehabilitation medicine and 100 rheumatologists concerning their perceptions of the value of 11 different physical modalities--cold, active and passive exercise, interferential current, laser, magnetotherapy, microwave, shortwave diathermy, traction, ultrasound and transcutaneous nerve stimulation in the treatment of seven different musculoskeletal conditions--acute arthritis, joint contracture, neck pain, back pain, tendinitis, reflex sympathetic dystrophy and frozen shoulder. There were significant differences in the perceived benefits of modalities which varied by modality and condition. Overall, rehabilitation medicine specialists regarded modalities to be helpful more often than rheumatologists (P < 0.001).

Comparative analysis of success of psoriasis treatment with standard therapeutic modalities and balneotherapy.

PubMed

Baros, Duka Ninković; Gajanin, Vesna S; Gajanin, Radoslav B; Zrnić, Bogdan

2014-01-01

Psoriasis is a chronic, inflammatory, immune-mediated skin disease. In addition to standard therapeutic modalities (antibiotics, cytostatics, phototherapy, photochemotherapy and retinoids), nonstandard methods can be used in the treatment of psoriasis. This includes balneotherapy which is most commonly used in combination with therapeutic resources. The aim of this research was to determine the length of remission of psoriasis in patients treated with standard therapeutic modalities, balneotherapy, and combined treatment (standard therapeutic modalities and balneotherapy). The study analyzed 60 adult patients, of both sexes, with different clinical forms of psoriasis, who were divided into three groups according to the applied therapeutic modalities: the first group (treated with standard therapeutic modalities), the second group (treated with balneotherapy) and the third group (treated with combined therapy-standard methods therapy and balneotherapy). The Psoriasis Area and Severity Index was determined in first, third and sixth week of treatment for all patients. The following laboratory analysis were performed and monitored: C reactive protein, iron with total iron binding capacity, unsaturated iron binding capacity and ferritin, uric acid, rheumatoid factors and antibodies to streptolysin O in the first and sixth week of treatment. The average length of remission in patients treated with standard therapeutic modalities and in those treated with balneotherapy was 1.77 +/- 0.951 months and 1.79 +/- 0.918 months, respectively. There was a statistically significant difference in the duration of remission between the patients treated with combination therapy and patients treated with standard therapeutic modalities (p = 0.019) and balneotherapy (p = 0.032). The best results have been achieved when the combination therapy was administered.

Spatial Analysis of Case-Mix and Dialysis Modality Associations.

PubMed

Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

2016-01-01

♦ Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency. Copyright © 2016 International Society for Peritoneal Dialysis.

Spatial Analysis of Case-Mix and Dialysis Modality Associations

PubMed Central

Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

2016-01-01

♦ Background: Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ Methods: The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ Result: The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ Conclusions: The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency. PMID:26475843

Different treatment modalities of fusiform basilar trunk aneurysm: study on computational hemodynamics.

PubMed

Wu, Chen; Xu, Bai-Nan; Sun, Zheng-Hui; Wang, Fu-Yu; Liu, Lei; Zhang, Xiao-Jun; Zhou, Ding-Biao

2012-01-01

Unclippable fusiform basilar trunk aneurysm is a formidable condition for surgical treatment. The aim of this study was to establish a computational model and to investigate the hemodynamic characteristics in a fusiform basilar trunk aneurysm. The three-dimensional digital model of a fusiform basilar trunk aneurysm was constructed using MIMICS, ANSYS and CFX software. Different hemodynamic modalities and border conditions were assigned to the model. Thirty points were selected randomly on the wall and within the aneurysm. Wall total pressure (WTP), wall shear stress (WSS), and blood flow velocity of each point were calculated and hemodynamic status was compared between different modalities. The quantitative average values of the 30 points on the wall and within the aneurysm were obtained by computational calculation point by point. The velocity and WSS in modalities A and B were different from those of the remaining 5 modalities; and the WTP in modalities A, E and F were higher than those of the remaining 4 modalities. The digital model of a fusiform basilar artery aneurysm is feasible and reliable. This model could provide some important information to clinical treatment options.

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.

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

ERIC Educational Resources Information Center

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

2004-01-01

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

Monitoring tumor growth and treatment in small animals with magnetic resonance and optical tomographic imaging

NASA Astrophysics Data System (ADS)

Masciotti, J.; Provenzano, F.; Papa, J.; Klose, A.; Hur, J.; Gu, X.; Yamashiro, D.; Kandel, J.; Hielscher, A. H.

2006-02-01

Small animal models are employed to simulate disease in humans and to study its progression, what factors are important to the disease process, and to study the disease treatment. Biomedical imaging modalities such as magnetic resonance imaging (MRI) and Optical Tomography make it possible to non-invasively monitor the progression of diseases in living small animals and study the efficacy of drugs and treatment protocols. MRI is an established imaging modality capable of obtaining high resolution anatomical images and along with contrast agents allow the studying of blood volume. Optical tomography, on the other hand, is an emerging imaging modality, which, while much lower in spatial resolution, can separate the effects of oxyhemoglobin, deoxyhemoglobin, and blood volume with high temporal resolution. In this study we apply these modalities to imaging the growth of kidney tumors and then there treatment by an anti-VEGF agent. We illustrate how these imaging modalities have their individual uses, but can still supplement each other and cross validation can be performed.

Fractional labelmaps for computing accurate dose volume histograms

NASA Astrophysics Data System (ADS)

Sunderland, Kyle; Pinter, Csaba; Lasso, Andras; Fichtinger, Gabor

2017-03-01

PURPOSE: In radiation therapy treatment planning systems, structures are represented as parallel 2D contours. For treatment planning algorithms, structures must be converted into labelmap (i.e. 3D image denoting structure inside/outside) representations. This is often done by triangulated a surface from contours, which is converted into a binary labelmap. This surface to binary labelmap conversion can cause large errors in small structures. Binary labelmaps are often represented using one byte per voxel, meaning a large amount of memory is unused. Our goal is to develop a fractional labelmap representation containing non-binary values, allowing more information to be stored in the same amount of memory. METHODS: We implemented an algorithm in 3D Slicer, which converts surfaces to fractional labelmaps by creating 216 binary labelmaps, changing the labelmap origin on each iteration. The binary labelmap values are summed to create the fractional labelmap. In addition, an algorithm is implemented in the SlicerRT toolkit that calculates dose volume histograms (DVH) using fractional labelmaps. RESULTS: We found that with manually segmented RANDO head and neck structures, fractional labelmaps represented structure volume up to 19.07% (average 6.81%) more accurately than binary labelmaps, while occupying the same amount of memory. When compared to baseline DVH from treatment planning software, DVH from fractional labelmaps had agreement acceptance percent (1% ΔD, 1% ΔV) up to 57.46% higher (average 4.33%) than DVH from binary labelmaps. CONCLUSION: Fractional labelmaps promise to be an effective method for structure representation, allowing considerably more information to be stored in the same amount of memory.

Brain metastases in women with epithelial ovarian cancer: multimodal treatment including surgery or gamma-knife radiation is associated with prolonged survival.

PubMed

Niu, Xiaoyu; Rajanbabu, Anupama; Delisle, Megan; Peng, Feng; Vijaykumar, Dehannathuparambil K; Pavithran, Keechilattu; Feng, Yukuan; Lau, Susie; Gotlieb, Walter H; Press, Joshua Z

2013-09-01

To explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer. We conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only. Twelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India. Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months). Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 25.6 months, compared with 6.0 months in patients whose treatment did not include this type of focused localized modality (P = 0.006). Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs. 6.0 months, P < 0.001). In the subset of patients with brain metastases from ovarian cancer, prolonged survival may result from use of multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision.

Missing Data in Alcohol Clinical Trials with Binary Outcomes

PubMed Central

Hallgren, Kevin A.; Witkiewitz, Katie; Kranzler, Henry R.; Falk, Daniel E.; Litten, Raye Z.; O’Malley, Stephanie S.; Anton, Raymond F.

2017-01-01

Background Missing data are common in alcohol clinical trials for both continuous and binary endpoints. Approaches to handle missing data have been explored for continuous outcomes, yet no studies have compared missing data approaches for binary outcomes (e.g., abstinence, no heavy drinking days). The present study compares approaches to modeling binary outcomes with missing data in the COMBINE study. Method We included participants in the COMBINE Study who had complete drinking data during treatment and who were assigned to active medication or placebo conditions (N=1146). Using simulation methods, missing data were introduced under common scenarios with varying sample sizes and amounts of missing data. Logistic regression was used to estimate the effect of naltrexone (vs. placebo) in predicting any drinking and any heavy drinking outcomes at the end of treatment using four analytic approaches: complete case analysis (CCA), last observation carried forward (LOCF), the worst-case scenario of missing equals any drinking or heavy drinking (WCS), and multiple imputation (MI). In separate analyses, these approaches were compared when drinking data were manually deleted for those participants who discontinued treatment but continued to provide drinking data. Results WCS produced the greatest amount of bias in treatment effect estimates. MI usually yielded less biased estimates than WCS and CCA in the simulated data, and performed considerably better than LOCF when estimating treatment effects among individuals who discontinued treatment. Conclusions Missing data can introduce bias in treatment effect estimates in alcohol clinical trials. Researchers should utilize modern missing data methods, including MI, and avoid WCS and CCA when analyzing binary alcohol clinical trial outcomes. PMID:27254113

Missing Data in Alcohol Clinical Trials with Binary Outcomes.

PubMed

Hallgren, Kevin A; Witkiewitz, Katie; Kranzler, Henry R; Falk, Daniel E; Litten, Raye Z; O'Malley, Stephanie S; Anton, Raymond F

2016-07-01

Missing data are common in alcohol clinical trials for both continuous and binary end points. Approaches to handle missing data have been explored for continuous outcomes, yet no studies have compared missing data approaches for binary outcomes (e.g., abstinence, no heavy drinking days). This study compares approaches to modeling binary outcomes with missing data in the COMBINE study. We included participants in the COMBINE study who had complete drinking data during treatment and who were assigned to active medication or placebo conditions (N = 1,146). Using simulation methods, missing data were introduced under common scenarios with varying sample sizes and amounts of missing data. Logistic regression was used to estimate the effect of naltrexone (vs. placebo) in predicting any drinking and any heavy drinking outcomes at the end of treatment using 4 analytic approaches: complete case analysis (CCA), last observation carried forward (LOCF), the worst case scenario (WCS) of missing equals any drinking or heavy drinking, and multiple imputation (MI). In separate analyses, these approaches were compared when drinking data were manually deleted for those participants who discontinued treatment but continued to provide drinking data. WCS produced the greatest amount of bias in treatment effect estimates. MI usually yielded less biased estimates than WCS and CCA in the simulated data and performed considerably better than LOCF when estimating treatment effects among individuals who discontinued treatment. Missing data can introduce bias in treatment effect estimates in alcohol clinical trials. Researchers should utilize modern missing data methods, including MI, and avoid WCS and CCA when analyzing binary alcohol clinical trial outcomes. Copyright © 2016 by the Research Society on Alcoholism.

Treatment of Pediculosis Capitis

PubMed Central

Verma, Prashant; Namdeo, Chaitanya

2015-01-01

An endeavour to delineate the salient details of the treatment of head lice infestation has been made in the present article. Treatment modalities including over the counter permethrin and pyrethrin, and prescription medicines, including malathion, lindane, benzyl alcohol, spinosad are discussed. Salient features of alternative medicine and physical treatment modalities are outlined. The problem of resistance to treatment has also been taken cognizance of. PMID:26120148

Multimodal image registration based on binary gradient angle descriptor.

PubMed

Jiang, Dongsheng; Shi, Yonghong; Yao, Demin; Fan, Yifeng; Wang, Manning; Song, Zhijian

2017-12-01

Multimodal image registration plays an important role in image-guided interventions/therapy and atlas building, and it is still a challenging task due to the complex intensity variations in different modalities. The paper addresses the problem and proposes a simple, compact, fast and generally applicable modality-independent binary gradient angle descriptor (BGA) based on the rationale of gradient orientation alignment. The BGA can be easily calculated at each voxel by coding the quadrant in which a local gradient vector falls, and it has an extremely low computational complexity, requiring only three convolutions, two multiplication operations and two comparison operations. Meanwhile, the binarized encoding of the gradient orientation makes the BGA more resistant to image degradations compared with conventional gradient orientation methods. The BGA can extract similar feature descriptors for different modalities and enable the use of simple similarity measures, which makes it applicable within a wide range of optimization frameworks. The results for pairwise multimodal and monomodal registrations between various images (T1, T2, PD, T1c, Flair) consistently show that the BGA significantly outperforms localized mutual information. The experimental results also confirm that the BGA can be a reliable alternative to the sum of absolute difference in monomodal image registration. The BGA can also achieve an accuracy of [Formula: see text], similar to that of the SSC, for the deformable registration of inhale and exhale CT scans. Specifically, for the highly challenging deformable registration of preoperative MRI and 3D intraoperative ultrasound images, the BGA achieves a similar registration accuracy of [Formula: see text] compared with state-of-the-art approaches, with a computation time of 18.3 s per case. The BGA improves the registration performance in terms of both accuracy and time efficiency. With further acceleration, the framework has the potential for application in time-sensitive clinical environments, such as for preoperative MRI and intraoperative US image registration for image-guided intervention.

Economic evaluation of bone stimulation modalities: A systematic review of the literature.

PubMed

Button, Melissa L; Sprague, Sheila; Gharsaa, Osama; Latouche, Sandra; Bhandari, Mohit

2009-04-01

Various bone stimulation modalities are commonly used in treatment of fresh fractures and nonunions; however, the effectiveness and efficiency of these modalities remain uncertain. A systematic review of trials evaluating the clinical and economical outcomes of ultrasounds, electrical stimulation, and extracorporeal sound waves on fracture healing was conducted. We searched four electronic databases for economic evaluations that assessed bone stimulation modalities using ultrasound therapy, electrical stimulation, or extracorporeal shock waves. In addition, we searched the references and related articles of eligible studies, and a content expert was contacted. Information on the clinical and economical outcomes of patients was independently extracted by reviewers. Fourteen studies met the inclusion criteria; therefore, very limited research was found on the cost associated with treatments and the corresponding outcomes. The data available focus primarily on the efficacy of newly introduced treatment methods for bone growth, but failed to incorporate the costs of implementing such treatments. One economic analysis was identified that assessed different treatment paths using ultrasound. A total cost savings of 24-40% per patient occurred when ultrasound was used for fresh fractures and nonunions (grade C recommendation). The results suggest that the ultrasound is a viable alternative for bone stimulation; however, the impacts of the other modalities are left unknown due to the lack of research available. Methodological limitations leave the overall economic and clinical impact of these modalities uncertain. Large, prospective, randomized controlled trials that include cost-effectiveness analyses are needed to further define the clinical effectiveness and financial burden associated with bone stimulation modalities.

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

PubMed

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

2017-07-01

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

Hyperbaric oxygen modalities are differentially effective in distinct brain ischemia models

PubMed Central

Ostrowski, Robert P.; Stępień, Katarzyna; Pucko, Emanuela; Matyja, Ewa

2016-01-01

The effectiveness and efficacy of hyperbaric oxygen (HBO) preconditioning and post-treatment modalities have been demonstrated in experimental models of ischemic cerebrovascular diseases, including global brain ischemia, transient focal and permanent focal cerebral ischemia, and experimental neonatal hypoxia-ischemia encephalopathy. In general, early and repetitive post-treatment of HBO appears to create enhanced protection against brain ischemia whereas delayed HBO treatment after transient focal ischemia may even aggravate brain injury. This review advocates the level of injury reduction upon HBO as an important component for translational evaluation of HBO based treatment modalities. The combined preconditioning and HBO post-treatment that would provide synergistic effects is also worth considering. PMID:27826422

Treatment modalities of palmoplantar lichen planus: a brief review.

PubMed

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

2016-12-01

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

Bacterial vaginosis: Etiology and modalities of treatment—A brief note

PubMed Central

Kumar, Nikhil; Behera, Beauty; Sagiri, Sai S.; Pal, Kunal; Ray, Sirsendu S.; Roy, Saroj

2011-01-01

A large women population of the world is suffering from a vaginal infection commonly known as bacterial vaginosis. The disease is associated with the decrease in the lactobacilli count in the vagina. Till date, there is a lack of full proof treatment modalities for the cure of the disease. The treatment includes the use of antimicrobials and/or acidifying agents and probiotics, either separately or in combination. This note discusses about the etiology and the various present-day modalities of treatment of bacterial vaginosis. PMID:22219582

Combined Auditory and Vibrotactile Feedback for Human-Machine-Interface Control.

PubMed

Thorp, Elias B; Larson, Eric; Stepp, Cara E

2014-01-01

The purpose of this study was to determine the effect of the addition of binary vibrotactile stimulation to continuous auditory feedback (vowel synthesis) for human-machine interface (HMI) control. Sixteen healthy participants controlled facial surface electromyography to achieve 2-D targets (vowels). Eight participants used only real-time auditory feedback to locate targets whereas the other eight participants were additionally alerted to having achieved targets with confirmatory vibrotactile stimulation at the index finger. All participants trained using their assigned feedback modality (auditory alone or combined auditory and vibrotactile) over three sessions on three days and completed a fourth session on the third day using novel targets to assess generalization. Analyses of variance performed on the 1) percentage of targets reached and 2) percentage of trial time at the target revealed a main effect for feedback modality: participants using combined auditory and vibrotactile feedback performed significantly better than those using auditory feedback alone. No effect was found for session or the interaction of feedback modality and session, indicating a successful generalization to novel targets but lack of improvement over training sessions. Future research is necessary to determine the cognitive cost associated with combined auditory and vibrotactile feedback during HMI control.

Current and Under Development Treatment Modalities of Psoriasis: A Review.

PubMed

Albaghdadi, Abdullah

2017-01-01

Psoriasis is a chronic and complex autoimmune inflammatory skin disease that affects over 125 million people worldwide. It can exhibit at any age, in spite of the fact that children are less normally influenced than adults. It is characterized by distinct erythematous plaques shielded with conspicuous silvery scales that shows up in different areas of the skin. Knowledge of pathophysiology, especially the pathogenesis of psoriasis, has significantly progressed in the recent decade. Advancement in molecular knowledge leads to better understanding of the disease, thus influencing the development of efficient treatment modalities. However, even with the availability of various options of treatment most of the efficient treatment modalities are costly. Expenses of health care bring about major financial weight to the patients as well as to health care systems. Thus, it was important to review the available current treatment options and those which are under development, in terms of efficacy, safety and cost to assist in selecting the most appropriate treatment for psoriasis patients. Literatures were searched by using key words psoriasis, topical treatment, systemic treatment, biologics and phototherapies, on Embase, Medline, Jstor, Cochrane and Merck Index databases. Life-style choices such as smoking, alcohol consumption, obesity and stress are recognised as risk factors and triggers associated with psoriasis. Psoriasis poses psycho-social and economic burden on affected patients that sometimes leads to depression, reduced social interaction and suicidal tendencies in patients. Depending on the type, severity and extent of the disease, comorbidities, patient preference, efficacy and safety profile, numerous treatment modalities and therapeutic agents are available such as topical, systemic, biologic and phototherapeutic treatments. However, it was found that among all the current available treatments for psoriasis, biologic agents and phototherapeutic modalities are the most commonly employed treatment modalities for moderate to severe psoriasis. Evaluation of present-day available treatment alternatives will surely help physician to select a suitable module for each patient while keeping in mind the financial status of the patient. Future research should aim to develop therapies which are efficient, safe and cost-effective. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis.

PubMed

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Odegaard-Jensen, Jan; Flottorp, Signe

2010-03-01

Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08-3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19-0.68 and OR = 8.92, 95% CI = 4.37-18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12-11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice. (c) 2009 John Wiley & Sons, Ltd.

Plantar hyperhidrosis: A review of current management.

PubMed

Singh, Sanjay; Kaur, Simranjit; Wilson, Paul

2016-11-01

To critically appraise current literature regarding the management of plantar hyperhidrosis in the form of a structured review. A literature search was conducted using various databases and search criteria. The literature reports the use of conservative, medical and surgical treatment modalities for the management of plantar hyperhidrosis. However, long-term follow-up data are rare and some treatment modalities currently available are not fully understood. There is a considerable dearth in the literature on the management of plantar hyperhidrosis. Further study in larger populations with longer follow-up times is critical to access the long-term effects of treatment. Nonetheless, iontophoresis, botulinum toxin injection and lumbar sympathectomy are promising treatment modalities for this disorder.

Orthodontic Treatment Timing and Modalities in Anterior Open Bite: Case Series Study

PubMed Central

Al Hamadi, Wisam; Saleh, Fayez; Kaddouha, Mohamad

2017-01-01

Objective: The purpose of this study was to present early and adult cases of anterior open bite that were treated efficiently using different treatment approaches and mechanics. Materials and Methods: Five patients of different age groups (from 7 to 27 years), suffering from a clear Anterior open bite deformity, were properly diagnosed and relevant treatment modality for each was selected. Results: Positive overbite was efficiently achieved for all patients. Conclusion: Patient compliance is a key factor in using removable habit breakers. However, fixed palatal crib gave the same results but in shorter time. Anterior open bite of skeletal components should be thoroughly evaluated before selecting camouflage or orthognathic surgery treatment modality. PMID:29299074

Patients' perceptions of information and education for renal replacement therapy: an independent survey by the European Kidney Patients' Federation on information and support on renal replacement therapy.

PubMed

Van Biesen, Wim; van der Veer, Sabine N; Murphey, Mark; Loblova, Olga; Davies, Simon

2014-01-01

Selection of an appropriate renal replacement modality is of utmost importance for patients with end stage renal disease. Previous studies showed provision of information to and free modality choice by patients to be suboptimal. Therefore, the European Kidney Patients' Federation (CEAPIR) explored European patients' perceptions regarding information, education and involvement on the modality selection process. CEAPIR developed a survey, which was disseminated by the national kidney patient organisations in Europe. In total, 3867 patients from 36 countries completed the survey. Respondents were either on in-centre haemodialysis (53%) or had a functioning graft (38%) at the time of survey. The majority (78%) evaluated the general information about kidney disease and treatment as helpful, but 39% did not recall being told about alternative treatment options than their current one. Respondents were more often satisfied with information provided on in-centre haemodialysis (90%) and transplantation (87%) than with information provided on peritoneal dialysis (79%) or home haemodialysis (61%), and were more satisfied with information from health care professionals vs other sources such as social media. Most (75%) felt they had been involved in treatment selection, 29% perceived they had no free choice. Involvement in modality selection was associated with enhanced satisfaction with treatment (OR 3.13; 95% CI 2.72-3.60). Many respondents (64%) could not remember receiving education on how to manage their kidney disease in daily life. Perceptions on information seem to differ between countries. Kidney patients reported to be overall satisfied with the information they received on their disease and treatment, although information seemed mostly to have been focused on one modality. Patients involved in modality selection were more satisfied with their treatment. However, in the perception of the patients, the freedom to choose an alternative modality showed room for improvement.

Thermal-based treatment options for localized prostate cancer.

PubMed

Koch, Michael O; Gardner, Thomas A

2005-09-01

It seems clear that thermal-based therapies of prostate cancer have the potential to completely eradicate the prostate gland. Technical modifications continue to improve our ability to use these modalities more effectively, which can be seen in the ever decreasing morbidity from damage to adjacent structures. These treatments offer potential major advantages over surgery and radiation-based treatment modalities.

[Non-pharmacological, non-technical treatments for musculoskeletal disease: methodological challenges of clinical trials using the example of knee osteoarthritis and falls in the elderly].

PubMed

Thiem, Ulrich; Trampisch, Ulrike; Trampisch, Hans-Joachim

2013-01-01

Physical therapy modalities are regarded as an integral part of the treatment of musculoskeletal diseases like osteoarthritis of the knee or falls in the elderly. Guidelines and treatment recommendations promote such interventions. However, the evidence supporting physical therapy modalities is often weaker than that found for drug treatments. One reason is that a simple blinding of treatment assignments by means of a placebo is usually not possible. Another issue is patient preferences that have an impact on the conduct of the study and the interpretation of the results. This article highlights methodological challenges of studies investigating physical therapy modalities, and points out some possible solutions. (As supplied by publisher). Copyright © 2013. Published by Elsevier GmbH.

Treatment modalities and evaluation models for periodontitis

PubMed Central

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

2012-01-01

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

[Alternative treatments for interstitial cystitis].

PubMed

Gamé, X; Bart, S; Castel-Lacanal, E; De Sèze, M; Karsenty, G; Labat, J-J; Rigaud, J; Scheiber-Nogueira, M C; Ruffion, A

2009-06-01

Interstitial cystitis is the first cause of bladder pain. In case of failure of the usual treatments, several other modalities have been proposed. These therapeutic modalities are posterior sacral root neuromodulation, posterior tibial nerve stimulation, vanilloid agent intravesical instillation, intradetrusor botulinum toxin injections and surgery. A certain efficiency of each of these treatments in the interstitial cystitis has been reported. However, the evaluation of these treatments is limited and the level of evidence is too low to propose these treatments in routine.

Turbofan aft duct suppressor study

NASA Technical Reports Server (NTRS)

Syed, A. A.; Motsinger, R. E.; Fiske, G. H.; Joshi, M. C.; Kraft, R. E.

1983-01-01

Suppressions due to acoustic treatment in the annular exhaust duct of a model fan were theoretically predicted and compared with measured suppressions. The predictions are based on the modal analysis of sound propagation in a straight annular flow duct with segmented treatment. Modal distributions of the fan noise source (fan-stator interaction only) were measured using in-duct modal probes. The flow profiles were also measured in the vicinity of the modal probes. The acoustic impedance of the single degree of freedom treatment was measured in the presence of grazing flow. The measured values of mode distribution of the fan noise source, the flow velocity profile and the acoustic impedance of the treatment in the duct were used as input to the prediction program. The predicted suppressions, under the assumption of uniform flow in the duct, compared well with the suppressions measured in the duct for all test conditions. The interaction modes generated by the rotor-stator interaction spanned a cut-off ratio range from nearly 1 to 7.

Tailoring a psychophysical discrimination experiment upon assessment of the psychometric function: Predictions and results

NASA Astrophysics Data System (ADS)

Vilardi, Andrea; Tabarelli, Davide; Ricci, Leonardo

2015-02-01

Decision making is a widespread research topic and plays a crucial role in neuroscience as well as in other research and application fields of, for example, biology, medicine and economics. The most basic implementation of decision making, namely binary discrimination, is successfully interpreted by means of signal detection theory (SDT), a statistical model that is deeply linked to physics. An additional, widespread tool to investigate discrimination ability is the psychometric function, which measures the probability of a given response as a function of the magnitude of a physical quantity underlying the stimulus. However, the link between psychometric functions and binary discrimination experiments is often neglected or misinterpreted. Aim of the present paper is to provide a detailed description of an experimental investigation on a prototypical discrimination task and to discuss the results in terms of SDT. To this purpose, we provide an outline of the theory and describe the implementation of two behavioural experiments in the visual modality: upon the assessment of the so-called psychometric function, we show how to tailor a binary discrimination experiment on performance and decisional bias, and to measure these quantities on a statistical base. Attention is devoted to the evaluation of uncertainties, an aspect which is also often overlooked in the scientific literature.

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.

Awareness, knowledge, and attitude of patients toward dental implants - A questionnaire-based prospective study.

PubMed

Hosadurga, Rajesh; Shanti, Tenneti; Hegde, Shashikanth; Kashyap, Rajesh Shankar; Arunkumar, Suryanarayan Maiya

2017-01-01

In developing nations like India awareness and education about dental implants as a treatment modality is still scanty. The study was conducted to determine the awareness, knowledge, and attitude of patients toward dental implants as a treatment modality among the general population and to assess the influence of personality characteristics on accepting dental implants as a treatment modality in general and as well as treatment group. A structured questionnaire-based survey was conducted on 500 randomly selected participants attending the outpatient department. The study was conducted in 2 parts. In the first part of the study, level of awareness, knowledge, and attitude was assessed. In the second part of the study, interactive educational sessions using audiovisual aids were conducted following which a retest was conducted. The participants who agreed to undergo implant treatment were followed up to assess their change in attitude towards dental implants posttreatment. Thus pain, anxiety, functional, and esthetic benefits were measured using visual analog scale. They were further followed up for 1 year to reassess awareness, knowledge, and attitude towards dental implants. A total of 450 individuals completed the questionnaires. Only 106 individuals agreed to participate in the educational sessions and 83 individuals took the retest. Out of these, only 39 individuals chose implants as a treatment option. A significant improvement in the level of information, subjective and objective need for information, was noted after 1 year. In this study, a severe deficit in level of information, subjective and objective need for information towards, dental implants as a treatment modality was noted. In the treatment group, a significant improvement in perception of dental implant as a treatment modality suggests that professionally imparted knowledge can bring about a change in the attitude.

Closed treatment of unilateral mandibular condyle fractures in adults: a systematic review.

PubMed

Rozeboom, A V J; Dubois, L; Bos, R R M; Spijker, R; de Lange, J

2017-04-01

Of all mandibular fractures, 25-35% are condylar. Many studies have focused on whether to treat such fractures via open or closed modalities. A uniform protocol for closed treatment is lacking, but such a protocol could ensure good clinical practice. The aims of this systematic review were to provide an overview of the published studies exclusively pertaining to closed treatment and to summarize the existing modalities for closed treatment and their clinical outcomes. Sixteen studies were selected for detailed analysis. The treatments given were highly variable, ranging from doing nothing to applying maxillomandibular fixation with stainless steel wires. The results of the different studies and the treatment modalities used were difficult to interpret; however no clear differences in the outcome measures were seen between the treatment modalities applied. Complications encountered after closed treatment included malocclusion, limited mouth opening, reduced range of motion, and persistent pain. Due to the heterogeneity between groups, high loss-to-follow-up, poor descriptions of the treatments given, and variability in outcome measurement methods, no clear associations between adverse outcomes and the treatments applied could be determined. This review suggests that due to the high level of methodological variability in the relevant studies published to date, there are currently no uniform standards for the closed treatment of condylar fractures that can be expected to yield good clinical results. The establishment of such standards could potentially improve treatment outcomes. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A hybrid approach of using symmetry technique for brain tumor segmentation.

PubMed

Saddique, Mubbashar; Kazmi, Jawad Haider; Qureshi, Kalim

2014-01-01

Tumor and related abnormalities are a major cause of disability and death worldwide. Magnetic resonance imaging (MRI) is a superior modality due to its noninvasiveness and high quality images of both the soft tissues and bones. In this paper we present two hybrid segmentation techniques and their results are compared with well-recognized techniques in this area. The first technique is based on symmetry and we call it a hybrid algorithm using symmetry and active contour (HASA). In HASA, we take refection image, calculate the difference image, and then apply the active contour on the difference image to segment the tumor. To avoid unimportant segmented regions, we improve the results by proposing an enhancement in the form of the second technique, EHASA. In EHASA, we also take reflection of the original image, calculate the difference image, and then change this image into a binary image. This binary image is mapped onto the original image followed by the application of active contouring to segment the tumor region.

Chromatic characterization of ion-exchanged glass binary phase plates for mode-division multiplexing.

PubMed

Prieto-Blanco, Xesús; Montero-Orille, Carlos; Moreno, Vicente; Mateo, Eduardo F; Liñares, Jesús

2015-04-10

Mode-division multiplexing (MDM) in few-mode fibers is regarded as a promising candidate to increase optical network capacity. A fundamental element for MDM is a modal transformer to LP modes which can be implemented in a free-space basis by using multiregion phase plates, that is, LP plates. Likewise, several wavelengths have to be used due to wavelength multiplexing purposes, optical amplification tasks, and so on. In this work we show that efficient monolithic binary phase plates for different wavelengths can be fabricated by ion-exchange in glass and used for MDM tasks. We introduce an optical characterization method of the chromatic properties of such phase plates which combines the inverse Wentzel-Kramers-Brillouin (IWKB) together with Mach-Zehnder and Michelson-based interferometric techniques. The interferometric method provides a measurement of the phase step for several wavelengths, which characterizes the chromatic properties of the phase plate. Consequently, it is shown that the IWKB method allows us to design and characterize the phase plates in an easy and fast way.

Assessing Instructional Modalities: Individualized Treatment Effects for Personalized Learning

ERIC Educational Resources Information Center

Beemer, Joshua; Spoon, Kelly; Fan, Juanjuan; Stronach, Jeanne; Frazee, James P.; Bohonak, Andrew J.; Levine, Richard A.

2018-01-01

Estimating the efficacy of different instructional modalities, techniques, and interventions is challenging because teaching style covaries with instructor, and the typical student only takes a course once. We introduce the individualized treatment effect (ITE) from analyses of personalized medicine as a means to quantify individual student…

Non-invasive different modalities of treatment for temporomandibular disorders: review of literature

PubMed Central

2018-01-01

Temporomandibular disorders (TMDs) are diseases that affect the temporomandibular joint and supporting structures. The goal of treatment for TMDs is elimination or reduction of pain and return to normal temporomandibular joint function. Initial treatment for TMDs is non-invasive and conservative, not surgical. Oral and maxillofacial surgeons should fully understand and actively care about non-invasive treatments for TMDs. The purpose of this study is to review the validity and outcomes of non-invasive and surgical treatment modalities for TMDs. PMID:29732308

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

Ruan, D; Shao, W; Low, D

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

Novel methotrexate soft nanocarrier/fractional erbium YAG laser combination for clinical treatment of plaque psoriasis.

PubMed

Ramez, Shahenda A; Soliman, Mona M; Fadel, Maha; Nour El-Deen, Faisal; Nasr, Maha; Youness, Eman R; Aboel-Fadl, Dalea M

2018-02-15

Psoriasis is a commonly encountered chronic dermatological disease, presenting with inflammatory symptoms in patients. Systemic treatment of psoriasis is associated with several adverse effects, therefore the development of a customized topical treatment modality for psoriasis would be an interesting alternative to systemic delivery. The therapeutic modality explored in this article was the comparative treatment of psoriatic patients using nanoparticulated methotrexate in the form of jojoba oil-based microemulsion with or without fractional erbium YAG laser. Assessment parameters included follow-up photography for up to 8 weeks of treatment, estimation of the psoriasis severity [TES (thickness, erythema, scales)] score, and histopathological skin evaluation. The prepared methotrexate microemulsion was clinically beneficial and safe in treatment of psoriasis vulgaris. The concomitant use of the fractional laser provided improvement in the psoriatic plaques within shorter time duration (3 weeks compared to 8 weeks of treatment), presenting an alternative topical treatment modality for psoriasis vulgaris.

Ego mechanisms of defense are associated with patients' preference of treatment modality independent of psychological distress in end-stage renal disease.

PubMed

Hyphantis, Thomas; Katsoudas, Spiros; Voudiclari, Sonia

2010-03-24

Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients' treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirty-seven patients (53.4%) had chosen hemodialysis and 21 (46.6%) peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804-0.988), had received more education (OR, 8.84; 95% CI: 1.301-60.161), and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P < 0.033). On the contrary, the latter were more likely to adopt an image-distorting defense style (35.1% vs 14.3%; P = 0.038) and passive-aggressive defenses (OR, 0.73: 95% CI: 0.504-1.006). These results were independent of psychological distress. Our findings indicate that the patient's personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive-aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.

Non-ablative fractional resurfacing in combination with topical tretinoin cream as a field treatment modality for multiple actinic keratosis: a pilot study and a review of other field treatment modalities.

PubMed

Prens, Sebastiaan P; de Vries, Karin; Neumann, H A Martino; Prens, Errol P

2013-06-01

Actinic keratoses (AK) are premalignant lesions occurring mainly in sun-damaged skin. Current topical treatment options for AK and photo-damaged skin such as liquid nitrogen and electrosurgery are not suitable for field treatment. Otherwise, therapies suitable for field treatment bring along considerable patient discomfort. Non-ablative fractional resurfacing has emerged as a logical treatment option especially for field treatment of AK. To evaluate the clinical efficacy of fractional laser therapy for clearing AK and improving skin quality. To compare patient friendliness of the "fractional" therapy with those reported for other field treatment modalities. Ten patients with Fitzpatrick skin type I to III with multiple AK and extensive sun-damaged skin, received 5-10 sessions with a 4-week interval using a 1550 nm Erbium-Glass Fractionated laser (Sellas, Korea). Four weeks and 24 weeks after the last treatment the clinical results were evaluated by an independent physician. The mean degree of improvement, in terms of reduction in the number of AK and improvement of skin texture, was 54% on a 4 point PGA scale, and persisted for approximately 6 months. The biggest advantage of fractional laser treatment, besides the eradication of AK and a clear rejuvenation effect, is the absence of "downtime". Fractional non-ablative resurfacing induces significant reduction in the number of AK and improves the skin quality. Also all patients preferred fractional laser therapy above other AK treatment modalities.

Are there differential symptom profiles that improve in response to different pharmacological treatments of premenstrual syndrome/premenstrual dysphoric disorder?

PubMed

Halbreich, Uriel; O'Brien, P M Shaughn; Eriksson, Elias; Bäckström, Torbjörn; Yonkers, Kimberly A; Freeman, Ellen W

2006-01-01

Current evidence suggests that the accepted treatments for premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) have similar overall efficacy. While these treatments are more effective than placebo, response rates associated with them are far from satisfactory (<60%), such that, irrespective of treatment modality, there remain a significant number of women who are unresponsive to current conventional pharmacological therapy. The available data on response rates of specific types of premenstrual symptoms to, or symptom profiles that are most amenable to, each treatment modality are limited and not well defined because most studies were not designed to assess specific symptom profiles. Those studies that have attempted to evaluate which symptom profiles respond to specific therapies have revealed variations within the individual modalities, as well as between the different modalities. It appears that suppression of ovulation ameliorates a broad range of behavioural as well as physical premenstrual symptoms. SSRIs are most effective for irritability and anxiety symptoms, with lesser efficacy for 'atypical' premenstrual symptoms. GABAergic compounds are most efficacious for anxiety and anxious/depressive symptoms, while dopamine agonists, particularly bromocriptine, are perhaps most efficacious for mastalgia. Overall treatment response rates may improve if treatments are targeted at well-defined subgroups of patients. Re-analysis of available datasets from randomised clinical trials may shed more light on the notion that targeting women with specific premenstrual symptom profiles for specific treatment modalities would improve response rates beyond the current ceiling of approximately 60%. Such information would also improve understanding of the putative pathophysiological mechanisms underlying PMS and PMDD, and may point to a more specific diagnosis of these conditions.

Wilderness Therapy: Ethical Considerations for Mental Health Professionals

ERIC Educational Resources Information Center

Becker, Stephen P.

2010-01-01

Wilderness therapy is a growing treatment modality for adolescents presenting with a variety of clinical concerns, and wilderness therapy clinicians and referring mental health professionals must carefully consider the ethical issues that are unique to this modality. Following an overview of wilderness therapy as a mental health treatment,…

Alcoholism treatment and medical care costs from Project MATCH.

PubMed

Holder, H D; Cisler, R A; Longabaugh, R; Stout, R L; Treno, A J; Zweben, A

2000-07-01

This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Longitudinal study with pre- and post-treatment initiation. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Two hundred and seventy-nine patients. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Role of cell type and animal species in tumor metastasis

NASA Astrophysics Data System (ADS)

Solban, Nicolas; Georgakoudi, Irene; Rice, William L.; Lin, Charles; Hasan, Tayyaba

2004-06-01

Photodynamic therapy (PDT) is now a reasonably well-known therapeutic option and is approved as a first line treatment of age-related macular degeneration (AMD), a non-oncologic condition. For most cancer applications PDT is approved mainly as a palliative or adjunctive treatment often when all other options have failed. As the modality evolves toward becoming a first-line or curative option, long-term effects of processes involved will need to be studied. Cellular and tissue responses to PDT are more complex than responses to the more conventional therapies, perhaps because PDT is inherently a binary (or ternary) therapy. In addition to the nature and localization of the photosensitizer (PS), the timing of illumination after administration, the mode of administration and the PS and light doses, the efficacy and selectivity of responses are also determined by the physiology and geometry of tumors, the inherent survivability of tumor cells (in circulation and other anatomic sites) and cellular and molecular responses to PDT. The overall outcome of photodynamic treatment in the long term is determined by a combination, in varying degrees, of all of the above factors. In order to enhance and broaden the application of PDT to complex anatomical sites, an understanding of these factors would be useful. In the laboratory, the outcome is also dependent on the specific animal models being studied. This manuscript discusses preliminary studies along these lines using a variety of tools and implications, if any, of the results obtained.

Efficacy of pulsed dye laser treatment for common warts is not influenced by the causative HPV type: a prospective study.

PubMed

Fichman, Yoseph; Levi, Assi; Hodak, Emmilia; Halachmi, Shlomit; Mazor, Sigal; Wolf, Dana; Caplan, Orit; Lapidoth, Moshe

2018-05-01

Verruca vulgaris (VV) is a prevalent skin condition caused by various subtypes of human papilloma virus (HPV). The most common causes of non-genital lesions are HPV types 2 and 4, and to a lesser extent types 1, 3, 26, 29, and 57. Although numerous therapeutic modalities exist, none is universally effective or without adverse events (AE). Pulsed dye laser (PDL) is a favorable option due to its observed efficacy and relatively low AE rate. However, it is not known which verrucae are most likely to respond to PDL, or whether the causative viral subtype influences this response. The objective of this prospective blinded study was to assess whether the HPV subtype was predictive of response to PDL. For that matter, 26 verrucae from 26 immunocompetent patients were biopsied prior to treatment by PDL. HPV coding sequences were isolated and genotyped using PCR analysis. Patients were treated by PDL (595 nm wavelength, 5 mm spot size, 1.5 ms pulse duration, 12 J/cm 2 fluence) once a month for up to 6 months, and clinical response was assessed. Binary logistic regression analysis and linear logistic regression analysis were used in order to evaluate statistical significance. Different types of HPV were identified in 22 of 26 tissue samples. Response to treatment did not correlate with HPV type, age, or gender. As no association between HPV type and response to PDL therapy could be established, it is therefore equally effective for all HPV types and remains a favorable treatment option for all VV.

Evaluation of target coverage and margins adequacy during CyberKnife Lung Optimized Treatment.

PubMed

Ricotti, Rosalinda; Seregni, Matteo; Ciardo, Delia; Vigorito, Sabrina; Rondi, Elena; Piperno, Gaia; Ferrari, Annamaria; Zerella, Maria Alessia; Arculeo, Simona; Francia, Claudia Maria; Sibio, Daniela; Cattani, Federica; De Marinis, Filippo; Spaggiari, Lorenzo; Orecchia, Roberto; Riboldi, Marco; Baroni, Guido; Jereczek-Fossa, Barbara Alicja

2018-04-01

Evaluation of target coverage and verification of safety margins, in motion management strategies implemented by Lung Optimized Treatment (LOT) module in CyberKnife system. Three fiducial-less motion management strategies provided by LOT can be selected according to tumor visibility in the X ray images acquired during treatment. In 2-view modality the tumor is visible in both X ray images and full motion tracking is performed. In 1-view modality the tumor is visible in a single X ray image, therefore, motion tracking is combined with an internal target volume (ITV)-based margin expansion. In 0-view modality the lesion is not visible, consequently the treatment relies entirely on an ITV-based approach. Data from 30 patients treated in 2-view modality were selected providing information on the three-dimensional tumor motion in correspondence to each X ray image. Treatments in 1-view and 0-view modalities were simulated by processing log files and planning volumes. Planning target volume (PTV) margins were defined according to the tracking modality: end-exhale clinical target volume (CTV) + 3 mm in 2-view and ITV + 5 mm in 0-view. In the 1-view scenario, the ITV encompasses only tumor motion along the non-visible direction. Then, non-uniform ITV to PTV margins were applied: 3 mm and 5 mm in the visible and non-visible direction, respectively. We defined the coverage of each voxel of the CTV as the percentage of X ray images where such voxel was included in the PTV. In 2-view modality coverage was calculated as the intersection between the CTV centred on the imaged target position and the PTV centred on the predicted target position, as recorded in log files. In 1-view modality, coverage was calculated as the intersection between the CTV centred on the imaged target position and the PTV centred on the projected predictor data. In 0-view modality coverage was calculated as the intersection between the CTV centred on the imaged target position and the non-moving PTV. Similar to dose-volume histogram, CTV coverage-volume histograms (defined as CVH) were derived for each patient and treatment modality. The geometric coverages of the 90% and 95% of CTV volume (C90, C95, respectively) were evaluated. Patient-specific optimal margins (ensuring C95 ≥ 95%) were computed retrospectively. The median ± interquartile-rage of C90 and C95 for upper lobe lesions was 99.1 ± 0.6% and 99.0 ± 3.1%, whereas they were 98.9 ± 4.2% and 97.8 ± 7.5% for lower and middle lobe tumors. In 2-view, 1-view and 0-view modality, adopted margins ensured C95 ≥ 95% in 70%, 85% and 63% of cases and C95 ≥ 90% in 90%, 88% and 83% of cases, respectively. In 2-view, 1-view and 0-view a reduction in margins still ensured C95 ≥ 95% in 33%, 78% and 59% of cases, respectively. CTV coverage analysis provided an a-posteriori evaluation of the treatment geometric accuracy and allowed a quantitative verification of the adequacy of the PTV margins applied in CyberKnife LOT treatments offering guidance in the selection of CTV margins. © 2018 American Association of Physicists in Medicine.

Sensory impairments of the lower limb after stroke: a pooled analysis of individual patient data.

PubMed

Tyson, Sarah F; Crow, J Lesley; Connell, Louise; Winward, Charlotte; Hillier, Susan

2013-01-01

To obtain more generalizable information on the frequency and factors influencing sensory impairment after stroke and their relationship to mobility and function. A pooled analysis of individual data of stroke survivors (N = 459); mean (SD) age = 67.2 (14.8) years, 54% male, mean (SD) time since stroke = 22.33 (63.1) days, 50% left-sided weakness. Where different measurement tools were used, data were recorded. Descriptive statistics described frequency of sensory impairments, kappa coefficients investigated relationships between sensory modalities, binary logistic regression explored the factors influencing sensory impairments, and linear regression assessed the impact of sensory impairments on activity limitations. Most patients' sensation was intact (55%), and individual sensory modalities were highly associated (κ = 0.60, P < .001). Weakness and neglect influenced sensory impairment (P < .001), but demographics, stroke pathology, and spasticity did not. Sensation influenced independence in activities of daily living, mobility, and balance but less strongly than weakness. Pooled individual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated; interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.

Tableau Calculus for the Logic of Comparative Similarity over Arbitrary Distance Spaces

NASA Astrophysics Data System (ADS)

Alenda, Régis; Olivetti, Nicola

The logic CSL (first introduced by Sheremet, Tishkovsky, Wolter and Zakharyaschev in 2005) allows one to reason about distance comparison and similarity comparison within a modal language. The logic can express assertions of the kind "A is closer/more similar to B than to C" and has a natural application to spatial reasoning, as well as to reasoning about concept similarity in ontologies. The semantics of CSL is defined in terms of models based on different classes of distance spaces and it generalizes the logic S4 u of topological spaces. In this paper we consider CSL defined over arbitrary distance spaces. The logic comprises a binary modality to represent comparative similarity and a unary modality to express the existence of the minimum of a set of distances. We first show that the semantics of CSL can be equivalently defined in terms of preferential models. As a consequence we obtain the finite model property of the logic with respect to its preferential semantic, a property that does not hold with respect to the original distance-space semantics. Next we present an analytic tableau calculus based on its preferential semantics. The calculus provides a decision procedure for the logic, its termination is obtained by imposing suitable blocking restrictions.

The Evolution of Compact Binary Star Systems.

PubMed

Postnov, Konstantin A; Yungelson, Lev R

2006-01-01

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars - compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.

The Evolution of Compact Binary Star Systems.

PubMed

Postnov, Konstantin A; Yungelson, Lev R

2014-01-01

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Mergings of compact-star binaries are expected to be the most important sources for forthcoming gravitational-wave (GW) astronomy. In the first part of the review, we discuss observational manifestations of close binaries with NS and/or BH components and their merger rate, crucial points in the formation and evolution of compact stars in binary systems, including the treatment of the natal kicks, which NSs and BHs acquire during the core collapse of massive stars and the common envelope phase of binary evolution, which are most relevant to the merging rates of NS-NS, NS-BH and BH-BH binaries. The second part of the review is devoted mainly to the formation and evolution of binary WDs and their observational manifestations, including their role as progenitors of cosmologically-important thermonuclear SN Ia. We also consider AM CVn-stars, which are thought to be the best verification binary GW sources for future low-frequency GW space interferometers.

Analysis of the costs of dialysis and the effects of an incentive mechanism for low-cost dialysis modalities.

PubMed

Cleemput, Irina; De Laet, Chris

2013-05-01

Treatment costs of end-stage renal disease with dialysis are high and vary between dialysis modalities. Public healthcare payers aim at stimulating the use of less expensive dialysis modalities, with maintenance of healthcare quality. This study examines the effects of Belgian financial incentive mechanisms for the use of low-cost dialysis treatments. First, the costs of different dialysis modalities were calculated from the hospital's perspective. Data were obtained through a hospital survey. The balance between costs and revenues was simulated for an average Belgian dialysis programme. Incremental profits were calculated in function of the proportion of patients on alternative dialysis modalities. Hospital haemodialysis is the most expensive modality per patient year, followed by peritoneal dialysis and finally satellite haemodialysis. Under current reimbursement rules mean profits of a dialysis programme are maximal if about 28% of patients are treated with a low-cost dialysis modality. This is only slightly lower than the observed percentage in Belgian dialysis centres in the same period. In Belgium, the financial incentives for the use of low-cost dialysis modalities only had a modest impact due to the continuing profits that could be generated by high-cost dialysis. Profit neutrality is crucial for the success of any financial incentive mechanism for low-cost dialysis modalities. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Targeting Neovascularization in Ischemic Retinopathy: Recent Advances

PubMed Central

Al-Shabrawey, Mohamed; Elsherbiny, Mohamed; Nussbaum, Julian; Othman, Amira; Megyerdi, Sylvia; Tawfik, Amany

2014-01-01

Pathological retinal neovascularization (RNV) is a common micro-vascular complication in several retinal diseases including retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration and central vein occlusion. The current therapeutic modalities of RNV are invasive and although they may slow or halt the progression of the disease they are unlikely to restore normal acuity. Therefore, there is an urgent need to develop treatment modalities, which are less invasive and therefore associated with fewer procedural complications and systemic side effects. This review article summarizes our understanding of the pathophysiology and current treatment of RNV in ischemic retinopathies; lists potential therapeutic targets; and provides a framework for the development of future treatment modalities. PMID:25598837

Fast and robust multimodal image registration using a local derivative pattern.

PubMed

Jiang, Dongsheng; Shi, Yonghong; Chen, Xinrong; Wang, Manning; Song, Zhijian

2017-02-01

Deformable multimodal image registration, which can benefit radiotherapy and image guided surgery by providing complementary information, remains a challenging task in the medical image analysis field due to the difficulty of defining a proper similarity measure. This article presents a novel, robust and fast binary descriptor, the discriminative local derivative pattern (dLDP), which is able to encode images of different modalities into similar image representations. dLDP calculates a binary string for each voxel according to the pattern of intensity derivatives in its neighborhood. The descriptor similarity is evaluated using the Hamming distance, which can be efficiently computed, instead of conventional L1 or L2 norms. For the first time, we validated the effectiveness and feasibility of the local derivative pattern for multimodal deformable image registration with several multi-modal registration applications. dLDP was compared with three state-of-the-art methods in artificial image and clinical settings. In the experiments of deformable registration between different magnetic resonance imaging (MRI) modalities from BrainWeb, between computed tomography and MRI images from patient data, and between MRI and ultrasound images from BITE database, we show our method outperforms localized mutual information and entropy images in terms of both accuracy and time efficiency. We have further validated dLDP for the deformable registration of preoperative MRI and three-dimensional intraoperative ultrasound images. Our results indicate that dLDP reduces the average mean target registration error from 4.12 mm to 2.30 mm. This accuracy is statistically equivalent to the accuracy of the state-of-the-art methods in the study; however, in terms of computational complexity, our method significantly outperforms other methods and is even comparable to the sum of the absolute difference. The results reveal that dLDP can achieve superior performance regarding both accuracy and time efficiency in general multimodal image registration. In addition, dLDP also indicates the potential for clinical ultrasound guided intervention. © 2016 The Authors. Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Neuroimaging in ophthalmology

PubMed Central

Kim, James D.; Hashemi, Nafiseh; Gelman, Rachel; Lee, Andrew G.

2012-01-01

In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography (CT) and magnetic resonance imaging (MRI). However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities. PMID:23961025

Individual and group sensitivity to remedial reading program design: Examining reading gains across three middle school reading projects

PubMed Central

Calhoon, Mary Beth; Petscher, Yaacov

2015-01-01

The purpose of this project was to examine group- and individual-level responses by struggling adolescents readers (6th – 8th grades; N = 155) to three different modalities of the same reading program, Reading Achievement Multi-Component Program (RAMP-UP). The three modalities differ in the combination of reading components (phonological decoding, spelling, fluency, comprehension) that are taught and their organization. Latent change scores were used to examine changes in phonological decoding, fluency, and comprehension for each modality at the group level. In addition, individual students were classified as gainers versus non-gainers (a reading level increase of a year or more vs. less than one year) so that characteristics of gainers and differential sensitivity to instructional modality could be investigated. Findings from both group and individual analyses indicated that reading outcomes were related to modalities of reading instruction. Furthermore, differences in reading gains were seen between students who began treatment with higher reading scores than those with lower reading scores; dependent on modality of treatment. Results, examining group and individual analyses similarities and differences, and the effect the different modalities have on reading outcomes for older struggling readers will be discussed. PMID:25657503

Salvage therapy for locally recurrent prostate cancer after radiation.

PubMed

Marcus, David M; Canter, Daniel J; Jani, Ashesh B; Dobbs, Ryan W; Schuster, David M; Carthon, Bradley C; Rossi, Peter J

2012-12-01

External beam radiotherapy (EBRT) is widely utilized as primary therapy for clinically localized prostate cancer. For patients who develop locally recurrent disease after EBRT, local salvage therapy may be indicated. The primary modalities for local salvage treatment in this setting include radical prostatectomy, cryotherapy, and brachytherapy. To date, there is little data describing outcomes and toxicity associated with each of these salvage modalities. A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. We focused on prospective trials and multi-institutional retrospective series in order to identify the highest level of evidence describing these therapies. The majority of reports describing the use of local salvage treatment for recurrent prostate cancer after EBRT are single-institution, retrospective reports, although small prospective studies are available for salvage cryotherapy and salvage brachytherapy. Clinical outcomes and toxicity for each modality vary widely across studies, which is likely due to the heterogeneity of patient populations, treatment techniques, and definitions of failure. In general, most studies demonstrate that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. As there are no randomized trials comparing salvage treatment modalities for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis, with careful consideration of each patient's disease characteristics and tolerance for the risks of treatment. Additional data, ideally from prospective randomized trials, is needed to guide decision making for patients with local recurrence after EBRT failure.

Radiobiological concepts for treatment planning of schemes that combines external beam radiotherapy and systemic targeted radiotherapy

NASA Astrophysics Data System (ADS)

Fabián Calderón Marín, Carlos; González González, Joaquín Jorge; Laguardia, Rodolfo Alfonso

2017-09-01

The combination of radiotherapy modalities with external bundles and systemic radiotherapy (CIERT) could be a reliable alternative for patients with multiple lesions or those where treatment planning maybe difficult because organ(s)-at-risk (OARs) constraints. Radiobiological models should have the capacity for predicting the biological irradiation response considering the differences in the temporal pattern of dose delivering in both modalities. Two CIERT scenarios were studied: sequential combination in which one modality is executed following the other one and concurrent combination when both modalities are running simultaneously. Expressions are provided for calculation of the dose-response magnitudes Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP). General results on radiobiological modeling using the linear-quadratic (LQ) model are also discussed. Inter-subject variation of radiosensitivity and volume irradiation effect in CIERT are studied. OARs should be under control during the planning in concurrent CIERT treatment as the administered activity is increased. The formulation presented here may be used for biological evaluation of prescriptions and biological treatment planning of CIERT schemes in clinical situation.

Social Networking Sites: An Adjunctive Treatment Modality for Psychological Problems

PubMed Central

Menon, Indu S.; Sharma, Manoj Kumar; Chandra, Prabha S.; Thennarasu, K.

2014-01-01

Background: Social networking is seen as a way to enhance social support and feeling of well-being. The present work explores the potentials of social networking sites as an adjunctive treatment modality for initiating treatment contact as well as for managing psychological problems. Materials and Methods: Interview schedule, Facebook intensity questionnaire were administered on 28 subjects with a combination of 18 males and 10 females. They were taken from the in-patient and out-patient psychiatry setting of the hospital. Results: Facebook was the most popular sites and used to seek emotional support on the basis of the frequent updates of emotional content that users put in their profile; reconciliations, escape from the problems or to manage the loneliness; getting information about illness and its treatment and interaction with experts and also manifested as problematic use. Conclusions: It has implications for developing social networking based adjunctive treatment modality for psychological problems. PMID:25035548

The inducers of immunogenic cell death for tumor immunotherapy.

PubMed

Li, Xiuying

2018-01-01

Immunotherapy is a promising treatment modality that acts by selectively harnessing the host immune defenses against cancer. An effective immune response is often needed to eliminate tumors following treatment which can trigger the immunogenicity of dying tumor cells. Some treatment modalities (such as photodynamic therapy, high hydrostatic pressure or radiotherapy) and agents (some chemotherapeutic agents, oncolytic viruses) have been used to endow tumor cells with immunogenicity and/or increase their immunogenicity. These treatments and agents can boost the antitumor capacity by inducing immune responses against tumor neoantigens. Immunogenic cell death is a manner of cell death that can induce the emission of immunogenic damage-associated molecular patterns (DAMPs). DAMPs are sufficient for immunocompetent hosts to trigger the immune system. This review focuses on the latest developments in the treatment modalities and agents that can induce and/or enhance the immunogenicity of cancer cells.

Social networking sites: an adjunctive treatment modality for psychological problems.

PubMed

Menon, Indu S; Sharma, Manoj Kumar; Chandra, Prabha S; Thennarasu, K

2014-07-01

Social networking is seen as a way to enhance social support and feeling of well-being. The present work explores the potentials of social networking sites as an adjunctive treatment modality for initiating treatment contact as well as for managing psychological problems. Interview schedule, Facebook intensity questionnaire were administered on 28 subjects with a combination of 18 males and 10 females. They were taken from the in-patient and out-patient psychiatry setting of the hospital. Facebook was the most popular sites and used to seek emotional support on the basis of the frequent updates of emotional content that users put in their profile; reconciliations, escape from the problems or to manage the loneliness; getting information about illness and its treatment and interaction with experts and also manifested as problematic use. It has implications for developing social networking based adjunctive treatment modality for psychological problems.

Causal analysis of ordinal treatments and binary outcomes under truncation by death.

PubMed

Wang, Linbo; Richardson, Thomas S; Zhou, Xiao-Hua

2017-06-01

It is common that in multi-arm randomized trials, the outcome of interest is "truncated by death," meaning that it is only observed or well-defined conditioning on an intermediate outcome. In this case, in addition to pairwise contrasts, the joint inference for all treatment arms is also of interest. Under a monotonicity assumption we present methods for both pairwise and joint causal analyses of ordinal treatments and binary outcomes in presence of truncation by death. We illustrate via examples the appropriateness of our assumptions in different scientific contexts.

Mental Health Disorder Therapeutic Modalities Modified for the GMS.

PubMed

Sumneangsanor, Tipsuda; Vuthiarpa, Sararud; Somprasert, Chomchueun

2017-12-01

Mental health disorders can affect physical and psychological behaviors. The people of the Greater Mekong Subregion (GMS) have a high risk of mental health disorders, such as depression, stress, and substance abuse be-cause the people in this region are trafficked for forced sex work and various forms of forced labor. In these situations, vic-tims often endure violence and abuse from trafficking recruiters, employers, and other individuals. The purposes of this study were to identify the elements characterizing mental health disorders, especially in terms of depression, stress, and sub-stance abuse, and to identify the treatment modalities for mental health disorders in the GMS. The researcher undertook a comparative analysis of the literature, reviews of epidemiological studies and mental disorder therapies, and overviews of previous research studies, were used to generate a synthesis of the existing knowledge of the mental disorder therapeutic modalities. Regarding the search methods, the data from the electronic databases PubMed, PsycINFO, Dynamed and ScienceDirect were supplemented with a manual reference search covering relevant studies from 2005 to 2016. Thirty-one papers were included in the review of elements characterizing mental health disorders, especially in terms of depression, stress, and substance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Nine papers defined characterizing mental health disorders, in terms of depression, stress, and substance abuse. Twenty-two papers showed the treatment modalities for mental health disorders that the treatment was effective, these in-cluded pharmacological treatments and psychological treatments, such as mindfulness-based cognitive therapy, biofeedback, and music therapy. Useful guidance can be provided for the prevention and treatment of mental health disorders, and for the care of people in the Greater Mekong Subregion. The finding of this review confirms the therapeutic modalities can provide useful guidance for the prevention and treatment of mental health disorders and the care of the people in the Greater Mekong Sub-region. In addition, the effective interventions should be tested regarding their suitability for the socio-cultural context in the Greater Mekong Subregion.

Mental Health Disorder Therapeutic Modalities Modified for the GMS

PubMed Central

Sumneangsanor, Tipsuda; Vuthiarpa, Sararud; Somprasert, Chomchueun

2017-01-01

Background: Mental health disorders can affect physical and psychological behaviors. The people of the Greater Mekong Subregion (GMS) have a high risk of mental health disorders, such as depression, stress, and substance abuse be-cause the people in this region are trafficked for forced sex work and various forms of forced labor. In these situations, vic-tims often endure violence and abuse from trafficking recruiters, employers, and other individuals. The purposes of this study were to identify the elements characterizing mental health disorders, especially in terms of depression, stress, and sub-stance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Methods: The researcher undertook a comparative analysis of the literature, reviews of epidemiological studies and mental disorder therapies, and overviews of previous research studies, were used to generate a synthesis of the existing knowledge of the mental disorder therapeutic modalities. Regarding the search methods, the data from the electronic databases PubMed, PsycINFO, Dynamed and ScienceDirect were supplemented with a manual reference search covering relevant studies from 2005 to 2016. Results: Thirty-one papers were included in the review of elements characterizing mental health disorders, especially in terms of depression, stress, and substance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Nine papers defined characterizing mental health disorders, in terms of depression, stress, and substance abuse. Twenty-two papers showed the treatment modalities for mental health disorders that the treatment was effective, these in-cluded pharmacological treatments and psychological treatments, such as mindfulness-based cognitive therapy, biofeedback, and music therapy. Useful guidance can be provided for the prevention and treatment of mental health disorders, and for the care of people in the Greater Mekong Subregion. Conclusion: The finding of this review confirms the therapeutic modalities can provide useful guidance for the prevention and treatment of mental health disorders and the care of the people in the Greater Mekong Sub-region. In addition, the effective interventions should be tested regarding their suitability for the socio-cultural context in the Greater Mekong Subregion. PMID:29657562

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

PubMed

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

2014-03-01

Refractory epilepsy is a common disorder both in humans and dogs and treatment protocols are difficult to optimise. In humans, different non-pharmacological treatment modalities currently available include surgery, the ketogenic diet and neurostimulation. Surgery leads to freedom from seizures in 50-75% of patients, but requires strict patient selection. The ketogenic diet is indicated in severe childhood epilepsies, but efficacy is limited and long-term compliance can be problematic. In the past decade, various types of neurostimulation have emerged as promising treatment modalities for humans with refractory epilepsy. Currently, none of these treatment options are used in routine daily clinical practice to treat dogs with the condition. Since many dogs with poorly controlled seizures do not survive, the search for alternative treatment options for canine refractory epilepsy should be prioritised. This review provides an overview of non-pharmacological treatment options for human refractory epilepsy. The current knowledge and limitations of these treatments in canine refractory epilepsy is also discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nonpharmacological, somatic treatments of depression: electroconvulsive therapy and novel brain stimulation modalities

PubMed Central

Eitan, Renana; Lerer, Bernard

2006-01-01

Until recently, a review of nonpharmacological, somatic treatments of psychiatric disorders would have included only electroconvulsive therapy (ECT). This situation is now changing very substantially Although ECT remains the only modality in widespread clinical use, several new techniques are under investigation. Their principal indication in the psychiatric context is the treatment of major depression, but other applications are also being studied. All the novel treatments involve brain stimulation, which is achieved by different technological methods. The treatment closest to the threshold of clinical acceptability is transcranial magnetic stimulation (TMS). Although TMS is safe and relatively easy to administer, its efficacy has still to be definitively established. Other modalities, at various stages of research development, include magnetic seizure therapy (MST), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). We briefly review the development and technical aspects of these treatments, their potential role in the treatment of major depression, adverse effects, and putative mechanism of action. As the only one of these treatment modalities that is in widespread clinical use, more extended consideration is given to ECT. Although more than half a century has elapsed since ECT was first introduced, it remains the most effective treatment for major depression, with efficacy in patients refractory to antidepressant drugs and an acceptable safety profile. Although they hold considerable promise, the novel brain stimulation techniques reviewed here will be need to be further developed before they achieve clinical acceptability. PMID:16889109

Four novel prosthodontic methods for managing upper airway resistance syndrome: an investigative analysis revealing the efficacy of the new nasopharyngeal aperture guard appliance.

PubMed

Venkat, R; Gopichander, N; Vasantakumar, M

2010-01-01

Obstructive sleep apnea is the most frequent cause for insomnia in the populace. Snoring is mulled over as the potential factor that can lead the sequel to obstructive sleep apnea. Although the etiology and deterrence measures for snoring are yet to be undoubtedly clarified by our scientific sorority, various means of surgical corrections have been affirmed and put into practice, with a substantial degree of success. Despite this, it is implicit that a noninvasive method of managing obstructive sleep apnea is more relevant for overcoming this condition. This manuscript intends to establish how snoring can be controlled prosthodontically by different modalities of scientifically defensible approaches. The most effective among the modalities was affirmed as the investigative analyses of the treatment outcomes with each modality. NOVEL METHODS: Four new methods of managing obstructive sleep apnea--uvula lift appliance, uvula and velopharynx lift appliance, nasopharyngeal aperture guard, and soft palate lift appliance were demonstrated through this article. The four new modalities stated and one conventional modality of mandibular advancement appliance for managing obstructive sleep apnea, a total of five types of appliance therapies, were described with case reports for each. Five individuals undergoing the appliance therapy were chosen for each modality. The treatment outcome with each modality was examined by analysis of clinical predictors and also by means of standard investigation, with nasal and oral endoscopic analyses. Among the five types of appliance therapies, the nasopharyngeal aperture guard provided the best treatment outcome in terms of clinical predictors and endoscopic analyses. Nasopharyngeal aperture guard, the novel method stated in this article is the better modality for managing obstructive sleep apnea, among the five different appliance therapies.

Active vibration control of thin-plate structures with partial SCLD treatment

NASA Astrophysics Data System (ADS)

Lu, Jun; Wang, Pan; Zhan, Zhenfei

2017-02-01

To effectively suppress the low-frequency vibration of a thin-plate, the strategy adopted is to develop a model-based approach to the investigation on the active vibration control of a clamped-clamped plate with partial SCLD treatment. Firstly, a finite element model is developed based on the constitutive equations of elastic, piezoelectric and viscoelastic materials. The characteristics of viscoelastic materials varying with temperature and frequency are described by GHM damping model. A low-dimensional real modal control model which can be used as the basis for active vibration control is then obtained from the combined reduction. The emphasis is placed on the feedback control system to attenuate the vibration of plates with SCLD treatments. A modal controller in conjunction with modal state estimator is designed to solve the problem of full state feedback, making it much more feasible to real-time control. Finally, the theoretical model is verified by modal test, and an active vibration control is validated by hardware-in-the-loop experiment under different external excitations. The numerical and experimental study demonstrate how the piezoelectric actuators actively control the lower modes (first bending and torsional modes) using modal controller, while the higher frequency vibration attenuated by viscoelastic passive damping layer.

Novel mouth-exercising device for oral submucous fibrosis.

PubMed

Patil, Pravinkumar G; Patil, Smita P

2012-10-01

Oral submucous fibrosis (OSMF) is a chronic inflammatory disease resulting in progressive juxtaepithelial fibrosis of the oral soft tissues and can cause increasing difficulty in mastication, swallowing, speaking, and mouth opening. The treatment of severe trismus requires a combination of surgical release and physiotherapy. Often physiotherapy alone can modify tissue remodeling in OSMF to increase oral opening. This article describes the fabrication and use of a new mouth-exercising device that helps the patient to squeeze/stretch the cheek mucosa to increase elasticity. The device can be used as a sole treatment modality or can be used in association with pharmacological and surgical treatment modalities for OSMF. Improvement in mouth opening was observed in four OSMF patients treated with a mouth-exercising device for 6 months as a sole treatment modality. © 2012 by the American College of Prosthodontists.

A comparison of multiple imputation methods for incomplete longitudinal binary data.

PubMed

Yamaguchi, Yusuke; Misumi, Toshihiro; Maruo, Kazushi

2018-01-01

Longitudinal binary data are commonly encountered in clinical trials. Multiple imputation is an approach for getting a valid estimation of treatment effects under an assumption of missing at random mechanism. Although there are a variety of multiple imputation methods for the longitudinal binary data, a limited number of researches have reported on relative performances of the methods. Moreover, when focusing on the treatment effect throughout a period that has often been used in clinical evaluations of specific disease areas, no definite investigations comparing the methods have been available. We conducted an extensive simulation study to examine comparative performances of six multiple imputation methods available in the SAS MI procedure for longitudinal binary data, where two endpoints of responder rates at a specified time point and throughout a period were assessed. The simulation study suggested that results from naive approaches of a single imputation with non-responders and a complete case analysis could be very sensitive against missing data. The multiple imputation methods using a monotone method and a full conditional specification with a logistic regression imputation model were recommended for obtaining unbiased and robust estimations of the treatment effect. The methods were illustrated with data from a mental health research.

Current and emerging therapeutic modalities for hyperhidrosis, part 1: conservative and noninvasive treatments.

PubMed

Ram, Ramin; Lowe, Nicholas J; Yamauchi, Paul S

2007-03-01

Approximately 1% to 3% of the US population has hyperhidrosis (HH). HH can be an incapacitating medical condition because it not only hinders patient quality of life but also causes the secondary effect of excess cutaneous sweat. There is a broad spectrum of treatment modalities including topical and systemic therapies, iontophoresis, localized neuroinhibitory injections, and surgical interventions. This article reviews HH and the conservative treatments for the condition.

Evaluation of the U.S. Army Alcohol and Drug Abuse Prevention and Control Program. Phase 2

DTIC Science & Technology

1994-06-13

24 Alcohol Last Use and Frequency of Use by Track ................ 26 ! Cannabis and Cocaine Last Use By Track...Outcome ...................................... 69 Alcohol Track II Probability Results ........................... 70 Cannabis Track I1 Probability...81 Time By Treatment Modality for Alcohol By Track ................. 82 Time By Treatment Modality for Cannabis and Cocaine ............. 84

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

ERIC Educational Resources Information Center

Duindam, Ton

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

Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review.

PubMed

Prins, Fieke M; Kerkmeijer, Linda G W; Pronk, Anne A; Vonken, Evert-Jan P A; Meijer, Richard P; Bex, Axel; Barendrecht, Maurits M

2017-10-01

The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.

Determining the best treatment for simple bone cyst: a decision analysis.

PubMed

Lee, Seung Yeol; Chung, Chin Youb; Lee, Kyoung Min; Sung, Ki Hyuk; Won, Sung Hun; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon; Yeo, Ji Hyun; Park, Moon Seok

2014-03-01

The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence. A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters. The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%. In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.

Complementary and alternative medicine use by psychiatric inpatients.

PubMed

Elkins, Gary; Rajab, M Hasan; Marcus, Joel

2005-02-01

82 psychiatric inpatients hospitalized for acute care were interviewed about their use of complementary and alternative medicine (CAM) modalities. The clinical diagnoses of respondents included Depressive Disorder (61%), Substance Abuse (26%), Schizophrenia (9%), and Anxiety Disorders (5%). Analysis indicated that 63% used at least one CAM modality within the previous 12 mo. The most frequently used modality was herbal therapies (44%), followed by mind-body therapies such as relaxation or mental imagery, hypnosis, meditation, biofeedback (30%), and spiritual healing by another (30%). Physical modalities such as massage, chiropractic treatment, acupuncture, and yoga were used by 21% of respondents. CAM therapies were used for a variety of reasons ranging from treatment of anxiety and depression to weight loss. However, most respondents indicated they did not discuss such use with their psychiatrist or psychotherapist.

Few-body modes of binary formation in core collapse

NASA Astrophysics Data System (ADS)

Tanikawa, Ataru; Heggie, Douglas C.; Hut, Piet; Makino, Junichiro

2013-11-01

At the moment of deepest core collapse, a star cluster core contains less than ten stars. This small number makes the traditional treatment of hard binary formation, assuming a homogeneous background density, suspect. In a previous paper, we have found that indeed the conventional wisdom of binary formation, based on three-body encounters, is incorrect. Here we refine that insight, by further dissecting the subsequent steps leading to hard binary formation. For this purpose, we add some analysis tools in order to make the study less subjective. We find that the conventional treatment does remain valid for direct three-body scattering, but fails for resonant three-body scattering. Especially democratic resonance scattering, which forms an important part of the analytical theory of three-body binary formation, takes too much space and time to be approximated as being isolated, in the context of a cluster core around core collapse. We conclude that, while three-body encounters can be analytically approximated as isolated, subsequent strong perturbations typically occur whenever those encounters give rise to democratic resonances. We present analytical estimates postdicting our numerical results. If we only had been a bit more clever, we could have predicted this qualitative behaviour.

Black hole/pulsar binaries in the Galaxy

NASA Astrophysics Data System (ADS)

Shao, Yong; Li, Xiang-Dong

2018-06-01

We have performed population synthesis calculation on the formation of binaries containing a black hole (BH) and a neutron star (NS) in the Galactic disc. Some of important input parameters, especially for the treatment of common envelope evolution, are updated in the calculation. We have discussed the uncertainties from the star formation rate of the Galaxy and the velocity distribution of NS kicks on the birthrate (˜ 0.6-13 M yr^{-1}) of BH/NS binaries. From incident BH/NS binaries, by modelling the orbital evolution due to gravitational wave radiation and the NS evolution as radio pulsars, we obtain the distributions of the observable parameters such as the orbital period, eccentricity, and pulse period of the BH/pulsar binaries. We estimate that there may be ˜3-80 BH/pulsar binaries in the Galactic disc and around 10 per cent of them could be detected by the Five-hundred-metre Aperture Spherical radio Telescope.

The dissociation between command following and communication in disorders of consciousness: an fMRI study in healthy subjects.

PubMed

Osborne, Natalie R; Owen, Adrian M; Fernández-Espejo, Davinia

2015-01-01

Neuroimaging studies have identified a subgroup of patients with a Disorder of Consciousness (DOC) who, while being behaviorally non-responsive, are nevertheless able to follow commands by modulating their brain activity in motor imagery (MI) tasks. These techniques have even allowed for binary communication in a small number of DOC patients. However, the majority of patients who can follow commands are unable to use their responses to communicate. A similar dissociation between present command following (CF) and absent communication abilities has been reported in overt behavioral assessments. However, the neural correlates of this dissociation in both overt and covert modalities are unknown. Here, we used functional magnetic resonance imaging (fMRI) to explore the neural mechanisms underlying CF and selection of responses for binary communication using either executed or imagined movements. Fifteen healthy participants executed or imagined two different types of arm movements that were either pre-determined by the experimenters (CF) or decided by them (action selection, AS). Action selection involved greater activity in high-level associative areas in frontal and parietal regions than CF. Additionally, motor execution (ME), as compared to MI, activated contralateral motor cortex, while the opposite contrast revealed activation in the ipsilateral sensorimotor cortex and the left inferior frontal gyrus. Importantly, there was no interaction between the task (CF/AS) and modality (MI/ME). Our results suggest that the neural processes involved in following a motor command or selecting between two motor actions are not dependent on how the response is expressed (via ME/MI). They also suggest a potential neural basis for the distinction in cognitive abilities seen in DOC patients.

The dissociation between command following and communication in disorders of consciousness: an fMRI study in healthy subjects

PubMed Central

Osborne, Natalie R.; Owen, Adrian M.; Fernández-Espejo, Davinia

2015-01-01

Neuroimaging studies have identified a subgroup of patients with a Disorder of Consciousness (DOC) who, while being behaviorally non-responsive, are nevertheless able to follow commands by modulating their brain activity in motor imagery (MI) tasks. These techniques have even allowed for binary communication in a small number of DOC patients. However, the majority of patients who can follow commands are unable to use their responses to communicate. A similar dissociation between present command following (CF) and absent communication abilities has been reported in overt behavioral assessments. However, the neural correlates of this dissociation in both overt and covert modalities are unknown. Here, we used functional magnetic resonance imaging (fMRI) to explore the neural mechanisms underlying CF and selection of responses for binary communication using either executed or imagined movements. Fifteen healthy participants executed or imagined two different types of arm movements that were either pre-determined by the experimenters (CF) or decided by them (action selection, AS). Action selection involved greater activity in high-level associative areas in frontal and parietal regions than CF. Additionally, motor execution (ME), as compared to MI, activated contralateral motor cortex, while the opposite contrast revealed activation in the ipsilateral sensorimotor cortex and the left inferior frontal gyrus. Importantly, there was no interaction between the task (CF/AS) and modality (MI/ME). Our results suggest that the neural processes involved in following a motor command or selecting between two motor actions are not dependent on how the response is expressed (via ME/MI). They also suggest a potential neural basis for the distinction in cognitive abilities seen in DOC patients. PMID:26441593

Observing Mergers of Nonspinning Black Hole Binaries with LISA

NASA Technical Reports Server (NTRS)

McWilliams S.; Baker, John G.; Boggs, William D.; Centrella, Joan; Kelly Bernard J.; Thorpe, J. Ira; vanMeter, James R.

2008-01-01

Recent advances in the field of numerical relativity now make it possible to calculate the final, most powerful merger phase of binary black hole coalescence. We present the application of nonspinning numerical relativity waveforms to the search for and precision measurement of black hole binary coalescences using LISA. In particular, we focus on the advances made in moving beyond the equal mass, nonspinning case into other regions of parameter space, focusing on the case of nonspinning holes with ever-increasing mass ratios. We analyze the available unequal mass merger waveforms from numerical relativity, and compare them to two models, both of which use an effective one body treatment of the inspiral, but which use fundamentally different approaches to the treatment of the merger-ringdown. We confirm the expected mass ratio scaling of the merger, and investigate the changes in waveform behavior and their observational impact with changing mass ratio. Finally, we investigate the potential contribution from the merger portion of the waveform to measurement uncertainties of the binary's parameters for the unequal mass case.

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

PubMed Central

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

2012-01-01

Objectives To characterize the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (dose-escalated 3-dimensional conformal radiation, intensity-modulated radiation, brachytherapy, or combination), using a comprehensive, lifetime decision analytic model. Patients and Methods A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes following primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. Patients could experience remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the U.S. payer perspective, with incorporation of patient costs in a sensitivity analysis. Results Differences in quality-adjusted life years across modalities were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6 to 10.5 for intermediate-risk patients, and 7.8 to 9.3 for high-risk patients. There were no statistically significant differences among surgical modalities, which tended to be more effective than radiation modalities, with the exception of combination external beam + brachytherapy for high-risk disease. Radiation modalities were consistently more expensive than surgical modalities; costs ranged from $19,901 (robot-assisted prostatectomy for low-risk disease) to $50,276 (combination radiation for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Conclusions Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions regarding strategies to improve efficiency of treatment selection for localized prostate cancer. PMID:23279038

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

PubMed Central

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

2015-01-01

Background Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood. Methods A systematic search of 12 literature databases using Cochrane’s guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment. Results The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%–75%) or treatment duration (62%–72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length. Conclusions While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results. PMID:25714373

Communication restriction in adults who stutter: Part II.

PubMed

Lee, Amanda; Robb, Michael; van Dulm, Ondene; Ormond, Tika

This article presents a follow-up study to Lee, van Dulm, Robb, and Ormond (2015). The aim was to explore communication restriction in adults with stuttering (AWS) using typical language measures and systemic functional linguistics (SFL) analyses. The article compared the pre- and post-treatment performance of AWS in language productivity and complexity, transitivity, modality, appraisal, and theme. Ten-minute conversational samples were obtained from 20 AWS before and after participation in intensive stuttering treatment. Transcripts were analysed for quantity and complexity of verbal output, and frequency of transitivity, modality, appraisal and theme resources. Between pre- and post-treatment, the following differences were observed: (1) a significant increase in frequency of modal operators, and trends approaching significance for (2) increased language complexity (3) increased language expressing appraisal. These changes suggest increased flexibility of language use in AWS following treatment, particularly towards interpersonal engagement. The value of SFL to this area of research is discussed.

An overview of clinical and experimental treatment modalities for port wine stains

PubMed Central

Chen, Jennifer K.; Ghasri, Pedram; Aguilar, Guillermo; van Drooge, Anne Margreet; Wolkerstorfer, Albert; Kelly, Kristen M.; Heger, Michal

2014-01-01

Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy. PMID:22305042

Protocol for a systematic review with network meta-analysis of the modalities used to deliver eHealth interventions for chronic pain.

PubMed

Slattery, Brian W; Haugh, Stephanie; Francis, Kady; O'Connor, Laura; Barrett, Katie; Dwyer, Christopher P; O'Higgins, Siobhan; Egan, Jonathan; McGuire, Brian E

2017-03-03

As eHealth interventions prove both efficacious and practical, and as they arguably overcome certain barriers encountered by traditional face-to-face treatment for chronic pain, their number has increased dramatically in recent times. However, there is a dearth of research that focuses on evaluating and comparing the different types of technology-assisted interventions. This is a protocol for a systematic review that aims to evaluate the eHealth modalities in the context of psychological and non-psychological (other than non-drug) interventions for chronic pain. We will search the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase and PsycINFO. Randomised controlled trials (RCTs) with more than 20 participants per trial arm that have evaluated non-drug psychological or non-psychological interventions delivered via an eHealth modality and have pain as an outcome measure will be included. Two review authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one outcome variable in accordance with the IMMPACT guidelines (i.e. pain severity, pain interference, physical functioning, symptoms, emotional functioning, global improvement and disposition). Secondary outcomes will be measures of depression and health-related quality of life (HRQoL). A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of modalities across treatment trials, which will return rankings for the eHealth modalities in terms of their effectiveness. Most trials that use an eHealth intervention to manage chronic pain typically use one modality. As a result, little evidence exists to support which modality type is the most effective. The current review will address this gap in the literature and compare the different eHealth modalities used for technology-assisted interventions for chronic pain. With the growing reliance and use of technology as a medium for delivering treatment for chronic conditions more generally, it is imperative that research identify the most efficacious eHealth modalities and systematically identify the most important features of such treatment types, so they may be replicated and used for research and in the provision of care. PROSPERO, CRD42016035595.

Visual and Spoken Texts in MCALL Courseware: The Effects of Text Modalities on the Vocabulary Retention of EFL Learners

ERIC Educational Resources Information Center

Sabet, Masoud Khalili; Shalmani, Hamed Babaie

2010-01-01

The present study sought to explore the effects of Multimedia Computer-Assisted Language Learning (MCALL) programs drawing on two different text modalities on the vocabulary retention of Iranian EFL learners. The two groups under study received treatment on vocabulary items under two multimedia conditions: The first group received treatment on the…

Barriers and challenges in integration of anthroposophic medicine in supportive breast cancer care.

PubMed

Ben-Arye, Eran; Schiff, Elad; Levy, Moti; Raz, Orit Gressel; Barak, Yael; Bar-Sela, Gil

2013-01-01

In the last decade, more and more oncology centers are challenged with complementary medicine (CM) integration within supportive breast cancer care. Quality of life (QOL) improvement and attenuation of oncology treatment side effects are the core objectives of integrative CM programs in cancer care. Yet, limited research is available on the use of specific CM modalities in an integrative setting and on cancer patients' compliance with CM consultation. Studies are especially warranted to view the clinical application of researched CM modalities, such as anthroposophic medicine (AM), a unique CM modality oriented to cancer supportive care. Our objective was to characterize consultation patterns provided by physicians trained in CM following oncology health-care practitioners' referral of patients receiving chemotherapy. We aimed to identify characteristics of patients who consulted with AM and to explore patients' compliance to AM treatment. Of the 341 patients consulted with integrative physicians, 138 were diagnosed with breast cancer. Following integrative physician consultation, 56 patients were advised about AM treatment and 285 about other CM modalities. Logistic multivariate regression model found that, compared with patients receiving non-anthroposophic CM, the AM group had significantly greater rates of previous CM use [EXP(B) = 3.25, 95% C.I. 1.64-6.29, p = 0.001] and higher rates of cancer recurrence at baseline (p = 0.038). Most AM users (71.4%) used a single AM modality, such as mistletoe (viscum album) injections, oral AM supplements, or music therapy. Compliance with AM modalities following physician recommendation ranged from 44% to 71% of patients. We conclude that AM treatment provided within the integrative oncology setting is feasible based on compliance assessment. Other studies are warranted to explore the effectiveness of AM in improving patients' QOL during chemotherapy.

Dosimetric comparison of different treatment modalities for stereotactic radiotherapy.

PubMed

Hsu, Shih-Ming; Lai, Yuan-Chun; Jeng, Chien-Chung; Tseng, Chia-Ying

2017-09-16

The modalities for performing stereotactic radiotherapy (SRT) on the brain include the cone-based linear accelerator (linac), the flattening filter-free (FFF) volumetric modulated arc therapy (VMAT) linac, and tomotherapy. In this study, the cone-based linac, FFF-VMAT linac, and tomotherapy modalities were evaluated by measuring the differences in doses delivered during brain SRT and experimentally assessing the accuracy of the output radiation doses through clinical measurements. We employed a homemade acrylic dosimetry phantom representing the head, within which a thermoluminescent dosimeter (TLD) and radiochromic EBT3 film were installed. Using the conformity/gradient index (CGI) and Paddick methods, the quality of the doses delivered by the various SRT modalities was evaluated. The quality indicators included the uniformity, conformity, and gradient indices. TLDs and EBT3 films were used to experimentally assess the accuracy of the SRT dose output. The dose homogeneity indices of all the treatment modalities were lower than 1.25. The cone-based linac had the best conformity for all tumors, regardless of the tumor location and size, followed by the FFF-VMAT linac; tomography was the worst-performing treatment modality in this regard. The cone-based linac had the best gradient, regardless of the tumor location and size, whereas the FFF-VMAT linac had a better gradient than tomotherapy for a large tumor diameter (28 mm). The TLD and EBT3 measurements of the dose at the center of tumors indicated that the average difference between the measurements and the calculated dose was generally less than 4%. When the 3% 3-mm gamma passing rate metric was used, the average passing rates of all three treatment modalities exceeded 98%. Regarding the dose, the cone-based linac had the best conformity and steepest dose gradient for tumors of different sizes and distances from the brainstem. The results of this study suggest that SRT should be performed using the cone-based linac on tumors that require treatment plans with a steep dose gradient, even as the tumor is slightly irregular, we should also consider using a high dose gradient of the cone base to treat and protect the normal tissue. If normal tissues require special protection exist at positions that are superior or inferior to the tumor, we can consider using tomotherapy or Cone base with couch at 0° for treatment.

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

PubMed

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

2017-05-01

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

[Pay attention to the application of the international intraocular retinoblastoma classification and sequential multiple modality treatment].

PubMed

Fan, X Q

2017-08-11

Retinoblastoma (RB) is the most common intraocular malignancy in childhood. It may seriously affect vision, and even threaten the life. The early diagnosis rate of RB in China remains low, and the majority of patients are at late phase with high rates of enucleation and mortality. The International Intraocular Retinoblastoma Classification and TNM staging system are guidances for therapeutic choices and bases for prognosis evaluation. Based on the sequential multi-method treatment modality, chemotherapy combined with local therapy is the mainstream in dealing with RB, which may maximize the results of eye saving and even vision retaining. New therapeutic techniques including supra-selective ophthalmic artery interventional chemotherapy and intravitreal chemotherapy can further improve the efficacy of treatment, especially the eye salvage rate. The overall level of RB treatment should be improved by promoting the international staging, new therapeutic techniques, and the sequential multiple modality treatment. (Chin J Ophthalmol, 2017, 53: 561 - 565) .

Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice?

PubMed

Peter, W F; Nelissen, R G H H; Vlieland, T P M Vliet

2014-09-01

In a Dutch guideline on physiotherapy (PT) in hip and knee osteoarthritis, a number of recommendations on post-acute (i.e. after discharge from hospital) PT following total hip (THA) and total knee (TKA) arthroplasty were included. Little is known about the uptake of these recommendations in daily clinical practice. The aim of the present study was to determine the extent to which the guideline recommendations regarding post-acute PT after THA and TKA are followed in daily clinical practice. An online pilot survey on the delivery of post-acute, postoperative PT was sent to a random sample of 957 Dutch physiotherapists. The survey included questions on the application of recommended, neither recommended nor advised against, and advised against treatment modalities and various treatment modalities for which there were no formulated recommendations. A total of 219 physiotherapists completed the questionnaire, with a mean age of 40 years (standard deviation 12.6), 55% female and 95% working in primary care. The vast majority reported the use of the recommended exercise modalities (muscle strengthening exercises (96%), and functional exercises (99%). Continuous passive motion, which was neither recommended nor advised against, and electrical muscle stimulation, which was not recommended, were provided by 1%. Reported treatment modalities for which there were no formulated recommendations included patient education (99%), gait training (95%), active range of motion (ROM) exercises (93%), balance exercises (86%), passive ROM exercises (58%), aerobic exercises (50%), massage (18%) and cold therapy (11%). The vast majority of physiotherapists reported adhering to recommendations on post-acute postoperative PT in THA and TKA patients after discharge from hospital. Although yet to be confirmed in a larger nationwide survey, the relatively high frequency of use of many other treatment modalities, for which there were no formulated recommendations, suggests the need to extend the current set of recommendations to include evidence-based statements on additional treatment modalities. Copyright © 2014 John Wiley & Sons, Ltd.

Wideband two-port beam splitter of a binary fused-silica phase grating.

PubMed

Wang, Bo; Zhou, Changhe; Feng, Jijun; Ru, Huayi; Zheng, Jiangjun

2008-08-01

The usual beam splitter of multilayer-coated film with a wideband spectrum is not easy to achieve. We describe the realization of a wideband transmission two-port beam splitter based on a binary fused-silica phase grating. To achieve high efficiency and equality in the diffracted 0th and -1st orders, the grating profile parameters are optimized using rigorous coupled-wave analysis at a wavelength of 1550 nm. Holographic recording and the inductively coupled plasma dry etching technique are used to fabricate the fused-silica beam splitter grating. The measured efficiency of (45% x 2) = 90% diffracted into the both orders can be obtained with the fabricated grating under Littrow mounting. The physical mechanism of such a wideband two-port beam splitter grating can be well explained by the modal method based on two-beam interference of the modes excited by the incident wave. With the high damage threshold, low coefficient of thermal expansion, and wideband high efficiency, the presented beam splitter etched in fused silica should be a useful optical element for a variety of practical applications.

Direct visualization of gastrointestinal tract with lanthanide-doped BaYbF5 upconversion nanoprobes.

PubMed

Liu, Zhen; Ju, Enguo; Liu, Jianhua; Du, Yingda; Li, Zhengqiang; Yuan, Qinghai; Ren, Jinsong; Qu, Xiaogang

2013-10-01

Nanoparticulate contrast agents have attracted a great deal of attention along with the rapid development of modern medicine. Here, a binary contrast agent based on PAA modified BaYbF5:Tm nanoparticles for direct visualization of gastrointestinal (GI) tract has been designed and developed via a one-pot solvothermal route. By taking advantages of excellent colloidal stability, low cytotoxicity, and neglectable hemolysis of these well-designed nanoparticles, their feasibility as a multi-modal contrast agent for GI tract was intensively investigated. Significant enhancement of contrast efficacy relative to clinical barium meal and iodine-based contrast agent was evaluated via X-ray imaging and CT imaging in vivo. By doping Tm(3+) ions into these nanoprobes, in vivo NIR-NIR imaging was then demonstrated. Unlike some invasive imaging modalities, non-invasive imaging strategy including X-ray imaging, CT imaging, and UCL imaging for GI tract could extremely reduce the painlessness to patients, effectively facilitate imaging procedure, as well as rationality economize diagnostic time. Critical to clinical applications, long-term toxicity of our contrast agent was additionally investigated in detail, indicating their overall safety. Based on our results, PAA-BaYbF5:Tm nanoparticles were the excellent multi-modal contrast agent to integrate X-ray imaging, CT imaging, and UCL imaging for direct visualization of GI tract with low systemic toxicity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Perceived Odor-Taste Congruence Influences Intensity and Pleasantness Differently.

PubMed

Amsellem, Sherlley; Ohla, Kathrin

2016-10-01

The role of congruence in cross-modal interactions has received little attention. In most experiments involving cross-modal pairs, congruence is conceived of as a binary process according to which cross-modal pairs are categorized as perceptually and/or semantically matching or mismatching. The present study investigated whether odor-taste congruence can be perceived gradually and whether congruence impacts other facets of subjective experience, that is, intensity, pleasantness, and familiarity. To address these questions, we presented food odorants (chicken, orange, and 3 mixtures of the 2) and tastants (savory-salty and sour-sweet) in pairs varying in congruence. Participants were to report the perceived congruence of the pairs along with intensity, pleasantness, and familiarity. We found that participants could perceive distinct congruence levels, thereby favoring a multilevel account of congruence perception. In addition, familiarity and pleasantness followed the same pattern as the congruence while intensity was highest for the most congruent and the most incongruent pairs whereas intensities of the intermediary-congruent pairs were reduced. Principal component analysis revealed that pleasantness and familiarity form one dimension of the phenomenological experience of odor-taste pairs that was orthogonal to intensity. The results bear implications for the understanding the behavioral underpinnings of perseverance of habitual food choices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Hybrid wavefront sensor for the fast detection of wavefront disturbances.

PubMed

Dong, Shihao; Haist, Tobias; Osten, Wolfgang

2012-09-01

Strongly aberrated wavefronts lead to inaccuracies and nonlinearities in holography-based modal wavefront sensing (HMWS). In this contribution, a low-resolution Shack-Hartmann sensor (LRSHS) is incorporated into HMWS via a compact holographic design to extend the dynamic range of HMWS. A static binary-phase computer-generated hologram is employed to generate the desired patterns for Shack-Hartmann sensing and HMWS. The low-order aberration modes dominating the wavefront error are first sensed with the LRSHS and corrected by the wavefront modulator. The system then switches to HMWS to obtain better sensor sensitivity and accuracy. Simulated as well as experimental results are shown for validating the proposed method.

The Talbot effect in a metamaterial

NASA Astrophysics Data System (ADS)

Nikkhah, H.; Hasan, M.; Hall, T. J.

2018-02-01

The effect of anisotropy and spatial dispersion of a metamaterial on the Talbot effect may be engineered in principle. This has profound implications for applications of the Talbot effect such as the design of a multimode interference coupler (MMI). The paper describes how a metamaterial can suppress the modal phase error which otherwise limits the scaling of MMI port dimension. A binary multilayer dielectric material described by the Kronig-Penney model is shown to provide a close approximation to the required dispersion relation. Results of simulations of a multi-slotted waveguide MMI engineered to provide a polarising beam splitter function are given as an example of the method.

Physical modalities in chronic pain management.

PubMed

Rakel, Barbara; Barr, John O

2003-09-01

The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness of physical modalities, as has been seen with TENS. These characteristics include depression, high trait anxiety, a powerful others locus of control, obesity, narcotic use, and neuroticism. The effect on pain by various modalities is generally strongest in the short-term period immediately after the intervention series, but effects can last as long as 1 year after treatment (e.g., with massage). Most research has tested the effect of physical modalities on chronic low back pain and knee OA. The effectiveness of physical modalities for other chronic pain conditions needs to be evaluated more completely. Older and younger adults often experience similar effects on their perception of pain from treatment with physical modalities. Therefore, use of these modalities for chronic pain in older adults is appropriate, but special precautions need to be taken. Practitioners applying physical modalities need formal training that includes the risks and precautions for these modalities. If practitioners lack formal training in the use of physical modalities, or if modality use is not within their scope of practice, it is important to consult with and refer patients to members of the team who have this specialized training. Use of a multidisciplinary approach to chronic pain management is of value for all adults and older individuals in particular [79-81]. Historically, physical therapists have been trained to evaluate and treat patients with the range of physical modalities discussed in this article. Although members of the nursing staff traditionally have used some of these modalities (e.g. some forms of heat or cold and massage), increasing numbers of nurses now are being trained to apply more specialized procedures (e.g., TENS). Healthcare professionals must be knowledgeable about the strength of evidence underlying the use of physical modalities for the management of chronic pain. Based on the limited research evidence available (especially related to assistive devices, orthotics, and thermal modalities), it often is difficult to accept or exclude select modalities as having a potential role in chronic pain management for adults and older individuals. Improved research methodologies are needed to address physical modality effectiveness better.

Pain and emotional distress among substance-use patients beginning treatment relative to a representative comparison group

PubMed Central

Wiest, Katharina L.; Colditz, Jason B.; Carr, Kathryn; Asphaug, Victoria J.; McCarty, Dennis; Pilkonis, Paul A.

2014-01-01

Objectives: A secondary analysis assessed health-related quality of life characteristics (i.e. anxiety, depression, fatigue, and types of pain) among patients entering substance-use treatment, and identified characteristics specific to treatment modalities relative to a representative comparison group. Methods: As part of a larger alcohol bank assessment, substance-use patients (n=406) beginning methadone treatment (n=170) or other outpatient treatment (n=236) and a comparison group representative of the general population (n=1000) completed a survey measuring anxiety, depression, fatigue, pain interference, and pain in the last 7 days. Previous studies lacked comparable and concurrent assessments across these three groups. Results: Patients entering substance-use treatment had relatively high levels of emotional distress and poorer health-related quality of life relative to the general population. Among treatment modalities, patients beginning methadone treatment reported the highest levels of pain interference and pain behavior and the poorest physical functioning. Prior to the potentially modifying effects of methadone maintenance, patients beginning agonist therapy reported the greatest levels of compromised quality of life. Conclusion: These data present the magnitude of differences in health-related quality of life characteristics between treatment and comparison groups using the same assessment rubric and may help inform the design and timing of treatment modalities, thereby enhancing treatment efficacy for patients. PMID:25275876

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

PubMed

Zhang, W; Moskowitz, R W; Nuki, G; Abramson, S; Altman, R D; Arden, N; Bierma-Zeinstra, S; Brandt, K D; Croft, P; Doherty, M; Dougados, M; Hochberg, M; Hunter, D J; Kwoh, K; Lohmander, L S; Tugwell, P

2008-02-01

To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.

What is the role of imaging in the clinical diagnosis of osteoarthritis and disease management?

PubMed

Wang, Xia; Oo, Win Min; Linklater, James M

2018-05-01

While OA is predominantly diagnosed on the basis of clinical criteria, imaging may aid with differential diagnosis in clinically suspected cases. While plain radiographs are traditionally the first choice of imaging modality, MRI and US also have a valuable role in assessing multiple pathologic features of OA, although each has particular advantages and disadvantages. Although modern imaging modalities provide the capability to detect a wide range of osseous and soft tissue (cartilage, menisci, ligaments, synovitis, effusion) OA-related structural damage, this extra information has not yet favourably influenced the clinical decision-making and management process. Imaging is recommended if there are unexpected rapid changes in clinical outcomes to determine whether it relates to disease severity or an additional diagnosis. On developing specific treatments, imaging serves as a sensitive tool to measure treatment response. This narrative review aims to describe the role of imaging modalities to aid in OA diagnosis, disease progression and management. It also provides insight into the use of these modalities in finding targeted treatment strategies in clinical research.

Age-related guideline adherence and outcome in low rectal cancer.

PubMed

Schiphorst, Anandi H W; Verweij, Norbert M; Pronk, Apollo; Hamaker, Marije E

2014-08-01

Care for elderly patients with low rectal cancer can pose dilemmas, because radical total mesorectal excision surgery comes with high morbidity and mortality rates. The purpose of this study was to analyze the treatment of patients with low rectal cancer, comparing treatment choices, guideline adherence, and outcomes for elderly patients (≥75 years) with younger patients (<75 years). Patient data were retrieved from the hospital pathology database and from the hospital prospective colorectal surgery database for surgically treated patients. Records were reviewed for nonadherence to treatment guidelines. Delivered treatment modalities for patients with stage I to III rectal cancer were compared with treatment advised by national guidelines, and reasons stated by the treating physician for nonadherence to guidelines were subsequently collected. This study was performed at a high-volume teaching hospital. Patients included were those with newly diagnosed rectal cancer (≤10 cm from the anal verge). Treatment decisions, guideline adherence, and outcome of surgical treatment were the main outcome parameters. Of 218 included patients, 75 (34%) were aged ≥75 years. Guideline adherence for all of the treatment modalities in stage I to III rectal cancer was significantly lower in elderly patients (62% versus 87% for aged <75 years; p < 0.001), and age was the primary reason mentioned for withholding treatment. Palliative anticancer treatment for stage IV disease was also initiated significantly less frequently in elderly patients (60% versus 97%; p = 0.002). Overall rates of treatment complications were similar for both patient groups (p = 0.71), but the impact of complications on survival was much greater for elderly patients (p = 0.002). Data on outcome of other treatment modalities, such as chemotherapy and radiotherapy, are lacking. Guideline adherence for all of the treatment modalities in stage I to III rectal cancer declines significantly with increasing age. Future research should focus on strategies of treatment tailored to patient health status rather than chronological age.

Binary culture of microalgae as an integrated approach for enhanced biomass and metabolites productivity, wastewater treatment, and bioflocculation.

PubMed

Rashid, Naim; Park, Won-Kun; Selvaratnam, Thinesh

2018-03-01

Ecological studies of microalgae have revealed their potential to co-exist in the natural environment. It provides an evidence of the symbiotic relationship of microalgae with other microorganisms. The symbiosis potential of microalgae is inherited with distinct advantages, providing a venue for their scale-up applications. The deployment of large-scale microalgae applications is limited due to the technical challenges such as slow growth rate, low metabolites yield, and high risk of biomass contamination by unwanted bacteria. However, these challenges can be overcome by exploring symbiotic potential of microalgae. In a symbiotic system, photosynthetic microalgae co-exist with bacteria, fungi, as well as heterotrophic microalgae. In this consortium, they can exchange nutrients and metabolites, transfer gene, and interact with each other through complex metabolic mechanism. Microalgae in this system, termed as a binary culture, are reported to exhibit high growth rate, enhanced bio-flocculation, and biochemical productivity without experiencing contamination. Binary culture also offers interesting applications in other biotechnological processes including bioremediation, wastewater treatment, and production of high-value metabolites. The focus of the study is to provide a perspective to enhance the understanding about microalgae binary culture. In this review, the mechanism of binary culture, its potential, and limitations are briefly discussed. A number of queries are evolved through this study, which needs to be answered by executing future research to assess the real potential of binary culture. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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

Ma Lijun, E-mail: lijunma@radonc.ucsf.ed; Sahgal, Arjun; Descovich, Martina

2010-03-01

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

Characteristics and use of treatment modalities of patients with binge-eating disorder in the Department of Veterans Affairs.

PubMed

Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Pawaskar, Manjiri; Babcock, Thomas; LaFleur, Joanne

2016-04-01

In 2013 binge-eating disorder (BED) was recognized as a formal diagnosis, but was historically included under the diagnosis code for eating disorder not otherwise specified (EDNOS). This study compared the characteristics and use of treatment modalities in BED patients to those with EDNOS without BED (EDNOS-only) and to matched-patients with no eating disorders (NED). Patients were identified for this study from electronic health records in the Department of Veterans Affairs from 2000 to 2011. Patients with BED were identified using natural language processing and patients with EDNOS-only were identified by ICD-9 code (307.50). First diagnosis defined index date for these groups. NED patients were frequency matched to BED patients up to 4:1, as available, on age, sex, BMI, depression, and index month encounter. Baseline characteristics and use of treatment modalities during the post-index year were compared using t-tests or chi-square tests. There were 593 BED, 1354 EDNOS-only, and 1895 matched-NED patients identified. Only 68 patients with BED had an EDNOS diagnosis. BED patients were younger (48.7 vs. 49.8years, p=0.04), more were male (72.2% vs. 62.8%, p<0.001) and obese (BMI 40.2 vs. 37.0, p<0.001) than EDNOS-only patients. In the follow-up period fewer BED (68.0%) than EDNOS-only patients (87.6%, p<0.001), but more BED than NED patients (51.9%, p<0.001) used at least one treatment modality. The characteristics of BED patients were different from those with EDNOS-only and NED as was their use of treatment modalities. These differences highlight the need for a separate identifier of BED. Copyright © 2016 Elsevier Ltd. All rights reserved.

Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial

PubMed Central

Van Coevorden, Frits; Punt, Cornelis J. A.; Pierie, Jean-Pierre E. N.; Borel-Rinkes, Inne; Ledermann, Jonathan A.; Poston, Graeme; Bechstein, Wolf; Lentz, Marie-Ange; Mauer, Murielle; Folprecht, Gunnar; Van Cutsem, Eric; Ducreux, Michel; Nordlinger, Bernard

2017-01-01

Background: Tumor ablation is often employed for unresectable colorectal liver metastases. However, no survival benefit has ever been demonstrated in prospective randomized studies. Here, we investigate the long-term benefits of such an aggressive approach. Methods: In this randomized phase II trial, 119 patients with unresectable colorectal liver metastases (n < 10 and no extrahepatic disease) received systemic treatment alone or systemic treatment plus aggressive local treatment by radiofrequency ablation ± resection. Previously, we reported that the primary end point (30-month overall survival [OS] > 38%) was met. We now report on long-term OS results. All statistical tests were two-sided. The analyses were according to intention to treat. Results: At a median follow up of 9.7 years, 92 of 119 (77.3%) patients had died: 39 of 60 (65.0%) in the combined modality arm and 53 of 59 (89.8%) in the systemic treatment arm. Almost all patients died of progressive disease (35 patients in the combined modality arm, 49 patients in the systemic treatment arm). There was a statistically significant difference in OS in favor of the combined modality arm (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.38 to 0.88, P = .01). Three-, five-, and eight-year OS were 56.9% (95% CI = 43.3% to 68.5%), 43.1% (95% CI = 30.3% to 55.3%), 35.9% (95% CI = 23.8% to 48.2%), respectively, in the combined modality arm and 55.2% (95% CI = 41.6% to 66.9%), 30.3% (95% CI = 19.0% to 42.4%), 8.9% (95% CI = 3.3% to 18.1%), respectively, in the systemic treatment arm. Median OS was 45.6 months (95% CI = 30.3 to 67.8 months) in the combined modality arm vs 40.5 months (95% CI = 27.5 to 47.7 months) in the systemic treatment arm. Conclusions: This phase II trial is the first randomized study demonstrating that aggressive local treatment can prolong OS in patients with unresectable colorectal liver metastases. PMID:28376151

Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial.

PubMed

Ruers, Theo; Van Coevorden, Frits; Punt, Cornelis J A; Pierie, Jean-Pierre E N; Borel-Rinkes, Inne; Ledermann, Jonathan A; Poston, Graeme; Bechstein, Wolf; Lentz, Marie-Ange; Mauer, Murielle; Folprecht, Gunnar; Van Cutsem, Eric; Ducreux, Michel; Nordlinger, Bernard

2017-09-01

Tumor ablation is often employed for unresectable colorectal liver metastases. However, no survival benefit has ever been demonstrated in prospective randomized studies. Here, we investigate the long-term benefits of such an aggressive approach. In this randomized phase II trial, 119 patients with unresectable colorectal liver metastases (n < 10 and no extrahepatic disease) received systemic treatment alone or systemic treatment plus aggressive local treatment by radiofrequency ablation ± resection. Previously, we reported that the primary end point (30-month overall survival [OS] > 38%) was met. We now report on long-term OS results. All statistical tests were two-sided. The analyses were according to intention to treat. At a median follow up of 9.7 years, 92 of 119 (77.3%) patients had died: 39 of 60 (65.0%) in the combined modality arm and 53 of 59 (89.8%) in the systemic treatment arm. Almost all patients died of progressive disease (35 patients in the combined modality arm, 49 patients in the systemic treatment arm). There was a statistically significant difference in OS in favor of the combined modality arm (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.38 to 0.88, P = .01). Three-, five-, and eight-year OS were 56.9% (95% CI = 43.3% to 68.5%), 43.1% (95% CI = 30.3% to 55.3%), 35.9% (95% CI = 23.8% to 48.2%), respectively, in the combined modality arm and 55.2% (95% CI = 41.6% to 66.9%), 30.3% (95% CI = 19.0% to 42.4%), 8.9% (95% CI = 3.3% to 18.1%), respectively, in the systemic treatment arm. Median OS was 45.6 months (95% CI = 30.3 to 67.8 months) in the combined modality arm vs 40.5 months (95% CI = 27.5 to 47.7 months) in the systemic treatment arm. This phase II trial is the first randomized study demonstrating that aggressive local treatment can prolong OS in patients with unresectable colorectal liver metastases. © The Author 2017. Published by Oxford University Press.

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

PubMed

Nogami, Shinnosuke; Yamauchi, Kensuke; Shiiba, Shunji; Kataoka, Yoshihiro; Hirayama, Bunichi; Takahashi, Tetsu

2015-03-01

The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement. One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB). A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs. Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts. Wiley Periodicals, Inc.

Portfolio of prospective clinical trials including brachytherapy: an analysis of the ClinicalTrials.gov database.

PubMed

Cihoric, Nikola; Tsikkinis, Alexandros; Miguelez, Cristina Gutierrez; Strnad, Vratislav; Soldatovic, Ivan; Ghadjar, Pirus; Jeremic, Branislav; Dal Pra, Alan; Aebersold, Daniel M; Lössl, Kristina

2016-03-22

To evaluate the current status of prospective interventional clinical trials that includes brachytherapy (BT) procedures. The records of 175,538 (100 %) clinical trials registered at ClinicalTrials.gov were downloaded on September 2014 and a database was established. Trials using BT as an intervention were identified for further analyses. The selected trials were manually categorized according to indication(s), BT source, applied dose rate, primary sponsor type, location, protocol initiator and funding source. We analyzed trials across 8 available trial protocol elements registered within the database. In total 245 clinical trials were identified, 147 with BT as primary investigated treatment modality and 98 that included BT as an optional treatment component or as part of the standard treatment. Academic centers were the most frequent protocol initiators in trials where BT was the primary investigational treatment modality (p < 0.01). High dose rate (HDR) BT was the most frequently investigated type of BT dose rate (46.3 %) followed by low dose rate (LDR) (42.0 %). Prostate was the most frequently investigated tumor entity in trials with BT as the primary treatment modality (40.1 %) followed by breast cancer (17.0 %). BT was rarely the primary investigated treatment modality for cervical cancer (6.8 %). Most clinical trials using BT are predominantly in early phases, investigator-initiated and with low accrual numbers. Current investigational activities that include BT mainly focus on prostate and breast cancers. Important questions concerning the optimal usage of BT will not be answered in the near future.

Hyperbaric Oxygen Therapy—A Novel Treatment Modality in Oral Submucous Fibrosis: A Review

PubMed Central

Kumar, M. Ashwini; Radhika, Besta; Reddy, Satya Prakash; Yaga, Uday Shankar

2015-01-01

Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxta epithelial fibrosis of the oral cavity and regarded as a potentially malignant disorder. Numerous treatment modalities ranging from various drugs to behavioral therapy have been tried with inconsistent results with varying degrees of success reflecting low predictability, requiring further evaluation and standardization. Novel treatment modality such as Hyperbaric oxygen therapy (HBOT) involves inhalation of 100% oxygen at increased atmospheric pressure usually ranging between 2.0 and 2.5 atmospheres for periods between 60 and 120 min. HBOT which can increase oxygen tension and delivery to oxygen-deficient tissue, is a supplementary therapy to improve hypoxic environment of OSMF and also possesses potent anti-inflammatory properties. This article enlightens on possible beneficial effects of HBOT in the management of OSMF at cellular and molecular level. PMID:26155590

Unified-planning, graded-administration, and centralized-controlling: a management modality for treating acquired immune deficiency syndrome with Chinese medicine in Henan Province of China.

PubMed

Xu, Li-Ran; Guo, Hui-jun; Liu, Zhi-bin; Li, Qiang; Yang, Ji-ping; He, Ying

2015-04-01

Henan Province in China has a major epidemic of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Chinese medicine (CM) has been used throughout the last decade, and a management modality was developed, which can be described by unified-planning, graded-administration, and centralized-controlling (UGC). The UGC modality has one primary concept (patient-centered medicine from CM theory), four basic foundations (classifying administrative region, characteristics of CM on disease treatment, health resource conditions, and distribution of patients living with HIV), six important relationships (the "three uniformities and three combinations," and the six relationships therein guide the treatment of AIDS with CM), and four key sections (management, operation, records, and evaluation). In this article, the authors introduce the UGC modality, which could be beneficial to developing countries or resource-limited areas for the management of chronic infectious disease.

Consensus recommendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices.

PubMed

Tanghetti, Emil; Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Eichenfield, Lawrence F; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

2014-02-01

The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.

Combined optical tomographic and magnetic resonance imaging of tumor bearing mice

NASA Astrophysics Data System (ADS)

Masciotti, J.; Abdoulaev, G.; Hur, J.; Papa, J.; Bae, J.; Huang, J.; Yamashiro, D.; Kandel, J.; Hielscher, A. H.

2005-04-01

With the advent of small animal imaging systems, it has become possible to non-invasively monitor the progression of diseases in living small animals and study the efficacy of drugs and treatment protocols. Magnetic resonance imaging (MRI) is an established imaging modality capable of obtaining high resolution anatomical images as well as studying cerebral blood volume (CBV), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen (CMRO2). Optical tomography, on the other hand, is an emerging imaging modality, which, while much lower in spatial resolution and insensitive to CBF, can separate the effects of oxyhemoglobin, deoxyhemoglobin, and CBV with high temporal resolution. In this study we present our first results concerning coregistration of MRI and optical data. By applying both modalities to imaging of kidney tumors in mice that undergo VEGF treatment, we illustrate how these imaging modalities can supplement each other and cross validation can be performed.

Identification of Alzheimer's disease and mild cognitive impairment using multimodal sparse hierarchical extreme learning machine.

PubMed

Kim, Jongin; Lee, Boreom

2018-05-07

Different modalities such as structural MRI, FDG-PET, and CSF have complementary information, which is likely to be very useful for diagnosis of AD and MCI. Therefore, it is possible to develop a more effective and accurate AD/MCI automatic diagnosis method by integrating complementary information of different modalities. In this paper, we propose multi-modal sparse hierarchical extreme leaning machine (MSH-ELM). We used volume and mean intensity extracted from 93 regions of interest (ROIs) as features of MRI and FDG-PET, respectively, and used p-tau, t-tau, and Aβ42 as CSF features. In detail, high-level representation was individually extracted from each of MRI, FDG-PET, and CSF using a stacked sparse extreme learning machine auto-encoder (sELM-AE). Then, another stacked sELM-AE was devised to acquire a joint hierarchical feature representation by fusing the high-level representations obtained from each modality. Finally, we classified joint hierarchical feature representation using a kernel-based extreme learning machine (KELM). The results of MSH-ELM were compared with those of conventional ELM, single kernel support vector machine (SK-SVM), multiple kernel support vector machine (MK-SVM) and stacked auto-encoder (SAE). Performance was evaluated through 10-fold cross-validation. In the classification of AD vs. HC and MCI vs. HC problem, the proposed MSH-ELM method showed mean balanced accuracies of 96.10% and 86.46%, respectively, which is much better than those of competing methods. In summary, the proposed algorithm exhibits consistently better performance than SK-SVM, ELM, MK-SVM and SAE in the two binary classification problems (AD vs. HC and MCI vs. HC). © 2018 Wiley Periodicals, Inc.

Perspectives of human verification via binary QRS template matching of single-lead and 12-lead electrocardiogram.

PubMed

Krasteva, Vessela; Jekova, Irena; Schmid, Ramun

2018-01-01

This study aims to validate the 12-lead electrocardiogram (ECG) as a biometric modality based on two straightforward binary QRS template matching characteristics. Different perspectives of the human verification problem are considered, regarding the optimal lead selection and stability over sample size, gender, age, heart rate (HR). A clinical 12-lead resting ECG database, including a population of 460 subjects with two-session recordings (>1 year apart) is used. Cost-effective strategies for extraction of personalized QRS patterns (100ms) and binary template matching estimate similarity in the time scale (matching time) and dissimilarity in the amplitude scale (mismatch area). The two-class person verification task, taking the decision to validate or to reject the subject identity is managed by linear discriminant analysis (LDA). Non-redundant LDA models for different lead configurations (I,II,III,aVF,aVL,aVF,V1-V6) are trained on the first half of 230 subjects by stepwise feature selection until maximization of the area under the receiver operating characteristic curve (ROC AUC). The operating point on the training ROC at equal error rate (EER) is tested on the independent dataset (second half of 230 subjects) to report unbiased validation of test-ROC AUC and true verification rate (TVR = 100-EER). The test results are further evaluated in groups by sample size, gender, age, HR. The optimal QRS pattern projection for single-lead ECG biometric modality is found in the frontal plane sector (60°-0°) with best (Test-AUC/TVR) for lead II (0.941/86.8%) and slight accuracy drop for -aVR (-0.017/-1.4%), I (-0.01/-1.5%). Chest ECG leads have degrading accuracy from V1 (0.885/80.6%) to V6 (0.799/71.8%). The multi-lead ECG improves verification: 6-chest (0.97/90.9%), 6-limb (0.986/94.3%), 12-leads (0.995/97.5%). The QRS pattern matching model shows stable performance for verification of 10 to 230 individuals; insignificant degradation of TVR in women by (1.2-3.6%), adults ≥70 years (3.7%), younger <40 years (1.9%), HR<60bpm (1.2%), HR>90bpm (3.9%), no degradation for HR change (0 to >20bpm).

Telescopic retainers: an old or new solution? A second chance to have normal dental function.

PubMed

Breitman, Joseph B; Nakamura, Scott; Freedman, Arnold L; Yalisove, Irving L

2012-01-01

This article is an overview of the biomechanics and advantages of telescopic retainers. Telescopic retainers offer more possibilities than any other treatment modality available in modern dentistry. Telescopic implant fixtures make the already versatile technique even more flexible. Telescopes should not be forgotten as a treatment modality, but should be embraced as a great option. © 2011 by the American College of Prosthodontists.

Review of current therapies for secondary hypertrophic pulmonary osteoarthropathy.

PubMed

Nguyen, Sheila; Hojjati, Mehrnaz

2011-01-01

Hypertrophic osteoarthropathy (HOA) is a disabling condition that may occur secondarily to primary lung cancer. It is characterized by digital clubbing, arthralgia/arthritis, and periostosis of the tubular bones. The pain associated with HOA can be disabling and often refractory to conventional analgesics. We performed a comprehensive review of the literature using the PubMed database on treatment modalities available for HOA. We found 52 relevant articles-40 case reports, six case series, two review papers, and four combined case series and review papers. There were no randomized controlled trials reported. We then classified treatments used for HOA into two categories: (1) treatment of primary cause (i.e., resection of tumor, chemotherapy, radiotherapy, treatment of infection, etc.) and (2) symptomatic treatments (i.e., bisphosphonates, octreotide, NSAIDs, vagotomy, etc.). Subsequently, we summarized the main findings for each treatment. Although the clinical diagnosis of HOA has existed for over 100 years, the pathogenesis mechanism has not yet been elucidated, and treatment options for this condition remain experimental. Primary treatment is the most widely reported modality to be efficacious. In cases which primary therapy is not possible, several symptomatic treatment modalities are suggested, with various degree of success. Further research is needed to clarify the pathophysiological mechanism of HOA as to appropriately direct therapy.

The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement

PubMed Central

French, Michael T.; Popovici, Ioana; Tapsell, Lauren

2008-01-01

Federal, State, and local government agencies require current and accurate cost information for publicly funded substance abuse treatment programs to guide program assessments and reimbursement decisions. The Center for Substance Abuse Treatment (CSAT) published a list of modality-specific cost bands for this purpose in 2002. However, the upper and lower values in these ranges are so wide that they offer little practical guidance for funding agencies. Thus, the dual purpose of this investigation was to assemble the most current and comprehensive set of economic cost estimates from the readily-available literature and then use these estimates to develop updated modality-specific cost bands for more reasonable reimbursement policies. Although cost estimates were scant for some modalities, the recommended cost bands are based on the best available economic research, and we believe these new ranges will be more useful and pertinent for all stakeholders of publicly-funded substance abuse treatment. PMID:18294803

Methyl-aminolevulinate photodynamic therapy for the treatment of actinic cheilitis: a retrospective evaluation of 29 patients.

PubMed

Fai, D; Romano, I; Cassano, N; Vena, G A

2012-02-01

Multiple treatment modalities have been proposed for actinic cheilitis (AC), and topical photodynamic therapy (PDT) has recently been included among these modalities. We report our experience with PDT using methyl-aminolevulinate (MAL) in AC. We performed a retrospective analysis of 29 patients who had undergone MAL-PDT for treatment of AC: 4 patients received one single session and 25 patients two consecutive weekly sessions. At 3 months, 21 patients (72%) obtained a complete clinical response, which was sustained over a follow-up period of 6-36 months (mean, 20 months) in 20 patients. Cosmetic outcome was generally rated as good or very good. Transient local adverse events related to the procedure were common and mild to moderate in the majority of cases. Our preliminary experience suggests that MAL-PDT may be considered a valid modality for the treatment of AC, although long-term follow-up studies in large patient series are required to obtain precise data about clinical and histological recurrences.

An overview of clinical and experimental treatment modalities for port wine stains.

PubMed

Chen, Jennifer K; Ghasri, Pedram; Aguilar, Guillermo; van Drooge, Anne Margreet; Wolkerstorfer, Albert; Kelly, Kristen M; Heger, Michal

2012-08-01

Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Dual-modality imaging with a ultrasound-gamma device for oncology

NASA Astrophysics Data System (ADS)

Polito, C.; Pellegrini, R.; Cinti, M. N.; De Vincentis, G.; Lo Meo, S.; Fabbri, A.; Bennati, P.; Cencelli, V. Orsolini; Pani, R.

2018-06-01

Recently, dual-modality systems have been developed, aimed to correlate anatomical and functional information, improving disease localization and helping oncological or surgical treatments. Moreover, due to the growing interest in handheld detectors for preclinical trials or small animal imaging, in this work a new dual modality integrated device, based on a Ultrasounds probe and a small Field of View Single Photon Emission gamma camera, is proposed.

The optimal hormonal replacement modality selection for multiple organ procurement from brain-dead organ donors

PubMed Central

Mi, Zhibao; Novitzky, Dimitri; Collins, Joseph F; Cooper, David KC

2015-01-01

The management of brain-dead organ donors is complex. The use of inotropic agents and replacement of depleted hormones (hormonal replacement therapy) is crucial for successful multiple organ procurement, yet the optimal hormonal replacement has not been identified, and the statistical adjustment to determine the best selection is not trivial. Traditional pair-wise comparisons between every pair of treatments, and multiple comparisons to all (MCA), are statistically conservative. Hsu’s multiple comparisons with the best (MCB) – adapted from the Dunnett’s multiple comparisons with control (MCC) – has been used for selecting the best treatment based on continuous variables. We selected the best hormonal replacement modality for successful multiple organ procurement using a two-step approach. First, we estimated the predicted margins by constructing generalized linear models (GLM) or generalized linear mixed models (GLMM), and then we applied the multiple comparison methods to identify the best hormonal replacement modality given that the testing of hormonal replacement modalities is independent. Based on 10-year data from the United Network for Organ Sharing (UNOS), among 16 hormonal replacement modalities, and using the 95% simultaneous confidence intervals, we found that the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the best modality for multiple organ procurement for transplantation. PMID:25565890

Treatment in Borderline Class III Malocclusion: Orthodontic Camouflage (Extraction) Versus Orthognathic Surgery.

PubMed

Rabie, A-Bakr M; Wong, Ricky W K; Min, G U

2008-01-01

To investigate the differences in morphological characteristics of borderline class III patients who had undergone camouflage orthodontic treatment or orthognathic surgery, and to compare the treatment effects between these two modalities. Cephalograms of 25 patients (13 orthodontic, 12 surgical) with class III malocclusion were analyzed. All had a pretreatment ANB angle greater than -5 masculine. Using discriminant analysis, only Holdaway angle was selected to differentiate patients in the pretreatment stage. Seventy-two per cent patients were correctly classified. In the orthodontic group, reverse overjet was corrected by retraction of the lower incisors and downward and backward rotation of the mandible. The surgical group was corrected by setback of the lower anterior dentoalveolus and uprighting of the lower incisors. No difference was found in posttreatment soft tissue measurements between the two groups. Twelve degree for the Holdaway angle can be a guideline in determining the treatment modalities for borderline class III patients, but the preferences of operators and patients are also important. (2) Both therapeutic options should highlight changes in the lower dentoalveolus and lower incisors. (3) Both treatment modalities can achieve satisfactory improvements to the people.

Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on (18)F-FDG PET-CT for radiotherapy treatment planning.

PubMed

Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

2012-01-01

Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process.

Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on 18F-FDG PET-CT for radiotherapy treatment planning

PubMed Central

Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

2012-01-01

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process. PMID:24377032

Pathogenesis and treatment modalities of localized scleroderma.

PubMed

Valančienė, Greta; Jasaitienė, Daiva; Valiukevičienė, Skaidra

2010-01-01

Localized scleroderma is a chronic inflammatory disease primarily of the dermis and subcutaneous fat that ultimately leads to a scar-like sclerosis of connective tissue. The disorder manifests as various plaques of different shape and size with signs of skin inflammation, sclerosis, and atrophy. This is a relatively rare inflammatory disease characterized by a chronic course, unknown etiology, and insufficiently clear pathogenesis. Many factors may influence its appearance: trauma, genetic factors, disorders of the immune system or hormone metabolism, viral infections, toxic substances or pharmaceutical agents, neurogenic factors, and Borrelia burgdorferi infection. Various therapeutic modalities are being used for the treatment of localized scleroderma. There is no precise treatment scheme for this disease. A majority of patients can be successfully treated with topical pharmaceutical agents and phototherapy, but some of them with progressive, disseminated, and causing disability localized scleroderma are in need of systemic treatment. The aim of this article is not only to dispute about the clinical and morphological characteristics of localized scleroderma, but also to present the newest generalized data about the possible origin, pathogenesis, and treatment modalities of this disease.

Practical performance and its efficiency of arsenic removal from groundwater using Fe-Mn binary oxide.

PubMed

Chang, Fangfang; Qu, Jiuhui; Liu, Ruiping; Zhao, Xu; Lei, Pengju

2010-01-01

A treatment unit packed by granular adsorbent of Fe-Mn binary oxide incorporated into diatomite (FMBO(1:1)-diatomite) was studied to remove arsenic from anaerobic groundwater without any pre-treatment or post-treatment. The raw anaerobic groundwater containing 35-45 microg/L of arsenic was collected from suburb of Beijing. Arsenic (III) constituted roughly 60%-80% of the total arsenic content. Approximately 7,000 bed volumes (ratio of effluent volume to adsorbent volume) treated water with arsenic concentration below 10 microg/L were produced in the operation period of four months. The regeneration of FMBO (1:1)-diatomite had been operated for 15 times. In the first stage, the regeneration process significantly improved the adsorption capacity of FMBO (1:1)-diatomite. With increased loading amount of Fe-Mn binary oxide, the adsorption capacity for arsenic decreased 20%-40%. Iron and manganese in anaerobic groundwater were oxidized and adsorptive filtrated by FMBO (1:1)-diatomite efficiently. The final concentrations of iron and manganese in effluents were nearly zero. The continued safe performance of the treatment units proved that adsorbent FMBO (1:1)-diatomite had high oxidation ability and exhibited strong adsorptive filtration.

Alcohol treatment and cognitive-behavioral therapy: enhancing effectiveness by incorporating spirituality and religion.

PubMed

Hodge, David R

2011-01-01

Cognitive-behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients. More specifically, by integrating clients' spiritual beliefs and practices into treatment, this modality may speed recovery, enhance treatment compliance, prevent relapse, and reduce treatment disparities by providing more culturally congruent services. The process of constructing spiritually modified CBT self-statements is described and illustrated, and suggestions are provided for working with client spirituality in an ethical manner. The article concludes by emphasizing the importance of this approach in light of the growing spiritual diversity that characterizes contemporary society.

Complications Following Radiofrequency Ablation of Benign Thyroid Nodules: A Systematic Review

PubMed Central

Wang, Jin-Fen; Wu, Tao; Hu, Kun-Peng; Xu, Wen; Zheng, Bo-Wen; Tong, Ge; Yao, Zhi-Cheng; Liu, Bo; Ren, Jie

2017-01-01

Objective: This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs). Data Sources: PubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy. Study Selection: Thirty-two studies relating to 3409 patients were included in this systematic review. Results: Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome. Conclusions: RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules. PMID:28524837

A Statistical Model for Misreported Binary Outcomes in Clustered RCTs of Education Interventions

ERIC Educational Resources Information Center

Schochet, Peter Z.

2013-01-01

In education randomized control trials (RCTs), the misreporting of student outcome data could lead to biased estimates of average treatment effects (ATEs) and their standard errors. This article discusses a statistical model that adjusts for misreported binary outcomes for two-level, school-based RCTs, where it is assumed that misreporting could…

Motivation and Readiness for Drug Treatment: Differences by Modality and Special Populations

PubMed Central

Melnick, Gerald; Hawke, Josephine; De Leon, George

2014-01-01

The purpose of this research is to expand our knowledge of motivational factors among admissions to various substance abuse treatment modalities and among those entering special programs. Differences in motivation are reported in a convenience sample of over 6000 admissions to 38 programs. Results from multilevel analyses show (1) an ordered increase in motivation by settings from referral to out patient, to methadone maintenance, to highest levels in residential programs; (2) significantly lower motivation among admissions to programs for special populations. Results are discussed in relation to the demand characteristics of treatment and non-recovery reasons for entering treatment. PMID:24735224

Motivation and readiness for drug treatment: differences by modality and special populations.

PubMed

Melnick, Gerald; Hawke, Josephine; De Leon, George

2014-01-01

The purpose of this research is to expand our knowledge of motivational factors among admissions to various substance abuse treatment modalities and among those entering special programs. Differences in motivation are reported in a convenience sample of more than 6,000 admissions to 38 programs. Results from multilevel analyses show (a) an ordered increase in motivation by settings from referral to outpatient, to methadone maintenance, and to the highest levels in residential programs and (b) significantly lower motivation among admissions to programs for special populations. Results are discussed in relation to the demand characteristics of treatment and non-recovery reasons for entering treatment.

Treatments of traumatic neuropathic pain: a systematic review

PubMed Central

Yao, Chenglun; Zhou, Xijie; Zhao, Bin; Sun, Chao; Poonit, Keshav; Yan, Hede

2017-01-01

Traumatic neuropathic pain caused by traumatic neuroma has long been bothering both doctors and patients, the mechanisms of traumatic neuropathic pain are widely discussed by researchers and the treatment is challenging. Clinical treatment of painful neuroma is unclear. Numerous treatment modalities have been introduced by experts in this field. However, there is still no single standard recognized treatment. Different forms of treatments have been tested in animals and humans, but pharmacotherapies (antidepressants, antiepileptics) remain the basis of traumatic neuropathic pain management. For intractable cases, nerve stump transpositions into a muscle, vein or bone are seen as traditional surgical procedures which provide a certain degree of efficacy. Novel surgical techniques have emerged in recent years, such as tube guided nerve capping, electrical stimulation and adipose autograft have substantially enriched the abundance of the treatment for traumatic neuropathic pain. Several treatments show advantages over the others in terms of pain relief and prevention of neuroma formation, making it difficult to pick out a single modality as the reference. An effective and standardized treatment for traumatic neuropathic pain would provide better choice for researchers and clinical workers. In this review, we summarized current knowledge on the treatment of traumatic neuropathic pain, and found a therapeutic strategy for this intractable pain. We tried to provide a useful guideline for choosing the right modality in management of traumatic neuropathic pain. PMID:28915703

Treatment modalities and medication recommended by health care professionals for treating recurrent herpes labialis.

PubMed

Raborn, G Wayne; Chan, Karen S; Grace, Michael

2004-01-01

The authors conducted a survey to determine how health care professionals respond to patients' inquiries about cold sores, also known as recurrent herpes labialis, and their choices of treatment modalities and medications. The authors mailed a one-page, pretested survey to a random sample of dentists, pharmacists and family physicians in Alberta, Canada. After receiving ethics approval from the University of Alberta, Edmonton, the authors mailed 998 surveys. The response rate was 51 percent. Topical antiviral medication was the most common treatment recommended (63 percent). Over-the-counter medication was the first choice for pharmacists (83 percent) as compared with dentists (15 percent) and physicians (16 percent). Emotional stress (60 percent) was reported by patients to be the most common trigger, and pain or discomfort (81 percent) was their primary concern. Acyclovir ointment was the most common antiviral drug recommended or prescribed by health care professionals (60 percent), and cost was the major reason they gave for not recommending or prescribing antiviral drugs (73 percent). The authors found variation in treatment modalities and recommendations by each health profession, despite the fact that patients reported similar triggers and concerns. This may be due to individual patient need and the health care professional's lack of knowledge. Survey results may serve as a reference for health care professionals to use to determine how their choices of medications and treatment modalities compare with those of other practitioners. Professionals should know the benefits and limitations of all therapies, discuss them with the patients and select a treatment.

PHYSICS OF ECLIPSING BINARIES. II. TOWARD THE INCREASED MODEL FIDELITY

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

Prša, A.; Conroy, K. E.; Horvat, M.

The precision of photometric and spectroscopic observations has been systematically improved in the last decade, mostly thanks to space-borne photometric missions and ground-based spectrographs dedicated to finding exoplanets. The field of eclipsing binary stars strongly benefited from this development. Eclipsing binaries serve as critical tools for determining fundamental stellar properties (masses, radii, temperatures, and luminosities), yet the models are not capable of reproducing observed data well, either because of the missing physics or because of insufficient precision. This led to a predicament where radiative and dynamical effects, insofar buried in noise, started showing up routinely in the data, but weremore » not accounted for in the models. PHOEBE (PHysics Of Eclipsing BinariEs; http://phoebe-project.org) is an open source modeling code for computing theoretical light and radial velocity curves that addresses both problems by incorporating missing physics and by increasing the computational fidelity. In particular, we discuss triangulation as a superior surface discretization algorithm, meshing of rotating single stars, light travel time effects, advanced phase computation, volume conservation in eccentric orbits, and improved computation of local intensity across the stellar surfaces that includes the photon-weighted mode, the enhanced limb darkening treatment, the better reflection treatment, and Doppler boosting. Here we present the concepts on which PHOEBE is built and proofs of concept that demonstrate the increased model fidelity.« less

Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA.

PubMed

Han, Eun Young; Paudel, Nava; Sung, Jiwon; Yoon, Myonggeun; Chung, Weon Kuu; Kim, Dong Wook

2016-04-19

The risk of secondary cancer from radiation treatment remains a concern for long-term breast cancer survivors, especially those treated with radiation at the age younger than 45 years. Treatment modalities optimally maximize the dose delivery to the tumor while minimizing radiation doses to neighboring organs, which can lead to secondary cancers. A new TomoTherapy treatment machine, TomoHDATM, can treat an entire breast with two static but intensity-modulated beams in a slice-by-slice fashion. This feature could reduce scattered and leakage radiation doses. We compared the plan quality and lifetime attributable risk (LAR) of a second malignancy among five treatment modalities: three-dimensional conformal radiation therapy, field-in-field forward-planned intensity-modulated radiation therapy, inverse-planned intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy, and TomoDirect mode on the TomoHDA system. Ten breast cancer patients were selected for retrospective analysis. Organ equivalent doses, plan characteristics, and LARs were compared. Out-of-field organ doses were measured with radio-photoluminescence glass dosimeters. Although the IMRT plan provided overall better plan quality, including the lowest probability of pneumonitis, it caused the second highest LAR. The TomoTherapy plan provided plan quality comparable to the IMRT plan and posed the lowest total LAR to neighboring organs. Therefore, it can be a better treatment modality for younger patients who have a longer life expectancy.

Persistent Flagellate Hyperpigmentation

DTIC Science & Technology

2017-04-28

hydroquinone), laser modalities such as Q-switched 755/1064 nm lasers , and ablative C02 resurfacing lasers . In addition, patients should be counseled on...the importance of UV protection. The patient was treated with each of these treatment modal ities with minimal improvement. Resources: 1. Lee HY

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

Margalit, Danielle N.; Mamon, Harvey J.; Ancukiewicz, Marek

Purpose: To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Methods and Materials: We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham and Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbiditymore » index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability. Results: Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed {>=}4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p = 0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p = 1.0). Conclusions: The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of combined modality therapy for rectal cancer should be performed with caution in elderly patients, who require aggressive supportive care to complete treatment.« less

Physiotherapy and cardiac rhythm devices: a review of the current scope of practice.

PubMed

Digby, Geneviève C; Daubney, Marguerite E; Baggs, Jim; Campbell, Debra; Simpson, Christopher S; Redfearn, Damian P; Brennan, F James; Abdollah, Hoshiar; Baranchuk, Adrian

2009-07-01

Several case reports have demonstrated negative interactions between various physiotherapy modalities and cardiac rhythm devices (CRD). Fear of these potential interactions may lead to suboptimal utilization of physiotherapy treatments in CRD patients. No prior review of available guidelines, or management strategies, on the interaction between physiotherapy modalities and CRD patients has been reported. To review existing guidelines regarding the use of physiotherapy modalities in patients with pacemakers and/or implantable cardioverter-defibrillators (ICDs). To retrospectively analyse CRD patient encounters at a local physiotherapy facility during a period of 2 years. A review of the literature regarding the potential interactions between physiotherapy modalities and CRDs was performed. Next, a 2 year retrospective analysis of patient encounters at a physiotherapy facility was conducted. In addition, seven international physiotherapy societies and four CRD manufacturers were surveyed with respect to recommendations regarding physiotherapy treatments in device patients. The local physiotherapy facility treated 25 patients with CRD (22 pacemaker and 3 ICD patients) for a total of 230 visits (9.2 visits/patient). Five patients received transcutaneous electrical nerve stimulation (TENS) and all 25 were administered additional treatment in the form of ultrasound (15), acupuncture (19), Laser (7), traction/manual therapy (12), exercise (8), education (18), taping (5), and/or moist heat (5). No complications occurred. Meanwhile, international societies and device manufacturers offered few specific or consistent recommendations. There are no specific international policies regarding the administration of physiotherapy modalities in CRD patients and, thus, there are no specific guidelines to be implemented at the local level. Review of the literature and of recommendations from CRD manufacturers suggests that TENS, Diathermy, and Interferential Electrical Current Therapy are best avoided in patients with CRDs. However, there is no consensus and it may be possible to safely deliver these modalities in a proper setting with device and patient monitoring. Although further research is required in this regard, active collaboration between physiotherapists and CRD clinic physicians should allow for the safe application of most physiotherapy modalities.

A Novel Therapeutic Modality for Advanced Stage Prostate Cancer Treatment

DTIC Science & Technology

2017-10-01

Unlimited The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of...PrCa are non-selective and provide only limited response rate Thus, novel treatment modalities are needed to treat advanced stage PrCa. In this...of ORM on MTA1 protein. Considering effective therapeutic index of ORM, we are also making more potent analogues of ORM. These findings suggest that

Postinflammatory hyperpigmentation in patients with skin of color.

PubMed

Shokeen, Divya

2016-01-01

Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.

Human papillomavirus reduces the prognostic value of nodal involvement in tonsillar squamous cell carcinomas.

PubMed

Straetmans, Jos M J A A; Olthof, Nadine; Mooren, Jeroen J; de Jong, Jos; Speel, Ernst-Jan M; Kremer, Bernd

2009-10-01

Assessment of the prognostic value of nodal status in relation to human papillomavirus (HPV) status and the various treatment modalities in tonsillar squamous cell carcinomas (TSCC). Retrospective 5-year survival analysis. A 5-year follow-up of disease-free, disease-specific, and overall survival in a group of 81 patients with TSCC was conducted. The nodal status and integration of HPV-DNA in the genome (detected with fluorescence in situ hybridization) as prognostic indicators were examined while correcting for other clinical parameters (smoking habits, alcohol consumption, treatment modality, differentiation, TNM classification). Of TSCCs, 41% were positive for HPV type 16. In these TSCCs, the primary tumor was significantly smaller when compared to HVP-negative TSCCs (P = .04), whereas the percentage of cases with cervical metastases was identical. In the total population, it was not nodal involvement, but rather HPV manifestation, which was related to patient prognosis. Within the treatment modalities (surgery combined with radiotherapy and radiotherapy alone), neither nodal status nor HPV were prognostic indicators. Since a substantial percentage of TSCCs are HPV-positive and metastasizes to cervical lymph nodes in less advanced primary tumors, the N status is an unreliable prognostic indicator in TSCCs. HPV is only prognostically relevant in the total tumor population, but loses its value within patient groups receiving a single treatment modality. The value of HPV for prognosis of patients with TSCC requires further study.

Decision making around dialysis options.

PubMed

Mooney, Andrew

2009-01-01

We have previously shown that information given to patients approaching end stage renal failure to make an informed decision about dialysis modality is frequently incomplete and difficult to comprehend [1]. We have now studied whether there are differences in decisions made about dialysis modality according to the method employed to deliver this information. In an online study, 784 participants viewed treatment information about hemodialysis (HD) and continuous cycling peritoneal dialysis (CCPD) and completed a questionnaire. A control group saw only basic information, but otherwise treatment information was varied by format (written or videotaped) and who presented the information (male or female; 'patient' or 'doctor'). The information was carefully controlled to ensure comparable content and comprehensibility. In addition to collection of demographic data, measures included: treatment choice, reasons for treatment choice, decisional conflict, need for affect, need for cognition, decision regret, quality of information, previous knowledge of end-stage renal failure and social comparison. There were a number of differences in choices made among subjects who viewed written or video information presented as if by doctors or patients. There was a statistically significant effect that subjects chose the dialysis modality recommended by the patient (whether CCPD or HD). There was no significant effect of the gender of the person presenting information on the modality chosen. However, among participants, females were more satisfied with the information presented, and more likely to choose CCPD (compared to male participants). Subjects' style of information processing (need for cognition/need for affect) had no significant effect on choice of dialysis modality. There was a higher drop-out rate among subjects viewing videotaped information. The use of testimonials might bias patients decision making regarding dialysis options and until these effects are understood, they should be used with caution.

Perceptions of hypertension treatment among patients with and without diabetes.

PubMed

Anthony, Heymann; Valinsky, Liora; Inbar, Zucker; Gabriel, Chodick; Varda, Shalev

2012-03-26

Despite the availability of a wide selection of effective antihypertensive treatments and the existence of clear treatment guidelines, many patients with hypertension do not have controlled blood pressure. We conducted a qualitative study to explore beliefs and perceptions regarding hypertension and gain an understanding of barriers to treatment among patients with and without diabetes. Ten focus groups were held for patients with hypertension in three age ranges, with and without diabetes. The topic guides for the groups were: What will determine your future health status? What do you understand by "raised blood pressure"? How should one go about treating raised blood pressure? People with hypertension tend to see hypertension not as a disease but as a risk factor for myocardial infarction or stroke. They do not view it as a continuous, degenerative process of damage to the vascular system, but rather as a binary risk process, within which you can either be a winner (not become ill) or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome. Patients with diabetes are more likely to accept hypertension as a chronic illness with minor impact on their routine, and less important than their diabetes. Most participants overestimated the effect of stress as a causative factor believing that a reduction in levels of stress is the most important treatment modality. Many believe they "know their bodies" and are able to control their blood pressure. Patients without diabetes were most likely to adopt a treatment which is a compromise between their physician's suggestions and their own understanding of hypertension. Patient denial and non-adherence to hypertension treatment is a prevalent phenomenon reflecting a conscious choice made by the patient, based on his knowledge and perceptions regarding the medical condition and its treatment. There is a need to change perception of hypertension from a gamble to a disease process. Changing the message from the existing one of "silent killer" to one that depicts hypertension as a manageable disease process may have the potential to significantly increase adherence rates.

Respiratory medicine of reptiles.

PubMed

Schumacher, Juergen

2011-05-01

Noninfectious and infectious causes have been implicated in the development of respiratory tract disease in reptiles. Treatment modalities in reptiles have to account for species differences in response to therapeutic agents as well as interpretation of diagnostic findings. Data on effective drugs and dosages for the treatment of respiratory diseases are often lacking in reptiles. Recently, advances have been made on the application of advanced imaging modalities, especially computed tomography for the diagnosis and treatment monitoring of reptiles. This article describes common infectious and noninfectious causes of respiratory disease in reptiles, including diagnostic and therapeutic regimen. Copyright © 2011 Elsevier Inc. All rights reserved.

Novel minimally invasive multi-modality monitoring modalities in neurocritical care.

PubMed

Al-Mufti, Fawaz; Smith, Brendan; Lander, Megan; Damodara, Nitesh; Nuoman, Rolla; El-Ghanem, Mohammad; Kamal, Naveed; Al-Marsoummi, Sarmad; Alzubaidi, Basim; Nuoaman, Halla; Foreman, Brandon; Amuluru, Krishna; Gandhi, Chirag D

2018-07-15

Elevated intracranial pressure (ICP) following brain injury contributes to poor outcomes for patients, primarily by reducing the caliber of cerebral vasculature, and thereby reducing cerebral blood flow. Careful monitoring of ICP is critical in these patients in order to determine prognosis, implement treatment when ICP becomes elevated, and to judge responsiveness to treatment. Currently, the gold standard for monitoring is invasive pressure transducers, usually an intraventricular monitor, which presents significant risk of infection and hemorrhage. These risks made discovering non-invasive methods for monitoring ICP and cerebral perfusion a priority for researchers. Herein we sought to review recent publications on novel minimally invasive multi-modality monitoring techniques that provide surrogate data on ICP, cerebral oxygenation, metabolism and blood flow. While limitations in various forms preclude them from supplanting the use of invasive monitors, these modalities represent useful screening tools within our armamentarium that may be invaluable when the risks of invasive monitoring outweigh the associated benefits. Copyright © 2018 Elsevier B.V. All rights reserved.

Stellar and Binary Evolution in Star Clusters

NASA Technical Reports Server (NTRS)

McMillan, Stephen L. W.

2001-01-01

This paper presents a final report on research activities covered on Stellar and Binary Evolution in Star Clusters. Substantial progress was made in the development and dissemination of the "Starlab" software environment. Significant improvements were made to "kira," an N-body simulation program tailored to the study of dense stellar systems such as star clusters and galactic nuclei. Key advances include (1) the inclusion of stellar and binary evolution in a self-consistent manner, (2) proper treatment of the anisotropic Galactic tidal field, (3) numerous technical enhancements in the treatment of binary dynamics and interactions, and (4) full support for the special-purpose GRAPE-4 hardware, boosting the program's performance by a factor of 10-100 over the accelerated version. The data-reduction and analysis tools in Starlab were also substantially expanded. A Starlab Web site (http://www.sns.ias.edu/-starlab) was created and developed. The site contains detailed information on the structure and function of the various tools that comprise the package, as well as download information, "how to" tips and examples of common operations, demonstration programs, animations, etc. All versions of the software are freely distributed to all interested users, along with detailed installation instructions.

MO-B-BRC-00: Prostate HDR Treatment Planning - Considering Different Imaging Modalities

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

NONE

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.

PubMed

Schneider, Harry P; Baca, John M; Carpenter, Brian B; Dayton, Paul D; Fleischer, Adam E; Sachs, Brett D

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Neutron therapy of resistant thyroid gland cancer

NASA Astrophysics Data System (ADS)

Choynzonov, E. L.; Gribova, O. V.; Startseva, Zh. A.; Lisin, V. A.; Novikov, V. A.; Musabaeva, L. I.

2017-09-01

The purpose of this study was to analyze the results of the combined modality treatment and radiation therapy using 6.3 MeV fast neutrons c. The study included 45 patients with thyroid gland cancers who received the combined modality treatment and radiation therapy alone with the use of 6.3 MeV fast neutrons generated within U-120 cyclotron. The clinical trial of neutron-photon therapy used alone and in combination with the surgery for the patients with aggressive forms of thyroid cancer showed feasibility of increasing the effectiveness of treatment due to the reduction in the incidence of local recurrences. In addition, satisfactory treatment tolerance and absence of severe specific complications dictate the necessity of prospective studies to improve treatment outcomes.

Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial

PubMed Central

Balcı, Nilay Comuk; Yuruk, Zeliha Ozlem; Zeybek, Aslican; Gulsen, Mustafa; Tekindal, Mustafa Agah

2016-01-01

[Purpose] The aim of our study was to compare the initial effects of scapular proprioceptive neuromuscular facilitation techniques and classic exercise interventions with physiotherapy modalities on pain, scapular dyskinesis, range of motion, and function in adhesive capsulitis. [Subjects and Methods] Fifty-three subjects were allocated to 3 groups: scapular proprioceptive neuromuscular facilitation exercies and physiotherapy modalities, classic exercise and physiotherapy modalities, and only physiotherapy modalities. The intervention was applied in a single session. The Visual Analog Scale, Lateral Scapular Slide Test, range of motion and Simple Shoulder Test were evaluated before and just after the one-hour intervention in the same session (all in one session). [Results] All of the groups showed significant differences in shoulder flexion and abduction range of motion and Simple Shoulder Test scores. There were statistically significant differences in Visual Analog Scale scores in the proprioceptive neuromuscular facilitation and control groups, and no treatment method had significant effect on the Lateral Scapular Slide Test results. There were no statistically significant differences between the groups before and after the intervention. [Conclusion] Proprioceptive neuromuscular facilitation, classic exercise, and physiotherapy modalities had immediate effects on adhesive capsulitis in our study. However, there was no additional benefit of exercises in one session over physiotherapy modalities. Also, an effective treatment regimen for shoulder rehabilitation of adhesive capsulitis patients should include scapular exercises. PMID:27190456

Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

PubMed

McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

2016-04-01

The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

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

PubMed Central

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

2013-01-01

The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) vs. non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics. PMID:23988192

SU-E-T-308: Dosimetric Comparison of SBRT VMAT Treatment Plans Generated for 6 MV, 6 MV FFF, and 10 MV FFF Photon Beams

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

Wilson, D; Wang, B; Dunlap, N

2015-06-15

Purpose: To assess differences in treatment plan quality between VMAT stereotactic body plans generated using the 6 MV, 6 MV FFF, and 10 MV FFF modalities available in our clinic. Plans for lung, spine, and other sites were compared to see if there is any advantage of one modality over the other. Methods: Treatment plans done for actual SBRT patients were selected. Groups of ten lung plans, five spine plans, and five plans from other sites were selected. New treatment plans were generated for each plan using the Varian Eclipse AAA algorithm. The constraints were kept the same as usedmore » in the actual plans, but the same version of software was used to generate plans for the three modalities. In addition, because there are natural variations in plans re-done with the same dose constraints, one of the lung plans was repeated ten times to assess those differences. Volumes of the 100%, 90%, 50%, 20% and 10% isodose surfaces were compared. Maximum dose two centimeters from the PTV were compared, as well as the volume of the 105% isodose surface outside of the PTV. In addition, the 20 Gray lung volume was compared for the lung plans. The values of these parameters were divided by the values for the 6 MV plans for comparison. Average and standard deviations were obtained for quantities in each group. The Student t test was done to determine if differences were seen at the 95% confidence level. Results: Comparison of the treatment plans showed no significant differences when assessing these volumes and doses. There were not any trends seen when comparing modalities as a function of PTV volume either. Conclusion: There is no obvious dosimetric advantage in selection of one modality over another for these types of SBRT plans.« less

[Treatment of chronic shoulder tendinitis].

PubMed

Brox, J I; Bøhmer, A S; Ljunggren, A E; Staff, P H

1994-02-20

The authors review current treatment modalities and present a study comparing supervised exercises and arthroscopic surgery in patients with rotator cuff disease. Exercises supervised by a physiotherapist emphasize relearning of normal patterns of movement and local endurance training to improve tendon and muscle tissue, and are supplemented by ergonomic advice. The clinician should try to elucidate whether the patient is supposed to benefit solely from information and self-treatment. For several of the currently used treatment modalities, such as ultrasound, soft laser, heat and massage, no effect has been documented. Surgery should be reserved for persons who do not benefit from supervised exercises. Careful rehabilitation is necessary for patients who report having a physically demanding job.

[Physical treatment modalities for chronic leg ulcers].

PubMed

Dissemond, J

2010-05-01

An increasing numbers of physical treatment options are available for chronic leg ulcer. In this review article, compression therapy, therapeutic ultrasound, negative pressure therapy, extracorporeal shock wave therapy, electrostimulation therapy, electromagnetic therapy, photodynamic therapy, water-filtered infrared-A-radiation and hydrotherapy are discussed in terms of their practical applications and the underlying evidence. With the exception of compression therapy for most of these treatments, good scientific data are not available. However this is a widespread problem in the treatment of chronic wounds. Nevertheless, several of the described methods such as negative pressure therapy represent one of the gold standards in practical treatment of patients with chronic leg ulcers. Although the use of physical treatment modalities may improve healing in patients with chronic leg ulcers, the diagnosis and treatment of the underlying causes are essential for long-lasting success.

Treatment of Intra-abdominal Abscesses in Crohn’s Disease – A Nationwide Analysis of Patterns and Outcomes of Care

PubMed Central

Ananthakrishnan, Ashwin N; McGinley, Emily L

2013-01-01

Background Abdominal abscesses are a common complication in Crohn’s disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses. Methods We identified all adult CD-related non-elective hospitalizations from the Nationwide Inpatient Sample 2007 that were complicated by an intra-abdominal abscess. Treatment modality was categorized into 3 strata – medical treatment alone, percutaneous drainage, and surgery. We analyzed the nationwide patterns in the treatment and outcomes of each treatment modality and examined for patient demographic, disease, or hospital-related disparities in treatment and outcome. Results There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD. Approximately 39% were treated by medical treatment alone, 29% with percutaneous drainage, and 32% with surgery with a significant increase in the use of percutaneous drainage since 1998 (7%). Co-morbidity burden, admission to a teaching hospital, and complicated Crohn’s disease (fistulae, stricture) were associated with non-medical treatment. Use of percutaneous drainage was more common in teaching hospitals. Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days respectively and early intervention was associated with significantly shorter hospitalization. Conclusions We describe the nationwide pattern in the treatment of abdominal abscesses and demonstrate an increase in the use of percutaneous drainage for the treatment of this subgroup. Early treatment intervention was predictive of shorter hospitalization. PMID:23392744

Treatment in Borderline Class III Malocclusion: Orthodontic Camouflage (Extraction) Versus Orthognathic Surgery

PubMed Central

Rabie, A-Bakr M.; Wong, Ricky W.K.; Min, G.U.

2008-01-01

Aims: To investigate the differences in morphological characteristics of borderline class III patients who had undergone camouflage orthodontic treatment or orthognathic surgery, and to compare the treatment effects between these two modalities. Materials and Methods: Cephalograms of 25 patients (13 orthodontic, 12 surgical) with class III malocclusion were analyzed. All had a pretreatment ANB angle greater than -5º. Results: Using discriminant analysis, only Holdaway angle was selected to differentiate patients in the pretreatment stage. Seventy-two per cent patients were correctly classified. In the orthodontic group, reverse overjet was corrected by retraction of the lower incisors and downward and backward rotation of the mandible. The surgical group was corrected by setback of the lower anterior dentoalveolus and uprighting of the lower incisors. No difference was found in posttreatment soft tissue measurements between the two groups. Conclusions: Twelve degree for the Holdaway angle can be a guideline in determining the treatment modalities for borderline class III patients, but the preferences of operators and patients are also important. (2) Both therapeutic options should highlight changes in the lower dentoalveolus and lower incisors. (3) Both treatment modalities can achieve satisfactory improvements to the people. PMID:19088881

Non-surgical treatment for eyelid retraction in thyroid eye disease (TED).

PubMed

Grisolia, Ana Beatriz Diniz; Couso, Ricardo Christopher; Matayoshi, Suzana; Douglas, Raymond S; Briceño, César Augusto

2017-08-09

Thyroid eye disease (TED) is an autoimmune condition with an unpredictable course that may lead to permanent facial disfigurement. Eyelid retraction is one of the most common findings, and frequently demands attention due to ocular exposure and impaired cosmesis. Surgical treatment remains the most effective option, but there is a role for temporary corrections during the active phase of the disease, as well as in patients who are poor surgical candidates. The aim of this review is to describe the non-surgical modalities currently available for treatment of eyelid malposition in TED. The authors have focused on the use of hyaluronic acid, triamcinolone injections and botulinum toxin type A as non-surgical treatment alternatives, paying special attention to dosing, technique, efficacy and duration of effect. Non-surgical treatment modalities may represent viable in cases where surgical correction is not an option. Although temporary, these modalities appear to be beneficial for ocular exposure remediation, improving quality of life and broadening our therapeutic arsenal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A single institution experience of combined modality management of extra skeletal Ewings sarcoma.

PubMed

Venkitaraman, Ramachandran; George, Mathew K; Ramanan, S Ganapathy; Sagar, T G

2007-01-11

Extraskeletal Ewings sarcoma are rare tumors for which there is no consensus on optimal management. A retrospective review of the clinical features, treatment and outcome of patients with extraskeletal Ewings sarcoma who reported to a single institution between January 1992-December 2003 is reported. A total of 19 patients with extraskeletal Ewings sarcoma were identified. Of these, 4 patients had metastatic disease at presentation and 15 patients with non-metastatic disease received combined modality treatment with primary combination chemotherapy followed by local treatment with radiotherapy or surgery. Disease free survival and overall survival for patients with non metastatic disease after combined modality treatment were 60% and 30% respectively. The significant predictors for prolonged disease free survival and overall survival were high haemoglobin (p = 0.002), low lactate dehydrogenase (p = 0.028), chemotherapy with Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide and Etoposide regime (p = 0.008) and complete response to chemotherapy (p = 0.001). Aggressive combination chemotherapy followed by complete surgery or radiotherapy to a dose of more than 50 Gy is essential to confer optimal outcome for patients with extraskeletal Ewings sarcoma.

Retrospective study of the physical therapy modalities applied in head and neck l ymphedema treatment.

PubMed

Tacani, Pascale Mutti; Franceschini, Juliana Pereira; Tacani, Rogério Eduardo; Machado, Aline Fernanda Perez; Montezello, Débora; Góes, João Carlos Guedes Sampaio; Marx, Angela

2016-02-01

Secondary lymphedema after head and neck cancer treatment is a serious complication and its management can be a challenge. The purpose of this study was to verify which physical therapy modalities were applied in the treatment of head and neck lymphedema through a retrospective analysis. A retrospective study was developed, based on the analysis of medical records of 32 patients treated in the physiotherapy outpatient department of the Brazilian Institute of Cancer Control (IBCC). The physiotherapy included manual lymphatic drainage, massage, exercises, patient education, and compression therapy with an average of 23.9 ± 14.8 sessions. Measurement results showed a significant reduction of face and neck lymphedema (p < .05) and pain (from 7.8 ± 2.2 to 3.6 ± 1.6; p < .001). The physical therapy modalities based on strategic manual lymphatic drainage, shoulder girdle massage, facial, tongue and neck exercises, compressive therapy at home, and patient education showed reduction of the lymphedema and pain, both of them secondary to head and neck cancer treatment. © 2014 Wiley Periodicals, Inc.

A Review and Update of Treatment Options and Controversies in the Management of Hepatocellular Carcinoma.

PubMed

Dhir, Mashaal; Melin, Alyson A; Douaiher, Jeffrey; Lin, Chi; Zhen, Weining Ken; Hussain, Shahid M; Geschwind, Jean-Francois H; Doyle, Maria B Majella; Abou-Alfa, Ghassan K; Are, Chandrakanth

2016-06-01

To review the current management, outline recent advances and address controversies in the management of hepatocellular carcinoma (HCC). The treatment of HCC is multidisciplinary involving hepatologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, and other disciplines. Each of these disciplines brings its unique perspective and differing opinions that add to controversies in the management of HCC. A focused literature review was performed to identify recent studies on the management of HCC and thereby summarize relevant information on the various therapeutic modalities and controversies involved in the treatment of HCC. The main treatment algorithms continue to rely on hepatic resection or transplantation with controversies involving patients harboring early stage disease and borderline hepatic function. The other treatment strategies include locoregional therapies, radiation, and systemic therapy used alone or in combination with other treatment modalities. Recent advances in locoregional therapies, radiation, and systemic therapies have provided better therapeutic options with curative intent potential for some locoregional therapies. Further refinements in combination therapies such as algorithms consisting of locoregional therapies and systemic or radiation therapies are likely to add additional options and improve survival. The management of HCC has witnessed significant strides with advances in existing options and introduction of several new treatment modalities of various combinations. Further refinements in these treatment options combined with enrollment in clinical trials are essential to improve the management and outcomes of patients with HCC.

THE EFFECTIVENESS OF COMPULSORY DRUG TREATMENT: A SYSTEMATIC REVIEW

PubMed Central

Werb, D; Kamarulzaman, A; Meacham, MC; Rafful, C; Fisher, B; Strathdee, SA; Wood, E

2016-01-01

Background Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. Methods We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. Results Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e. 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. Conclusion There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms. PMID:26790691

Advances in diagnostic and treatment modalities for intracranial tumors.

PubMed

Dickinson, P J

2014-01-01

Intracranial neoplasia is a common clinical condition in domestic companion animals, particularly in dogs. Application of advances in standard diagnostic and therapeutic modalities together with a broad interest in the development of novel translational therapeutic strategies in dogs has resulted in clinically relevant improvements in outcome for many canine patients. This review highlights the status of current diagnostic and therapeutic approaches to intracranial neoplasia and areas of novel treatment currently in development. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Machine learning approaches for integrating clinical and imaging features in late-life depression classification and response prediction.

PubMed

Patel, Meenal J; Andreescu, Carmen; Price, Julie C; Edelman, Kathryn L; Reynolds, Charles F; Aizenstein, Howard J

2015-10-01

Currently, depression diagnosis relies primarily on behavioral symptoms and signs, and treatment is guided by trial and error instead of evaluating associated underlying brain characteristics. Unlike past studies, we attempted to estimate accurate prediction models for late-life depression diagnosis and treatment response using multiple machine learning methods with inputs of multi-modal imaging and non-imaging whole brain and network-based features. Late-life depression patients (medicated post-recruitment) (n = 33) and older non-depressed individuals (n = 35) were recruited. Their demographics and cognitive ability scores were recorded, and brain characteristics were acquired using multi-modal magnetic resonance imaging pretreatment. Linear and nonlinear learning methods were tested for estimating accurate prediction models. A learning method called alternating decision trees estimated the most accurate prediction models for late-life depression diagnosis (87.27% accuracy) and treatment response (89.47% accuracy). The diagnosis model included measures of age, Mini-mental state examination score, and structural imaging (e.g. whole brain atrophy and global white mater hyperintensity burden). The treatment response model included measures of structural and functional connectivity. Combinations of multi-modal imaging and/or non-imaging measures may help better predict late-life depression diagnosis and treatment response. As a preliminary observation, we speculate that the results may also suggest that different underlying brain characteristics defined by multi-modal imaging measures-rather than region-based differences-are associated with depression versus depression recovery because to our knowledge this is the first depression study to accurately predict both using the same approach. These findings may help better understand late-life depression and identify preliminary steps toward personalized late-life depression treatment. Copyright © 2015 John Wiley & Sons, Ltd.

Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients.

PubMed

Dell'oglio, Paolo; Valiquette, Anne Sophie; Leyh-Bannurah, Sami-Ramzi; Tian, Zhe; Trudeau, Vincent; Larcher, Alessandro; Shariat, Shahrokh F; Capitanio, Umberto; Briganti, Alberto; Graefen, Markus; Montorsi, Francesco; Karakiewicz, Pierre I

2018-03-19

The absolute and proportional numbers of elderly patients diagnosed with localized prostate cancer (PCa) are on the rise. We examined treatment trends and reimbursement figures in localized PCa patients aged ≥80 years. Between 2000 and 2008, we identified 30 217 localized PCa patients aged ≥80 years in Surveillance, Epidemiology and End Results (SEER)-Medicare-linked database. Alternative treatment modalities consisted of conservative management (CM), radiation therapy (RT), radical prostatectomy (RP), and primary androgen-deprivation therapy (PADT). For all four modalities, utilization and reimbursements were examined. PADT was the most frequently used treatment modality between 2000 and 2005. CM became the dominant treatment modality from 2006-2008. RP rates were marginal and RT ranked third and its annual rate increased from 20.77% in 2000 to 29.13% in 2008. Median individual reimbursement of RT was highest and ranged from $29 343 in 2000 to $31 090 in 2008, followed by RP (from $20 560 in 2000 to $19 580 in 2008), PADT (from $18 901 in 2000 to $8000 in 2008) and CM (from $1824 in 2000 to $1938 in 2008). RT contributed to most of the cumulative annual reimbursements from 2003 (49.24%) to 2008 (72.97%). PADT ranked first from 2000 (54.56%) to 2002 (50.49%), but decreased by 19.40% in 2008. CM's contribution increased from 4.42% in 2000 to 6.96% in 2008. RP share of reimbursements was stable during the study period. Our results, focusing on localized PCa treatment in patients aged ≥80 years, showed an important increase in rates, median cost, and proportion of cumulative cost related to RT.

Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis.

PubMed

Al-Adra, D P; Gill, R S; Axford, S J; Shi, X; Kneteman, N; Liau, S-S

2015-01-01

Radioembolization with yttrium-90 microspheres offers an alternative treatment option for patients with unresectable intrahepatic cholangiocarcinoma (ICC). However, the rarity and heterogeneity of ICC makes it difficult to draw firm conclusions about treatment efficacy. Therefore, the goal of the current study is to systematically review the existing literature surrounding treatment of unresectable ICCs with yttrium-90 microspheres and provide a comprehensive review of the current experience and clinical outcome of this treatment modality. We performed a comprehensive search of electronic databases for ICC treatment and identified 12 studies with relevant data regarding radioembolization therapy with yttrium-90 microspheres. Based on pooled analysis, the overall weighted median survival was 15.5 months. Tumour response based on radiological studies demonstrated a partial response in 28% and stable disease in 54% of patients at three months. Seven patients were able to be downstaged to surgical resection. The complication profile of radioembolization is similar to that of other intra-arterial treatment modalities. Overall survival of patients with ICC after treatment with yttrium-90 microspheres is higher than historical survival rates and shows similar survival to those patients treated with systemic chemotherapy and/or trans-arterial chemoembolization therapy. Therefore, the use of yttrium-90 microspheres should be considered in the list of available treatment options for ICC. However, future randomized trials comparing systemic chemotherapy, TACE and local radiation will be required to identify the optimal treatment modality for unresectable ICC. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Extended Y chromosome haplotypes resolve multiple and unique lineages of the Jewish priesthood.

PubMed

Hammer, Michael F; Behar, Doron M; Karafet, Tatiana M; Mendez, Fernando L; Hallmark, Brian; Erez, Tamar; Zhivotovsky, Lev A; Rosset, Saharon; Skorecki, Karl

2009-11-01

It has been known for over a decade that a majority of men who self report as members of the Jewish priesthood (Cohanim) carry a characteristic Y chromosome haplotype termed the Cohen Modal Haplotype (CMH). The CMH has since been used to trace putative Jewish ancestral origins of various populations. However, the limited number of binary and STR Y chromosome markers used previously did not provide the phylogenetic resolution needed to infer the number of independent paternal lineages that are encompassed within the Cohanim or their coalescence times. Accordingly, we have genotyped 75 binary markers and 12 Y-STRs in a sample of 215 Cohanim from diverse Jewish communities, 1,575 Jewish men from across the range of the Jewish Diaspora, and 2,099 non-Jewish men from the Near East, Europe, Central Asia, and India. While Cohanim from diverse backgrounds carry a total of 21 Y chromosome haplogroups, 5 haplogroups account for 79.5% of Cohanim Y chromosomes. The most frequent Cohanim lineage (46.1%) is marked by the recently reported P58 T->C mutation, which is prevalent in the Near East. Based on genotypes at 12 Y-STRs, we identify an extended CMH on the J-P58* background that predominates in both Ashkenazi and non-Ashkenazi Cohanim and is remarkably absent in non-Jews. The estimated divergence time of this lineage based on 17 STRs is 3,190 +/- 1,090 years. Notably, the second most frequent Cohanim lineage (J-M410*, 14.4%) contains an extended modal haplotype that is also limited to Ashkenazi and non-Ashkenazi Cohanim and is estimated to be 4.2 +/- 1.3 ky old. These results support the hypothesis of a common origin of the CMH in the Near East well before the dispersion of the Jewish people into separate communities, and indicate that the majority of contemporary Jewish priests descend from a limited number of paternal lineages.

Methodologies in the modeling of combined chemo-radiation treatments

NASA Astrophysics Data System (ADS)

Grassberger, C.; Paganetti, H.

2016-11-01

The variety of treatment options for cancer patients has increased significantly in recent years. Not only do we combine radiation with surgery and chemotherapy, new therapeutic approaches such as immunotherapy and targeted therapies are starting to play a bigger role. Physics has made significant contributions to radiation therapy treatment planning and delivery. In particular, treatment plan optimization using inverse planning techniques has improved dose conformity considerably. Furthermore, medical physics is often the driving force behind tumor control and normal tissue complication modeling. While treatment optimization and outcome modeling does focus mainly on the effects of radiation, treatment modalities such as chemotherapy are treated independently or are even neglected entirely. This review summarizes the published efforts to model combined modality treatments combining radiation and chemotherapy. These models will play an increasing role in optimizing cancer therapy not only from a radiation and drug dosage standpoint, but also in terms of spatial and temporal optimization of treatment schedules.

Towards a Clinical Decision Support System for External Beam Radiation Oncology Prostate Cancer Patients: Proton vs. Photon Radiotherapy? A Radiobiological Study of Robustness and Stability

PubMed Central

Walsh, Seán; Roelofs, Erik; Kuess, Peter; van Wijk, Yvonka; Lambin, Philippe; Jones, Bleddyn; Verhaegen, Frank

2018-01-01

We present a methodology which can be utilized to select proton or photon radiotherapy in prostate cancer patients. Four state-of-the-art competing treatment modalities were compared (by way of an in silico trial) for a cohort of 25 prostate cancer patients, with and without correction strategies for prostate displacements. Metrics measured from clinical image guidance systems were used. Three correction strategies were investigated; no-correction, extended-no-action-limit, and online-correction. Clinical efficacy was estimated via radiobiological models incorporating robustness (how probable a given treatment plan was delivered) and stability (the consistency between the probable best and worst delivered treatments at the 95% confidence limit). The results obtained at the cohort level enabled the determination of a threshold for likely clinical benefit at the individual level. Depending on the imaging system and correction strategy; 24%, 32% and 44% of patients were identified as suitable candidates for proton therapy. For the constraints of this study: Intensity-modulated proton therapy with online-correction was on average the most effective modality. Irrespective of the imaging system, each treatment modality is similar in terms of robustness, with and without the correction strategies. Conversely, there is substantial variation in stability between the treatment modalities, which is greatly reduced by correction strategies. This study provides a ‘proof-of-concept’ methodology to enable the prospective identification of individual patients that will most likely (above a certain threshold) benefit from proton therapy. PMID:29463018

Distance from the growth plate and Its relation to the outcome of unicameral bone cyst treatment.

PubMed

Haidar, Saadallah George; Culliford, David J; Gent, Edward David; Clarke, Nicholas M P

2011-04-01

Interventions to treat unicameral bone cysts vary. Nonetheless, regardless of the intervention modality, the outcome is not certain. The purpose of this study was to determine if the distance between the growth plate and the cyst can be used to predict the outcome of the treatment. Retrospectively, we assessed the outcome of 39 interventions in nineteen children that were performed between 1994 and 2003. Seventeen different modalities of treatment were employed. There were three female and sixteen male patients. The average age was 8 years. Nine cysts were in the greater trochanter area, three were in the femoral capital area and seven were in the proximal humerus. According to the cyst's distance from the growth plate, at the intervention time, there were 18 cases within less than 2 cm and 21 cases of more than 2 cm. Complete healing was achieved in 10 children (employing seven different modalities). In nine of them, the cysts were more than 2 cm away from the growth plate. In one child, the cyst was within less than 2 cm of the growth plate, however, treatment here involved epiphyseodesis. This study confirmed that, regardless of intervention modality, complete healing was not achievable in those cysts that are within less than 2 cm of an active growth plate. Complete healing was possible in those cysts that are more than 2 cm away from the growth plate. The 2-cm distance from the growth plate could be used as a predictor of treatment outcome of unicameral bone cysts.

Polyarteritis nodosa: MDCT as a 'One-Stop Shop' Modality for Whole-Body Arterial Evaluation

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

Tsai, W.-L.; Tsai, I-C.; Lee Tain, E-mail: s841082@ym.edu.t

Polyarteritis nodosa is a rare disease, which is characterized by aneurysm formation and occlusion in the arteries of multiple systems. Due to its extensive involvement, whole-body evaluation is necessary for diagnosis and treatment monitoring. We report a case of polyarteritis nodosa using multidetector-row computed tomography (MDCT) as a 'one-stop shop' modality for whole-body arterial evaluation. With precise protocol design, MDCT can be used as a reliable noninvasive modality providing comprehensive whole-body arterial evaluation.

Coal liquefaction process using pretreatment with a binary solvent mixture

DOEpatents

Miller, R.N.

1986-10-14

An improved process for thermal solvent refining or hydroliquefaction of non-anthracitic coal at elevated temperatures under hydrogen pressure in a hydrogen donor solvent comprises pretreating the coal with a binary mixture of an aromatic hydrocarbon and an aliphatic alcohol at a temperature below 300 C before the hydroliquefaction step. This treatment generally increases both conversion of coal and yields of oil. 1 fig.

Coal liquefaction process using pretreatment with a binary solvent mixture

DOEpatents

Miller, Robert N.

1986-01-01

An improved process for thermal solvent refining or hydroliquefaction of non-anthracitic coal at elevated temperatures under hydrogen pressure in a hydrogen donor solvent comprises pretreating the coal with a binary mixture of an aromatic hydrocarbon and an aliphatic alcohol at a temperature below 300.degree. C. before the hydroliquefaction step. This treatment generally increases both conversion of coal and yields of oil.

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

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

Mohatt, D; Malhotra, H

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

Assessment of uncertainties in radiation-induced cancer risk predictions at clinically relevant doses

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

Nguyen, J.; Moteabbed, M.; Paganetti, H., E-mail: hpaganetti@mgh.harvard.edu

2015-01-15

Purpose: Theoretical dose–response models offer the possibility to assess second cancer induction risks after external beam therapy. The parameters used in these models are determined with limited data from epidemiological studies. Risk estimations are thus associated with considerable uncertainties. This study aims at illustrating uncertainties when predicting the risk for organ-specific second cancers in the primary radiation field illustrated by choosing selected treatment plans for brain cancer patients. Methods: A widely used risk model was considered in this study. The uncertainties of the model parameters were estimated with reported data of second cancer incidences for various organs. Standard error propagationmore » was then subsequently applied to assess the uncertainty in the risk model. Next, second cancer risks of five pediatric patients treated for cancer in the head and neck regions were calculated. For each case, treatment plans for proton and photon therapy were designed to estimate the uncertainties (a) in the lifetime attributable risk (LAR) for a given treatment modality and (b) when comparing risks of two different treatment modalities. Results: Uncertainties in excess of 100% of the risk were found for almost all organs considered. When applied to treatment plans, the calculated LAR values have uncertainties of the same magnitude. A comparison between cancer risks of different treatment modalities, however, does allow statistically significant conclusions. In the studied cases, the patient averaged LAR ratio of proton and photon treatments was 0.35, 0.56, and 0.59 for brain carcinoma, brain sarcoma, and bone sarcoma, respectively. Their corresponding uncertainties were estimated to be potentially below 5%, depending on uncertainties in dosimetry. Conclusions: The uncertainty in the dose–response curve in cancer risk models makes it currently impractical to predict the risk for an individual external beam treatment. On the other hand, the ratio of absolute risks between two modalities is less sensitive to the uncertainties in the risk model and can provide statistically significant estimates.« less

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

PubMed

Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

2011-02-01

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

Childhood Enuresis: Current Diagnostic Formulations, Salient Findings, and Effective Treatment Modalities.

PubMed

Thurber, Steven

2017-06-01

Enuresis constitutes a frequently encountered problem area for children that may adversely affect social and emotional adjustment. This type of incontinence has been of concern to the human family for centuries. A brief history of enuresis is presented followed by current conceptualizations, diagnostic criteria, prevalence rates and psychiatric comorbidities. Historic notions of causation together with ineffective, sometimes barbaric treatments are then discussed, ending with a presentation of evidence-based treatment modalities, with the urine alarm being an essential element of effective treatment. An intervention termed dry bed training combines the urine alarm with a series of procedures designed in part to reduce relapse potential and should be a primary consideration for implementation by treatment professionals. Finally, a brief case study is presented illustrating special etiological and treatment considerations with juvenile psychiatric patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Coloring brain tumor with multi-potent micellar nanoscale drug delivery system

NASA Astrophysics Data System (ADS)

Chong, Kyuha; Choi, Kyungsun; Kim, EunSoo; Han, Eun Chun; Lee, Jungsul; Cha, Junghwa; Ku, Taeyun; Yoon, Jonghee; Park, Ji Ho; Choi, Chulhee

2012-10-01

Brain tumor, especially glioblastoma multiforme (GBM), is one of the most malignant tumors, which not only demands perplexing treatment approaches but also requires potent and effective treatment modality to deal with recurrence of the tumor. Photodynamic therapy (PDT) is a treatment which has been recommended as a third-level treatment. We are trying to investigate possibility of the PDT as an efficient adjuvant therapeutic modality for the treatment of brain tumor. Inhibition of tumor progression with photosensitizer was verified, in vitro. With micellar nanoscale drug delivery system, localization of the tumor was identified, in vivo, which is able to be referred as photodynamic diagnosis. With consequent results, we are suggesting photodynamic diagnosis and therapy is able to be performed simultaneously with our nanoscale drug delivery system.

Colon Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Colon cancer treatment often involves open surgical resection as the primary treatment for localized disease. Other modalities include chemotherapy, targeted therapy, radiation therapy, and local ablation. Get detailed information about colon cancer treatment in this summary for clinicians.

Oral lichen planus: An update on pathogenesis and treatment

PubMed Central

Lavanya, N; Jayanthi, P; Rao, Umadevi K; Ranganathan, K

2011-01-01

Oral lichen planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. Several antigen-specific and nonspecific inflammatory mechanisms have been put forward to explain the accumulation and homing of CD8+ T cells subepithelially and the subsequent keratinocyte apoptosis. A wide spectrum of treatment modalities is available, from topical corticosteroids to laser ablation of the lesion. In this review, we discuss the various concepts in the pathogenesis and current treatment modalities of OLP. PMID:22529568

Impact of child and family characteristics on cerebral palsy treatment.

PubMed

Rackauskaite, Gija; Uldall, Peter W; Bech, Bodil H; Østergaard, John R

2015-10-01

The aim of the study was to describe the relationship between the child's and family's characteristics and the most common treatment modalities in a national population-based sample of 8- to 15-year-old children with cerebral palsy. A cross-sectional study, based on the Danish Cerebral Palsy Registry. The parents of 462 children answered a questionnaire about their child's treatment and the family's characteristics (living with a single parent, having siblings, living in a city, parental education level). Descriptive and logistic regression analyses were performed for every treatment modality, stratified by Gross Motor Function Classification System (GMFCS) level. An IQ below 85 was associated with weekly therapy in GMFCS level I (adjusted odds ratio [ORadj ] 2.5 [CI 1.1-5.7]) and the use of oral spasmolytics in GMFCS levels III to V (ORadj 3.1 [CI 1.3-7.4]). Older children in GMFCS levels III to V used daily orthoses less frequently (ORadj 0.7 [CI 0.6-0.9] per year). Of all of the family characteristics studied, only the parents' education level had significant associations with more than one treatment modality. A child's cognitive function showed an impact on treatment of the motor impairment in children 8 to 15 years of age with cerebral palsy. Parental education level may influence the choice of treatment. © 2015 Mac Keith Press.

Review of Smartphone Applications for the Treatment of Eating Disorders

PubMed Central

Juarascio, Adrienne S.; Manasse, Stephanie M.; Goldstein, Stephanie P.; Forman, Evan M.; Butryn, Meghan L.

2016-01-01

mHealth tools may be a feasible modality for delivering evidence-based treatments and principles (EBPs), and may enhance treatment for eating disorders (EDs). However, research on the efficacy of mHealth tools for EDs and the extent to which they include EBPs is lacking. The current study sought to (i) review existing apps for EDs, (ii) determine the extent to which available treatment apps utilize EBPs, and (iii) assess the degree to which existing smartphone apps utilize recent advances in smartphone technology. Overall, existing ED intervention apps contained minimal EBPs and failed to incorporate smartphone capabilities. For smartphone apps to be a feasible and effective ED treatment modality, it may be useful for creators to begin taking utilizing the abilities that set smartphones apart from in-person treatment while incorporating EBPs. Before mHealth tools are incorporated into treatments for EDs, it is necessary that the feasibility, acceptability, and efficacy be evaluated. PMID:25303148

A conservative approach for treating young adult patients with porcelain laminate veneers.

PubMed

Chen, Yen-Wei; Raigrodski, Ariel J

2008-01-01

Controversy persists regarding the treatment planning criteria for young adult patients in need of esthetic restorations. The trend of conservative treatment modalities continues to become widely acknowledged. One of the conservative treatment modalities is porcelain laminate veneers (PLVs). PLVs not only provide suitable esthetics but also reliable functional strength. This article presents two anterior esthetic cases to demonstrate a conservative treatment planning approach and its application as a nontraditional solution for young adult patients. It is recommended that a conservative approach be used wherever possible as an alternative to treatment options that may aggressively sacrifice tooth structure as well as the health of the supporting tissues. By using a conservative approach to treatment with porcelain veneers, long-lasting, esthetic, and functional results may be achieved. Sacrificing as little tooth structure as possible and conserving the supporting tissues will facilitate prospective treatments for young adult patients.

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

PubMed

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

2016-11-01

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

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

PubMed Central

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

2016-01-01

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

Diagnosis and management of lentigo maligna: a review

PubMed Central

Kasprzak, Julia M; Xu, Yaohui G

2015-01-01

Lentigo maligna is a melanocytic neoplasm occurring on sun-exposed skin, usually on the head and neck, of middle-aged and elderly patients. It is thought to represent the in situ phase of lentigo maligna melanoma. The ill-defined nature and potentially large size of lesions can pose significant diagnostic and treatment challenges. The goal of therapy is to cure the lesions in order to prevent development of invasive disease, and surgical excision is the treatment of choice to achieve clear histological margins. Nonsurgical treatment modalities have been reported; however, evidence is lacking to support their use. Age, general health, and comorbidities need to be taken into account when deciding the right treatment modality for each individual patient. PMID:26082796

Between pink and blue: a multi-dimensional family approach to gender nonconforming children and their families.

PubMed

Malpas, Jean

2011-12-01

Families of gender nonconforming children need to negotiate the interactions between two gender systems: a rigid gender binary imported from familial, social, and cultural experiences and a fluid gender spectrum articulated by their child. This article reviews parental reactions to nonconforming gender developments and poses that the parental mandates of protection and acceptance are problematized by the difference of gender norms between the child and the family, as well as the child and the environment. Through multiple therapeutic modalities-parental coaching and education, parent support group, and child and family therapy-the author illustrates interventions supporting both parents and prepubescent children in their negotiation of safety, connection, and fluidity. Case vignettes illustrate the method in action.

Digitally controlled distributed phase shifter

DOEpatents

Hietala, V.M.; Kravitz, S.H.; Vawter, G.A.

1993-08-17

A digitally controlled distributed phase shifter is comprised of N phase shifters. Digital control is achieved by using N binary length-weighted electrodes located on the top surface of a waveguide. A control terminal is attached to each electrode thereby allowing the application of a control signal. The control signal is either one or two discrete bias voltages. The application of the discrete bias voltages changes the modal index of a portion of the waveguide that corresponds to a length of the electrode to which the bias voltage is applied, thereby causing the phase to change through the underlying portion of the waveguide. The digitally controlled distributed phase shift network has a total phase shift comprised of the sum of the individual phase shifters.

Digitally controlled distributed phase shifter

DOEpatents

Hietala, Vincent M.; Kravitz, Stanley H.; Vawter, Gregory A.

1993-01-01

A digitally controlled distributed phase shifter is comprised of N phase shifters. Digital control is achieved by using N binary length-weighted electrodes located on the top surface of a waveguide. A control terminal is attached to each electrode thereby allowing the application of a control signal. The control signal is either one or two discrete bias voltages. The application of the discrete bias voltages changes the modal index of a portion of the waveguide that corresponds to a length of the electrode to which the bias voltage is applied, thereby causing the phase to change through the underlying portion of the waveguide. The digitally controlled distributed phase shift network has a total phase shift comprised of the sum of the individual phase shifters.

Multi-Modal Treatment of Nocturnal Enuresis.

ERIC Educational Resources Information Center

Mohr, Caroline; Sharpley, Christopher F.

1988-01-01

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

Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis.

PubMed

Herman, Patricia M; Coulter, Ian D

2016-09-01

The purpose of this project was to examine the policy implications of politically defining complementary and alternative medicine (CAM) professions by their treatment modalities rather than by their full professional scope. This study used a 2-stage exploratory grounded approach. In stage 1, we identified how CAM is represented (if considered as professions vs modalities) across a purposely sampled diverse set of policy topic domains using exemplars to describe and summarize each. In stage 2 we convened 2 stakeholder panels (12 CAM practitioners and 9 health policymaker representatives), and using the results of stage 1 as a starting point and framing mechanism, we engaged panelists in a discussion of how they each see the dichotomy and its impacts. Our discussion focused on 4 licensed CAM professions: acupuncture and Oriental medicine, chiropractic, naturopathic medicine, and massage. Workforce policies affected where and how members of CAM professions could practice. Licensure affected whether a CAM profession was recognized in a state and which modalities were allowed. Complementary and alternative medicine research examined the effectiveness of procedures and modalities and only rarely the effectiveness of care from a particular profession. Treatment guidelines are based on research and also focus on procedures and modalities. Health plan reimbursement policies address which professions are covered and for which procedures/modalities and conditions. The policy landscape related to CAM professions and modalities is broad, complex, and interrelated. Although health plan reimbursement tends to receive the majority of attention when CAM health care policy is discussed, it is clear, given the results of our study, that coverage policies cannot be addressed in isolation and that a wide range of stakeholders and social institutions will need to be involved. Copyright © 2016. Published by Elsevier Inc.

Economic Analyses in Squamous Cell Carcinoma of the Head and Neck: A Review of the Literature From a Clinical Perspective

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

Souza, Jonas A. de, E-mail: jdesouza@medicine.bsd.uchicago.edu; Santana, Iuri A.; Castro, Gilberto de

The purpose of this review was to describe cost-effectiveness and cost analysis studies across treatment modalities for squamous cell carcinoma of the head and neck (SCCHN), while placing their results in context of the current clinical practice. We performed a literature search in PubMed for English-language studies addressing economic analyses of treatment modalities for SCCHN published from January 2000 to March 2013. We also performed an additional search for related studies published by the National Institute for Health and Clinical Excellence in the United Kingdom. Identified articles were classified into 3 clinical approaches (organ preservation, radiation therapy modalities, and chemotherapy regimens)more » and into 2 types of economic studies (cost analysis and cost-effectiveness/cost-utility studies). All cost estimates were normalized to US dollars, year 2013 values. Our search yielded 23 articles: 13 related to organ preservation approaches, 5 to radiation therapy modalities, and 5 to chemotherapy regimens. In general, studies analyzed different questions and modalities, making it difficult to reach a conclusion. Even when restricted to comparisons of modalities within the same clinical approach, studies often yielded conflicting findings. The heterogeneity across economic studies of SCCHN should be carefully understood in light of the modeling assumptions and limitations of each study and placed in context with relevant settings of clinical practices and study perspectives. Furthermore, the scarcity of comparative effectiveness and quality-of-life data poses unique challenges for conducting economic analyses for a resource-intensive disease, such as SCCHN, that requires a multimodal care. Future research is needed to better understand how to compare the costs and cost-effectiveness of different modalities for SCCHN.« less

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

ERIC Educational Resources Information Center

Seufert, Tina; Schutze, Maren; Brunken, Roland

2009-01-01

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

An evaluation of the various aspects of the progress in clinical applications of laser driven ionizing radiation

NASA Astrophysics Data System (ADS)

Hideghéty, K.; Szabó, E. R.; Polanek, R.; Szabó, Z.; Ughy, B.; Brunner, S.; Tőkés, T.

2017-03-01

There has been a vast development of laser-driven particle acceleration (LDPA) using high power lasers. This has initiated by the radiation oncology community to use the dose distribution and biological advantages of proton/heavy ion therapy in cancer treatment with a much greater accessibility than currently possible with cyclotron/synchrotron acceleration. Up to now, preclinical experiments have only been performed at a few LDPA facilities; technical solutions for clinical LDPA have been theoretically developed but there is still a long way to go for the clinical introduction of LDPA. Therefore, to explore the further potential bio-medical advantages of LDPA has pronounced importance. The main characteristics of LDPA are the ultra-high beam intensity, the flexibility in beam size reduction and the potential particle and energy selection whilst conventional accelerators generate single particle, quasi mono-energetic beams. There is a growing number of studies on the potential advantages and applications of Energy Modulated X-ray Radiotherapy, Modulated Electron Radiotherapy and Very High Energy Electron (VHEE) delivery system. Furthermore, the ultra-high space and/or time resolution of super-intense beams are under intensive investigation at synchrotrons (microbeam radiation and very high dose rate (> 40 Gy/s) electron accelerator flash irradiation) with growing evidence of significant improvement of the therapeutic index. Boron Neutron Capture Therapy (BNCT) is an advanced cell targeted binary treatment modality. Because of the high linear energy transfer (LET) of the two particles (7Li and 4He) released by 10BNC reaction, all of the energy is deposited inside the tumour cells, killing them with high probability, while the neighbouring cells are not damaged. The limited availability of appropriate neutron sources, prevent the more extensive exploration of clinical benefit of BNCT. Another boron-based novel binary approach is the 11B-Proton Fusion, which result in the release of three high LET alpha particles. These promising, innovative approaches for cancer therapy present huge challenges for dose calculation, dosimetry and for investigation of the biological effects. The planned LDPA (photons, VHEE, protons, carbon ions) at ELI facilities has the unique property of ultra-high dose rate (> Gy/s-10), short pulses, and at ELI-ALPS high repetition rate, have the potential to develop and establish encouraging novel methods working towards compact hospital-based clinical applications.

Restricted Acoustic Modal Analysis Applied to Internal Combustor Spectra and Cross-Spectra Measurements

NASA Technical Reports Server (NTRS)

Miles, Jeffrey Hilton

2006-01-01

A treatment of the modal decomposition of the pressure field in a combustor as determined by two Kulite pressure measurements is developed herein. It is applied to a Pratt & Whitney PW4098 engine combustor over a range of operating conditions. For modes other than the plane wave the new part of the treatment is the assumption that there are distinct frequency bands in which the individual modes, including the plane wave mode, overlap such that if circumferential mode m and circumferential mode m-1 are present than circumferential mode m 2 is not. Consequently, in the analysis used herein at frequencies above the first cut-off mode frequency, only pairs of circumferential modes are individually present at each frequency. Consequently, this is a restricted modal analysis. A new result is that the successful use of the same modal span frequencies over a range of operating conditions for this particular engine suggests that the temperature, T, and the velocity, v, of the flow at each operating condition are related by c(sup 2)-v(sup 2) = a constant where c is the speed of sound.

Treatment Components and Their Relationships with Drug and Alcohol Abstinence.

ERIC Educational Resources Information Center

Orwin, Rob; Ellis, Bruce

This study evaluates the effect of treatment components through a secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES). The study examines the relationship between treatment components, client-level factors, and treatment outcomes, and how these relationships vary by treatment modality. It seeks to understand…

FoCa: a modular treatment planning system for proton radiotherapy with research and educational purposes

NASA Astrophysics Data System (ADS)

Sánchez-Parcerisa, D.; Kondrla, M.; Shaindlin, A.; Carabe, A.

2014-12-01

FoCa is an in-house modular treatment planning system, developed entirely in MATLAB, which includes forward dose calculation of proton radiotherapy plans in both active and passive modalities as well as a generic optimization suite for inverse treatment planning. The software has a dual education and research purpose. From the educational point of view, it can be an invaluable teaching tool for educating medical physicists, showing the insights of a treatment planning system from a well-known and widely accessible software platform. From the research point of view, its current and potential uses range from the fast calculation of any physical, radiobiological or clinical quantity in a patient CT geometry, to the development of new treatment modalities not yet available in commercial treatment planning systems. The physical models in FoCa were compared with the commissioning data from our institution and show an excellent agreement in depth dose distributions and longitudinal and transversal fluence profiles for both passive scattering and active scanning modalities. 3D dose distributions in phantom and patient geometries were compared with a commercial treatment planning system, yielding a gamma-index pass rate of above 94% (using FoCa’s most accurate algorithm) for all cases considered. Finally, the inverse treatment planning suite was used to produce the first prototype of intensity-modulated, passive-scattered proton therapy, using 13 passive scattering proton fields and multi-leaf modulation to produce a concave dose distribution on a cylindrical solid water phantom without any field-specific compensator.

[Rehabilitation for the patients with low-back pain].

PubMed

Shirado, Osamu; Watanabe, Yasuyuki; Kawase, Masafumi

2005-03-01

The first choice for the treatment of low-back pain should be physical therapy, or rehabilitation. These are mainly divided into two modalities; passive and active modality. The former includes bed rest, hot pack, massage, and brace. The latter includes therapeutic exercise. The modality used should be dependent of the stages in each patient. Bed rest is indicated in the acute stage within a week after the occurrence low-back pain. The rest longer than a week is basically contraindicated, because of disuse syndrome such as muscle weakness, osteoporosis, and soft tissue contracture. Therapeutic exercise is the mainstay in the chronic stage. It includes trunk muscles strengthening exercise and stretching. Lumbar stabilization exercise has currently drawn attention for the treatment of low-back pain. Patient education such as back-school also plays an important role to manage low-back pain.

Multi-Modality Phantom Development

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

Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

2009-03-20

Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe bothmore » our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.« less

Utilization of services in a randomized trial testing phone- and web-based interventions for smoking cessation.

PubMed

Zbikowski, Susan M; Jack, Lisa M; McClure, Jennifer B; Deprey, Mona; Javitz, Harold S; McAfee, Timothy A; Catz, Sheryl L; Richards, Julie; Bush, Terry; Swan, Gary E

2011-05-01

Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone-Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. One thousand two hundred and two participants were randomized to phone, Web, or combined phone-Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone-Web, 41% Web), and those in the phone-Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities.

Treatment and prognostic factors of radiation-associated angiosarcoma (RAAS) after primary breast cancer: a systematic review.

PubMed

Depla, A L; Scharloo-Karels, C H; de Jong, M A A; Oldenborg, S; Kolff, M W; Oei, S B; van Coevorden, F; van Rhoon, G C; Baartman, E A; Scholten, R J; Crezee, J; van Tienhoven, G

2014-07-01

Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities. Databases were searched for articles with published individual patient data on prognostic factors, treatment and follow-up of patients with RAAS. A regression analysis was performed to test the prognostic values of age, interval between primary treatment and RAAS, tumour size and grade on the local recurrence-free interval (LRFI) and overall survival (OS). The effects of treatment modalities surgery, radiation (with or without hyperthermia) and chemotherapy or combinations were evaluated. 74 articles were included, representing data on 222 patients. In these patients, the 5-year OS was 43% and 5-year LRFI was 32%. Tumour size and age were significant prognostic factors on LRFI and OS. Of all patients, 68% received surgery alone, 17% surgery and reirradiation and 6% surgery with chemotherapy. The remaining 9% received primary treatments without surgery. Surgery with radiotherapy had a better 5-year LRFI of 57% compared to 34% for surgery alone (p=0.008). The value of other treatment modalities could not be assessed. This systematic review confirms the poor prognosis of RAAS. Tumour size and age were of prognostic value. The addition of reirradiation to surgery in the treatment of RAAS appears to enhance local control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Neutron therapy for salivary and thyroid gland cancer

NASA Astrophysics Data System (ADS)

Gribova, O. V.; Musabaeva, L. I.; Choynzonov, E. L.; Lisin, V. A.; Novikov, V. A.

2016-08-01

The purpose of this study was to analyze the results of the combined modality treatment and radiation therapy using 6.3 MeV fast neutrons for salivary gland cancer and prognostically unfavorable thyroid gland cancer. The study group comprised 127 patients with salivary gland cancer and 46 patients with thyroid gland cancer, who received neutron therapy alone and in combination with surgery. The results obtained demonstrated that the combined modality treatment including fast neutron therapy led to encouraging local control in patients with salivary and thyroid gland cancers.

Neutron therapy for salivary and thyroid gland cancer

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

Gribova, O. V., E-mail: gribova79@mail.ru; Choynzonov, E. L., E-mail: nii@oncology.tomsk.ru; National Research Tomsk Polytechnic University, Lenina Avenue 30, Tomsk, 634050

The purpose of this study was to analyze the results of the combined modality treatment and radiation therapy using 6.3 MeV fast neutrons for salivary gland cancer and prognostically unfavorable thyroid gland cancer. The study group comprised 127 patients with salivary gland cancer and 46 patients with thyroid gland cancer, who received neutron therapy alone and in combination with surgery. The results obtained demonstrated that the combined modality treatment including fast neutron therapy led to encouraging local control in patients with salivary and thyroid gland cancers.

Patterning of pain and power with guided imagery.

PubMed

Lewandowski, Wendy A

2004-07-01

Using Martha Rogers' science of unitary human beings, changes in pain and power among 42 patients were examined in relation to the use of a guided imagery modality. Participants were randomly assigned to treatment and control groups and repeated measures MANCOVA was used to detect differences in pain and power over a 4-day period of time. The treatment group's pain decreased during the last 2 days of the study. No differences in power emerged. Guided imagery appeared to have potential as a useful nursing modality for chronic pain sufferers.

Damage detection based on acceleration data using artificial immune system

NASA Astrophysics Data System (ADS)

Chartier, Sandra; Mita, Akira

2009-03-01

Nowadays, Structural Health Monitoring (SHM) is essential in order to prevent damages occurrence in civil structures. This is a particularly important issue as the number of aged structures is increasing. Damage detection algorithms are often based on changes in the modal properties like natural frequencies, modal shapes and modal damping. In this paper, damage detection is completed by using Artificial Immune System (AIS) theory directly on acceleration data. Inspired from the biological immune system, AIS is composed of several models like negative selection which has a great potential for this study. The negative selection process relies on the fact that T-cells, after their maturation, are sensitive to non self cells and can not detect self cells. Acceleration data were provided by using the numerical model of a 3-story frame structure. Damages were introduced, at particular times, by reduction of story's stiffness. Based on these acceleration data, undamaged data (equivalent to self data) and damaged data (equivalent to non self data) can be obtained and represented in the Hamming shape-space with a binary representation. From the undamaged encoded data, detectors (equivalent to T-cells) are derived and are able to detect damaged encoded data really efficiently by using the rcontiguous bits matching rule. Indeed, more than 95% of detection can be reached when efficient combinations of parameters are used. According to the number of detected data, the localization of damages can even be determined by using the differences between story's relative accelerations. Thus, the difference which presents the highest detection rate, generally up to 89%, is directly linked to the location of damage.

An innovative multimodal virtual platform for communication with devices in a natural way

NASA Astrophysics Data System (ADS)

Kinkar, Chhayarani R.; Golash, Richa; Upadhyay, Akhilesh R.

2012-03-01

As technology grows people are diverted and are more interested in communicating with machine or computer naturally. This will make machine more compact and portable by avoiding remote, keyboard etc. also it will help them to live in an environment free from electromagnetic waves. This thought has made 'recognition of natural modality in human computer interaction' a most appealing and promising research field. Simultaneously it has been observed that using single mode of interaction limit the complete utilization of commands as well as data flow. In this paper a multimodal platform, where out of many natural modalities like eye gaze, speech, voice, face etc. human gestures are combined with human voice is proposed which will minimize the mean square error. This will loosen the strict environment needed for accurate and robust interaction while using single mode. Gesture complement Speech, gestures are ideal for direct object manipulation and natural language is used for descriptive tasks. Human computer interaction basically requires two broad sections recognition and interpretation. Recognition and interpretation of natural modality in complex binary instruction is a tough task as it integrate real world to virtual environment. The main idea of the paper is to develop a efficient model for data fusion coming from heterogeneous sensors, camera and microphone. Through this paper we have analyzed that the efficiency is increased if heterogeneous data (image & voice) is combined at feature level using artificial intelligence. The long term goal of this paper is to design a robust system for physically not able or having less technical knowledge.

Evidenced-Based Treatment of Depression in the College Population

ERIC Educational Resources Information Center

Lee, Carolyn L.

2005-01-01

This review explores evidence-based treatment for depression within the college and university population. Treatments for depression in adults are among the most rigorous studied treatment modalities in the psychotherapy literature, providing consistent evidence for the efficacy of at least two treatments, cognitive behavioral therapy and…

Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials.

PubMed

Huisstede, Bionka M; Hoogvliet, Peter; Franke, Thierry P; Randsdorp, Manon S; Koes, Bart W

2017-09-20

To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database. Two reviewers independently applied the inclusion criteria to select potential eligible studies. Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool. A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified. Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Current Approaches, Challenges and Future Directions for Monitoring Treatment Response in Prostate Cancer

PubMed Central

Wallace, T.J.; Torre, T.; Grob, M.; Yu, J.; Avital, I.; Brücher, BLDM; Stojadinovic, A.; Man, Y.G.

2014-01-01

Prostate cancer is the most commonly diagnosed non-cutaneous neoplasm in men in the United States and the second leading cause of cancer mortality. One in 7 men will be diagnosed with prostate cancer during their lifetime. As a result, monitoring treatment response is of vital importance. The cornerstone of current approaches in monitoring treatment response remains the prostate-specific antigen (PSA). However, with the limitations of PSA come challenges in our ability to monitor treatment success. Defining PSA response is different depending on the individual treatment rendered potentially making it difficult for those not trained in urologic oncology to understand. Furthermore, standard treatment response criteria do not apply to prostate cancer further complicating the issue of treatment response. Historically, prostate cancer has been difficult to image and no single modality has been consistently relied upon to measure treatment response. However, with newer imaging modalities and advances in our understanding and utilization of specific biomarkers, the future for monitoring treatment response in prostate cancer looks bright. PMID:24396494

Evaluating the efficacy of an integrated motivational interviewing and multi-modal exercise intervention for youth with major depression: Healthy Body, Healthy Mind randomised controlled trial protocol.

PubMed

Nasstasia, Yasmina; Baker, Amanda L; Halpin, Sean A; Hides, Leanne; Lewin, Terry J; Kelly, Brian J; Callister, Robin

2018-03-01

Recent meta-analytic reviews suggest exercise can reduce depression severity among adults with major depressive disorder (MDD); however, efficacy studies with depressed youth are limited. Few studies have investigated the efficacy of multi-modal exercise interventions in this population, addressed treatment engagement, or explored the differential effects of exercise on depressive symptom profiles. This paper describes the study protocol and recruitment pattern for an assessor blinded, two-arm randomised controlled trial investigating the efficacy of an integrated motivational interviewing (MI) and multi-modal exercise intervention in youth diagnosed with MDD. Associations between depressive symptom profiles (cognitive, somatic and affective) and psychological, physiological (fitness), and biological (blood biomarker) outcomes will also be examined. Participants aged 15-25 years with current MDD were recruited. Eligible participants were randomised and stratified according to gender and depression severity to either an immediate or delayed (control) group. The immediate group received a brief MI intervention followed by a 12-week small group exercise intervention (3 times per week for 1 h), all delivered by personal trainers. The delayed control group received the same intervention 12-weeks later. Both groups were reassessed at mid-treatment or mid-control, post-treatment or post-control, and follow-up (12 weeks post-treatment). 68 participants were recruited and randomly allocated to an intervention group. This trial will increase our understanding of the efficacy of multi-modal exercise interventions for depression and the specific effects of exercise on depressive symptom profiles. It also offers a novel contribution by addressing treatment engagement in exercise efficacy trials in youth with MDD.

Breaking Binaries? Biomedicine and Serostatus Borderlands among Couples with Mixed HIV Status.

PubMed

Persson, Asha; Newman, Christy E; Ellard, Jeanne

2017-01-01

With recent breakthroughs in HIV treatment and prevention, the meanings of HIV-positivity and HIV-negativity are changing at biomedical and community levels. We explore how binary constructions of HIV serostatus identities are giving way to something more complex that brings both welcome possibilities and potential concerns. We draw on research with couples with mixed HIV status to argue that, in the context of lived experiences, serostatus identities have always been more ambiguous than allowed for in HIV discourse. However, their supposed dichotomous quality seems even more dubious now in view of contemporary biomedical technologies. Invoking the anthropological concept of "borderlands," we consider how biomedicine is generating more diverse serostatus identities, widening the options for how to live with HIV, and eroding the stigmatizing serostatus binary that has haunted the epidemic. But we also ask whether this emerging borderland, and its "normalizing" tendencies, is concomitantly giving rise to new and troubling binaries.

Surgical treatment of solitary brain metastases.

PubMed

Gates, Marilyn; Alsaidi, Mohammed; Kalkanis, Steven

2012-01-01

Brain metastases are the most common form of brain tumors and are diagnosed in about 40% of all patients with systemic malignancies. Although the percentage of solitary brain metastases has dropped in recent estimates from about 50-30% of all patients with brain metastases, this percentage still represents a significant number of patients, and the overall incidence of brain metastases is still on the rise. Historically, brain metastases carried a grim prognosis with a median survival of only a few weeks. The utilization of whole-brain radiation therapy (WBRT) and steroids improved the prognosis to few months. However, it was not until the advent of advanced surgical techniques in conjunction with other treatment modalities such as WBRT and stereotactic radiosurgery that patients became less likely to succumb to neurological complications. In the last few decades, surgical resection has evolved from a mere emergent palliative treatment to a standard treatment modality that has led to improved clinical outcomes in carefully selected patients with brain metastases. This positive contribution has been made possible by randomized clinical trials, advancement of surgical techniques and tools, imaging modalities, and better understanding of the pathophysiology and perioperative care. Copyright © 2012 S. Karger AG, Basel.

Chronic Lymphocytic Leukemia Treatment (PDQ®)—Health Professional Version

Cancer.gov

Chronic lymphocytic leukemia (CLL) treatment options can include observation, steroids, chemotherapy, targeted therapy, and/or stem cell transplant. Get detailed information about newly diagnosed and recurrent CLL and available treatment modalities in this summary for clinicians.

Test equality in binary data for a 4 × 4 crossover trial under a Latin-square design.

PubMed

Lui, Kung-Jong; Chang, Kuang-Chao

2016-10-15

When there are four or more treatments under comparison, the use of a crossover design with a complete set of treatment-receipt sequences in binary data is of limited use because of too many treatment-receipt sequences. Thus, we may consider use of a 4 × 4 Latin square to reduce the number of treatment-receipt sequences when comparing three experimental treatments with a control treatment. Under a distribution-free random effects logistic regression model, we develop simple procedures for testing non-equality between any of the three experimental treatments and the control treatment in a crossover trial with dichotomous responses. We further derive interval estimators in closed forms for the relative effect between treatments. To evaluate the performance of these test procedures and interval estimators, we employ Monte Carlo simulation. We use the data taken from a crossover trial using a 4 × 4 Latin-square design for studying four-treatments to illustrate the use of test procedures and interval estimators developed here. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Plantar fasciitis: what is the diagnosis and treatment?

PubMed

Johnson, Rachel E; Haas, Kim; Lindow, Kyle; Shields, Robert

2014-01-01

Foot pain, specifically plantar heel pain, is a common complaint among patients in a podiatric or orthopaedic office setting but may be seen in primary care offices, urgent care centers, or emergency departments as well. There are numerous causes for heel pain, but plantar fasciitis is the most frequent cause. The diagnosis of plantar fasciitis is generally made clinically, but there are many diagnostic modalities that may be used to confirm the diagnosis. Treatment of plantar fasciitis ranges from conservative measures to surgical interventions, but most cases of plantar fasciitis can be managed conservatively. There is no definitive treatment proven to be the best option for plantar fasciitis. Treatment is patient dependent and commonly requires a combination of different modalities to successfully alleviate the symptoms. In this article, plantar fasciitis from defining the disorder, diagnosis, and treatment are discussed.

DEALING WITH DENTAL IMPLANT FAILURES

PubMed Central

Levin, Liran

2008-01-01

An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them. PMID:19089213

Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders

PubMed Central

Vasilev, Georgi; Milcheva, Svetla; Vassileva, Jasmin

2016-01-01

Opinion Statement The global prevalence in the use of opiates and opioids has remained stable, though there were some unprecedented recent increases in opioid use and associated mortality and morbidity in the United States. Internationally, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured and balanced approaches to regional and national drug policies. However, there are considerable differences in the scope, focus, and implementation of national drug policies and the political context is shaping drug prevention, treatment and rehabilitation efforts to an extent not typically observed in other public health domains. As a result, though in theory, there is a considerable multi-national agreement about the efficacy and effectiveness of different treatment modalities for opioid dependence, in practice, there are striking differences among different world regions and countries in the degree of implementation of these treatment modalities into clinical practice. Such discrepancies between theory and practice are observed even in high-income countries such as the United States and European Union member states, where evidence-based treatment modalities are still not well implemented into clinical practice. Despite the lack of evidence-based support for the role of detoxification as a stand-alone treatment for opioid use disorders, it appears to be the most widely used intervention for opioid use across the world. PMID:27493878

[Comparative evaluation of the effectiveness of various treatment modalities for accommodation disorders and acquired progressive myopia].

PubMed

Tarutta, E P; Tarasova, N A

2015-01-01

To evaluate the effectiveness of non-surgical treatment of accommodation disorders and progressive myopia in children. A total of 190 patients (380 eyes) with myopia aged from 6 to 18 years (10.79±0.18 years on average) were enrolled and divided into 9 groups depending on the treatment prescribed. Comparative evaluation of different hardware-based treatment modalities for progressive myopia allowed to work out their optimal combination: "Visotronic", "MACDEL 09", and magnetophoresis of Taufon 4%. Such courses, provided twice a year, were associated with optimization of accommodative response and 1.9-2.8 times reduction of the rate of myopia progression. On the contrary, pleoptic therapy showed a negative effect on accommodative tonus and the rate of progression of acquired myopia. Comparative evaluation of different hardware-based treatment modalities for progressive myopia and accommodation disorders allowed to work out their optimal combination: "Visotronic", "MACDEL 09" and magnetophoresis of Taufon 4%. This treatment, provided twice a year, allows to increase accommodative reserves and volume, improve objective accommodative response, and reduce accommodative hypertonus as well as the rate of myopia progression (1.9-2.8 times over a 1.5-year period). Under pleoptic therapy (specialized software, near field speckles, color pulse therapy, Ambliokor device), both accommodative tonus and the rate of myopia progression increased (1.3-1.5 and 1.6 times correspondingly).

The Geography of Primary Hepatic Neoplasms Treatments in Canada: Changes in Latitudes and Changes in Attitudes

PubMed Central

Cwinn, Matthew; Rahman, Sheikh Hasibur

2017-01-01

Background Studies on treatment modalities for primary hepatic neoplasms (PHN) in Canada are lacking. Our primary aim was to analyze the age-standardized incidence of hepatic resection, ablation, transplantation, and embolization for PHN between 2002 and 2013. Secondary aim was to evaluate temporal trends for these treatment modalities. Study Design National Canadian Cancer Registries were accessed for relevant epidemiological data. Age-standardized incidence of treatment ratios (SIRs) was calculated and comparisons were performed for Atlantic Canada, Ontario, the Prairies, and British Columbia. Results British Columbia recorded the highest SIRs for ablation (1.9; 95% CI 1.8–2.0), hepatic resection (1.2; 95% CI 1.1–1.3), and transarterial locoregional therapies (2.8; 95% CI 2.4–3.2). For hepatic resection, the lowest SIR was found in Atlantic Canada (0.7; 95% CI 0.6–0.9), while the Prairies recorded the lowest estimate for transarterial therapies (0.2; 95% CI 0.1–0.4). Liver transplantation had the highest SIR in Ontario (1.5; 95% CI 1.3–1.6) and the lowest SIR in British Columbia. No significant temporal changes in SIRs were observed for any of the treatments except for transarterial therapies. Conclusions Treatment of PHN in Canada differs by geography. Variations might be due to differences in expertise or access to therapeutic modalities. PMID:28815170

Substance Use Disorder Counselors' Reports of Tobacco Cessation Services Availability, Implementation, and Tobacco-related Knowledge.

PubMed

Muilenburg, Jessica L; Laschober, Tanja C; Eby, Lillian T

2015-09-01

Adolescence is a prime developmental stage for early tobacco cessation (TC) intervention. This study examined substance use disorder counselors' reports of the availability and implementation of TC services (behavioral treatments and pharmacotherapies) in their treatment programs and the relationship between their tobacco-related knowledge and implementation of TC services. Survey data were collected in 2012 from 63 counselors working in 22 adolescent-only treatment programs. Measures included 15 TC behavioral treatments, nine TC pharmacotherapies, and three tobacco-related knowledge scales (morbidity/mortality, modalities and effectiveness, pharmacology). First, nine of the 15 behavioral treatments are reported as being available by more than half of counselors; four of the 15 behavioral treatments are used by counselors with more than half of adolescents. Of the nine pharmacotherapies, availability of the nicotine patch is reported by almost 40%, buproprion by nearly 30%, and clonidine by about 21% of counselors. Pharmacotherapies are used by counselors with very few adolescents. Second, counselors' tobacco-related knowledge varies based on the knowledge scale examined. Third, we only find a significant positive relationship between counselors' implementation of TC behavioral treatments and TC modalities and effectiveness knowledge. Findings suggest that more behavioral treatments should be made available in substance use disorder treatment programs considering that they are the main treatment recommendation for adolescents. Counselors should be encouraged to routinely use a wide range of available behavioral treatments. Finally, counselors should be encouraged to expand their knowledge of TC modalities and effectiveness because of the relationship with behavioral treatments implementation. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Roles of frequency, attitudes, and multiple intelligence modality surrounding Electricity Content-Based Reader's Theatre

NASA Astrophysics Data System (ADS)

Hosier, Julie Winchester

Integration of subjects is something elementary teachers must do to insure required objectives are covered. Science-based Reader's Theatre is one way to weave reading into science. This study examined the roles of frequency, attitudes, and Multiple Intelligence modalities surrounding Electricity Content-Based Reader's Theatre. This study used quasi-experimental, repeated measures ANOVA with time as a factor design. A convenience sample of two fifth-grade classrooms participated in the study for eighteen weeks. Five Electricity Achievement Tests were given throughout the study to assess students' growth. A Student Reader's Theatre Attitudinal Survey revealed students' attitudes before and after Electricity Content-Based Reader's Theatre treatment. The Multiple Intelligence Inventory for Kids (Faris, 2007) examined whether Multiple Intelligence modality played a role in achievement on Electricity Test 4, the post-treatment test. Analysis using repeated measures ANOVA and an independent t-test found that students in the experimental group, which practiced its student-created Electricity Content-Based Reader's Theatre skits ten times versus two times for the for control group, did significantly better on Electricity Achievement Test 4, t(76) = 3.018, p = 0.003. Dependent t-tests did not find statistically significant differences between students' attitudes about Electricity Content-Based Reader's Theatre before and after treatment. A Kruskal-Wallis test found no statistically significant difference between the various Multiple Intelligence modalities score mean ranks (x2 = 5.57, df = 2, alpha = .062). Qualitative data do, however, indicate students had strong positive feelings about Electricity Content-Based Reader's Theatre after treatment. Students indicated it to be motivating, confidence-building, and a fun way to learn about science; however, they disliked writing their own scripts. Examining the frequency, attitudes, and Multiple Intelligence modalities lead to the conclusion that the role of frequency had the greatest impact on the success of Electricity Content-Based Reader's Theatre. The participating teachers, students, and research found integrating science and reading through Electricity Content-Based Reader's Theatre beneficial.

Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

PubMed

Storino, Alessandra; Castillo-Angeles, Manuel; Watkins, Ammara A; Vargas, Christina; Mancias, Joseph D; Bullock, Andrea; Demirjian, Aram; Moser, A James; Kent, Tara S

2016-09-01

The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that <25% of the information is accurate, a score of 2 indicates that 26%-50% of the information is accurate, a score of 3 indicates that 51%-75% of the information is accurate, a score of 4 indicates that 76%-99% of the information is accurate, and a score of 5 indicates that 100% of the information is accurate). The 50 evaluated websites differed in readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P < .001) and academic (median readability level, 14.8 [IQR, 12.9-17.0]) (P < .001) websites. Privately owned websites (median readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the lowest accuracy scores (median accuracy score, 2 [IQR, 1-4]) (P < .001). Nonprofit (median accuracy score, 4 [IQR, 4-5]), government (median accuracy score, 5 [IQR, 4-5]), and academic (median accuracy score, 4 [IQR, 3.5-5]) websites were more accurate than privately owned (median accuracy score, 3.5 [IQR, 1.5-4]) and media (median accuracy score, 4 [IQR, 2-4]) websites (P < .004). Websites with higher accuracy were more difficult to read than websites with lower accuracy. Online information on pancreatic cancer overestimates the reading ability of the overall population and lacks accurate information about alternative therapy. In the absence of quality control on the Internet, physicians should provide guidance to patients in the selection of online resources with readable and accurate information.

Clinical Case Report on Treatment of Generalized Aggressive Periodontitis: 5-Year Follow-up.

PubMed

Hu, Kai-Fang; Ho, Ya-Ping; Ho, Kun-Yen; Wu, Yi-Min; Wang, Wen-Chen; Chou, Yu-Hsiang

2015-01-01

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease associated with considerably more rapid periodontal tissue destruction than chronic periodontitis. This study presents the 5-year follow-up of a patient with GAgP. A 29-year-old man reported experiencing increasing gingival recession. He was treated using cause-related therapy, provisional splints, and flap surgery combined with allograft grafting and was followed up for 5 years. This case study shows that elimination of infectious microorganisms and meticulous long-term maintenance provide an effective treatment modality for aggressive periodontitis cases. This treatment modality can restore the masticatory function and provide the GAgP patient with improved quality of life.

A wide-angle high Mach number modal expansion for infrasound propagation.

PubMed

Assink, Jelle; Waxler, Roger; Velea, Doru

2017-03-01

The use of modal expansions to solve the problem of atmospheric infrasound propagation is revisited. A different form of the associated modal equation is introduced, valid for wide-angle propagation in atmospheres with high Mach number flow. The modal equation can be formulated as a quadratic eigenvalue problem for which there are simple and efficient numerical implementations. A perturbation expansion for the treatment of attenuation, valid for stratified media with background flow, is derived as well. Comparisons are carried out between the proposed algorithm and a modal algorithm assuming an effective sound speed, including a real data case study. The comparisons show that the effective sound speed approximation overestimates the effect of horizontal wind on sound propagation, leading to errors in traveltime, propagation path, trace velocity, and absorption. The error is found to be dependent on propagation angle and Mach number.

Surgery versus radiation therapy as single-modality treatment of tonsillar fossa carcinoma: the Roswell Park Cancer Institute experience (1971-1991).

PubMed

Hicks, W L; Kuriakose, M A; Loree, T R; Orner, J B; Schwartz, G; Mullins, A; Donaldson, C; Winston, J M; Bakamjian, V Y

1998-07-01

To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single modality therapy. From 1971 to 1991 239 patients with oral pharyngeal cancer were treated at Roswell Park Cancer Institute. Of these patients 90 had tonsillar carcinoma. Seventy-six of these patients received either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single-modality therapy and are the subject of this review. All patients in the radiation arm of this review were surgical candidates who declined primary surgical therapy. Sixty-three percent of the SA and 80% of the RA treatment groups presented with either stage III or stage IV disease (P < or = .05). Forty-seven percent of the SA group and 52% of the RA patients had clinically positive regional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved region. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA group was 75%, compared with 60% in the RA group (P value was not significant). The disease-specific survival (all stages) was 61% in the SA group and 37% in the RA group (P < or = .05). The disease-free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P < or = .05). Survival measured against clinical response to radiation therapy, in complete responders (all stages) was 83%; by contrast there were no survivors past 24 months in the partial response group (P < or = .001). The results from this study suggest that for early disease (stage I/II), surgery or radiation therapy as single-modality treatment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single-modality treatment, as measured by ultimate survival and the local control of disease. There is, however, a subset of patients with advanced disease who respond to radiation therapy and whose survival is equivalent to our surgical cohort of patients.

Interaction, Modality, and Word Engagement as Factors in Lexical Learning in a Chinese Context

ERIC Educational Resources Information Center

Niu, Ruiying; Helms-Park, Rena

2014-01-01

This study investigates the roles of collaborative output, the modality of output, and word engagement in vocabulary learning and retention by Chinese-speaking undergraduate EFL learners. The two treatment groups reconstructed a passage that they had read in one of two ways: (1) dyadic oral interaction while producing a written report (Written…

Joint Probability Models of Radiology Images and Clinical Annotations

ERIC Educational Resources Information Center

Arnold, Corey Wells

2009-01-01

Radiology data, in the form of images and reports, is growing at a high rate due to the introduction of new imaging modalities, new uses of existing modalities, and the growing importance of objective image information in the diagnosis and treatment of patients. This increase has resulted in an enormous set of image data that is richly annotated…

Clinical and Microbiologic Characteristics of Clostridium difficile Infection Caused by Binary Toxin Producing Strain in Korea.

PubMed

Kim, Jieun; Seo, Mi-Ran; Kang, Jung Oak; Choi, Tae Yeal; Pai, Hyunjoo

2013-06-01

Binary toxin-producing Clostridium difficile infections (CDI) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. There has been few data of binary toxin-producing CDI in Korea. Objective of the study is to characterize clinical and microbiological trait of CDI cause by binary-toxin producing isolates in Korea. From September 2008 through January 2010, clinical characteristics, medication history and treatment outcome of all the CDI patients were collected prospectively. Toxin characterization, PCR ribotyping and antibiotic susceptibility were performed with the stool isolates of C. difficile. During the period, CDI caused by 11binary toxin-producing isolates and 105 toxin A & toxin B-positive binary toxin-negative isolates were identified. Comparing the disease severity and clinical findings between two groups, leukocytosis and mucoid stool were more frequently observed in patients with binary toxin-positive isolates (OR: 5.2, 95% CI: 1.1 to 25.4, P = 0.043; OR: 7.6, 95% CI: 1.6 to 35.6, P = 0.010, respectively), but clinical outcome of 2 groups did not show any difference. For the risk factors for acquisition of binary toxin-positive isolates, previous use of glycopeptides was the significant risk factor (OR: 6.2, 95% CI: 1.4 to 28.6, P = 0.019), but use of probiotics worked as an inhibitory factor (OR: 0.1, 95% CI: 0.0 to 0.8; P = 0.026). PCR ribotypes of binary toxinproducing C. difficile showed variable patterns: ribotype 130, 4 isolates; 027, 3 isolates; 267 and 122, 1 each isolate and unidentified C1, 2 isolates. All 11 binary toxin-positive isolates were highly susceptible to clindamycin, moxifloxacin, metronidazole, vancomycin and piperacillin-tazobactam, however, 1 of 11 of the isolates was resistant to rifaximin. Binary toxin-producing C. difficile infection was not common in Korea and those isolates showed diverse PCR ribotypes with high susceptibility to antimicrobial agents. Glycopeptide use was a risk factor for CDI by those isolates.

Clinical and Microbiologic Characteristics of Clostridium difficile Infection Caused by Binary Toxin Producing Strain in Korea

PubMed Central

Kim, Jieun; Seo, Mi-ran; Kang, Jung Oak; Choi, Tae Yeal

2013-01-01

Background Binary toxin-producing Clostridium difficile infections (CDI) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. There has been few data of binary toxin-producing CDI in Korea. Objective of the study is to characterize clinical and microbiological trait of CDI cause by binary-toxin producing isolates in Korea. Materials and Methods From September 2008 through January 2010, clinical characteristics, medication history and treatment outcome of all the CDI patients were collected prospectively. Toxin characterization, PCR ribotyping and antibiotic susceptibility were performed with the stool isolates of C. difficile. Results During the period, CDI caused by 11binary toxin-producing isolates and 105 toxin A & toxin B-positive binary toxin-negative isolates were identified. Comparing the disease severity and clinical findings between two groups, leukocytosis and mucoid stool were more frequently observed in patients with binary toxin-positive isolates (OR: 5.2, 95% CI: 1.1 to 25.4, P = 0.043; OR: 7.6, 95% CI: 1.6 to 35.6, P = 0.010, respectively), but clinical outcome of 2 groups did not show any difference. For the risk factors for acquisition of binary toxin-positive isolates, previous use of glycopeptides was the significant risk factor (OR: 6.2, 95% CI: 1.4 to 28.6, P = 0.019), but use of probiotics worked as an inhibitory factor (OR: 0.1, 95% CI: 0.0 to 0.8; P = 0.026). PCR ribotypes of binary toxinproducing C. difficile showed variable patterns: ribotype 130, 4 isolates; 027, 3 isolates; 267 and 122, 1 each isolate and unidentified C1, 2 isolates. All 11 binary toxin-positive isolates were highly susceptible to clindamycin, moxifloxacin, metronidazole, vancomycin and piperacillin-tazobactam, however, 1 of 11 of the isolates was resistant to rifaximin. Conclusions Binary toxin-producing C. difficile infection was not common in Korea and those isolates showed diverse PCR ribotypes with high susceptibility to antimicrobial agents. Glycopeptide use was a risk factor for CDI by those isolates. PMID:24265965

The management of patients with limited-stage classical Hodgkin lymphoma.

PubMed

Gospodarowicz, Mary K; Meyer, Ralph M

2006-01-01

The term limited-stage Hodgkin lymphoma refers to those patients with stage I-II disease and an absence of bulky disease. Among those patients with classical Hodgkin lymphoma, approximately one-third of patients will fall into this category. As long-term disease control can now be anticipated in more than 90% of these patients, management strategies must increasingly address the need to reduce the long-term treatment-related risks. Current treatment options include use of combined modality therapy that includes an abbreviated course of chemotherapy and involved-field radiation or treatment with chemotherapy, currently consisting of ABVD, as a single modality. The choice of treatment between these two options involves specific trade-offs that must balance issues of disease control against long-term risk of late effects.

Multidisciplinary Care.

PubMed

Daly, Megan E; Riess, Jonathan W

Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care. Well-integrated multidisciplinary care may reduce treatment delays, improve cancer-specific outcomes, and enhance quality of life. We address key topics and areas of ongoing investigation in multidisciplinary decision making at each stage of the lung cancer treatment course for early-stage, locally advanced, and metastatic lung cancer patients.

Cutaneous lichen planus: A systematic review of treatments.

PubMed

Fazel, Nasim

2015-06-01

Various treatment modalities are available for cutaneous lichen planus. Pubmed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database were searched for all the systematic reviews and randomized controlled trials related to cutaneous lichen planus. Two systematic reviews and nine relevant randomized controlled trials were identified. Acitretin, griseofulvin, hydroxychloroquine and narrow band ultraviolet B are demonstrated to be effective in the treatment of cutaneous lichen planus. Sulfasalazine is effective, but has an unfavorable safety profile. KH1060, a vitamin D analogue, is not beneficial in the management of cutaneous lichen planus. Evidence from large scale randomized trials demonstrating the safety and efficacy for many other treatment modalities used to treat cutaneous lichen planus is simply not available.

Effect of treatment in fractionated schedules with the combination of x-irradiation and six cytotoxic drugs on the RIF-1 tumor and normal mouse skin

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

Lelieveld, P.; Scoles, M.A.; Brown, J.M.

1985-01-01

RIF-1 tumors, implanted syngeneically in the gastrocnemius muscles of the right hind legs of C3H/Km mice, were treated either with X ray alone, drug alone, or drug and X ray combined. The drugs tested were bleomycin, BCNU, cis-diamminedichloro platinum, adriamycin, cyclophosphamide, and actinomycin-D. All drugs were administered either in the maximum tolerated dose or a dose that causes minimal tumor growth delay. Both drugs and X rays were administered either as a single dose or in five daily fractions. In addition to the single modality controls, seven different schedules of combined modalities were tested. Tumors were measured periodically after treatmentmore » in order that the day at which each tumor reached 4 times its initial cross-sectional area, i.e., its size at the time of treatment, could be determined. The effect of treatment on tumors was based upon excess growth delay (GD), i.e., T400% (treated)-T400% (untreated control). Treatment effects for the same combined modality schedules were also determined for normal skin, using the early skin reaction as an endpoint. Dose effect factors (DEF) were computed for all combined modality schedules and were based upon calculated radiation dose equivalents. We also calculated supra-additivity ratios, SR/sub I/ and SR/sub II/, therapeutic gain factors and adjusted therapeutic gain factors. The only drugs to produce significant supra-additivity with X rays were cis-Pt and cyclo.« less

Successful testing and treating of HIV/AIDS in Indonesia depends on the addiction treatment modality

PubMed Central

Iskandar, Shelly; de Jong, Cor AJ; Hidayat, Teddy; Siregar, Ike MP; Achmad, Tri H; van Crevel, Reinout; van der Ven, Andre

2012-01-01

Background In many settings, people who inject drugs (PWID) have limited access to human immunodeficiency virus (HIV) care which is provided in several hospitals and primary health centers in big cities. Substance abuse treatment (SAT) can be used as the entry-point to HIV programs. The aim of this study is to describe the characteristics of the PWID who had accessed SAT and determine which SAT modality associates significantly with HIV programs. Methods PWID were recruited by respondent-driven sampling in an urban setting in Java, Indonesia and interviewed with the Addiction Severity Index (ASI), Blood-Borne Virus Transmission Risk Assessment Questionnaires, and Knowledge Questionnaire on HIV/AIDS. The information regarding the use of substance abuse treatment and HIV program were based on questions in ASI. Results Seventy-seven percent of 210 PWID had accessed SAT at least once. PWID who had accessed a SAT modality reported more severe drug problems. The most widely used SAT were opioid substitution (57%) and traditional/faith-based treatment (56%). Accessing substitution treatment (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5–13.9) or residential drug-free treatment (adjusted OR = 3.7; 95% CI: 1.4–9.7) was significantly associated with HIV testing, whereas accessing substitution treatment (adjusted OR = 3.8; 95% CI: 1.9–7.5) or other medical services (adjusted OR = 3.1; 95% CI: 1.1–8.7) was significantly associated with HIV treatment. There was no significant association between accessing traditional/faith-based treatment and HIV testing and treatment. Conclusion Efforts should be made to link HIV services with traditional/faith-based treatment to increase the coverage of HIV programs. PMID:23293529

Successful testing and treating of HIV/AIDS in Indonesia depends on the addiction treatment modality.

PubMed

Iskandar, Shelly; de Jong, Cor Aj; Hidayat, Teddy; Siregar, Ike Mp; Achmad, Tri H; van Crevel, Reinout; van der Ven, Andre

2012-01-01

In many settings, people who inject drugs (PWID) have limited access to human immunodeficiency virus (HIV) care which is provided in several hospitals and primary health centers in big cities. Substance abuse treatment (SAT) can be used as the entry-point to HIV programs. The aim of this study is to describe the characteristics of the PWID who had accessed SAT and determine which SAT modality associates significantly with HIV programs. PWID were recruited by respondent-driven sampling in an urban setting in Java, Indonesia and interviewed with the Addiction Severity Index (ASI), Blood-Borne Virus Transmission Risk Assessment Questionnaires, and Knowledge Questionnaire on HIV/AIDS. The information regarding the use of substance abuse treatment and HIV program were based on questions in ASI. Seventy-seven percent of 210 PWID had accessed SAT at least once. PWID who had accessed a SAT modality reported more severe drug problems. The most widely used SAT were opioid substitution (57%) and traditional/faith-based treatment (56%). Accessing substitution treatment (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5-13.9) or residential drug-free treatment (adjusted OR = 3.7; 95% CI: 1.4-9.7) was significantly associated with HIV testing, whereas accessing substitution treatment (adjusted OR = 3.8; 95% CI: 1.9-7.5) or other medical services (adjusted OR = 3.1; 95% CI: 1.1-8.7) was significantly associated with HIV treatment. There was no significant association between accessing traditional/faith-based treatment and HIV testing and treatment. Efforts should be made to link HIV services with traditional/faith-based treatment to increase the coverage of HIV programs.

SU-E-P-10: Imaging in the Cardiac Catheterization Lab - Technologies and Clinical Applications

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

Fetterly, K

2014-06-01

Purpose: Diagnosis and treatment of cardiovascular disease in the cardiac catheterization laboratory is often aided by a multitude of imaging technologies. The purpose of this work is to highlight the contributions to patient care offered by the various imaging systems used during cardiovascular interventional procedures. Methods: Imaging technologies used in the cardiac catheterization lab were characterized by their fundamental technology and by the clinical applications for which they are used. Whether the modality is external to the patient, intravascular, or intracavity was specified. Specific clinical procedures for which multiple modalities are routinely used will be highlighted. Results: X-ray imaging modalitiesmore » include fluoroscopy/angiography and angiography CT. Ultrasound imaging is performed with external, trans-esophageal echocardiography (TEE), and intravascular (IVUS) transducers. Intravascular infrared optical coherence tomography (IVOCT) is used to assess vessel endothelium. Relatively large (>0.5 mm) anatomical structures are imaged with x-ray and ultrasound. IVUS and IVOCT provide high resolution images of vessel walls. Cardiac CT and MRI images are used to plan complex cardiovascular interventions. Advanced applications are used to spatially and temporally merge images from different technologies. Diagnosis and treatment of coronary artery disease frequently utilizes angiography and intra-vascular imaging, and treatment of complex structural heart conditions routinely includes use of multiple imaging modalities. Conclusion: There are several imaging modalities which are routinely used in the cardiac catheterization laboratory to diagnose and treat both coronary artery and structural heart disease. Multiple modalities are frequently used to enhance the quality and safety of procedures. The cardiac catheterization laboratory includes many opportunities for medical physicists to contribute substantially toward advancing patient care.« less

Which technology to select for primary focal treatment of prostate cancer?-European Section of Urotechnology (ESUT) position statement.

PubMed

Ganzer, Roman; Arthanareeswaran, Vinodh Kumar Adithyaa; Ahmed, Hashim U; Cestari, Andrea; Rischmann, Pascal; Salomon, Georg; Teber, Dogu; Liatsikos, Evangelos; Stolzenburg, Jens-Uwe; Barret, Eric

2018-05-09

With growing interest in focal therapy (FT) of prostate cancer (PCa) there is an increasing armamentarium of treatment modalities including high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation (FLA), irreversible electroporation (IRE), vascular targeted photodynamic therapy (VTP), focal brachytherapy (FBT) and stereotactic ablative radiotherapy (SABR). Currently there are no clear recommendations as to which of these technologies are appropriate for individual patient characteristics. Our intention was to review the literature for special aspects of the different technologies that might be of advantage depending on individual patient and tumour characteristics. The current literature on FT was screened for the following factors: morbidity, repeatability, tumour risk category, tumour location, tumour size and prostate volume and anatomical issues. The ESUT expert panel arrived at consensus regarding a position statement on a structured pathway for available FT technologies based on a combination of the literature and expert opinion. Side effects were low across different studies and FT modalities with urinary continence rates of 90-100% and erectile dysfunction between 5 and 52%. Short to medium cancer control based on post-treatment biopsies were variable between ablative modalities. Expert consensus suggested that posterior lesions are better amenable to FT using HIFU. Cryotherapy provides best possible outcomes for anterior tumours. Apical lesions, when treated with FBT, may yield the least urethral morbidity. Further prospective trials are required to assess medium to long term disease control of different ablative modalities for FT. Amongst different available FT modalities our ESUT expert consensus suggests that some may be better for diffe`rent tumour locations. Tumour risk, tumour size, tumour location, and prostate volume are all important factors to consider and might aid in designing future FT trials.

Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy: A Marginal Structural Model Analysis

PubMed Central

Lukowsky, Lilia R.; Mehrotra, Rajnish; Kheifets, Leeka; Arah, Onyebuchi A.; Nissenson, Allen R.

2013-01-01

Summary Background and objectives There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy. Design, setting, participants, & measurements This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements. Results On dialysis treatment day 90, there were 23,718 incident dialysis—22,360 hemodialysis and 1,358 peritoneal dialysis—patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34–0.80]). Conclusions Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates. PMID:23307879

Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis.

PubMed

Lukowsky, Lilia R; Mehrotra, Rajnish; Kheifets, Leeka; Arah, Onyebuchi A; Nissenson, Allen R; Kalantar-Zadeh, Kamyar

2013-04-01

There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy. This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements. On dialysis treatment day 90, there were 23,718 incident dialysis-22,360 hemodialysis and 1,358 peritoneal dialysis-patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34-0.80]). Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates.

Differences in Funding Sources of Phase III Oncology Clinical Trials by Treatment Modality and Cancer Type.

PubMed

Jairam, Vikram; Yu, James B; Aneja, Sanjay; Wilson, Lynn D; Lloyd, Shane

2017-06-01

Given the limited resources available to conduct clinical trials, it is important to understand how trial sponsorship differs among different therapeutic modalities and cancer types and to consider the ramifications of these differences. We searched clinicaltrials.gov for a cross-sectional register of active, phase III, randomized controlled trials (RCTs) studying treatment-related endpoints such as survival and recurrence for the 24 most prevalent malignancies. We classified the RCTs into 7 categories of therapeutic modality: (1) chemotherapy/other cancer-directed drugs, (2) targeted therapy, (3) surgery, (4) radiation therapy (RT), (5) RT with other modalities, (6) multimodality therapy without RT, and (7) other. RCTs were categorized as being funded by one or more of the following groups: (1) government, (2) hospital/university, (3) industry, and (4) other. χ analysis was performed to detect differences in funding source distribution between modalities and cancer types. The percentage of multimodality trials (5%) and radiation RCTs (4%) funded by industry was less than that for chemotherapy (32%, P<0.01) or targeted therapy (48%, P<0.01). Trials studying targeted therapy were less likely to have hospital/university funding than any of the other modalities (P<0.01 in each comparison). Trials of chemotherapy were more likely to be funded by industry if they also studied targeted therapy (P<0.01). RCTs studying targeted therapies are more likely to be funded by industry than trials studying multimodality therapy or radiation. The impact of industry funding versus institutional or governmental sources of funding for cancer research is unclear and requires further study.

Perception about the importance and use of therapeutic massage as a treatment modality among physical therapists working in Saudi Arabia

PubMed Central

Zafar, Hamayun; Oluseye, Kamaldeen; Alghadir, Ahmad; Iqbal, Zaheen A.

2015-01-01

[Purpose] To report perceptions about the importance and use of therapeutic massage as a treatment modality among physical therapists working in Saudi Arabia. [Subjects and Methods] A 21-item structured questionnaire was used to assess various domains including the demographic and professional characteristics of physical therapists and their perceptions about the importance and use of therapeutic massage in their daily practice. The questionnaire was uploaded online and the web link was sent to 140 members of the Saudi Physical Therapy Association (SPTA). [Results] The overall response rate was 86%. Among the respondents, 31% reported occasional use of therapeutic massage in their clinical practice, and 55% reported to have received formal training for therapeutic massage. Use of therapeutic massage was more common among female physical therapists. [Conclusion] Many physical therapists working in Saudi Arabia consider therapeutic massage to be an important treatment modality, but its use is relatively limited, either due to the time and effort required to dispense it, or the lack of scientific evidence for its efficacy. PMID:26180330

Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis

PubMed Central

Yu, Jeong Il; Park, Hee Chul

2016-01-01

Although the current standard treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy (RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT. PMID:27570422

Physiological Modalities for Relaxation Skill Transfer in Biofeedback Games.

PubMed

Parnandi, Avinash; Gutierrez-Osuna, Ricardo

2017-03-01

We present an adaptive biofeedback game for teaching self-regulation of stress. Our approach consists of monitoring the user's physiology during gameplay and adapting the game using a positive feedback loop that rewards relaxing behaviors and penalizes states of high arousal. We evaluate the approach using a casual game under three biofeedback modalities: electrodermal activity, heart rate variability, and breathing rate. The three biosignals can be measured noninvasively with wearable sensors, and represent different degrees of voluntary control and selectivity toward arousal. We conducted an experiment trial with 25 participants to compare the three modalities against a standard treatment (deep breathing) and a control condition (the game without biofeedback). Our results indicate that breathing-based game biofeedback is more effective in inducing relaxation during treatment than the other four groups. Participants in this group also showed greater retention of the relaxation skills (without biofeedback) during a subsequent stressor.

Cultural congruence with psychotherapy efficacy: A network meta-analytic examination in China.

PubMed

Xu, Hui; Tracey, Terence J G

2016-04-01

We used network meta-analysis to examine the relative efficacy of 3 treatment modalities in China (i.e., cognitive-psychoeducational therapy, humanistic-experiential therapy, and indigenous therapy) on the basis of a comprehensive review of randomized control trials (n = 235). The cultural congruence hypothesis derived from the contextual model argues that psychotherapy efficacy varies by the extent to which therapy modalities match the cultural context in its description of pathology and healing modalities. Given the experiential-subjective emphasis of Chinese culture, we proposed indigenous therapy and humanistic-experiential therapy being more effective than cognitive-psychoeducational therapy. Results based on indirect and direct comparisons supported the hypothesized differences in effectiveness. Treatments that more closely matched Chinese understandings of pathology and change experience were more effective. The practical and theoretical implications of the present study were discussed along with limitations. (c) 2016 APA, all rights reserved).

Imaging Ultrasound Guidance and on-line Estimation of Thermal Behavior in HIFU Exposed Targets

NASA Astrophysics Data System (ADS)

Chauhan, Sunita; Haryanto, Amir

2006-05-01

Elevated temperatures have been used for many years to combat several diseases including treatment of certain types of cancers/tumors. High Intensity Focused Ultrasound (HIFU) has emerged as a potential non-invasive modality for trackless targeting of deep-seated cancers of human body. For the procedures which require thermal elevation such as hyperthermia and tissue ablation, temperature becomes a parameter of vital importance in order to monitor the treatment on-line. Also, embedding invasive temperature probes for this purpose beats the supremacy of the non-invasive ablating modality. In this paper, we describe the use of a non-invasive and inexpensive conventional imaging ultrasound modality for lesion positioning and estimation of thermal behavior of the tissue on exposure to HIFU. Representative results of our online lesion tracking algorithm for discerning lesioning behavior using image capture, processing and phase-shift measurements are presented.

Patient-specific model-based segmentation of brain tumors in 3D intraoperative ultrasound images.

PubMed

Ilunga-Mbuyamba, Elisee; Avina-Cervantes, Juan Gabriel; Lindner, Dirk; Arlt, Felix; Ituna-Yudonago, Jean Fulbert; Chalopin, Claire

2018-03-01

Intraoperative ultrasound (iUS) imaging is commonly used to support brain tumor operation. The tumor segmentation in the iUS images is a difficult task and still under improvement because of the low signal-to-noise ratio. The success of automatic methods is also limited due to the high noise sensibility. Therefore, an alternative brain tumor segmentation method in 3D-iUS data using a tumor model obtained from magnetic resonance (MR) data for local MR-iUS registration is presented in this paper. The aim is to enhance the visualization of the brain tumor contours in iUS. A multistep approach is proposed. First, a region of interest (ROI) based on the specific patient tumor model is defined. Second, hyperechogenic structures, mainly tumor tissues, are extracted from the ROI of both modalities by using automatic thresholding techniques. Third, the registration is performed over the extracted binary sub-volumes using a similarity measure based on gradient values, and rigid and affine transformations. Finally, the tumor model is aligned with the 3D-iUS data, and its contours are represented. Experiments were successfully conducted on a dataset of 33 patients. The method was evaluated by comparing the tumor segmentation with expert manual delineations using two binary metrics: contour mean distance and Dice index. The proposed segmentation method using local and binary registration was compared with two grayscale-based approaches. The outcomes showed that our approach reached better results in terms of computational time and accuracy than the comparative methods. The proposed approach requires limited interaction and reduced computation time, making it relevant for intraoperative use. Experimental results and evaluations were performed offline. The developed tool could be useful for brain tumor resection supporting neurosurgeons to improve tumor border visualization in the iUS volumes.

Cervical Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Cervical cancer treatment modalities include surgery, radiation therapy, chemotherapy and targeted therapy. They may be used alone or in combination depending on tumor volume, spread pattern, and FIGO staging. Get detailed information about cervical cancer treatment in this summary for clinicians.

Childhood Nasopharyngeal Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Treatment options for children with nasopharyngeal cancer include combined-modality therapy with chemotherapy and radiation. Surgery has a limited role because the disease is usually considered unresectable due to extensive local spread. Get detailed treatment information in this clinician summary.

Binary black hole mergers from globular clusters: Masses, merger rates, and the impact of stellar evolution

NASA Astrophysics Data System (ADS)

Rodriguez, Carl L.; Chatterjee, Sourav; Rasio, Frederic A.

2016-04-01

The recent discovery of GW150914, the binary black hole merger detected by Advanced LIGO, has the potential to revolutionize observational astrophysics. But to fully utilize this new window into the Universe, we must compare these new observations to detailed models of binary black hole formation throughout cosmic time. Expanding upon our previous work [C. L. Rodriguez, M. Morscher, B. Pattabiraman, S. Chatterjee, C.-J. Haster, and F. A. Rasio, Phys. Rev. Lett. 115, 051101 (2015).], we study merging binary black holes formed in globular clusters using our Monte Carlo approach to stellar dynamics. We have created a new set of 52 cluster models with different masses, metallicities, and radii to fully characterize the binary black hole merger rate. These models include all the relevant dynamical processes (such as two-body relaxation, strong encounters, and three-body binary formation) and agree well with detailed direct N -body simulations. In addition, we have enhanced our stellar evolution algorithms with updated metallicity-dependent stellar wind and supernova prescriptions, allowing us to compare our results directly to the most recent population synthesis predictions for merger rates from isolated binary evolution. We explore the relationship between a cluster's global properties and the population of binary black holes that it produces. In particular, we derive a numerically calibrated relationship between the merger times of ejected black hole binaries and a cluster's mass and radius. With our improved treatment of stellar evolution, we find that globular clusters can produce a significant population of massive black hole binaries that merge in the local Universe. We explore the masses and mass ratios of these binaries as a function of redshift, and find a merger rate of ˜5 Gpc-3yr-1 in the local Universe, with 80% of sources having total masses from 32 M⊙ to 64 M⊙. Under standard assumptions, approximately one out of every seven binary black hole mergers in the local Universe will have originated in a globular cluster, but we also explore the sensitivity of this result to different assumptions for binary stellar evolution. If black holes were born with significant natal kicks, comparable to those of neutron stars, then the merger rate of binary black holes from globular clusters would be comparable to that from the field, with approximately 1 /2 of mergers originating in clusters. Finally we point out that population synthesis results for the field may also be modified by dynamical interactions of binaries taking place in dense star clusters which, unlike globular clusters, dissolved before the present day.

The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) study: expected outcome from the DD2 project and two intervention studies

PubMed Central

Beck-Nielsen, Henning; Solomon, Thomas PJ; Lauridsen, Jørgen; Karstoft, Kristian; Pedersen, Bente K; Johnsen, Søren P; Nielsen, Jens Steen; Kryger, Tine Bjerregaard; Sortsø, Camilla; Vaag, Allan

2012-01-01

The overall aim of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) is to near-normalize metabolic control in newly diagnosed patients with type 2 diabetes (T2D) using an individualized treatment approach. We hypothesize that this will not only prevent complications and improve quality of life for T2D patients but also result in increased cost efficiency compared with current treatment modalities. This paper provides an overview of the expected outcomes from DD2, focusing on the two main intervention studies. The main data for the DD2 project are collected during patient enrollment and stored using the individual civil registration number. This enables subsequent linking to other national databases where supplemental data can be obtained. All data will be used for designing treatment guidelines and continuously monitoring the development of diabetic complications, thereby obtaining knowledge about predictors for the long-term outcome and identifying targets for new interventions. Further data are being collected from two intervention studies. The aim of the first intervention study is to improve T2D treatment using an individualized treatment modality optimizing medication according to individual metabolic responses and phenotypic characteristics. The aim of the second intervention study is to develop an evidence-based training protocol to be implemented as a treatment modality for T2D and used for initiating lifelong changes in physical activity levels in patients with T2D. An initial pilot study evaluating an interval-based walking protocol is ongoing, and preliminary results indicate that this protocol is an optimal “free-living” training intervention. An initial health-economic analysis will also be performed as a basis for analysis of the data collected during the project. A cost-benefit analysis of the two intervention studies will be conducted. The DD2 project is expected to lead to improved treatment modalities and increased knowledge about existing treatment guidelines, and will also provide a solid base for health-economic decision-making. PMID:23071408

Splenic preservation after traumatic rupture. A remote hospital experience.

PubMed

Hamour, O A; Kashgari, R H; Al Harbi, M A; Azmi, A

1996-01-01

The aim of this study is to describe the outcome of treatment modalities, the length of hospital stay and blood transfusion requirements of patients with traumatic splenic rupture. It also discusses the pros and cons of each treatment given, to determine its feasibility and pre-requisites in a set-up similar to this one. SET-UP: The Royal Commission Medical Centre is a 340-bed secondary care facility located in Yanbu Industrial City, in the western part of Saudi Arabia. It serves the population of the city (approximately 40,000) plus a catchment area of nearly 300,000. A retrospective cross-sectional design was used in this study. The medical records were reviewed to abstract the required data. Twenty-one patients (15 males, 6 females) were included. The age ranged between 4 and 57 years, with a mean of 20.8 years and a SD of 13.3 years. A total of 14 spleens (66.6%) were preserved. Non-operative treatment (active conservative) was given to 12 patients while two spleens were preserved operatively by splenorraphy. Seven (33.3%) had operative treatment in the form of splenectomy. The blood transfusion requirement was significantly less in the non-operative treatment modality (p<0.005). The outcome of treatment was significantly better in the non-operative treatment modality (p<0.005). The length of hospital stay was not statistically significantly different. Active-conservative treatment is a viable and safe alternative in stable patients with splenic injury due to blunt trauma when intensive care and monitoring facilities are available and properly utilized.

A novel treatment modality in patients with premature ejaculation resistant to conventional methods: the neuromodulation of dorsal penile nerves by pulsed radiofrequency.

PubMed

Basal, Seref; Goktas, Serdar; Ergin, Atilla; Yildirim, Ibrahim; Atim, Abdulkadir; Tahmaz, Lutfi; Dayanc, Murat

2010-01-01

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of <1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 +/- 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 +/- 17.9 and 139.9 +/- 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 +/- 0.3 and 4.6 +/- 0.5, and mean SSSs of partners before and after treatment were 1.3 +/- 0.4 and 4.4 +/- 0.5, respectively. In all cases, IELT and SSS were significantly increased (P < .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 +/- 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

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

PubMed

Zobel, R; Tkalčić, S

2013-02-01

Retained placenta is a worldwide recognized clinical condition in puerperal cows, which can significantly affect their health and fertility. Available treatment modalities are often of questionable efficacy or associated with time constraints, practicality or monetary considerations for their wide application in a routine dairy practice. The objective of this study was to compare and assess the efficacy of different treatment options, including a novel ozone treatment, for the retained placenta. Two hundred cows diagnosed with retained placenta were divided into five treatment groups, each receiving a different treatment option. Group A (n = 40) was given a combination treatment of intrauterine ozone and parenteral cephalexin; group B (n = 40) was given intrauterine ozone; group C (n = 40) was given a combination of parenteral cephalexin and intrauterine antibiotic tablets; group D (n = 40) was given only parenteral cephalexin and group E (n = 40) was given parenteral prostaglandins in 11-day intervals. The control group (group Z, n = 200) included cows that gave birth without assistance and were not diagnosed with a retained placenta. The ozone treatment (groups A and B) was found to be the most effective modality resulting in the shortest period of days open, the smallest number of artificial inseminations until pregnancy, the smallest number of animals diagnosed with fever within 10 days post-calving, the highest percentage of animals pregnant within 200 days after calving and the smallest number of animals culled because of infertility, when compared to the other treatment groups. The intrauterine ozone flush therefore has a potential as an efficacious and cost-effective treatment option for retained placenta, with an overall positive effect on puerperal health and fertility in cows. © 2012 Blackwell Verlag GmbH.

Utilization of Services in a Randomized Trial Testing Phone- and Web-Based Interventions for Smoking Cessation

PubMed Central

Jack, Lisa M.; McClure, Jennifer B.; Deprey, Mona; Javitz, Harold S.; McAfee, Timothy A.; Catz, Sheryl L.; Richards, Julie; Bush, Terry; Swan, Gary E.

2011-01-01

Introduction: Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone–Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. Methods: One thousand two hundred and two participants were randomized to phone, Web, or combined phone–Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Results: Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone–Web, 41% Web), and those in the phone–Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Conclusions: Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities. PMID:21330267

Measuring treatment process in cognitive-behavioral and interactional group therapies for adolescent substance abusers.

PubMed

Kaminer, Y; Blitz, C; Burleson, J A; Kadden, R M; Rounsaville, B J

1998-07-01

The state of the art for treatment efficacy studies now requires manual guided treatments and tests of therapist adherence. This report provides findings regarding adherence assessment of therapists participating in an investigation of treatment matching in adolescent substance abusers. The Group Sessions Rating Scale (GSRS), a group-therapy process measure, was studied to determine its appropriateness for assessing group treatment of adolescents with a) substance use disorders (SUD), b) interrater reliability, c) internal consistency, and d) ability to discriminate the active ingredients of cognitive-behavioral therapy (CBT) from interactional therapy (IT). Interrater reliabilities were moderate to high, with those for CBT generally higher than those for IT. Internal consistency of CBT items was moderate, whereas those of IT were moderately high. Discriminability between the two treatment modalities was high. The frequency of active ingredients was generally therapy-specific: high for the relevant and low for the nonrelevant therapeutic modality items. The GSRS was found to be effective in the measurement of treatment process in adolescents with SUD.

Current treatment options for recurrent/metastatic head and neck cancer: a post-ASCO 2011 update and review of last year's literature.

PubMed

Kurzweg, T; Möckelmann, N; Laban, S; Knecht, R

2012-10-01

The majority of patients with a squamous cell carcinoma of the head and neck present with locally advanced tumors. The first-line treatment of locally advanced tumor stages consists of a combined modality management. Despite these aggressive protocols, many patients develop locoregional recurrences or metastasis and place particularly high demands on the interdisciplinary treatment team. Treatment with a curative intent must be differentiated from a palliative one. In addition to prior treatment, resectability, age and performance status, patient wishes must be taken into consideration in treatment planning, especially considering that most therapies offer little to no overall survival benefit. Salvage surgery, chemo- and target therapies, and reirradiation are head and neck surgeon's and radiooncologist's weapons in the fight against these strong opponents. This review focuses on publications and meeting news from last year and reviews the current status of the clinical application of each treatment modality in recurrent or metastatic head and neck cancer.

Efficacy and Safety of Tranexamic Acid in Melasma: A Meta-analysis and Systematic Review.

PubMed

Kim, Hyun Jung; Moon, Seok Hoon; Cho, Sang Hyun; Lee, Jeong Deuk; Kim, Hei Sung

2017-07-06

Tranexamic acid is a novel treatment option for melasma; however, there is no consensus on its use. This systematic review searched major databases for relevant publications to March 2016. Eleven studies with 667 participants were included. Pooled data from tranexamic acid-only observational studies with pre- and post-treatment Melasma Area and Severity Index (MASI) showed a decrease of 1.60 in MASI (95% confidence interval (CI), 1.20-2.00; p<0.001) after treat-ment with tranexamic acid. The addition of tranexamic acid to routine treatment modalities resulted in a further decrease in MASI of 0.94 (95% CI 0.10-1.79; p = 0.03). Side-effects were minor, with a few cases reporting hypo-menorrhoea, mild abdominal discomfort, and transient skin irritation. These results support the efficacy and safety of tranexamic acid, either alone or as an adjuvant to routine treatment modalities for melasma.

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

PubMed

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

2017-01-01

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

Dual-modal photoacoustic and ultrasound imaging of dental implants

NASA Astrophysics Data System (ADS)

Lee, Donghyun; Park, Sungjo; Kim, Chulhong

2018-02-01

Dental implants are common method to replace decayed or broken tooth. As the implant treatment procedures varies according to the patients' jawbone, bone ridge, and sinus structure, appropriate examinations are necessary for successful treatment. Currently, radiographic examinations including periapical radiology, panoramic X-ray, and computed tomography are commonly used for diagnosing and monitoring. However, these radiographic examinations have limitations in that patients and operators are exposed to radioactivity and multiple examinations are performed during the treatment. In this study, we demonstrated photoacoustic (PA) and ultrasound (US) combined imaging of dental implant that can lower the total amount of absorbed radiation dose in dental implant treatment. An acoustic resolution PA macroscopy and a clinical PA/US system was used for dental implant imaging. The acquired dual modal PA/US imaging results support that the proposed photoacoustic imaging strategy can reduce the radiation dose rate during dental implant treatment.

Neuromodulation for cephalgias

PubMed Central

Rasskazoff, Serge Y.; Slavin, Konstantin V.

2013-01-01

Headaches (cephalgias) are a common reason for patients to seek medical care. There are groups of patients with recurrent headache and craniofacial pain presenting with malignant course of their disease that becomes refractory to pharmacotherapy and other medical management options. Neuromodulation can be a viable treatment modality for at least some of these patients. We review the available evidence related to the use of neuromodulation modalities for the treatment of medically refractory craniofacial pain of different nosology based on the International Classification of Headache Disorders, 2nd edition (ICHD-II) classification. This article also reviews the scientific rationale of neuromodulation application in management of cephalgias. PMID:23682340

LongoVital- An Imminent Therapeutic Modality: An Unseen Drug Review with Advanced Features and Hypothesis.

PubMed

Khanna, Ruchika; Dua, Nisha; Kumar, Anand; Khanna, Ruchit; Khanna, Pyare Mohan Lal

2016-04-01

Herbal medication still happens to be the backbone of the major world's population essentially because of the assumption that these drugs are free of any side effects and easily available. LongoVital (LV) is a herbal preparation with documented immune-modulatory and immune-stimulatory effects in man. Various studies conducted to date, have shown LV to have prolonged and beneficial impact in the treatment of orofacial diseases, when administered in recommended daily doses. With its combined antimicrobial and immunostimulatory effects, LV can be regarded as an emerging therapeutic modality in the treatment of orofacial diseases.

Clinical potential for imaging in patients with asthma and other lung disorders.

PubMed

DeBoer, Emily M; Spielberg, David R; Brody, Alan S

2017-01-01

The ability of lung imaging to phenotype patients, determine prognosis, and predict response to treatment is expanding in clinical and translational research. The purpose of this perspective is to describe current imaging modalities that might be useful clinical tools in patients with asthma and other lung disorders and to explore some of the new developments in imaging modalities of the lung. These imaging modalities include chest radiography, computed tomography, lung magnetic resonance imaging, electrical impedance tomography, bronchoscopy, and others. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Complementary and alternative exercise for fibromyalgia: a meta-analysis.

PubMed

Mist, Scott David; Firestone, Kari A; Jones, Kim Dupree

2013-01-01

Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.

Current status of the use of modalities in wound care: electrical stimulation and ultrasound therapy.

PubMed

Ennis, William J; Lee, Claudia; Plummer, Malgorzata; Meneses, Patricio

2011-01-01

Wound healing is a complex pathway that requires cells, an appropriate biochemical environment (i.e., cytokines, chemokines), an extracellular matrix, perfusion, and the application of both macrostrain and microstrain. The process is both biochemically complex and energy dependent. Healing can be assisted in difficult cases through the use of physical modalities. In the current literature, there is much debate over which treatment modality, dosage level, and timing is optimal. The mechanism of action for both electrical stimulation and ultrasound are reviewed along with possible clinical applications for the plastic surgeon.

Experimental modal analysis of the fuselage panels of an Aero Commander aircraft

NASA Technical Reports Server (NTRS)

Geisler, D.

1981-01-01

The reduction of interior noise in light aircraft was investigated with emphasis the thin fuselage sidewall. The approach used is theoretical and involves modeling of the sidewall panels and stiffeners. Experimental data obtained from tests investigating the effects of mass and stiffness treatments to the sidewalls are presented. The dynamic characteristics of treated panels are contrasted with the untreated sidewall panels using experimental modal analysis techniques. The results include the natural frequencies, modal dampling, and mode shapes of selected panels. Frequency response functions, data relating to the global fuselage response, and acoustic response are also presented.

The National Treatment Improvement Evaluation Study: Retention Analysis.

ERIC Educational Resources Information Center

Orwin, Rob; Williams, Valerie

This study focuses on programmatic factors that predict retention for individuals in drug and alcohol treatment programs through secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES). It addresses the relationships between completion rates, lengths of stay, and treatment modality. It examines the effect of…

Pulsed xenon flashlamp device for the treatment of psoriasis

NASA Astrophysics Data System (ADS)

Baumgardner, Jonathan M.; Hennings, David R.; Johnston, Thomas F., Jr.; Taylor, Eric

2003-06-01

We present our research into a pulsed xenon lamp source for the treatment of psoriasis and other skin disorders. Various filtering techniques, lamp configurations, power supply configurations and delivery systems are discussed. Comparisons are made to existing treatment modalities. Cryogen cooling of the treatment site is discussed.

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

PubMed

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

2009-01-01

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

Subcellular SIMS imaging of gadolinium isotopes in human glioblastoma cells treated with a gadolinium containing MRI agent

NASA Astrophysics Data System (ADS)

Smith, Duane R.; Lorey, Daniel R.; Chandra, Subhash

2004-06-01

Neutron capture therapy is an experimental binary radiotherapeutic modality for the treatment of brain tumors such as glioblastoma multiforme. Recently, neutron capture therapy with gadolinium-157 has gained attention, and techniques for studying the subcellular distribution of gadolinium-157 are needed. In this preliminary study, we have been able to image the subcellular distribution of gadolinium-157, as well as the other six naturally abundant isotopes of gadolinium, with SIMS ion microscopy. T98G human glioblastoma cells were treated for 24 h with 25 mg/ml of the metal ion complex diethylenetriaminepentaacetic acid Gd(III) dihydrogen salt hydrate (Gd-DTPA). Gd-DTPA is a contrast enhancing agent used for MRI of brain tumors, blood-brain barrier impairment, diseases of the central nervous system, etc. A highly heterogeneous subcellular distribution was observed for gadolinium-157. The nuclei in each cell were distinctly lower in gadolinium-157 than in the cytoplasm. Even within the cytoplasm the gadolinium-157 was heterogeneously distributed. The other six naturally abundant isotopes of gadolinium were imaged from the same cells and exhibited a subcellular distribution consistent with that observed for gadolinium-157. These observations indicate that SIMS ion microscopy may be a viable approach for subcellular studies of gadolinium containing neutron capture therapy drugs and may even play a major role in the development and validation of new gadolinium contrast enhancing agents for diagnostic MRI applications.

Bioethanol production optimization: a thermodynamic analysis.

PubMed

Alvarez, Víctor H; Rivera, Elmer Ccopa; Costa, Aline C; Filho, Rubens Maciel; Wolf Maciel, Maria Regina; Aznar, Martín

2008-03-01

In this work, the phase equilibrium of binary mixtures for bioethanol production by continuous extractive process was studied. The process is composed of four interlinked units: fermentor, centrifuge, cell treatment unit, and flash vessel (ethanol-congener separation unit). A proposal for modeling the vapor-liquid equilibrium in binary mixtures found in the flash vessel has been considered. This approach uses the Predictive Soave-Redlich-Kwong equation of state, with original and modified molecular parameters. The congeners considered were acetic acid, acetaldehyde, furfural, methanol, and 1-pentanol. The results show that the introduction of new molecular parameters r and q in the UNIFAC model gives more accurate predictions for the concentration of the congener in the gas phase for binary and ternary systems.

Engagement Models for Adolescents in DATOS-A.

ERIC Educational Resources Information Center

Broome, Kirk M.; Joe, George W.; Simpson, D. Dwayne

2001-01-01

Examined relationships between patient background, treatment readiness, and therapeutic engagement in national sample of adolescents admitted to 20 treatment programs representing 3 modalities (residential, outpatient drug free, and short-term inpatient). Found that patients with higher treatment readiness at intake subsequently became more…

The treatment of Cushing's syndrome and adrenal cancer.

PubMed

Loriaux, D L

1991-12-01

Cushing's syndrome can be classified as either ACTH-dependent or ACTH-independent, and appropriate treatment depends on an accurate differential diagnosis as the treatment modality is different for each category. This article details the therapies now being used and their success rates.

Design and fabrication of a polarization-independent two-port beam splitter.

PubMed

Feng, Jijun; Zhou, Changhe; Zheng, Jiangjun; Cao, Hongchao; Lv, Peng

2009-10-10

We design and manufacture a fused-silica polarization-independent two-port beam splitter grating. The physical mechanism of this deeply etched grating can be shown clearly by using the simplified modal method with consideration of corresponding accumulated phase difference of two excited propagating grating modes, which illustrates that the binary-phase fused-silica grating structure depends little on the incident wavelength, but mainly on the ratio of groove depth to grating period and the ratio of incident wavelength to grating period. These analytic results would also be very helpful for wavelength bandwidth analysis. The exact grating profile is optimized by using the rigorous coupled-wave analysis. Holographic recording technology and inductively coupled plasma etching are used to manufacture the fused-silica grating. Experimental results agree well with the theoretical values.

Modern classification and outcome predictors of surgery in patients with brain arteriovenous malformations.

PubMed

Tayebi Meybodi, Ali; Lawton, Michael T

2018-02-23

Brain arteriovenous malformations (bAVM) are challenging lesions. Part of this challenge stems from the infinite diversity of these lesions regarding shape, location, anatomy, and physiology. This diversity has called on a variety of treatment modalities for these lesions, of which microsurgical resection prevails as the mainstay of treatment. As such, outcome prediction and managing strategy mainly rely on unraveling the nature of these complex tangles and ways each lesion responds to various therapeutic modalities. This strategy needs the ability to decipher each lesion through accurate and efficient categorization. Therefore, classification schemes are essential parts of treatment planning and outcome prediction. This article summarizes different surgical classification schemes and outcome predictors proposed for bAVMs.

Working Memory and Neurofeedback.

PubMed

YuLeung To, Eric; Abbott, Kathy; Foster, Dale S; Helmer, D'Arcy

2016-01-01

Impairments in working memory are typically associated with impairments in other cognitive faculties such as attentional processes and short-term memory. This paper briefly introduces neurofeedback as a treatment modality in general, and, more specifically, we review several of the current modalities successfully used in neurofeedback (NF) for the treatment of working memory deficits. Two case studies are presented to illustrate how neurofeedback is applied in treatment. The development of Low Resolution Electromagnetic Tomography (LORETA) and its application in neurofeedback now makes it possible to specifically target deep cortical/subcortical brain structures. Developments in neuroscience concerning neural networks, combined with highly specific yet practical NF technologies, makes neurofeedback of particular interest to neuropsychological practice, including the emergence of specific methodologies for treating very difficult working memory (WM) problems.

Electroconvulsive therapy: Promoting awareness among primary care physicians.

PubMed

Sicher, Sarah; Gedzior, Joanna

2016-04-01

This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

Prevention of age-related macular degeneration.

PubMed

Wong, Ian Yat Hin; Koo, Simon Chi Yan; Chan, Clement Wai Nang

2011-02-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula.

In-situ investigation of stress-induced martensitic transformation in Ti–Nb binary alloys with low Young's modulus [In-situ high-energy X-ray diffraction investigation on stress-induced martensitic transformation in Ti-Nb binary alloys

DOE PAGES

Chang, L. L.; Wang, Y. D.; Ren, Y.

2015-11-04

Microstructure evolution, mechanical behaviors of cold rolled Ti-Nb alloys with different Nb contents subjected to different heat treatments were investigated. Here, optical microstructure and phase compositions of Ti-Nb alloys were characterized using optical microscopy and X-ray diffractometre, while mechanical behaviors of Ti-Nb alloys were examined by using tension tests. Stress-induced martensitic transformation in a Ti-30. at%Nb binary alloy was in-situ explored by synchrotron-based high-energy X-ray diffraction (HE-XRD). The results obtained suggested that mechanical behavior of Ti-Nb alloys, especially Young's modulus was directly dependent on chemical compositions and heat treatment process. According to the results of HE-XRD, α"-V1 martensite generated priormore » to the formation of α"-V2 during loading and a partial reversible transformation from α"-V1 to β phase was detected while α"-V2 tranformed to β completely during unloading.« less

[Physical factors in the treatment of patients with osteoarthrosis and venous insufficiency].

PubMed

Tereshina, L G; Oranskiĭ, I E; Kozlova, L A; Veselkova, E E

1995-01-01

Comparative evaluation of two variants of multiple modality treatment for osteoarthritis gives preference to combination of decimetric wave radiation and effervescent baths over magnetotherapy combination with effervescent baths.

Radiation oncology: a primer for medical students.

PubMed

Berman, Abigail T; Plastaras, John P; Vapiwala, Neha

2013-09-01

Radiation oncology requires a complex understanding of cancer biology, radiation physics, and clinical care. This paper equips the medical student to understand the fundamentals of radiation oncology, first with an introduction to cancer treatment and the use of radiation therapy. Considerations during radiation oncology consultations are discussed extensively with an emphasis on how to formulate an assessment and plan including which treatment modality to use. The treatment planning aspects of radiation oncology are then discussed with a brief introduction to how radiation works, followed by a detailed explanation of the nuances of simulation, including different imaging modalities, immobilization, and accounting for motion. The medical student is then instructed on how to participate in contouring, plan generation and evaluation, and the delivery of radiation on the machine. Lastly, potential adverse effects of radiation are discussed with a particular focus on the on-treatment patient.

Retrograde intrarenal surgery for renal stones - Part 2

PubMed Central

Kılıç, Özcan; Akand, Murat; Van Cleynenbreugel, Ben

2017-01-01

Retrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature. PMID:28861294

Chronic Recurrent Non-specific Parotitis: A Case Report and Review.

PubMed

Mahalakshmi, Saibaba; Kandula, Srinivas; Shilpa, Patil; Kokila, Ganganna

2017-01-01

Chronic recurrent non-specific parotitis is characterized by recurrent episodes of swelling and pain of unknown etiology in the parotid gland. Sialography is a hallmark in the diagnosis of salivary gland disorders; newer imaging modalities like CT-Sialography, sialoendoscopy and MRI can be used. Various treatment modalities have been tried, from conservative approach to surgical excision depending on the recurrence rate and severity of the condition. Although symptomatic treatment with antibiotics and analgesic, injection of intraductal medicament, aggressive treatment like duct ligation or excision of gland are some of the treatment modalities, there is no established algorithm as to which treatment method should be opted in such clinical situation. A 20 years old male patient reported with pain and salty taste in the mouth that had began before a week. Examination revealed an elevated right parotid papilla; ropy, cloudy appearing saliva was oozing out on milking the gland. Unstimulated and stimulated whole salivary flow rate was assessed using drooling method. Sialography was used as a diagnostic and a therapeutic aid. In our case, sialography as a treatment showed a good response with no recurrence after two years of follow-up. We highlighted the role of sialography as a therapeutic aid. Recurrent attacks significantly affect the quality of life and also lead to progressive gland destruction. Preventing or reducing the frequency of recurrence remains the goal of therapeutic procedure. Hence, conventional sialography is useful in the diagnosis and also effective as a therapeutic aid in recurrent parotitis.

Comparison of various treatment modalities for acute tinnitus.

PubMed

Shim, Hyun Joon; Song, Seong Jun; Choi, A Young; Hyung Lee, Rae; Yoon, Sang Won

2011-12-01

Because in most cases the development of tinnitus is triggered by cochlear damage, there exists the opportunity to eliminate tinnitus while the cochlear lesion is still reversible. Therefore, we evaluated the therapeutic effects of various treatment modalities on acute subjective idiopathic tinnitus (SIT) and investigated prognostic factors affecting the treatment outcome. Prospective, controlled, double-blind trial. A total 107 patients who underwent treatment for unilateral SIT that had developed within the previous 3 months completed the study. The patients were randomly assigned into three groups according to the treatment modality: group I (n = 32), alprazolam orally for 3 months; group II (n = 35), as for group I plus four intratympanic dexamethasone (ITD) injections; and group III (n = 40), as for group II plus four intravenous injections of lipo-prostaglandin E(1) . The improvement rate of group II (75.8%) was significantly higher than that of group I (40.3%; P < .05), and there was no significant difference in the improvement rate of group III (50.0%) compared with groups I and II (P > .05). The cure rates of group II (25.8%) and group III (20.0%) were significantly higher than that of group I (9.8%; P < .05). There was a significant correlation between the cure rate and duration of symptoms. The results of the present study indicate that ITD injection plus alprazolam medication is the best treatment choice for acute SIT within 3 months of development. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Detecting Latent Heterogeneity

ERIC Educational Resources Information Center

Pearl, Judea

2017-01-01

We address the task of determining, from statistical averages alone, whether a population under study consists of several subpopulations, unknown to the investigator, each responding to a given treatment markedly differently. We show that such determination is feasible in three cases: (1) randomized trials with binary treatments, (2) models where…

Individual differences in decision making by foraging hummingbirds.

PubMed

Morgan, Kate V; Hurly, T Andrew; Healy, Susan D

2014-11-01

For both humans and animals preference for one option over others can be influenced by the context in which the options occur. In animals, changes in preference could be due to comparative decision-making or to changes in the energy state of the animal when making decisions. We investigated which of these possibilities better explained the response of wild hummingbirds to the addition of a decoy option to a set of two options by presenting Rufous hummingbirds (Selasphorus rufus) with a foraging experiment with two treatments. In each treatment the birds were presented with a binary choice between two options and a trinary choice with three options. In treatment one the binary choice was between a volume option and a concentration option, whereas in treatment two the same volume option was presented alongside an alternative concentration option. In the trinary choice, birds were presented with the same options as in the binary choice plus one of two inferior options. Birds changed their preferences when a poorer option was added to the choice set: birds increased their preference for the same option when in the presence of either decoy. Which option differed across individuals and the changes in preference were not readily explained by either energy maximisation or the decoy effect. The consistency in response within individuals, however, would suggest that the individual itself brings an extra dimension to context-dependent decision-making. This article is part of a Special Issue entitled: Cognition in the wild. Copyright © 2014 Elsevier B.V. All rights reserved.

Percutaneous Tumor Ablation Tools: Microwave, Radiofrequency, or Cryoablation—What Should You Use and Why?

PubMed Central

Lubner, Meghan G.; Ziemlewicz, Timothy J.; Lee, Fred T.; Brace, Christopher L.

2014-01-01

Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients. ©RSNA, 2014 PMID:25208284

Acute whole-body cooling for exercise-induced hyperthermia: a systematic review.

PubMed

McDermott, Brendon P; Casa, Douglas J; Ganio, Matthew S; Lopez, Rebecca M; Yeargin, Susan W; Armstrong, Lawrence E; Maresh, Carl M

2009-01-01

To assess existing original research addressing the efficiency of whole-body cooling modalities in the treatment of exertional hyperthermia. During April 2007, we searched MEDLINE, EMBASE, Scopus, SportDiscus, CINAHL, and Cochrane Reviews databases as well as ProQuest for theses and dissertations to identify research studies evaluating whole-body cooling treatments without limits. Key words were cooling, cryotherapy, water immersion, cold-water immersion, ice-water immersion, icing, fanning, bath, baths, cooling modality, heat illness, heat illnesses, exertional heatstroke, exertional heat stroke, heat exhaustion, hyperthermia, hyperthermic, hyperpyrexia, exercise, exertion, running, football, military, runners, marathoner, physical activity, marathoning, soccer, and tennis. Two independent reviewers graded each study on the Physiotherapy Evidence Database (PEDro) scale. Seven of 89 research articles met all inclusion criteria and a minimum score of 4 out of 10 on the PEDro scale. After an extensive and critical review of the available research on whole-body cooling for the treatment of exertional hyperthermia, we concluded that ice-water immersion provides the most efficient cooling. Further research comparing whole-body cooling modalities is needed to identify other acceptable means. When ice-water immersion is not possible, continual dousing with water combined with fanning the patient is an alternative method until more advanced cooling means can be used. Until future investigators identify other acceptable whole-body cooling modalities for exercise-induced hyperthermia, ice-water immersion and cold-water immersion are the methods proven to have the fastest cooling rates.

Clinical and radiological outcomes of surgical treatment for symptomatic arachnoid cysts in adults.

PubMed

Wang, Yongqian; Wang, Fei; Yu, Mingkun; Wang, Weiping

2015-09-01

We retrospectively analyzed 63 patients (31 males and 32 females) with arachnoid cysts managed over a 15 year period at our institution. Surgical indications and modalities for the treatment of intracranial arachnoid cysts are controversial, although endoscopic fenestration is often recommended as a standard procedure. In our cohort, clinical postoperative results and radiological assessments based on the presenting symptoms, cyst location, cyst volume and surgical modalities were recorded. The most common symptoms included headaches (66.7%), dizziness (46%) and seizures (36.5%). Cyst wall excision with microsurgical craniotomy was carried out in 28 patients (44.4%), cyst fenestration in 16 (25.4%), cystoperitoneal or ventriculoperitoneal shunting in 15 (23.8%) and endoscopic fenestration in four patients (6.3%). A satisfactory clinical outcome was achieved in 51 patients (80.9%) and cyst reduction was achieved in 49 (77.8%), at the last follow-up. Clinical improvement correlated significantly with volume reduction in patients with suprasellar and infratentorial cysts (r=0.495; p=0.022) while a similar result was not found after surgery in patients with frontal and temporal cysts. Surgical complications were not correlated with surgical modalities, occurring in only seven patients (11.1%). The various surgical modalities did not influence outcomes. Patients with nonspecific symptoms such as headache may obtain favourable outcomes from surgical treatment with no severe complications, although, intracranial hypertension and neurological deficits are more definite surgical indications for arachnoid cysts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Non-binary or genderqueer genders.

PubMed

Richards, Christina; Bouman, Walter Pierre; Seal, Leighton; Barker, Meg John; Nieder, Timo O; T'Sjoen, Guy

2016-01-01

Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. The umbrella terms for such genders are 'genderqueer' or 'non-binary' genders. Such gender identities outside of the binary of female and male are increasingly being recognized in legal, medical and psychological systems and diagnostic classifications in line with the emerging presence and advocacy of these groups of people. Population-based studies show a small percentage--but a sizable proportion in terms of raw numbers--of people who identify as non-binary. While such genders have been extant historically and globally, they remain marginalized, and as such--while not being disorders or pathological in themselves--people with such genders remain at risk of victimization and of minority or marginalization stress as a result of discrimination. This paper therefore reviews the limited literature on this field and considers ways in which (mental) health professionals may assist the people with genderqueer and non-binary gender identities and/or expressions they may see in their practice. Treatment options and associated risks are discussed.

Phase relations in the system NaCl-KCl-H2O: V. Thermodynamic-PTX analysis of solid-liquid equilibria at high temperatures and pressures

USGS Publications Warehouse

Sterner, S.M.; Chou, I.-Ming; Downs, R.T.; Pitzer, Kenneth S.

1992-01-01

The Gibbs energies of mixing for NaCl-KCl binary solids and liquids and solid-saturated NaCl-KCl-H2O ternary liquids were modeled using asymmetric Margules treatments. The coefficients of the expressions were calibrated using an extensive array of binary solvus and solidus data, and both binary and ternary liquidus data. Over the PTX range considered, the system exhibits complete liquid miscibility among all three components and extensive solid solution along the anhydrous binary. Solid-liquid and solid-solid phase equilibria were calculated by using the resulting equations and invoking the equality of chemical potentials of NaCl and KCl between appropriate phases at equilibrium. The equations reproduce the ternary liquidus and predict activity coefficients for NaCl and KCl components in the aqueous liquid under solid-saturation conditions between 673 and 1200 K from vapor saturation up to 5 kbar. In the NaCl-KCl anhydrous binary system, the equations describe phase equilibria and predict activity coefficients of the salt components for all stable compositions of solid and liquid phases between room temperature and 1200 K and from 1 bar to 5 kbar. ?? 1992.

Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes)

PubMed Central

Patel, Vikram B.; Wasserman, Ronald; Imani, Farnad

2015-01-01

Context: Lower back pain is considered to be one of the most common complaints that brings a patient to a pain specialist. Several modalities in interventional pain management are known to be helpful to a patient with chronic low back pain. Proper diagnosis is required for appropriate intervention to provide optimal benefits. From simple trigger point injections for muscular pain to a highly complex intervention such as a spinal cord stimulator are very effective if chosen properly. The aim of this article is to provide the reader with a comprehensive reading for treatment of lower back pain using interventional modalities. Evidence Acquisition: Extensive search for published literature was carried out online using PubMed, Cochrane database and Embase for the material used in this manuscript. This article describes the most common modalities available to an interventional pain physician along with the most relevant current and past references for the treatment of lower back pain. All the graphics and images were prepared by and belong to the author. Results: This review article describes the most common modalities available to an interventional pain physician along with the most relevant current and past references for the treatment of lower back pain. All the graphics and images belong to the author. Although it is beyond the scope of this review article to include a very detailed description of each procedure along with complete references, a sincere attempt has been made to comprehensively cover this very complex and perplexing topic. Conclusion: Lower back pain is a major healthcare issue and this review article will help educate the pain practitioners about the current evidence based treatment options. PMID:26484298

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

PubMed

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

2016-01-01

The influence of different treatment modalities on the risk of developing major depression in patients with chronic renal failure (CRF) is not well understood. We aimed to explore the incidence of major depression among patients with CRF who were on different dialysis modalities, who had received renal transplantation (RT), and those who had not yet received any of the aforementioned renal replacement therapies. We conducted a population-based retrospective cohort study using a national health insurance research database. This study investigated 89,336 study controls, 17,889 patients with chronic kidney disease on conservative treatment, 3823 patients on hemodialysis (HD), 351 patients on peritoneal dialysis (PD), and 322 patients who had RT. We followed all individuals until the occurrence of major depression or the date of loss to follow-up. The PD group had the highest risk (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.26-4.69), whereas the RT group had the lowest risk (HR 0.18; 95% CI 0.03-1.29) of developing major depression compared with the control group. Patients initiated on PD had a higher risk of developing major depression than patients initiated on HD (pairwise comparison: HR 2.20; 95% CI 1.09-4.46). Different treatment modalities are associated with different risks of developing major depression in patients with CRF. Among renal replacement therapies, patients who have had RT have the lowest risk of developing major depression. Patients who initiate renal therapy on PD may have a higher risk of major depression compared with patients who initiate renal therapy on HD. © 2015 International Society for Hemodialysis.

Sinonasal extramedullary plasmacytoma: a population-based incidence and survival analysis.

PubMed

Patel, Tapan D; Vázquez, Alejandro; Choudhary, Moaz M; Kam, David; Baredes, Soly; Eloy, Jean Anderson

2015-09-01

Sinonasal extramedullary plasmacytoma (SN-EMP) is a rare plasma cell neoplasm. Published literature on this tumor largely consists of case reports and case-series with small sample sizes. This study analyzed population-based data on SN-EMP patients to understand demographic and clinical features as well as incidence and survival trends. The Surveillance, Epidemiology, and End Results (SEER) database was queried for SN-EMP and other head and neck EMP (HN-EMP) cases from 1973 to 2011. Cases were analyzed to determine patient demographics, initial treatment modality, and survival outcomes. Of 778 patients identified with EMP in the head and neck region, 367 patients had SN-EMP and 411 had other HN-EMP. There was a strong male predilection found, with a male-to-female ratio of 3.65:1 in the SN-EMP group and 1.87:1 in the other HN-EMP group. The majority of the patients presented with localized disease in both SN-EMP (84.4%) and other HN-EMP (81.0%) groups. The most common treatment modality reported in this database was surgery with adjuvant radiotherapy in both SN-EMP (46.3%) and other HN-EMP (38.9%) groups, followed by radiotherapy alone (SN-EMP: 40.7%; other HN-EMP: 34.2%). Five-year and 10-year disease-specific survival rates were comparable between SN-EMP (88.2% and 83.3%, respectively) and other HN-EMP (90.0% and 87.4%, respectively) (p = 0.6016 and p = 0.4015, respectively). This study analyzed the largest cohort of SN-EMP patients to date. There was no statistically significant survival advantage found for any 1 particular treatment modality over other treatment modalities in both SN-EMP and other HN-EMP. © 2015 ARS-AAOA, LLC.

Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia.

PubMed

Morin, Mélanie; Carroll, Marie-Soleil; Bergeron, Sophie

2017-07-01

Pelvic floor muscle physical therapy is recommended in clinical guidelines for women with provoked vestibulodynia (PVD). Including isolated or combined treatment modalities, physical therapy is viewed as an effective first-line intervention, yet no systematic review concerning the effectiveness of physical therapy has been conducted. To systematically appraise the current literature on the effectiveness of physical therapy modalities for decreasing pain during intercourse and improving sexual function in women with PVD. A systematic literature search using PubMed, Scopus, CINHAL, and PEDro was conducted until October 2016. Moreover, a manual search from reference lists of included articles was performed. Ongoing trials also were reviewed using clinicaltrial.gov and ISRCTNregistry. Randomized controlled trials, prospective and retrospective cohorts, and case reports evaluating the effect of isolated or combined physical therapy modalities in women with PVD were included in the review. Main outcome measures were pain during intercourse, sexual function, and patient's perceived improvement. The literature search resulted in 43 eligible studies including 7 randomized controlled trials, 20 prospective studies, 5 retrospective studies, 6 case reports, and 6 study protocols. Most studies had a high risk of bias mainly associated with the lack of a comparison group. Another common bias was related to insufficient sample size, non-validated outcomes, non-standardized intervention, and use of other ongoing treatment. The vast majority of studies showed that physical therapy modalities such as biofeedback, dilators, electrical stimulation, education, multimodal physical therapy, and multidisciplinary approaches were effective for decreasing pain during intercourse and improving sexual function. The positive findings for the effectiveness of physical therapy modalities in women with PVD should be investigated further in robust and well-designed randomized controlled trials. Morin M, Carroll M-S, Bergeron S. Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sex Med Rev 2017;5:295-322. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Leukapheresis treatment in elderly acute leukemia patients with hyperleukocytosis: A single center experience.

PubMed

Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Gozukara Bag, Harika; Nizam, Ilknur; Koroglu, Mustafa; Yigit, Ali; Ozgul, Mustafa

2016-02-01

Leukapheresis is an invasive treatment modality used for hyperleukocytosis. Various drugs and fluids are used during the leukapheresis. Aging itself and associated factors such as increased comorbidity, decreased tolerance to drugs, increased drug toxicity give rise to the application of other treatment modalities in elderly patients. Treatment of acute leukemia in the elderly differs from young patients. Consequently, we assumed that outcome, effectiveness, and side effects of leukapheresis treatment used for acute leukemia patients with hyperleukocytosis may be different in elderly compared to younger patients. We retrospectively evaluated a total of 39 patients. Eighteen patients were 65 years and older. Indications for leukapheresis were determined as symptoms of leukostasis and prophylaxis. Acid citrate dextrose-A, calcium gluconate, and plasma were used during the leukapheresis. Age, sex, diagnosis, count, and indications of leukapheresis procedures, leukocyte count, and lactate dehydrogenase level were analyzed at the onset of and after leukapheresis; side effects, causes of death, early and total mortality rates were also analyzed. We compared the two groups with regard to effectiveness, clinical outcomes, and side effects. There were no statistically significant differences between the two groups with respect to sex, diagnosis, initial leukocyte count, lactate dehydrogenase level, number of leukapheresis procedures, rates of side effects, or early and total mortality (P > 0.05). Leukapheresis treatment was effective in both groups (P < 0.05) and no significant difference was found in its effectiveness between two groups (P > 0.05). Leukapheresis is an effective and safe treatment modality in elderly acute leukemia patients with hyperleukocytosis. © 2015 Wiley Periodicals, Inc.

Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

PubMed Central

Caruba, Thibaut; Katsahian, Sandrine; Schramm, Catherine; Charles Nelson, Anaïs; Durieux, Pierre; Bégué, Dominique; Juillière, Yves; Dubourg, Olivier

2014-01-01

Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina. PMID:24896266

Computational identification of promising thermoelectric materials among known quasi-2D binary compounds

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

Gorai, Prashun; Toberer, Eric S.; Stevanović, Vladan

Quasi low-dimensional structures are abundant among known thermoelectric materials, primarily because of their low lattice thermal conductivities. In this work, we have computationally assessed the potential of 427 known binary quasi-2D structures in 272 different chemistries for thermoelectric performance. To assess the thermoelectric performance, we employ an improved version of our previously developed descriptor for thermoelectric performance [Yan et al., Energy Environ. Sci., 2015, 8, 983]. The improvement is in the explicit treatment of van der Waals interactions in quasi-2D materials, which leads to significantly better predictions of their crystal structures and lattice thermal conductivities. The improved methodology correctly identifiesmore » known binary quasi-2D thermoelectric materials such as Sb2Te3, Bi2Te3, SnSe, SnS, InSe, and In2Se3. As a result, we propose candidate quasi-2D binary materials, a number of which have not been previously considered for thermoelectric applications.« less

Thermal Timescale Mass Transfer In Binary Population Synthesis

NASA Astrophysics Data System (ADS)

Justham, S.; Kolb, U.

2004-07-01

Studies of binary evolution have, until recently, neglected thermal timescale mass transfer (TTMT). Recent work has suggested that this previously poorly studied area is crucial in the understanding of systems across the compact binary spectrum. We use the state-of-the-art binary population synthesis code BiSEPS (Willems and Kolb, 2002, MNRAS 337 1004-1016). However, the present treatment of TTMT is incomplete due to the nonlinear behaviour of stars in their departure from gravothermal `equilibrium'. Here we show work that should update the ultrafast stellar evolution algorithms within BiSEPS to make it the first pseudo-analytic code that can follow TTMT properly. We have generated fits to a set of over 300 Case B TTMT sequences with a range of intermediate-mass donors. These fits produce very good first approximations to both HR diagrams and mass-transfer rates (see figures 1 and 2), which we later hope to improve and extend. They are already a significant improvement over the previous fits.

Using the Milieu: Treatment-Environment Consistency.

ERIC Educational Resources Information Center

Szekais, Barbara

1985-01-01

Describes trial use of milieu and activity-based therapy in two adult day centers to increase client involvement in physical and social environments of treatment settings. Reports results from empirical observations and recommends further investigation of this treatment modality in settings for the elderly. (Author/NRB)

Osteoarthritis: A Critical Review

PubMed Central

Onishi, Kentaro; Utturkar, Amol; Chang, Eric; Panush, Richard; Hata, Justin; Perret-Karimi, Danielle

2015-01-01

Patients with osteoarthritis (OA) are faced with a barrage of treatment options, from recommendations from friends and social media to medications prescribed by the primary care physician. The purpose of this article is to critically review current approaches to generalized or monoarticular OA based on available evidence and to illustrate multidisciplinary and multimodal treatment strategies for the management of OA. Treatment options assessed for efficacy include patient education; oral and topical pharmacological agents; complementary and alternative medicine; surgery; manual medicine; acupuncture; interventional procedures (corticosteroid injection, viscosupplementation, and pulsed radiofrequency); bracing; assistive devices; physical therapy; and physical modalities. Multidisciplinary and multimodal treatment strategies combined with early detection and prevention strategies provide the best benefit to patients. This review also illustrates that traditional and alternative modalities of treatment can be both synergistic and beneficial. Physicians should be aware of the variety of tools available for the management of OA and the associated symptoms. Those healthcare providers who can best individualize treatment plans for specific patients and inspire their patients to embrace healthy lifestyle modifications will achieve the best results. PMID:25750483

Laser and light-based treatments of venous lakes: a literature review.

PubMed

Mlacker, Stephanie; Shah, Vidhi V; Aldahan, Adam S; McNamara, Colin A; Kamath, Preetha; Nouri, Keyvan

2016-09-01

Venous lake is a benign vascular malformation commonly seen in elderly patients, typically arising in sun-exposed areas of the body. Patients often seek treatment to prevent recurrent bleeding or because they find the lesion cosmetically unacceptable. Venous lake may negatively affect quality of life, due to the cosmetic disfigurement it can create and the resulting psychological distress. Traditional treatments, such as surgical excision, cryosurgery, sclerotherapy, and electrocoagulation, result in varying degrees of success and can cause discomfort. Laser- and light-based treatment modalities may offer a safe and effective alternative, as numerous studies have shown their benefit in the treatment of venous lakes, particularly with the long-pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG). Although various types of lasers and lights have been studied, there remains a lack of general consensus as to which one is the superior laser modality. Further studies that establish standardized protocols to compare the results of using different types of laser treatments are warranted.

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality.

PubMed

Lloyd, Belinda; Zahnow, Renee; Barratt, Monica J; Best, David; Lubman, Dan I; Ferris, Jason

2017-11-01

Studies consistently identify substance treatment populations as more likely to die prematurely compared with age-matched general population, with mortality risk higher out-of-treatment than in-treatment. While opioid-using pharmacotherapy cohorts have been studied extensively, less evidence exists regarding effects of other treatment types, and clients in treatment for other drugs. This paper examines mortality during and following treatment across treatment modalities. A retrospective seven-year cohort was utilised to examine mortality during and in the two years following treatment among clients from Victoria, Australia, recorded on the Alcohol and Drug Information Service database by linking with National Death Index. 18,686 clients over a 12-month period were included. Crude (CMRs) and standardised mortality rates (SMRs) were analysed in terms of treatment modality, and time in or out of treatment. Higher risk of premature death was associated with residential withdrawal as the last type of treatment engagement, while mortality following counselling was significantly lower than all other treatment types in the year post-treatment. Both CMRs and SMRs were significantly higher in-treatment than post-treatment. Better understanding of factors contributing to elevated mortality risk for clients engaged in, and following treatment, is needed to ensure that treatment systems provide optimal outcomes during and after treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA.

PubMed

Thumallapally, Nishitha; Meshref, Ahmed; Mousa, Mohammed; Terjanian, Terenig

2017-01-05

Solitary plasmacytoma (SP) is a localized neoplastic plasma cell disorder with an annual incidence of less than 450 cases. Given the rarity of this disorder, it is difficult to conduct large-scale population studies. Consequently, very limited information on the disorder is available, making it difficult to estimate the incidence and survival rates. Furthermore, limited information is available on the efficacy of various treatment modalities in relation to primary tumor sites. The data for this retrospective study were drawn from the Surveillance, Epidemiology and End Results (SEER) database, which comprises 18 registries; patient demographics, treatment modalities and survival rates were obtained for those diagnosed with SP from 1998 to 2007. Various prognostic factors were analyzed via Kaplan-Meier analysis and log-rank test, with 5-year relative survival rate defined as the primary outcome of interest. Cox regression analysis was employed in the multivariate analysis. The SEER search from 1998 to 2007 yielded records for 1691 SP patients. The median age at diagnosis was 63 years. The patient cohort was 62.4% male, 37.6% female, 80% Caucasian, 14.6% African American and 5.4% other races. Additionally, 57.8% had osseous plasmacytoma, and 31.9% had extraosseous involvement. Unspecified plasmacytoma was noted in 10.2% of patients. The most common treatment modalities were radiotherapy (RT) (48.8%), followed by combination surgery with RT (21.2%) and surgery alone (11.6%). Univariate analysis of prognostic factors revealed that the survival outcomes were better for younger male patients who received RT with surgery (p < 0.05). Additionally, patients who received neoadjuvant RT had increased survival rates compared to those receiving adjuvant RT (86% vs 73%, p < 0.05). Furthermore, the analyses revealed that 5-year survival rates for patients with axial plasmacytoma were superior when RT was combined with surgery (p < 0.05). In the multivariate analysis, age <60 years and treatment with either RT or surgery showed superior survival rates. Progression to multiple myeloma (MM) was noted in 551 patients. Age >60 years was associated with a lower 5-year survival in patients who progressed to MM compared to those who were diagnosed initially with MM (15.1 vs 16.6%). Finally, those who received RT and progressed to MM still had a higher chance of survival than those who were diagnosed with MM initially and treated with RT/surgery (21.8% vs 15.9%, p < 0.05). A review of the pertinent literature indicates that we provided the most comprehensive population-based analysis of SP to date. Moreover, our study contributes to the establishment of the optimal SP treatment modality, as RT is the favored option in frontline settings. Consensus is currently lacking regarding the benefits of combined treatment including surgery. Thus, the findings reported here elucidate the role of primary treatment modalities while also demonstrating the quantifiable benefits of combining RT with surgery in relation to different primary tumor sites. While our results are promising, they should be confirmed through further large-scale randomized studies.

Cortical GABAergic Interneurons in Cross-Modal Plasticity following Early Blindness

PubMed Central

Desgent, Sébastien; Ptito, Maurice

2012-01-01

Early loss of a given sensory input in mammals causes anatomical and functional modifications in the brain via a process called cross-modal plasticity. In the past four decades, several animal models have illuminated our understanding of the biological substrates involved in cross-modal plasticity. Progressively, studies are now starting to emphasise on cell-specific mechanisms that may be responsible for this intermodal sensory plasticity. Inhibitory interneurons expressing γ-aminobutyric acid (GABA) play an important role in maintaining the appropriate dynamic range of cortical excitation, in critical periods of developmental plasticity, in receptive field refinement, and in treatment of sensory information reaching the cerebral cortex. The diverse interneuron population is very sensitive to sensory experience during development. GABAergic neurons are therefore well suited to act as a gate for mediating cross-modal plasticity. This paper attempts to highlight the links between early sensory deprivation, cortical GABAergic interneuron alterations, and cross-modal plasticity, discuss its implications, and further provide insights for future research in the field. PMID:22720175

Effective Beginning Handwriting Instruction: Multi-Modal, Consistent Format for 2 Years, and Linked to Spelling and Composing

ERIC Educational Resources Information Center

Wolf, Beverly; Abbott, Robert D.; Berninger, Virginia W.

2017-01-01

In Study 1, the treatment group (N = 33 first graders, M = 6 years 10 months, 16 girls) received Slingerland multi-modal (auditory, visual, tactile, motor through hand, and motor through mouth) manuscript (unjoined) handwriting instruction embedded in systematic spelling, reading, and composing lessons; and the control group (N = 16 first graders,…

[Treatment of liver metastasis of endocrine tumors of the pancreas].

PubMed

Orozco Zepeda, H

1997-01-01

The aim of this review article is to analyze the diagnostic approach, presentation and therapeutic modalities in patients with liver metastasis from endocrine tumors. The paper shows the "state of the art" of therapeutic approaches with emphasis on the roll of different surgery, radio and chemotherapy, arterial embolization and other palliative procedures. The overall results of each of this modalities are also shown.

A unified procedure for meta-analytic evaluation of surrogate end points in randomized clinical trials

PubMed Central

Dai, James Y.; Hughes, James P.

2012-01-01

The meta-analytic approach to evaluating surrogate end points assesses the predictiveness of treatment effect on the surrogate toward treatment effect on the clinical end point based on multiple clinical trials. Definition and estimation of the correlation of treatment effects were developed in linear mixed models and later extended to binary or failure time outcomes on a case-by-case basis. In a general regression setting that covers nonnormal outcomes, we discuss in this paper several metrics that are useful in the meta-analytic evaluation of surrogacy. We propose a unified 3-step procedure to assess these metrics in settings with binary end points, time-to-event outcomes, or repeated measures. First, the joint distribution of estimated treatment effects is ascertained by an estimating equation approach; second, the restricted maximum likelihood method is used to estimate the means and the variance components of the random treatment effects; finally, confidence intervals are constructed by a parametric bootstrap procedure. The proposed method is evaluated by simulations and applications to 2 clinical trials. PMID:22394448

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

Respiratory and Cognitive Mediators of Treatment Change in Panic Disorder: Evidence for Intervention Specificity

ERIC Educational Resources Information Center

Meuret, Alicia E.; Rosenfield, David; Seidel, Anke; Bhaskara, Lavanya; Hofmann, Stefan G.

2010-01-01

Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this…

Regenerative endodontics--Creating new horizons.

PubMed

Dhillon, Harnoor; Kaushik, Mamta; Sharma, Roshni

2016-05-01

Trauma to the dental pulp, physical or microbiologic, can lead to inflammation of the pulp followed by necrosis. The current treatment modality for such cases is non-surgical root canal treatment. The damaged tissue is extirpated and the root canal system prepared. It is then obturated with an inert material such a gutta percha. In spite of advances in techniques and materials, 10%-15% of the cases may end in failure of treatment. Regenerative endodontics combines principles of endodontics, cell biology, and tissue engineering to provide an ideal treatment for inflamed and necrotic pulp. It utilizes mesenchymal stem cells, growth factors, and organ tissue culture to provide treatment. Potential treatment modalities include induction of blood clot for pulp revascularization, scaffold aided regeneration, and pulp implantation. Although in its infancy, successful treatment of damaged pulp tissue has been performed using principles of regenerative endodontics. This field is dynamic and exciting with the ability to shape the future of endodontics. This article highlights the fundamental concepts, protocol for treatment, and possible avenues for research in regenerative endodontics. © 2015 Wiley Periodicals, Inc.

Efficacy of long pulse Nd:YAG laser versus fractional Er:YAG laser in the treatment of hand wrinkles.

PubMed

Robati, Reza M; Asadi, Elmira; Shafiee, Anoosh; Namazi, Nastaran; Talebi, Atefeh

2018-04-01

There are different modalities for hand rejuvenation. Fractional Er:YAG laser and long pulse Nd:YAG laser were introduced for treating hand wrinkles. We plan to compare fractional Er:YAG laser and long pulse Nd:YAG laser in a randomized controlled double-blind design with multiple sessions and larger sample size in comparison with previous studies. Thirty-three participants with hand wrinkles entered this study. They were randomly allocated to undergo three monthly laser treatments on each hand, one with a fractional Er:YAG laser and the other with a long pulse Nd:YAG laser. The evaluations included assessment of clinical improvement determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of hands using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, potential side effects and patients' satisfaction have been documented at baseline, 1 month after each treatment, and 3 months after the final treatment session. Clinical evaluation revealed both modalities significantly reduce hand wrinkles (p value < 0.05), with no significant difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to those of the baseline in both laser groups. There was no serious persistent side effect after both laser treatments. Both fractional Er:YAG and long pulse Nd:YAG lasers show substantial clinical improvement of hand skin wrinkles with no serious side effects. However, combination treatment by these lasers along with the other modalities such as fat transfer could lead to better outcomes in hand rejuvenation. IRCT2016032020468N4.

A comparison of three different physiotherapy modalities used in the physiotherapy of burns.

PubMed

Sar, Zübeyir; Polat, Mine Gülden; Özgül, Bahar; Aydoğdu, Onur; Camcoğlu, Burcu; Acar, Ahmet Hakan; Yurdalan, Saadet Ufuk

2013-01-01

The present study compared the effectiveness of matrix rhythm therapy, ultrasound treatment (UT), laser treatment (LT) used in the physiotherapy of burns. The study was conducted at the Wound and Burn Healing Center, Dr. Lütfi Kırdar Kartal Education and Research Hospital (Turkey) from June 2009 to January 2012. The case series comprised 39 individuals with second- and third-degree upper-limb burns, whose burn traumas ended approximately 1 to 3 months previously. Participants were separated into three groups: matrix rhythm treatment (MRT), UT and LT; each group was also applied a treatment protocol including whirlpool and exercise. Pain, range of motion (ROM), muscular strength, skin elasticity, and sensory functions were evaluated before and after the treatment. Pressure sense and passive ROM were higher in the MRT group than in the LT group (P < .05). Pain was lower in the LT group than in the UT group, and passive ROM was higher in the UT group than the in LT group (P < .05). Active ROM was found to increase in all treatment groups, whereas passive ROM increased only in the MRT and UT groups; pressure sense increased only in the MRT group, and pain decreased only in the LT group (P < .05). MRT was found to be more effective in the restoration of sensory functions than LT, whereas LT was more effective in reducing pain than UT. No significant difference was observed in terms of skin elasticity according to the results of three treatment modalities. It is suggested that further research with more cases should be conducted to examine the long-term effect of treatment modalities.

Impact of salvage treatment modalities in patients with positive FDG-PET/CT after R-CHOP chemotherapy for aggressive B-cell non-Hodgkin lymphoma.

PubMed

Chin, Vicky; Fulham, Michael; Hertzberg, Mark; Jackson, Michael; Lindeman, Robert; Brighton, Timothy; Kidson-Gerber, Giselle; Wegner, Eva A; Cheung, Carol; MacCallum, Susan; Williams, Janet; Thompson, Stephen R

2018-06-01

To compare outcomes of different salvage treatment modalities in patients with aggressive B-cell non-Hodgkin lymphoma (NHL) who remain FDG-PET positive after R-CHOP chemotherapy. Existing data on these patients with FDG-PET primary refractory disease are limited. Patients with diffuse large B-cell lymphoma or grade 3 follicular lymphoma were retrospectively reviewed from the Prince of Wales Hospital databases. Eligibility criteria were: age≥18 years, treated with R-CHOP, with positive post-chemotherapy FDG-PET. Salvage treatment modalities were: radical radiotherapy (RT, dose≥30 Gy), high dose chemotherapy and autologous stem cell transplant (ASCT), or non-radical management. Survival was calculated from date of post-chemotherapy FDG-PET to last follow-up. Twenty-six patients from 2003-2015 met the inclusion criteria. Median age was 60 (range 19-84). Most had adverse baseline features: 21 (81%) stage III-IV, 24 (92%) bulky disease and nine (35%) skeletal involvement. Characteristics of PET-positivity post-chemotherapy were single site in 16 (62%), sites of prior bulk in 24 of 24, skeletal sites in five of nine, and able to be encompassed by RT in 21 (81%). Salvage treatment was: radical RT in 17 (65%), ASCT in four (15%) and non-radical in five (20%). Median follow-up of surviving patients was 31 months. Kaplan-Meier estimates of 3-year PFS and OS were 41% and 52%, respectively. By salvage modality, 3-year PFS was 51% for RT, 25% for ASCT and 20% for non-radical treatment, (P = 0.453); 3-year OS was respectively 65%, 25% and 40% (P = 0.173). Patients with FDG-PET positive disease after R-CHOP for aggressive B-cell NHL are salvageable with radiotherapy. © 2018 The Royal Australian and New Zealand College of Radiologists.

SU-F-T-27: A Comparative Case Study Among Four Modalities for the Superficial Treatment of Squamous Cell Carcinoma

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

Ashenafi, M; Koch, N; Peng, J

Purpose: We performed a comparative planning study among High Dose Rate (HDR) brachytherapy, superficial electrons, Volume Modulated Arc Therapy (VMAT), and Helical IMRT (Tomotherapy) for squamous cell carcinoma of the abdominal wall with consideration for the underlining bowel. Methods: A 69-year old female presented with squamous cell carcinoma protruding 8mm beyond the anterior skin surface of the midabdomen was considered for treatment. The patient had a ventral hernia which resulted in the reduction of the abdominal wall thickness and the adjacent small bowel being the dose limiting structure. Four plans were generated using different treatment modalities: a) an enface electronmore » field (eMC, Eclipse v. 11), b) Tomotherapy (HI-Art II v.5.0.5), c) VMAT (Acuros, Eclipse v. 11), and d) HDR using a Freiburg applicator (Oncentra v. 4.3). The following plan objectives were used for all four plans: for the CTV target, V90% ≥90% (61.8Gy2/2).For the small bowel, D0.1cc < 56.2 Gy2/2 was a hard constraint and expressed as a percentage of the prescription for comparison to demonstrate the dose fall-off achieved among the modalities.For HDR, V200% <0.1cc was an additional constraint. Multiple dosimetric parameters, including those listed above, were compared among the four modalities. Results: The HDR plan showed comparable target coverage compared to the Tomotherapy plan and better coverage compared to the electron plan. Small bowel doses (D0.1cc) were lower in HDR plan compared to Tomotherapy, electron, & VMAT plans (88.8%, 89.6%, 90.9%, & 96.6%). Integral dose to the whole body (V5%) was much higher for HDR, VMAT, and Tomotherapy when compared to electron plan by factors of seven, eight, and ten, respectively. After reviewing all treatment modalities, the physician selected HDR owing to better control of the small bowel dose while maintaining adequate target coverage. Conclusion: This case study demonstrated HDR can successfully treat superficial lesions with superior sparing of underlying structures.« less

Complementary and alternative exercise for fibromyalgia: a meta-analysis

PubMed Central

Mist, Scott David; Firestone, Kari A; Jones, Kim Dupree

2013-01-01

Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management. PMID:23569397

Modal Logics with Counting

NASA Astrophysics Data System (ADS)

Areces, Carlos; Hoffmann, Guillaume; Denis, Alexandre

We present a modal language that includes explicit operators to count the number of elements that a model might include in the extension of a formula, and we discuss how this logic has been previously investigated under different guises. We show that the language is related to graded modalities and to hybrid logics. We illustrate a possible application of the language to the treatment of plural objects and queries in natural language. We investigate the expressive power of this logic via bisimulations, discuss the complexity of its satisfiability problem, define a new reasoning task that retrieves the cardinality bound of the extension of a given input formula, and provide an algorithm to solve it.

Current applications of nanotechnology in dentistry: a review.

PubMed

Bhavikatti, Shaeesta Khaleelahmed; Bhardwaj, Smiti; Prabhuji, M L V

2014-01-01

With the increasing demand for advances in diagnosis and treatment modalities, nanotechnology is being considered as a groundbreaking and viable research subject. This technology, which deals with matter in nanodimensions, has widened our views of poorly understood health issues and provided novel means of diagnosis and treatment. Researchers in the field of dentistry have explored the potential of nanoparticles in existing therapeutic modalities with moderate success. The key implementations in the field of dentistry include local drug delivery agents, restorative materials, bone graft materials, and implant surface modifications. This review provides detailed insights about current developments in the field of dentistry, and discusses potential future uses of nanotechnology.

LongoVital- An Imminent Therapeutic Modality: An Unseen Drug Review with Advanced Features and Hypothesis

PubMed Central

Dua, Nisha; Kumar, Anand; Khanna, Ruchit; Khanna, Pyare Mohan Lal

2016-01-01

Herbal medication still happens to be the backbone of the major world’s population essentially because of the assumption that these drugs are free of any side effects and easily available. LongoVital (LV) is a herbal preparation with documented immune-modulatory and immune-stimulatory effects in man. Various studies conducted to date, have shown LV to have prolonged and beneficial impact in the treatment of orofacial diseases, when administered in recommended daily doses. With its combined antimicrobial and immunostimulatory effects, LV can be regarded as an emerging therapeutic modality in the treatment of orofacial diseases. PMID:27190969

Complementary and alternative medicine for childhood asthma: an overview of evidence and patents.

PubMed

Hon, Kam-Lun E; Fung, Ching Ki; Leung, Alexander K C; Leung, Theresa Ngan-Ho; Ng, Daniel K K

2015-01-01

Asthma is a prevalent childhood atopic disease associated with significant impairment of quality of life. Management relies on avoidance of triggers such as food and aeroallergens, the use of inhaled bronchodilators/corticosteroids and anti-allergic or immune-modulating therapies. Inhaled corticosteroids (ICSs) and bronchodilators have been the mainstay of treatment. In China as well as throughout Asia, myths and misconceptions on western medicine and corticosteroids are prevalent and result in non-adherence of treatment. A wide variety of complementary and alternative medicines (CAM) are available. Some of these have undergone extensive clinical trials and have been documented to have some therapeutic effects on asthma. Nevertheless, the majority of these treatment modalities is not efficacious and may even be detrimental. This article overviews the evidence for the clinical efficacy of all major CAM modalities. Despite CAM modalities are extensively used by the patients with asthma, very few CAM patents are available. This article also discusses recent patents pertinent to asthma. Only a few patents on herbal medicine for asthma have been evaluated but therapeutic efficacy is not substantially documented. Parents seeking CAM for asthma must consult qualified registered practitioners before using it.

[Which complementary and alternative medicine modalities are integrated within Israeli healthcare organizations and do they match the public's preferences?].

PubMed

Keshet, Yael; Ben-Arye, Eran

2011-08-01

Complementary and alternative medicine (CAM) is a broad term that encompasses diverse healthcare modalities that emanate from a variety of healing cultures. One of the basic principles of CAM is the promotion of cultural pluralism and openness to diverse cultural aspects of health and illness. Some CAM modalities have been integrated into Israeli healthcare organizations over the past two decades. The objective of this research was to examine whether the integrated CAM modalities match the preferences of Israel's diverse ethnic groups. The research was conducted in northern Israel, an area marked by ethnic and religious diversity. We gathered information about the types of CAM modalities included in the clinics of all four public health funds health maintenance organizations (HMOs)--by means of a telephone survey. This data was assessed in relation to previous data regarding patients' preferences on integrating CAM in community care. The 4 HMOs offer 24 CAM modalities within 58 clinics in northern Israel. The most common CAM modalities are: reflexology, Chinese Medicine and acupuncture, massage, shiatsu, twina, homeopathy and naturopathy. These modalities partly match the Jewish and Arab populations' preferences concerning Chinese medicine and touch/movement modalities. The Arab population, however, which reports greater use of folk-traditional medicine, such as consultation with healers and use of herbal medicine, do not have these treatment options available within healthcare organizations. Western-oriented CAM modalities are integrated within the IsraeLi HMOs, while local folk-traditional medicine is not. The integrated modalities accord with the Jewish populations' preferences more than with those of the Arab population. Some of the factors that influence integration are discussed. Certain homegrown traditional healthcare modalities, such as use of local medicinal herbs, should be considered for addition to current CAM practices. Developing integrative medicine within a common Jewish-Arabic space could have medical as well as social-cultural advantages.

Design and implementation of a novel modal space active force control concept for spatial multi-DOF parallel robotic manipulators actuated by electrical actuators.

PubMed

Yang, Chifu; Zhao, Jinsong; Li, Liyi; Agrawal, Sunil K

2018-01-01

Robotic spine brace based on parallel-actuated robotic system is a new device for treatment and sensing of scoliosis, however, the strong dynamic coupling and anisotropy problem of parallel manipulators result in accuracy loss of rehabilitation force control, including big error in direction and value of force. A novel active force control strategy named modal space force control is proposed to solve these problems. Considering the electrical driven system and contact environment, the mathematical model of spatial parallel manipulator is built. The strong dynamic coupling problem in force field is described via experiments as well as the anisotropy problem of work space of parallel manipulators. The effects of dynamic coupling on control design and performances are discussed, and the influences of anisotropy on accuracy are also addressed. With mass/inertia matrix and stiffness matrix of parallel manipulators, a modal matrix can be calculated by using eigenvalue decomposition. Making use of the orthogonality of modal matrix with mass matrix of parallel manipulators, the strong coupled dynamic equations expressed in work space or joint space of parallel manipulator may be transformed into decoupled equations formulated in modal space. According to this property, each force control channel is independent of others in the modal space, thus we proposed modal space force control concept which means the force controller is designed in modal space. A modal space active force control is designed and implemented with only a simple PID controller employed as exampled control method to show the differences, uniqueness, and benefits of modal space force control. Simulation and experimental results show that the proposed modal space force control concept can effectively overcome the effects of the strong dynamic coupling and anisotropy problem in the physical space, and modal space force control is thus a very useful control framework, which is better than the current joint space control and work space control. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Pheochromocytoma and Paraganglioma Treatment (PDQ®)—Health Professional Version

Cancer.gov

Pheochromocytoma and paraganglioma treatment is usually surgery, however, preoperative medical preparation is critical. Palliative care for metastatic disease may include chemotherapy, radiation therapy, targeted therapy, and other modalities. Get detailed information in this clinician summary.

Platelet-rich plasma-an 'Elixir' for treatment of alopecia: personal experience on 117 patients with review of literature.

PubMed

Garg, Suruchi; Manchanda, Shweta

2017-01-01

Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery and dermatology. PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias. Authors have proposed a hair model termed "Golden anchorage with 'molecular locking' of ectodermal and mesenchymal components for survival and integrity of hair follicle (HF)" in this article. Golden anchorage comprises of bulge stem cells, ectodermal basement membrane and bulge portion of APM. PRP with its autologous supply of millions of growth factors works on 'Golden anchorage' along with keratinocytes (PDGF), dermal papilla (IGF and fibroblast growth factor), vasculature (VEGF and PDGF) and neural cells (Nerve Growth Factor) in a multipronged manner serving as an 'elixir' for hair growth and improving overall environment.

Incidentally Detected Thyroid Follicular Neoplasm on Somatostatin Receptor Imaging and Post-therapy Scan.

PubMed

Sood, Apurva; Singh, Harpreet; Sood, Ashwani; Basher, Rajender Kumar; Mittal, Bhagwant Rai

2017-01-01

Peptide receptor radionuclide therapy (PRRT) either using Lu-177 or Y-90 peptide radiopharmaceuticals has emerged as promising treatment modality in patients with inoperable metastatic neuroendocrine tumour (NET) including medullary thyroid cancer, because of overexpression of somatostatin receptor 2 (sstr-2) on these cells. The several investigators have used PRRT in non-iodine avid differentiated thyroid cancer patients with limited success, where other treatment modalities have failed, probably due to faint sstr-2 expression in these lesions. However Hurthle cell neoplasms being predominantly non-iodine avid lesions have shown sstr-2 over-expression. The present case of inoperable NET patient imaged and treated with radiolabelled somatostatin analogue showed incidentally detected thyroid lesion highlighting the its importance in imaging and treatment in these type of thyroid malignancies.

Incidentally Detected Thyroid Follicular Neoplasm on Somatostatin Receptor Imaging and Post-therapy Scan

PubMed Central

Sood, Apurva; Singh, Harpreet; Sood, Ashwani; Basher, Rajender Kumar; Mittal, Bhagwant Rai

2017-01-01

Peptide receptor radionuclide therapy (PRRT) either using Lu-177 or Y-90 peptide radiopharmaceuticals has emerged as promising treatment modality in patients with inoperable metastatic neuroendocrine tumour (NET) including medullary thyroid cancer, because of overexpression of somatostatin receptor 2 (sstr-2) on these cells. The several investigators have used PRRT in non-iodine avid differentiated thyroid cancer patients with limited success, where other treatment modalities have failed, probably due to faint sstr-2 expression in these lesions. However Hurthle cell neoplasms being predominantly non-iodine avid lesions have shown sstr-2 over-expression. The present case of inoperable NET patient imaged and treated with radiolabelled somatostatin analogue showed incidentally detected thyroid lesion highlighting the its importance in imaging and treatment in these type of thyroid malignancies. PMID:28680210

Endoscopic management of difficult common bile duct stones

PubMed Central

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-01

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

Prevention of age-related macular degeneration

PubMed Central

Koo, Simon Chi Yan; Chan, Clement Wai Nang

2010-01-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula. PMID:20862519

Improving the analysis of composite endpoints in rare disease trials.

PubMed

McMenamin, Martina; Berglind, Anna; Wason, James M S

2018-05-22

Composite endpoints are recommended in rare diseases to increase power and/or to sufficiently capture complexity. Often, they are in the form of responder indices which contain a mixture of continuous and binary components. Analyses of these outcomes typically treat them as binary, thus only using the dichotomisations of continuous components. The augmented binary method offers a more efficient alternative and is therefore especially useful for rare diseases. Previous work has indicated the method may have poorer statistical properties when the sample size is small. Here we investigate small sample properties and implement small sample corrections. We re-sample from a previous trial with sample sizes varying from 30 to 80. We apply the standard binary and augmented binary methods and determine the power, type I error rate, coverage and average confidence interval width for each of the estimators. We implement Firth's adjustment for the binary component models and a small sample variance correction for the generalized estimating equations, applying the small sample adjusted methods to each sub-sample as before for comparison. For the log-odds treatment effect the power of the augmented binary method is 20-55% compared to 12-20% for the standard binary method. Both methods have approximately nominal type I error rates. The difference in response probabilities exhibit similar power but both unadjusted methods demonstrate type I error rates of 6-8%. The small sample corrected methods have approximately nominal type I error rates. On both scales, the reduction in average confidence interval width when using the adjusted augmented binary method is 17-18%. This is equivalent to requiring a 32% smaller sample size to achieve the same statistical power. The augmented binary method with small sample corrections provides a substantial improvement for rare disease trials using composite endpoints. We recommend the use of the method for the primary analysis in relevant rare disease trials. We emphasise that the method should be used alongside other efforts in improving the quality of evidence generated from rare disease trials rather than replace them.

Scar Management of the Burned Hand

PubMed Central

Sorkin, Michael; Cholok, David; Levi, Benjamin

2017-01-01

Unimpaired hand function is critical in almost all activities of daily living. Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Initial algorithms of acute burn management involve early debridement and skin grafting and early mobilization to prevent formation of hypertrophic scarring and ultimately digit contractures. While non-operative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated in order to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation with several modalities that address scar texture, color, pruritis and thickness. These can be utilized in conjunction with local corticosteroid treatment and other emerging modalities to modulate the scar and achieve optimal hand function. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars. PMID:28363297

Conversion of stranded waste-stream carbon and nutrients into value-added products via metabolically coupled binary heterotroph-photoautotroph system

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

Bohutskyi, Pavlo; Kucek, Leo A.; Hill, Eric

Metabolic flexibility and robustness of phototroph- heterotroph co-cultures provide a flexible binary engineering platform for a variety of biotechnological and environmental applications. Here, we metabolically coupled a heterotrophic bacterium Bacillus subtilis with astaxanthin producing alga Haematococcus pluvialis and successfully applied this binary co-culture for conversion of the starch-rich waste stream into valuable astaxanthin-rich biomass. Importantly, the implemented system required less mass transfer of CO2 and O2 due to in-situ exchange between heterotroph and phototroph, which can contribute to reduction in energy consumption for wastewater treatment. In addition, the maximum reduction in chemical oxygen demand, total nitrogen and phosphorus reached 65%,more » 55% and 30%, respectively. The preliminary economic analysis indicated that realization of produced biomass with 0.8% astaxanthin content may generate annual revenues of $3.2M (baseline scenario) from treatment of wastewater (1,090 m3/day) from a potato processing plant. Moreover, the revenues may be increased up to $18.2M for optimized scenario with astaxanthin content in algae of 2%. This work demonstrates a successful proof-of-principle for conversion of waste carbon and nutrients into targeted value-added products through metabolic connection of heterotrophic and phototrophic organisms. Utilization of heterotrophic-algal binary cultures opens new perspectives for designing highly-efficient production processes for feedstock biomass production as well as allows utilization of variety of organic agricultural, chemical, or municipal wastes.« less

[Current treatment of bacterial vaginosis].

PubMed

Borisov, I

1999-01-01

Therapeutic options for the treatment of accurately diagnosed bacterial vaginosis are reviewed on the basis of current concepts for treatment of bacterial vaginosis. The importance for screening for bacterial vaginosis is pointed out especially before intrauterine procedures and in pregnant women at risk for premature deliveries. Treatment regimens for pregnant women are discussed as well. Emphasis is given to treatment modalities for recurrent bacterial vaginosis.

Treatment of painful diabetic peripheral neuropathy.

PubMed

Rosenberg, Casandra J; Watson, James C

2015-02-01

Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. To discuss current treatment recommendations for painful diabetic peripheral neuropathy. Literature review. Systematic review of the literature discussing treatment of painful diabetic peripheral neuropathy. Existing treatment guidelines were studied and compared. Painful diabetic peripheral neuropathy occurs in about one in six people with diabetes. This condition impairs quality of life and increases healthcare costs. Treatment recommendations exist, but individual patient therapy can require a trial-and-error approach. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control. Adequate medication titration and a reasonable trial period should be allowed. The treatment of painful diabetic peripheral neuropathy can be challenging, but effective management can improve patient's quality of life. Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control. © The International Society for Prosthetics and Orthotics 2014.

Comparing methods for estimation of heterogeneous treatment effects using observational data from health care databases.

PubMed

Wendling, T; Jung, K; Callahan, A; Schuler, A; Shah, N H; Gallego, B

2018-06-03

There is growing interest in using routinely collected data from health care databases to study the safety and effectiveness of therapies in "real-world" conditions, as it can provide complementary evidence to that of randomized controlled trials. Causal inference from health care databases is challenging because the data are typically noisy, high dimensional, and most importantly, observational. It requires methods that can estimate heterogeneous treatment effects while controlling for confounding in high dimensions. Bayesian additive regression trees, causal forests, causal boosting, and causal multivariate adaptive regression splines are off-the-shelf methods that have shown good performance for estimation of heterogeneous treatment effects in observational studies of continuous outcomes. However, it is not clear how these methods would perform in health care database studies where outcomes are often binary and rare and data structures are complex. In this study, we evaluate these methods in simulation studies that recapitulate key characteristics of comparative effectiveness studies. We focus on the conditional average effect of a binary treatment on a binary outcome using the conditional risk difference as an estimand. To emulate health care database studies, we propose a simulation design where real covariate and treatment assignment data are used and only outcomes are simulated based on nonparametric models of the real outcomes. We apply this design to 4 published observational studies that used records from 2 major health care databases in the United States. Our results suggest that Bayesian additive regression trees and causal boosting consistently provide low bias in conditional risk difference estimates in the context of health care database studies. Copyright © 2018 John Wiley & Sons, Ltd.

The use of isotretinoin in acne

PubMed Central

2009-01-01

Systemic isotretinoin remains the most efficacious treatment for severe acne as well as many cases of more moderate disease that are unresponsive to other treatment modalities. The current chapter outlines the mechanisms behind the excellent efficacy, describes how to optimize treatment, reviews the recommended guidelines for monitoring and summarizes adverse effects. PMID:20436884

Quality of Life and Cost Effectiveness of Prostate Cancer Treatment

DTIC Science & Technology

2008-03-01

Study objective is to assess the effects of different treatments for prostate cancer on quality of life and cost of care for two ethnic groups. It...across ethnic groups; and (3) analyze resource utilization patterns, treatment modalities and quality of life of men with prostate cancer between non-VA

Treatment Service Patterns and Organizational Structures: An Analysis of Programs in DATOS-A.

ERIC Educational Resources Information Center

Delany, Peter J.; Broome, Kirk M.; Flynn, Patrick M.; Fletcher, Bennett W.

2001-01-01

Examined availability of various treatment services within a national sample of programs treating adolescent drug abuse patients. Created treatment service delivery profiles and examined them in context of organizational variables. Found that distinct profiles of services existed within residential and outpatient modalities and that these service…

Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion

ERIC Educational Resources Information Center

Hodge, David R.

2011-01-01

Cognitive-behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients. More specifically, by…

Treatment modalities in children with teeth affected by molar-incisor enamel hypomineralisation (MIH): A systematic review.

PubMed

Lygidakis, N A

2010-04-01

This was to review the literature concerning the treatment of permanent teeth with molar-incisor hypomineralised enamel (MIH), comment about possible shortcomings and propose areas of future research. A search of MedLine, Scopus, ResearchGate, Isis and Google Scholar databases was conducted using all terms relevant to the subject. Relevant papers published in English were identified after a review of their titles, abstracts or full reading of the papers. Of 189 references initially found, 66 papers were included; 34 directly relevant to the subject. From the latter, only 14 concerned laboratory or clinical studies dealing with treatment for MIH. Since 2000 11 reviews evaluated, to a certain extent, treatment options for affected teeth. Analysis of the proposed treatment modalities indicated options for prevention, restorations, and adhesion to hypomineralised enamel, full coronal coverage and extraction followed by orthodontics. Based on these findings, a treatment decision plan is proposed. Although treatment approaches for MIH have started to be clearer, long-term clinical trials, supported by laboratory studies, should be conducted to further facilitate the clinical management of this dental defect.

[Application of cantharidin, podophyllotoxin, and salicylic acid in recalcitrant plantar warts. A preliminary study].

PubMed

López-López, Daniel; Agrasar-Cruz, Carlos; Bautista-Casasnovas, Adolfo; Álvarez-Castro, Carlos Javier

2015-01-01

Plantar warts often are refractory to any treatment and can last for decades in adults. Recalcitrant warts are defined as those that have persisted for more than two years, or after at least two treatment modalities. A total of 15 consecutive patients with recalcitrant plantar warts were included in this preliminary study. The treatment consisted of applying one to two sessions that comprised compounding 1% cantharidin, 5% of podophyllotoxin, and 30% salicylic acid (CPS), with an interval between applications of four weeks. With treatment and subsequent follow-up for six months, there was complete eradication of lesions in 15 patients, eight (53.3%) required a single application of the solution, and seven (46.7%) two applications, with no side effects. Patient satisfaction related to treatment was measured by a visual analog scale (VAS) of 10 cm in length, with an average score 9.73 ± 0.46, and all said they would proceed with the treatment again if necessary. Topical treatment by compounding is safe, effective, and a promising therapeutic modality when applied in recalcitrant plantar warts.

Non-surgical management of early knee osteoarthritis.

PubMed

Kon, Elizaveta; Filardo, Giuseppe; Drobnic, Matej; Madry, Henning; Jelic, Mislav; van Dijk, Niek; Della Villa, Stefano

2012-03-01

Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future. Level of evidence IV.

Hemorrhoids and varicose veins: a review of treatment options.

PubMed

MacKay, D

2001-04-01

Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.

Use of complementary and alternative medicine by a sample of Turkish primary headache patients.

PubMed

Karakurum Göksel, Başak; Coşkun, Özlem; Ucler, Serap; Karatas, Mehmet; Ozge, Aynur; Ozkan, Secil

2014-01-01

Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache. One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches. The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not. Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

Electrotherapy: yesterday, today and tomorrow.

PubMed

Tiktinsky, R; Chen, L; Narayan, P

2010-07-01

The use of electrotherapy has been part of physical therapy treatment for the past few decades. There have been numerous modalities used such as TENS, interferential, diathermy, magnetic therapy, ultrasound, laser and surface electromyography to name a few. There has been an upsurge in the past decade of new and innovative modalities. There needs to be extensive research on each of these electrotherapy devices to determine the proper use of each device.

Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

PubMed

Api, Murat

2009-12-01

A number of novel surgical modalities that destroy or remove some ovarian tissue to restore ovarian function in patients with polycystic ovary syndrome have been described in the most recent literature. Although these modalities were reported to have easy applicability and low cost with shorter hospital stay, the efficacy and safety concerns need to be discussed extensively.

Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder.

PubMed

Ma, Sang-Yeol; Je, Hyun Dong; Jeong, Ji Hoon; Kim, Hae-Young; Kim, Hyeong-Dong

2013-01-01

To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder. A randomized trial. Hospital. Patients with AC of the shoulder (N=30). Patients were randomly assigned to 2 groups. The WBC group received physical therapy modalities, passive joint mobilization of the shoulder, and WBC, whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder. Visual analog scale (VAS), active range of motion (ROM) of flexion, abduction, internal and external rotation of the shoulder, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were measured before and after the intervention. A statistically significant difference between groups was found for the VAS, active ROM of flexion, abduction, internal rotation, and external rotation, and the ASES with greater improvements in the WBC group (Ps<.01). Overall, both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01. There is significant improvement with the addition of WBC to treatment interventions in this sample of patients. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis.

PubMed

Lin, Yi Hung; Tu, Yu Kang; Lu, Chun Tai; Chung, Wen Chen; Huang, Chiung Fang; Huang, Mao Suan; Lu, Hsein Kun

2014-01-01

Repigmentation variably occurs with different treatment methods in patients with gingival pigmentation. A systemic review was conducted of various treatment modalities for eliminating melanin pigmentation of the gingiva, comprising bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts, and laser techniques, to compare the recurrence rates (Rrs) of these treatment procedures. Electronic databases, including PubMed, Web of Science, Google, and Medline were comprehensively searched, and manual searches were conducted for studies published from January 1951 to June 2013. After applying inclusion and exclusion criteria, the final list of articles was reviewed in depth to achieve the objectives of this review. A Poisson regression was used to analyze the outcome of depigmentation using the various treatment methods. The systematic review was based on case reports mainly. In total, 61 eligible publications met the defined criteria. The various therapeutic procedures showed variable clinical results with a wide range of Rrs. A random-effects Poisson regression showed that cryosurgery (Rr = 0.32%), electrosurgery (Rr = 0.74%), and laser depigmentation (Rr = 1.16%) yielded superior result, whereas bur abrasion yielded the highest Rr (8.89%). Within the limit of the sampling level, the present evidence-based results show that cryosurgery exhibits the optimal predictability for depigmentation of the gingiva among all procedures examined, followed by electrosurgery and laser techniques. It is possible to treat melanin pigmentation of the gingiva with various methods and prevent repigmentation. Among those treatment modalities, cryosurgery, electrosurgery, and laser surgery appear to be the best choices for treating gingival pigmentation. © 2014 Wiley Periodicals, Inc.

Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations

PubMed Central

Pulcrano, Marisa; Feldman, Elizabeth D.; Patel, Ketan M.; Nahabedian, Maurice Y.; Weissler, Jason M.; Rodriguez, Eduardo D.

2015-01-01

Background Currently, there is a lack of clear guidelines regarding evaluation and management of giant juvenile fibroadenomas. The purpose of this study was to conduct a systematic review of giant juvenile fibroadenomas and to evaluate the most common diagnostic and therapeutic modalities. Methods A systematic literature search of PubMed and MEDLINE databases was conducted in February 2014 to identify articles related to giant juvenile fibroadenomas. Pooled outcomes are reported. Results Fifty-two articles (153 patients) met inclusion criteria. Mean age was 16.7 years old, with a mean lesion size of 11.2 cm. Most patients (86%) presented with a single breast mass. Imaging modalities included ultrasound in 72.5% and mammography in 26.1% of cases. Tissue diagnosis was obtained using a core needle biopsy in 18.3% of cases, fine-needle aspiration (FNA) in 25.5%, and excisional biopsy in 11.1% of patients. Surgical treatment was implemented in 98.7% of patients (mean time to treatment of 9.5 months, range, 3 days to 7 years). Surgical intervention included excision in all cases, of which four were mastectomies. Breast reconstruction was completed in 17.6% of cases. There were no postoperative complications. Conclusions Diagnosis and treatment of giant juvenile fibroadenoma is heterogeneous. There is a paucity of data to support observation and non-operative treatment. The most common diagnostic modalities include core needle or excisional biopsy. The mainstay of treatment is complete excision with an emphasis on preserving the developing breast parenchyma and nipple areolar complex. Breast reconstruction is uncommon, but may be necessary in certain cases. PMID:26312217

Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy

PubMed Central

Kim, Hyung Chan; Yoo, Dong Soo; Lee, Sang-Koo

2016-01-01

Objective Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality. Methods We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale. Results Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm. Conclusion We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration. PMID:27847578

Current concepts for the combined treatment modality of ionizing radiation with anticancer agents.

PubMed

Oehler, Christoph; Dickinson, Daniel J; Broggini-Tenzer, Angela; Hofstetter, Barbara; Hollenstein, Andreas; Riesterer, Oliver; Vuong, Van; Pruschy, Martin

2007-01-01

In current applied radiobiology, there exists a tremendous effort in basic and translational research to identify novel treatment modalities combining ionizing radiation with anticancer agents. This is mainly due to the highly improved molecular understanding of intrinsic radioresistance and the profiling of cellular stress responses to irradiation during recent years. Ionizing radiation not only damages DNA but also affects multiple cellular components that induce a multi-layered stress response. The treatment responses can be restricted to the individual cell level but might also be part of an intercellular stress communication network. Both DNA damage-induced signaling (which results in cell cycle arrest and induction of the DNA-repair machinery) and also ionizing radiation-induced signal transduction cascades, which are generated at cellular sites distant from and independent of DNA-damage, represent interesting targets for anticancer treatment modalities to sensitize for ionizing radiation. Due to the lack of molecular knowledge classic radiobiology assembled the cellular and tissue responses into four groups (4 R's of radiotherapy) which describe biological factors influencing the treatment response to fractionated radiotherapy. These classic 4 R's are Repair, Reassortment, Repopulation and Reoxygenation. With the tremendous progress in molecular oncology we now begin to understand theses factors on the molecular level. At the same time this classification may guide modern molecular radiobiologists to identify novel pharmaceuticals and antisignaling agents which can modulate the treatment response to irradiation. In this review we describe current approaches to sensitize tumor cells with novel anticancer agents along the lines of these 4 R's.

Verruca plana as a complication of CO2 laser treatment: a case report.

PubMed

Winn, Aubrey E; Kentosh, Joshua; Bingham, Jonathan L

2015-04-01

Carbon dioxide (CO2) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosmetic side effects. Here we report a case of verruca plana manifesting as a response to CO2 laser treatment. A 74-year-old female with recent Mohs surgery for a basal cell carcinoma, presented for full-face-fractionated CO2 treatment to address her surgical scars in addition to treating her mild diffuse actinic damage. Six weeks post treatment, the patient developed erythematous thin plaques over the areas that had been treated. Histology was consistent with verruca plana. Lesions showed mild improvement with topical tretinoin. Verruca plana are benign and typically self-limited; however, they can present a significant cosmetic burden to patients and are an important complication to consider when performing elective cosmetic procedures.

Picosecond 532-nm neodymium-doped yttrium aluminium garnet laser-a novel and promising modality for the treatment of café-au-lait macules.

PubMed

Artzi, Ofir; Mehrabi, Joseph N; Koren, Amir; Niv, Roni; Lapidoth, Moshe; Levi, Assi

2018-05-01

Café-au-lait macules (CALMs) present as benign hyperpigmented, well-circumscribed spots on the skin for which many patients seek treatment for aesthetic reasons. The objective of this study is to report our experience in treating CALMs using a picosecond 532-nm neodymium-doped yttrium aluminium garnet (PS 532 nm) laser. This is a retrospective case series of 16 patients with CALMs who were treated by a PS 532-nm laser (1-4 treatments, 4-8 weeks apart). Response as seen on clinical photographs was assessed by two independent dermatologists and graded on a scale of 0 (exacerbation) to 5 (95-100% improvement). Patient satisfaction and tolerance were documented at final visit. The results of 15 patients demonstrated significant improvement (average 3.43), and their satisfaction and tolerance levels were high. One patient had no response whatsoever to treatment. The PS 532-nm laser is a promising novel modality for the treatment of CALMs.

Surgical management of corneal infections.

PubMed

Tuli, Sonal; Gray, Matthew

2016-07-01

The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. Although the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Although there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient's situation. http://links.lww.com/COOP/A20.

Surgical management of corneal infections

PubMed Central

Tuli, Sonal; Gray, Matthew

2016-01-01

Purpose of review The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. While the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. Recent findings There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. While there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. Summary Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient’s situation. PMID:27096375

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature.

PubMed

Cheung, Vincent Y T

2015-01-01

The objective of this study was to determine the outcome of using ultrasound-guided local methotrexate injection as the first-line treatment of cesarean scar pregnancy (CSP). A literature review was performed on all eligible reports using this modality as the first-line treatment of CSP. Relevant publications were obtained from the PubMed electronic database from inception to December 2014. Ninety-six cases from 95 women reported in 17 articles were reviewed. The success rate was 73.9% after a single local methotrexate injection. An accumulated success rate of 88.5% could be achieved after additional local or intramuscular methotrexate administration. Eleven cases (11.5%) failed methotrexate treatment and required surgical interventions. Except for women with serum human chorionic gonadotropin levels higher than 100 000 IU/L, ultrasound-guided local methotrexate injection could be considered as a first-line treatment modality for CSP. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience.

PubMed

Fernando, Ruchira S W; Muthu, Carl

2014-08-01

To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). The outcomes of 354 consecutive EVLT procedures performed between 2007 and 2013 were reviewed. Data was collected from a prospectively maintained procedural database and by retrospective chart review. Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). EVLT is a safe and effective treatment for varicose veins and its adoption has allowed a large increase in the number of varicose vein patients treated at Auckland City Hospital.

SU-F-T-538: CyberKnife with MLC for Treatment of Large Volume Tumors: A Feasibility Study

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

Bichay, T; Mayville, A

2016-06-15

Purpose: CyberKnife is a well-documented modality for SRS and SBRT treatments. Typical tumors are small and 1–5 fractions are usually used. We determined the feasibility of using CyberKnife, with an InCise multileaf collimator option, for larger tumors undergoing standard dose and fractionation. The intent was to understand the limitation of using this modality for other external beam radiation treatments. Methods: Five tumors from different anatomical sites with volumes from 127.8 cc to 1,320.5 cc were contoured and planned on a Multiplan V5.1 workstation. The target average diameter ranged from 7 cm to 13 cm. The dose fractionation was 1.8–2.0 Gy/fractionmore » and 25–45 fractions for total doses of 45–81 Gy. The sites planned were: pancreas, head and neck, prostate, anal, and esophagus. The plans were optimized to meet conventional dose constraints based on various RTOG protocols for conventional fractionation. Results: The Multiplan treatment planning system successfully generated clinically acceptable plans for all sites studied. The resulting dose distributions achieved reasonable target coverage, all greater than 95%, and satisfactory normal tissue sparing. Treatment times ranged from 9 minutes to 38 minutes, the longest being a head and neck plan with dual targets receiving different doses and with multiple adjacent critical structures. Conclusion: CyberKnife, with the InCise multileaf collimation option, can achieve acceptable dose distributions in large volume tumors treated with conventional dose and fractionation. Although treatment times are greater than conventional accelerator time; target coverage and dose to critical structures can be kept within a clinically acceptable range. While time limitations exist, when necessary CyberKnife can provide an alternative to traditional treatment modalities for large volume tumors.« less

Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

PubMed

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

2008-07-08

Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

PubMed Central

Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

2008-01-01

Background Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated. PMID:18611250

Review of the treatment options for chronic constipation.

PubMed

Johanson, John F

2007-05-02

Constipation is a common gastrointestinal motility disorder that is often chronic, negatively affects patients' daily lives, and is associated with high healthcare costs. There is a considerable range of treatment modalities available for patients with constipation; however, the clinical evidence supporting their use varies widely. Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches, but data on the effectiveness of these measures are limited. The clinical benefits of various traditional pharmacologic agents (many of which are available over the counter, such as laxatives and fiber supplements) remain unclear. Although these modalities may benefit some patients with temporary constipation, their efficacy in patients for whom constipation is chronic is less well defined. Some studies suggest benefit with psyllium, polyethylene glycol, and lactulose; however, the use of other agents, such as calcium polycarbophil, methylcellulose, bran, magnesium hydroxide, and stimulant laxatives, is not supported by strong clinical evidence. More recently, newer agents have been approved for the treatment of patients with chronic constipation on the basis of comprehensive clinical investigation programs. Tegaserod, with its well-established clinical profile, and lubiprostone, the latest addition to the treatment armamentarium, represent the new generation of therapies for chronic constipation. This article reviews the efficacy and safety of traditional therapies used in the management of the multiple symptoms associated with chronic constipation and discusses recently approved and emerging therapies for this disorder.

[Cholinergic anti-inflammatory pathway of some non-pharmacological therapies of complementary medicine: possible implications for treatment of rheumatic and autoimmune diseases].

PubMed

Gamus, Dorit

2011-08-01

Rheumatologic and autoimmune diseases are among foremost diseases for which patients seek complementary and integrative medicine options. Therefore, physicians should be informed on the advances in research of these therapies, in order to be able to discuss possible indications and contraindications for these treatment modalities with their patients. This review summarizes several therapeutic modalities of complementary medicine that may be involved in the cholinergic anti-inflammatory pathway. The analysis of systematic reviews of acupuncture for rheumatic conditions has concluded that the evidence is sufficiently sound to warrant positive recommendations of this therapy for osteoarthritis, low back pain and lateral elbow pain. There is relatively strong evidence to support the use of hypnosis in pain treatment, such as in cases of fibromyalgia. A recent controlled study that evaLuated tai-chi in fibromyalgia has reported reductions in pain, improvements in mood, quality of Life, self efficacy and exercise capacity. There is also cumulative evidence that acupuncture, hypnosis and tai-chi may decrease the high frequency of heart rate variability, suggesting enhancement of vagus nerve activity. Hence, it has been hypothesized that these modalities might impact the cholinergic anti-inflammatory pathway to modulate inflammation. Further clinical and basic research to confirm this hypothesis should be performed in order to validate integration of these therapies in comprehensive treatment for some inflammatory and autoimmune diseases.

Reimbursements and frequency of tests in privately insured testicular cancer patients in the United States: Implications to national guidelines.

PubMed

Kamel, Mohamed H; Barber, Austin; Davis, Rodney; Raheem, Omer A; Bissada, Nabil; Abdelmaksoud, Alaa Eldin A; Eltahawy, Ehab

2017-01-01

The objective of this study was to assess the frequency of utilization and reimbursement of the common diagnostic tests and treatment modalities used in testicular cancer care. LifeLink™ (IMS Health, Danbury, CT, USA) Claims Database was used. We identified 877 subjects with a primary diagnosis of testicular cancer (ICD 186.9) between 2007 and 2012. Median reimbursement and frequency of the diagnostic/treatment modalities used were recorded. The most common claim was a vein puncture with median reimbursement of $9.11. Tumor markers, alpha-fetoprotein and beta human chorionic gonadotropin, were ranked 6 th and 7 th with median reimbursement of $52.13 and $48.71, respectively. Chest X-ray and computerized tomography (CT) scan of the chest were ranked 9 th and 13 th with median reimbursement of $68.51 and $769, respectively. A contrast CT scan of abdomen and pelvis was the 11 th most frequent claim with median reimbursement of $855.89. The three invasive treatment modalities, chemotherapy, radiation therapy, and retroperitoneal lymphadenectomy were ranked 8 th , 15 th , and 164 th with median reimbursement of $2858.38, $3988.25, and $2009.67, respectively. Testicular cancer is not an inexpensive disease. Surgery is the less utilized than radiation and chemotherapy despite lower cost. This may have implications to national guidelines and training since these treatments often carry the same grade of recommendation.

An auditory oddball brain-computer interface for binary choices.

PubMed

Halder, S; Rea, M; Andreoni, R; Nijboer, F; Hammer, E M; Kleih, S C; Birbaumer, N; Kübler, A

2010-04-01

Brain-computer interfaces (BCIs) provide non-muscular communication for individuals diagnosed with late-stage motoneuron disease (e.g., amyotrophic lateral sclerosis (ALS)). In the final stages of the disease, a BCI cannot rely on the visual modality. This study examined a method to achieve high accuracies using auditory stimuli only. We propose an auditory BCI based on a three-stimulus paradigm. This paradigm is similar to the standard oddball but includes an additional target (i.e. two target stimuli, one frequent stimulus). Three versions of the task were evaluated in which the target stimuli differed in loudness, pitch or direction. Twenty healthy participants achieved an average information transfer rate (ITR) of up to 2.46 bits/min and accuracies of 78.5%. Most subjects (14 of 20) achieved their best performance with targets differing in pitch. With this study, the viability of the paradigm was shown for healthy participants and will next be evaluated with individuals diagnosed with ALS or locked-in syndrome (LIS) after stroke. The here presented BCI offers communication with binary choices (yes/no) independent of vision. As it requires only little time per selection, it may constitute a reliable means of communication for patients who lost all motor function and have a short attention span. 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

NTCP reduction for advanced head and neck cancer patients using proton therapy for complete or sequential boost treatment versus photon therapy.

PubMed

Jakobi, Annika; Stützer, Kristin; Bandurska-Luque, Anna; Löck, Steffen; Haase, Robert; Wack, Linda-Jacqueline; Mönnich, David; Thorwarth, Daniel; Perez, Damien; Lühr, Armin; Zips, Daniel; Krause, Mechthild; Baumann, Michael; Perrin, Rosalind; Richter, Christian

2015-01-01

To determine by treatment plan comparison differences in toxicity risk reduction for patients with head and neck squamous cell carcinoma (HNSCC) from proton therapy either used for complete treatment or sequential boost treatment only. For 45 HNSCC patients, intensity-modulated photon (IMXT) and proton (IMPT) treatment plans were created including a dose escalation via simultaneous integrated boost with a one-step adaptation strategy after 25 fractions for sequential boost treatment. Dose accumulation was performed for pure IMXT treatment, pure IMPT treatment and for a mixed modality treatment with IMXT for the elective target followed by a sequential boost with IMPT. Treatment plan evaluation was based on modern normal tissue complication probability (NTCP) models for mucositis, xerostomia, aspiration, dysphagia, larynx edema and trismus. Individual NTCP differences between IMXT and IMPT (∆NTCPIMXT-IMPT) as well as between IMXT and the mixed modality treatment (∆NTCPIMXT-Mix) were calculated. Target coverage was similar in all three scenarios. NTCP values could be reduced in all patients using IMPT treatment. However, ∆NTCPIMXT-Mix values were a factor 2-10 smaller than ∆NTCPIMXT-IMPT. Assuming a threshold of ≥ 10% NTCP reduction in xerostomia or dysphagia risk as criterion for patient assignment to IMPT, less than 15% of the patients would be selected for a proton boost, while about 50% would be assigned to pure IMPT treatment. For mucositis and trismus, ∆NTCP ≥ 10% occurred in six and four patients, respectively, with pure IMPT treatment, while no such difference was identified with the proton boost. The use of IMPT generally reduces the expected toxicity risk while maintaining good tumor coverage in the examined HNSCC patients. A mixed modality treatment using IMPT solely for a sequential boost reduces the risk by 10% only in rare cases. In contrast, pure IMPT treatment may be reasonable for about half of the examined patient cohort considering the toxicities xerostomia and dysphagia, if a feasible strategy for patient anatomy changes is implemented.

A robust probabilistic collaborative representation based classification for multimodal biometrics

NASA Astrophysics Data System (ADS)

Zhang, Jing; Liu, Huanxi; Ding, Derui; Xiao, Jianli

2018-04-01

Most of the traditional biometric recognition systems perform recognition with a single biometric indicator. These systems have suffered noisy data, interclass variations, unacceptable error rates, forged identity, and so on. Due to these inherent problems, it is not valid that many researchers attempt to enhance the performance of unimodal biometric systems with single features. Thus, multimodal biometrics is investigated to reduce some of these defects. This paper proposes a new multimodal biometric recognition approach by fused faces and fingerprints. For more recognizable features, the proposed method extracts block local binary pattern features for all modalities, and then combines them into a single framework. For better classification, it employs the robust probabilistic collaborative representation based classifier to recognize individuals. Experimental results indicate that the proposed method has improved the recognition accuracy compared to the unimodal biometrics.

Is the perceived placebo effect comparable between adults and children? A meta-regression analysis.

PubMed

Janiaud, Perrine; Cornu, Catherine; Lajoinie, Audrey; Djemli, Amina; Cucherat, Michel; Kassai, Behrouz

2017-01-01

A potential larger perceived placebo effect in children compared with adults could influence the detection of the treatment effect and the extrapolation of the treatment benefit from adults to children. This study aims to explore this potential difference, using a meta-epidemiological approach. A systematic review of the literature was done to identify trials included in meta-analyses evaluating a drug intervention with separate data for adults and children. The standardized mean change and the proportion of responders (binary outcomes) were used to calculate the perceived placebo effect. A meta-regression analysis was conducted to test for the difference between adults and children of the perceived placebo effect. For binary outcomes, the perceived placebo effect was significantly more favorable in children compared with adults (β = 0.13; P = 0.001). Parallel group trials (β = -1.83; P < 0.001), subjective outcomes (β = -0.76; P < 0.001), and the disease type significantly influenced the perceived placebo effect. The perceived placebo effect is different between adults and children for binary outcomes. This difference seems to be influenced by the design, the disease, and outcomes. Calibration of new studies for children should consider cautiously the placebo effect in children.

Evolution of Binary Supermassive Black Holes in Rotating Nuclei

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

Rasskazov, Alexander; Merritt, David

The interaction of a binary supermassive black hole with stars in a galactic nucleus can result in changes to all the elements of the binary’s orbit, including the angles that define its orientation. If the nucleus is rotating, the orientation changes can be large, causing large changes in the binary’s orbital eccentricity as well. We present a general treatment of this problem based on the Fokker–Planck equation for f , defined as the probability distribution for the binary’s orbital elements. First- and second-order diffusion coefficients are derived for the orbital elements of the binary using numerical scattering experiments, and analyticmore » approximations are presented for some of these coefficients. Solutions of the Fokker–Planck equation are then derived under various assumptions about the initial rotational state of the nucleus and the binary hardening rate. We find that the evolution of the orbital elements can become qualitatively different when we introduce nuclear rotation: (1) the orientation of the binary’s orbit evolves toward alignment with the plane of rotation of the nucleus and (2) binary orbital eccentricity decreases for aligned binaries and increases for counteraligned ones. We find that the diffusive (random-walk) component of a binary’s evolution is small in nuclei with non-negligible rotation, and we derive the time-evolution equations for the semimajor axis, eccentricity, and inclination in that approximation. The aforementioned effects could influence gravitational wave production as well as the relative orientation of host galaxies and radio jets.« less

Treatment deintensification in human papillomavirus-positive oropharynx cancer: Outcomes from the National Cancer Data Base.

PubMed

Cheraghlou, Shayan; Yu, Phoebe K; Otremba, Michael D; Park, Henry S; Bhatia, Aarti; Zogg, Cheryl K; Mehra, Saral; Yarbrough, Wendell G; Judson, Benjamin L

2018-02-15

The growing epidemic of human papillomavirus-positive (HPV+) oropharyngeal cancer and the favorable prognosis of this disease etiology have led to a call for deintensified treatment for some patients with HPV+ cancers. One of the proposed methods of treatment deintensification is the avoidance of chemotherapy concurrent with definitive/adjuvant radiotherapy. To the authors' knowledge, the safety of this form of treatment de-escalation is unknown and the current literature in this area is sparse. The authors investigated outcomes after various treatment combinations stratified by American Joint Committee on Cancer (AJCC) eighth edition disease stage using patients from the National Cancer Data Base. A retrospective study of 4443 patients with HPV+ oropharyngeal cancer in the National Cancer Data Base was conducted. Patients were stratified into AJCC eighth edition disease stage groups. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted. For patients with stage I disease, treatment with definitive radiotherapy was associated with diminished survival compared with chemoradiotherapy (hazard ratio [HR], 1.798; P = .029), surgery with adjuvant radiotherapy (HR, 2.563; P = .002), or surgery with adjuvant chemoradiotherapy (HR, 2.427; P = .001). For patients with stage II disease, compared with treatment with chemoradiotherapy, patients treated with a single-modality (either surgery [HR, 2.539; P = .009] or radiotherapy [HR, 2.200; P = .030]) were found to have poorer survival. Among patients with stage III disease, triple-modality therapy was associated with improved survival (HR, 0.518; P = .024) compared with treatment with chemoradiotherapy. Deintensification of treatment from chemoradiotherapy to radiotherapy or surgery alone in cases of HPV+ AJCC eighth edition stage I or stage II disease may compromise patient safety. Treatment intensification to triple-modality therapy for patients with stage III disease may improve survival in this group. Cancer 2018;124:717-26. © 2017 American Cancer Society. © 2017 American Cancer Society.

Accuracy and Landmark Error Calculation Using Cone-Beam Computed Tomography–Generated Cephalograms

PubMed Central

Grauer, Dan; Cevidanes, Lucia S. H.; Styner, Martin A.; Heulfe, Inam; Harmon, Eric T.; Zhu, Hongtu; Proffit, William R.

2010-01-01

Objective To evaluate systematic differences in landmark position between cone-beam computed tomography (CBCT)–generated cephalograms and conventional digital cephalograms and to estimate how much variability should be taken into account when both modalities are used within the same longitudinal study. Materials and Methods Landmarks on homologous cone-beam computed tomographic–generated cephalograms and conventional digital cephalograms of 46 patients were digitized, registered, and compared via the Hotelling T2 test. Results There were no systematic differences between modalities in the position of most landmarks. Three landmarks showed statistically significant differences but did not reach clinical significance. A method for error calculation while combining both modalities in the same individual is presented. Conclusion In a longitudinal follow-up for assessment of treatment outcomes and growth of one individual, the error due to the combination of the two modalities might be larger than previously estimated. PMID:19905853

Volume curtaining: a focus+context effect for multimodal volume visualization

NASA Astrophysics Data System (ADS)

Fairfield, Adam J.; Plasencia, Jonathan; Jang, Yun; Theodore, Nicholas; Crawford, Neil R.; Frakes, David H.; Maciejewski, Ross

2014-03-01

In surgical preparation, physicians will often utilize multimodal imaging scans to capture complementary information to improve diagnosis and to drive patient-specific treatment. These imaging scans may consist of data from magnetic resonance imaging (MR), computed tomography (CT), or other various sources. The challenge in using these different modalities is that the physician must mentally map the two modalities together during the diagnosis and planning phase. Furthermore, the different imaging modalities will be generated at various resolutions as well as slightly different orientations due to patient placement during scans. In this work, we present an interactive system for multimodal data fusion, analysis and visualization. Developed with partners from neurological clinics, this work discusses initial system requirements and physician feedback at the various stages of component development. Finally, we present a novel focus+context technique for the interactive exploration of coregistered multi-modal data.

The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review.

PubMed

Ashrafi, Mohammed; Alonso-Rasgado, Teresa; Baguneid, Mohamed; Bayat, Ardeshir

2017-02-01

Current gold standard lower extremity cutaneous wound management is not always effective. Cutaneous wounds generate a "current of injury" which is directly involved in wound healing processes. Application of exogenous electrical stimulation has been hypothesised to imitate the natural electric current that occurs in cutaneous wounds. The aim of this extensive review was to provide a detailed update on the variety of electrical stimulation modalities used in the management of lower extremity wounds. Several different waveforms and delivery methods of electrical stimulation have been used. Pulsed current appears superior to other electrical modalities available. The majority of studies support the beneficial effects of pulsed current over conservative management of lower extremity cutaneous wounds. Although it appears to have no benefit over causal surgical intervention, it is a treatment option which could be utilised in those patients unsuitable for surgery. Other waveforms and modalities appear promising; however, they still lack large trial data to recommend a firm conclusion with regards to their use. Current studies also vary in quantity, quality and protocol across the different modalities. The ideal electrical stimulation device needs to be non-invasive, portable and cost-effective and provides minimal interference with patients' daily life. Further studies are necessary to establish the ideal electrical stimulation modality, parameters, method of delivery and duration of treatment. The development and implementation of newer devices in the management of acute and chronic wounds provides an exciting direction in the field of electrotherapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Integrative Medicine Preferences Among Coccidioidomycosis (Valley Fever) Patients.

PubMed

Short, Jack H; Bradley, Constance; Blair, Janis E; Stewart, Terry D; Burns, Mark W; Patron, Roberto L; Millstine, Denise M

2017-02-01

To understand the extent and modalities of integrative medicine strategies that patients with coccidioidomycosis (valley fever) have incorporated into their treatment regimens. A direct patient survey was distributed, with 100 unique responses, at a single infectious diseases clinic at an academic medical center in Arizona. Eligible patients, defined as those with confirmed coccidioidomycosis or currently under evaluation, were polled on their personal use of 36 integrative medicine modalities. Patients were also asked to indicate their level of fatigue on a 10-point scale in an attempt to correlate levels of fatigue to use of specific integrative medicine modalities. Of the patients surveyed, 64% had used at least one integrative medicine modality, and 53% used two or more, along with conventional medical therapy. The top three modalities were nutrition (39%), massage (27%), and breathing exercises (26%). The mean reported fatigue level was 4.7 on a 10-point scale, with a standard deviation of 3.0. There was no statistically significant association between use of a specific modality and reported level of fatigue. Nearly two thirds of patients (64%) surveyed had used at least one integrative medicine modality throughout the course of their therapy. Clinicians are probably unaware of the extent to which many patients, including this population, have embraced integrative medicine. Awareness of patients' goal and preferences is valuable in shared clinical decision making.

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

PubMed

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

2014-06-01

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

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

ERIC Educational Resources Information Center

Friedman-Cohen, Nancy; Kenward, Kevin

1981-01-01

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

Siah1/2 Ubiquitin Ligases in ER Stress Signaling in Melanoma

DTIC Science & Technology

2015-10-01

expression of RTK including EGFR, PDGFR and AXL , which were shown to be important in melanoma resistance phenotypes. This study was published few months ago...year will establish novel therapeutic modality for treatment of cancer, focused on melanoma. Major Task 3: Determine the effect of Siah1/2 and ER...foundation for novel stratification methods and therapeutic modalities for BCa. Specific Aims: (1) Identify RNF5-dependent and -independent

New perspectives in the treatment of body dysmorphic disorder

PubMed Central

Hong, Kevin; Nezgovorova, Vera; Hollander, Eric

2018-01-01

Body dysmorphic disorder (BDD) is a disabling illness with a high worldwide prevalence. Patients demonstrate a debilitating preoccupation with one or more perceived defects, often marked by poor insight or delusional convictions. Multiple studies have suggested that selective serotonin reuptake inhibitors and various cognitive behavioral therapy modalities are effective first-line treatments in decreasing BDD severity, relieving depressive symptoms, restoring insight, and increasing quality of life. Selective serotonin reuptake inhibitors have also recently been shown to be effective for relapse prevention. This review provides a comprehensive summary of the current understanding of BDD, including its clinical features, epidemiology, genetics, and current treatment modalities. Additional research is needed to fully elucidate the relationship between BDD and comorbid illnesses such as obsessive–compulsive-related disorders and depression and to develop therapies for refractory patients and those who have contraindications for pharmacological intervention. PMID:29636904

Radical prostatectomy in the 21st century - the gold standard for localized and locally advanced prostate cancer.

PubMed

Schostak, M; Miller, K; Schrader, M

2008-01-01

Radical prostatectomy for treatment of prostate cancer is a technically sophisticated operation. Simpler therapies have therefore been developed in the course of decades. The decisive advantage of a radical operation is the chance of a cure with minimal collateral damage. It is the only approach that enables precise tumor staging. The 10-year progression-free survival probability is approximately 85% for a localized tumor with negative resection margins. This high cure rate is unsurpassed by competitive treatment modalities. Nowadays, experienced surgeons achieve excellent functional results (for example, recovery of continence and erectile function) with minimum morbidity. Even in the locally advanced stage, results are very good compared to those obtained with other treatment modalities. Pathological staging enables stratified adjuvant therapy based on concrete information. The overall prognosis can thus be significantly improved.

Treatment of Lipoma by Injection Lipolysis

PubMed Central

Nanda, Soni

2011-01-01

Injection lipolysis or lipodissolve is the practice of injecting phosphatidyl choline/ sodium deoxycholate (PDC/DC) compounds in the subcutaneous fat. Though this practice is being used extensively for nonsurgical contouring of body and dissolving localized collections of excess fat, it's use as a treatment modality for lipomas needs further evaluation. We present a case where this technique was used for treating a lipoma, with no recurrence after 9 months of follow up. Injection lipolysis as a treatment modality for lipomas needs to be evaluated for safety and efficacy in trials on larger population. This could prove to be a very valuable adjunct to the current practice of excision, if done by a trained person in a properly selected patient. Also the side effects and the controversies regarding this procedure have been discussed in detail in the present paper. PMID:21976907

The principle of a three-staged operation in the surgery of acne scars.

PubMed

Whang, K K; Lee, M

1999-01-01

Acne scars cannot be effectively corrected by a single treatment modality because of their widely varied depth and width. We assessed the effectiveness of staged combinations of several surgical modalities in the treatment of acne scars. Focal chemical peeling, carbon dioxide (CO2) laser, scar excision, punch grafting, and dermabrasion were used. Initially, focal chemical peeling was performed on all patients and then CO2 laser, scar excision, and punch grafts were used for deep scars. Finally, dermabrasion was done for the remaining scars. Seventy-five percent of patients showed excellent or good results. The degree of improvement increased as the follow-up periods and number of focal chemical peeling procedures increased and as the 3-staged operation progressed. A 3-staged operation is effective in the treatment of patients with various types of acne scars.

Self-Treatment of Pain in a Rural Area

ERIC Educational Resources Information Center

Vallerand, April Hazard; Fouladbakhsh, Judith M.; Templin, Thomas

2004-01-01

In the United States, 42% of adults say they experience pain daily, the majority often relying on self-treatment. In addition, an increasing number of people are seeking complementary/alternative therapies, often without informing their health care providers. Purpose: To explore the occurrence of pain and the modalities of self-treatment used by…

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review.

PubMed

Weiskittle, Rachel E; Gramling, Sandra E

2018-01-01

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

The History and Evolution of Internal Maxillary Artery Bypass.

PubMed

Wang, Long; Cai, Li; Lu, Shuaibin; Qian, Hai; Lawton, Michael T; Shi, Xiang'en

2018-05-01

Internal maxillary artery (IMA) bypass has gained momentum in the last 5 years for the treatment of complex cerebrovascular disorders and skull base tumors. However, some issues regarding this treatment modality have been proposed. As one of the most experienced neurosurgical teams to perform internal maxillary artery bypass in the world (>100 clinical cases), we reviewed the literature in aspects of basic anatomy of maxillary artery with its variations to the lateral pterygoid muscle, initial anastomosis modalities, and subsequent exposure techniques in cadaver studies, preoperative arterial evaluation methods, optimal interposed graft selections, and surgical outcome in the management of complex aneurysms, skull base tumors, and steno-occlusive disorders. Copyright © 2018 Elsevier Inc. All rights reserved.

Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

PubMed Central

Pak, Jae; Kim, Jino

2017-01-01

Two relatively new modalities, follicular unit extraction (FUE) and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5%) and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination. PMID:29263945

Pseudofolliculitis barbae: review and update on new treatment modalities.

PubMed

Garcia-Zuazaga, Jorge

2003-07-01

Pseudofolliculits barbae, PFB, is a common cutaneous disease encountered frequently in medical practice. PFB represents a chronic inflammatory condition of the hair follicle caused by ingrown hairs producing an inflammatory foreign body reaction. The pathogenesis of PFB is multifactorial. Factors such as hair type and direction of hair growth play a role in the initial inflammatory reaction. In the armed forces, PFB represents a real challenge for both the physician and the patient. The combat environment, with the recent threat of biological and chemical weapons, requires the servicemen to be clean-shaven for appropriate gas mask fitting around the face. This article will review the etiology, pathogenesis, classification, and newer treatment modalities in the management of PFB.

Nonmetastatic Castration-resistant Prostate Cancer: A Modern Perspective.

PubMed

Cancian, Madeline; Renzulli, Joseph F

2018-06-01

Nonmetastatic castration-resistant prostate cancer (nmCRPC) presents a challenge to urologists as currently there are no Food and Drug Administration-approved therapies. However, there are new imaging modalities, including fluciclovine positron emission tomography-computed tomography and Ga-PSMA (prostate specific membrane antigent) positron emission tomography-computed tomography, which are improving accuracy of diagnosis. With improved imaging, we are better able to target therapy. Today there are 3 ongoing clinical trials studying second-generation antiandrogens in nmCRPC, which hold the promise of a new treatment paradigm. In this article, we will review the new imaging techniques and the rationale behind novel treatment modalities in nmCRPC. Copyright © 2018 Elsevier Inc. All rights reserved.

Optimal Use of Combined Modality Therapy in the Treatment of Esophageal Cancer.

PubMed

Shaikh, Talha; Meyer, Joshua E; Horwitz, Eric M

2017-07-01

Esophageal cancer is associated with a poor prognosis with 5-year survival rates of approximately 15% to 20%. Although patients with early stage disease may adequately be treated with a single modality, combined therapy typically consisting of neoadjuvant chemoradiation followed by esophagectomy is being adopted increasingly in patients with locally advanced disease. In patients who are not surgical candidates, definitive chemoradiation is the preferred treatment approach. All patients with newly diagnosed esophageal cancer should be evaluated in the multidisciplinary setting by a surgeon, radiation oncologist, and medical oncologist owing to the importance of each specialty in the management of these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of single and binary combinations of plant-derived molluscicides on reproduction and survival of the snail Achatina fulica.

PubMed

Rao, I G; Singh, D K

2000-11-01

The effects of sublethal treatments (20% and 60% of LC(50)/24 h) with plant-derived molluscicides on the reproduction of the giant African snail Achatina fulica were studied. Azadirachta indica oil, Cedrus deodara oil, Allium sativum bulb powder, and Nerium indicum bark powder singly and binary combinations on reproduction and survival of A. fulica were investigated. Repeated treatment occurred on day 0, day 15, and day 30. These plant-derived molluscicides significantly reduced fecundity, egg viability, and survival of A. fulica within 15 days. Discontinuation of the treatments after day 30 did not lead to a recovery trend in the next 30 days. Day 0 sublethal treatment of all the molluscicides caused a maximum reduction in protein, amino acid, DNA, RNA, and phospholipid levels and simultaneous increase in lipid peroxidation in the ovotestis of treated A. fulica. It is believed that sublethal exposure of these molluscicides on snail reproduction is a complex process, involving more than one factor in reducing the reproductive capacity of A. fulica.

Medical expulsive treatment in pediatric urolithiasis.

PubMed

Atan, Ali; Balcı, Melih

2015-03-01

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

Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome.

PubMed

Fernie, Bruce A; Murphy, Gabrielle; Wells, Adrian; Nikčević, Ana V; Spada, Marcantonio M

2016-07-01

Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS). One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up. In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities. Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities. The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.

Emerging immunotherapy for the treatment of esophageal cancer.

PubMed

Jackie Oh, SeungJu; Han, Songhee; Lee, Wooin; Lockhart, A Craig

2016-06-01

Esophageal cancer is the third most common cancer of the gastrointestinal tract. Despite new therapies, the prognosis for patients with these cancers remains poor with 5-year survival rates lower than 15%. Recently, immunotherapy has increasingly gained attention as a novel treatment strategy for advanced esophageal cancer. Recent success of immunotherapy in treating other solid tumors has shed light on the utility of these approaches for esophageal cancers. Here, the authors focus on antibody-based, adoptive-cell-therapy-based, and vaccine-based immunotherapies, and briefly address their rationale, clinical data, and implications. Immunotherapy is now established to be a key treatment modality that can improve the outcomes of many cancer patients and appears to be ushering in a new era in cancer treatment. Checkpoint inhibitor drugs have shown preliminary favorable results in esophageal cancer treatment. Adoptive cell therapy and vaccine studies have also shown some promise in various clinical studies. Future endeavors will need to focus on identifying patients who are likely to benefit from immunotherapy, monitoring and managing immune responses and designing optimal combination strategies where immunotherapy agents are combined with other traditional treatment modalities.

Modality and risk management for orthodontic extrusion procedures in interdisciplinary treatment for generating proper bone and tissue contours for the planned implant: a case report.

PubMed

Maeda, Sachiko; Sasaki, Takeshi

2015-12-01

In adult interdisciplinary treatments with using dental implants, limited orthodontic treatment, especially orthodontic extrusion (OE), offers many benefits by both correcting teeth alignment and by contributing to the regeneration of periodontal tissues. However, orthodontic procedures carry some risks and unpredictabilities that might compromise tooth and/or periodontal tissue health. Especially in complex cases, it is difficult to decide which orthodontic treatment modalities should be combined, in what sequences they should be applied, and what their force systems and treatment times are.To achieve optimum results, some cases require two or more OEs to the same site being carried out at different times while taking the treatment effects into consideration. Such staged OE offers minimum intervention and maximum efficiency. In this case report, OE was first applied for orthodontic extraction. After bone regeneration followed by an implant placement and another surgical operation, a second OE was applied to align the inclination of an adjacent tooth. As a result, a predictable prognosis of implants as well as greatly improved esthetics and periodontal tissue health were achieved.

Pulsed Radiofrequency Ablation Under Ultrasound Guidance for Huge Neuroma

PubMed Central

Jung, Il; Lee, Chang Hee; Kim, Se Hun; Kim, Jin Sun; Yoo, Byoung Woo

2014-01-01

Amputation neuroma can cause very serious, intractable pain. Many treatment modalities are suggested for painful neuroma. Pharmacologic treatment shows a limited effect on eliminating the pain, and surgical treatment has a high recurrence rate. We applied pulsed radiofrequency treatment at the neuroma stalk under ultrasonography guidance. The long-term outcome was very successful, prompting us to report this case. PMID:25031817

Treatment modalities for burning mouth syndrome: a systematic review.

PubMed

de Souza, Isadora Follak; Mármora, Belkiss Câmara; Rados, Pantelis Varvaki; Visioli, Fernanda

2018-06-01

In the burning mouth syndrome (BMS), patients experience a burning sensation in the oral cavity with no associated injury or clinical manifestation. The etiology of this condition is still poorly understood, and therefore, treatment is challenging. The aim of this study is to perform a systematic review of treatment possibilities described in the literature for BMS. PubMed, Embase, and SciELO databases were searched for randomized clinical trials published between 1996 and 2016. Following application of inclusion and exclusion criteria, 29 papers were analyzed and divided into five subcategories according to the type of treatment described: antidepressants, alpha-lipoic acid, phytotherapeutic agents, analgesic and anti-inflammatory agents, and non-pharmacological therapies. In each category, the results found were compared with regard to the methodology employed, sample size, assessment method, presence or absence of adverse effects, and treatment outcomes. The analysis revealed that the use of antidepressants and alpha-lipoic acid has been showing promising results; however, more studies are necessary before we can have a first-line treatment strategy for patients with BMS. To review systematically the literature about Burning Mouth Syndrome treatment may aid the clinicians to choose the treatment modality to improve patients symptoms based on the best evidence.

ADMultiImg: a novel missing modality transfer learning based CAD system for diagnosis of MCI due to AD using incomplete multi-modality imaging data

NASA Astrophysics Data System (ADS)

Liu, Xiaonan; Chen, Kewei; Wu, Teresa; Weidman, David; Lure, Fleming; Li, Jing

2018-02-01

Alzheimer's Disease (AD) is the most common cause of dementia and currently has no cure. Treatments targeting early stages of AD such as Mild Cognitive Impairment (MCI) may be most effective to deaccelerate AD, thus attracting increasing attention. However, MCI has substantial heterogeneity in that it can be caused by various underlying conditions, not only AD. To detect MCI due to AD, NIA-AA published updated consensus criteria in 2011, in which the use of multi-modality images was highlighted as one of the most promising methods. It is of great interest to develop a CAD system based on automatic, quantitative analysis of multi-modality images and machine learning algorithms to help physicians more adequately diagnose MCI due to AD. The challenge, however, is that multi-modality images are not universally available for many patients due to cost, access, safety, and lack of consent. We developed a novel Missing Modality Transfer Learning (MMTL) algorithm capable of utilizing whatever imaging modalities are available for an MCI patient to diagnose the patient's likelihood of MCI due to AD. Furthermore, we integrated MMTL with radiomics steps including image processing, feature extraction, and feature screening, and a post-processing for uncertainty quantification (UQ), and developed a CAD system called "ADMultiImg" to assist clinical diagnosis of MCI due to AD using multi-modality images together with patient demographic and genetic information. Tested on ADNI date, our system can generate a diagnosis with high accuracy even for patients with only partially available image modalities (AUC=0.94), and therefore may have broad clinical utility.

Patients' and urologists' preferences for prostate cancer treatment: a discrete choice experiment

PubMed Central

de Bekker-Grob, E W; Bliemer, M C J; Donkers, B; Essink-Bot, M-L; Korfage, I J; Roobol, M J; Bangma, C H; Steyerberg, E W

2013-01-01

Background: Patients' preferences are important for shared decision making. Therefore, we investigated patients' and urologists' preferences for treatment alternatives for early prostate cancer (PC). Methods: A discrete choice experiment was conducted among 150 patients who were waiting for their biopsy results, and 150 urologists. Regression analysis was used to determine patients' and urologists' stated preferences using scenarios based on PC treatment modality (radiotherapy, surgery, and active surveillance (AS)), and risks of urinary incontinence and erectile dysfunction. Results: The response rate was 110 out of 150 (73%) for patients and 50 out of 150 (33%) for urologists. Risk of urinary incontinence was an important determinant of both patients' and urologists' stated preferences for PC treatment (P<0.05). Treatment modality also influenced patients' stated preferences (P<0.05), whereas the risk of erectile dysfunction due to radiotherapy was mainly important to urologists (P<0.05). Both patients and urologists preferred AS to radical treatment, with the exception of patients with anxious/depressed feelings who preferred radical treatment to AS. Conclusion: Although patients and urologists generally may prefer similar treatments for PC, they showed different trade-offs between various specific treatment aspects. This implies that urologists need to be aware of potential differences compared with the patient's perspective on treatment decisions in shared decision making on PC treatment. PMID:23860533

Cooling Rate Study of Nickel-Rich Material During Thermal Treatment and Quench

NASA Technical Reports Server (NTRS)

Thomas, Fransua; Murguia, Silvia Briseno (Editor)

2016-01-01

To investigate quench cracking that results from water quenching after heat treatment of binary and Ni-rich material, cooling rates of specimens were measured during quenching and hardness post-thermal treatment. For specific applications binary Ni-Ti is customarily thermally treated and quenched to attain desired mechanical properties and hardness. However, one problem emerging from this method is thermal cracking, either during the heat treatment process or during the specimen's application. This can result in material and equipment failure as well as financial losses. The objective of the study is to investigate the internal cooling rate of 60-NiTi during quenching and determine possible factors causing thermal cracking. Cubic (1 in.3) samples of both material were heat treated in air at 1000 deg C for 2 hrs and quenched in room temperature water using two methods: (1) dropped in the water and (2) agitated in the water. Hardness of the two fore-mentioned methods was measured post heat treatment. Results indicate that the quenching method had an effect on cooling rate during quenching but hardness was observed to be essentially the same through the thickness of the samples.

SU-E-T-509: Inter-Observer and Inter-Modality Contouring Analysis for Organs at Risk for HDR Gynecological Brachytherapy

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

Sadeghi, P; Smith, W; Tom Baker Cancer Centre, Calgary, AB

2015-06-15

Purpose This study quantifies errors associated with MR-guided High Dose Rate (HDR) gynecological brachytherapy. Uncertainties in this treatment results from contouring, organ motion between imaging and treatment delivery, dose calculation, and dose delivery. We focus on interobserver and inter-modality variability in contouring and the motion of organs at risk (OARs) in the time span between the MR and CT scans (∼1 hour). We report the change in organ volume and position of center of mass (CM) between the two imaging modalities. Methods A total of 8 patients treated with MR-guided HDR brachytherapy were included in this study. Two observers contouredmore » the bladder and rectum on both MR and CT scans. The change in OAR volume and CM position between the MR and CT imaging sessions on both image sets were calculated. Results The absolute mean bladder volume change between the two imaging modalities is 67.1cc. The absolute mean inter-observer difference in bladder volume is much lower at 15.5cc (MR) and 11.0cc (CT). This higher inter-modality volume difference suggests a real change in the bladder filling between the two imaging sessions. Change in Rectum volume inter-observer standard error of means (SEM) is 3.18cc (MR) and 3.09cc (CT), while the inter-modality SEM is 3.65cc (observer 1), and 2.75cc (observer 2). The SEM for rectum CM position in the superior-inferior direction was approximately three times higher than in other directions for both the inter—observer (0.77 cm, 0.92 cm for observers 1 and 2, respectively) and inter-modality (0.91 cm, 0.95 cm for MR and CT, respectively) variability. Conclusion Bladder contours display good consistency between different observers on both CT and MR images. For rectum contouring the highest inconsistency stems from the observers’ choice of the superior-inferior borders. A complete analysis of a larger patient cohort will enable us to separate the true organ motion from the inter-observer variability.« less

Artefacts in multimodal imaging of titanium, zirconium and binary titanium–zirconium alloy dental implants: an in vitro study

PubMed Central

Schöllchen, Maximilian; Aarabi, Ghazal; Assaf, Alexandre T; Rendenbach, Carsten; Beck-Broichsitter, Benedicta; Semmusch, Jan; Sedlacik, Jan; Heiland, Max; Fiehler, Jens; Siemonsen, Susanne

2017-01-01

Objectives: To analyze and evaluate imaging artefacts induced by zirconium, titanium and titanium–zirconium alloy dental implants. Methods: Zirconium, titanium and titanium–zirconium alloy implants were embedded in gelatin and MRI, CT and CBCT were performed. Standard protocols were used for each modality. For MRI, line–distance profiles were plotted to quantify the accuracy of size determination. For CT and CBCT, six shells surrounding the implant were defined every 0.5 cm from the implant surface and histogram parameters were determined for each shell. Results: While titanium and titanium–zirconium alloy induced extensive signal voids in MRI owing to strong susceptibility, zirconium implants were clearly definable with only minor distortion artefacts. For titanium and titanium–zirconium alloy, the MR signal was attenuated up to 14.1 mm from the implant. In CT, titanium and titanium–zirconium alloy resulted in less streak artefacts in comparison with zirconium. In CBCT, titanium–zirconium alloy induced more severe artefacts than zirconium and titanium. Conclusions: MRI allows for an excellent image contrast and limited artefacts in patients with zirconium implants. CT and CBCT examinations are less affected by artefacts from titanium and titanium–zirconium alloy implants compared with MRI. The knowledge about differences of artefacts through different implant materials and image modalities might help support clinical decisions for the choice of implant material or imaging device in the clinical setting. PMID:27910719

Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study.

PubMed

Smeets, Ralf; Schöllchen, Maximilian; Gauer, Tobias; Aarabi, Ghazal; Assaf, Alexandre T; Rendenbach, Carsten; Beck-Broichsitter, Benedicta; Semmusch, Jan; Sedlacik, Jan; Heiland, Max; Fiehler, Jens; Siemonsen, Susanne

2017-02-01

To analyze and evaluate imaging artefacts induced by zirconium, titanium and titanium-zirconium alloy dental implants. Zirconium, titanium and titanium-zirconium alloy implants were embedded in gelatin and MRI, CT and CBCT were performed. Standard protocols were used for each modality. For MRI, line-distance profiles were plotted to quantify the accuracy of size determination. For CT and CBCT, six shells surrounding the implant were defined every 0.5 cm from the implant surface and histogram parameters were determined for each shell. While titanium and titanium-zirconium alloy induced extensive signal voids in MRI owing to strong susceptibility, zirconium implants were clearly definable with only minor distortion artefacts. For titanium and titanium-zirconium alloy, the MR signal was attenuated up to 14.1 mm from the implant. In CT, titanium and titanium-zirconium alloy resulted in less streak artefacts in comparison with zirconium. In CBCT, titanium-zirconium alloy induced more severe artefacts than zirconium and titanium. MRI allows for an excellent image contrast and limited artefacts in patients with zirconium implants. CT and CBCT examinations are less affected by artefacts from titanium and titanium-zirconium alloy implants compared with MRI. The knowledge about differences of artefacts through different implant materials and image modalities might help support clinical decisions for the choice of implant material or imaging device in the clinical setting.

Reconstructive procedures for disturbed functions within the upper airway: pharyngeal breathing/snoring

PubMed Central

Verse, Thomas

2005-01-01

Breathing disorders which have their origin within the pharynx mainly occur during sleep. These so-called obstructive sleep-related breathing disorders include three different disturbances which have to be distinguished properly: simple snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). Each disturbance requires a different treatment. Simple snoring does not affect the physical health of the snorer himself, but often leads to social problems due to the annoying character of the breathing sounds. Appropriate treatment modalities are oral devices and transcutaneous or ttransmucosal electrical stimulation of the muscles of the floor of the mouth via surface electrodes. As reconstructive surgical procedures adenotomies, tonsillectomies, tonsillotomies, or adenotonsillectomies are successfully used in children. Moreover, in adults radiofrequency treatments of the tonsils, the soft palate and of the base of tongue, as well as uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP) and palatal implants are adequate treatments for simple snoring. Adequate therapies for UARS and mild OSA (less than 20 breathing events per hour of sleep) are oral appliances. Nasal continuos positive airway pressure (NCPAP) ventilation is a very successful treatment modality, but shows low compliance in these patients, as daytime symptoms like excessive sleepiness or or impaired cognitive functions are often unincisive in patients with mild OSA. Reconstructive procedures like UPPP, radiofrequency surgery of the tonsils or the base of tongue, hyoid suspension, mandibular osteotomy with genioglossus advancement (MO) are successful treatment options either as isolated procedures or in combination within so-called multi-level surgery concepts. Goldstandard for the treatment of moderate to severe OSA is the nCPAP ventilation. All patients should at least try this treatment modality. Only in the rare cases of nCPAP failure (2%) and in the relatively frequent cases of nCPAP incompliance (30%) reconstructive surgical procedures become necessary as second choice treatments. These are adenectomies, tonsillectomies, tonsillotomies in children and hyoid suspension, MO, multi-level surgery concepts, or maxillomandibular advancement osteotomies in adults. PMID:22073056

SU-E-T-560: Inter- and Intra-Fraction Variations in Esophageal Dose for Lung Cancer Patients, and the Impact of Setup Technique and Treatment Modality.

PubMed

Carroll, M; Cheung, J; Zhang, L; Court, L

2012-06-01

To understand the dose-response of the esophagus in photon and proton therapy, it is important to appreciate the variations in delivered dose caused by inter- and intra-fraction motion. Four lung cancer patients were identified who had experienced grade 3 esophagitis during their treatment, and for whom their esophagus was close, but not encompassed by, the treatment volume. Each patient had been treated with proton therapy using 35-37 2Gy fractions, and had received weekly 4DCT imaging. IMRT plans were also created using the same treatment planning constraints. In-house image registration software was used to deform the esophagus contour from the treatment plan to each phase of the 4DCT for each weekly image set. Daily setup using both bony and soft tissue (GTV) registration was simulated, and the treatment dose calculated for each CT image. Changes to the esophagus DVH relative to the treatment plan were quantified in terms of the relative volume of the esophagus receiving 45, 55, and 65Gy (V45, V55 and V65). For all combinations of treatment modality (photon, proton) and setup method (bony, GTV), intra-fraction motion resulted in a range of V45, V55 and V65 from 3.6 to 5.5%. Inter-fraction motion comparing daily exhale or inhale phases showed the range of V45, V55 and V65 from 8.5 to 18.6% (exhale) and 9.8 to 16.3% (inhale). Inter-fractional motion resulted in larger variations in dose delivered to the esophagus than intra-fractional motion. The inter-fraction range for V45, V55 and V65 varied by around 10% between patients. The treatment modality (photon, proton) and setup technique (bony, GTV) had minimal impact on the results. © 2012 American Association of Physicists in Medicine.

Predicting treatment effect from surrogate endpoints and historical trials: an extrapolation involving probabilities of a binary outcome or survival to a specific time

PubMed Central

Sargent, Daniel J.; Buyse, Marc; Burzykowski, Tomasz

2011-01-01

SUMMARY Using multiple historical trials with surrogate and true endpoints, we consider various models to predict the effect of treatment on a true endpoint in a target trial in which only a surrogate endpoint is observed. This predicted result is computed using (1) a prediction model (mixture, linear, or principal stratification) estimated from historical trials and the surrogate endpoint of the target trial and (2) a random extrapolation error estimated from successively leaving out each trial among the historical trials. The method applies to either binary outcomes or survival to a particular time that is computed from censored survival data. We compute a 95% confidence interval for the predicted result and validate its coverage using simulation. To summarize the additional uncertainty from using a predicted instead of true result for the estimated treatment effect, we compute its multiplier of standard error. Software is available for download. PMID:21838732

Assessment and Implication of Prognostic Imbalance in Randomized Controlled Trials with a Binary Outcome – A Simulation Study

PubMed Central

Chu, Rong; Walter, Stephen D.; Guyatt, Gordon; Devereaux, P. J.; Walsh, Michael; Thorlund, Kristian; Thabane, Lehana

2012-01-01

Background Chance imbalance in baseline prognosis of a randomized controlled trial can lead to over or underestimation of treatment effects, particularly in trials with small sample sizes. Our study aimed to (1) evaluate the probability of imbalance in a binary prognostic factor (PF) between two treatment arms, (2) investigate the impact of prognostic imbalance on the estimation of a treatment effect, and (3) examine the effect of sample size (n) in relation to the first two objectives. Methods We simulated data from parallel-group trials evaluating a binary outcome by varying the risk of the outcome, effect of the treatment, power and prevalence of the PF, and n. Logistic regression models with and without adjustment for the PF were compared in terms of bias, standard error, coverage of confidence interval and statistical power. Results For a PF with a prevalence of 0.5, the probability of a difference in the frequency of the PF≥5% reaches 0.42 with 125/arm. Ignoring a strong PF (relative risk = 5) leads to underestimating the strength of a moderate treatment effect, and the underestimate is independent of n when n is >50/arm. Adjusting for such PF increases statistical power. If the PF is weak (RR = 2), adjustment makes little difference in statistical inference. Conditional on a 5% imbalance of a powerful PF, adjustment reduces the likelihood of large bias. If an absolute measure of imbalance ≥5% is deemed important, including 1000 patients/arm provides sufficient protection against such an imbalance. Two thousand patients/arm may provide an adequate control against large random deviations in treatment effect estimation in the presence of a powerful PF. Conclusions The probability of prognostic imbalance in small trials can be substantial. Covariate adjustment improves estimation accuracy and statistical power, and hence should be performed when strong PFs are observed. PMID:22629322

77 FR 24718 - Scientific Information Request on Chronic Venous Ulcers Treatments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities report, which is currently... improve the quality of this comparative effectiveness review. AHRQ is requesting this scientific information and conducting this comparative effectiveness review pursuant to Section 1013 of the Medicare...

[Sclerosing treatment of hydrocele].

PubMed

Saladié Roig, J M; Blasco Casares, F J; Areal Calama, J

1991-11-01

We present the results of treatment with aspiration and tetracycline sclerotherapy of 24 cases of hydrocele with a follow-up of 9 months. Only minor complications were observed and the cure rate was less than 50%. The indications of this therapeutic modality versus surgery are discussed.

Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures

PubMed Central

Sangisetty, Suma L; Miner, Thomas J

2012-01-01

Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites. PMID:22590662

[Socio- and psychotherapy in patients with Alzheimer disease].

PubMed

Hirsch, R D

2001-04-01

Symptoms presented by patients with Alzheimer-type dementia do not only reflect organic disturbances only but require a holistic and person-oriented view. Affective and behavioral disturbances are not necessarily secondary to cognitive impairment. Guidelines are presented for a multidimensional treatment involving the significant other. Socio- and psychotherapy are essential for this treatment. Their approaches have greatly increased in number and diversity in the past few years. Sociotherapy is based on milieu therapy and includes different training- and group activities. Several psychosocial treatment modalities are available, including validation, dementia care mapping, reminiscence therapy, cognitive training and psychoeducational group work. Psychotherapeutic approaches include relaxation techniques, and psychodynamic oriented- and behavioral modalities. The indication for a specific modality is based on an assessment of the disturbances present and available resources. Of special importance are also services to family carers, including counseling, psychotherapy, as well as support and modification of the care-setting. Even though there are only limited empirical data available on the effects of socio- and psychotherapy for patients with Alzheimer-type dementia, the available evidence is indicative of a positive influence on symptoms of this illness. Diversity of symptoms and individualized, variable course of the illness may point to the importance of psychological and social factors in this illness, by far larger than presently recognized.

Policy and administrative issues for large-scale clinical interventions following disasters.

PubMed

Scheeringa, Michael S; Cobham, Vanessa E; McDermott, Brett

2014-02-01

Large, programmatic mental health intervention programs for children and adolescents following disasters have become increasingly common; however, little has been written about the key goals and challenges involved. Using available data and the authors' experiences, this article reviews the factors involved in planning and implementing large-scale treatment programs following disasters. These issues include funding, administration, choice of clinical targets, workforce selection, choice of treatment modalities, training, outcome monitoring, and consumer uptake. Ten factors are suggested for choosing among treatment modalities: 1) reach (providing access to the greatest number), 2) retention of patients, 3) privacy, 4) parental involvement, 5) familiarity of the modality to clinicians, 6) intensity (intervention type matches symptom acuity and impairment of patient), 7) burden to the clinician (in terms of time, travel, and inconvenience), 8) cost, 9) technology needs, and 10) effect size. Traditionally, after every new disaster, local leaders who have never done so before have had to be recruited to design, administer, and implement programs. As expertise in all of these areas represents a gap for most local professionals in disaster-affected areas, we propose that a central, nongovernmental agency with national or international scope be created that can consult flexibly with local leaders following disasters on both overarching and specific issues. We propose recommendations and point out areas in greatest need of innovation.

[Nutritional therapy in acute pancreatitis: a practical guide for the initial enteral nutritional support.].

PubMed

Gutiérrez-Salmeán, G; Peláez-Luna, M

2010-01-01

Nutritional support is a cornerstone in acute pancreatitis (AP) treatment, which is a catabolic state that can result in patient's nutritional depletion. First step in the management of AP is to asses its severity. Despite mild AP cases usually do not require nutritional support severe cases benefit from its early initiation. Total enteral nutrition (TEN) decreases the frequency of complications and is the preferred nutrition modality in AP. Availability of nutrition specialists is often limited and usually the primary care physician decides when and how to start nutritional support in AP. To perform a systematic review about nutritional support in AP and create a TEN guide to aid the non nutrition specialist involved in the treatment of AP patients. The search for eligible studies was carried out using the Pub Med and the National Library of Medicine electronic data bases. Controlled clinical trials, treatment guidelines and systematic review articles were selected. It is recommended to initiate nutritional support in AP cases that will be without oral intake longer than a week and TEN is the election modality. We created a TEN guide explaining how to choose and initiate TEN in AP. Early TEN improves AP prognosis and is the nutritional modality of choice in every AP patients that will remain without oral intake longer than a week.

A comparative evaluation: Oral leukoplakia surgical management using diode laser, CO2 laser, and cryosurgery.

PubMed

Natekar, Madhukar; Raghuveer, Hosahallli-Puttaiah; Rayapati, Dilip-Kumar; Shobha, Eshwara-Singh; Prashanth, Nagesh-Tavane; Rangan, Vinod; Panicker, Archana G

2017-06-01

The comparatively evaluate the three surgical treatment modalities namely cryosurgery, diode and CO2 laser surgery in terms of healing outcomes on the day of surgery, first and second week post operatively and recurrence at the end of 18 months was assessed. Thirty selected patients were divided randomly into three groups. Each group comprising of ten patients were subjected to one of the three modalities of treatment namely cryosurgery, diode laser or CO2 laser surgery for ablation of OL. Obtained data was analyzed using mainly using Chi-square and Anova tests. Study showed statistical significant differences (p > 0.05) for evaluation parameters like pain, edema and scar. The parameters like infection, recurrence, bleeding showed no statistical significance. Pain was significantly higher in CO2 laser surgery group as compared with diode laser group. There was no recurrence observed at the end of the 6 months follow up period in all the three study groups. Observations from the study highlights that all three surgical modalities used in this study were effective for treatment of OL, and the overall summation of the results of the study showed that laser therapy (CO2 and Diode) seems to offer better clinically significant results than cryotherapy. Key words: Oral premalignant lesion, leukoplakia, cryosurgery, CO2 laser surgery, diode laser surgery.

Effect of different types of therapeutic trauma on vitiligo lesions.

PubMed

El Mofty, Medhat; Esmat, Samia; Hunter, Nahla; Mashaly, Heba M; Dorgham, Dina; Shaker, Olfat; Ibrahim, Sarah

2017-03-01

New treatment modalities for vitiligo acting by changing certain cytokines and metalloproteinases are newly emerging. The aim of this work is to To assess the efficacy of trichloroacetic acid (TCA) chemical peel, dermapen, and fractional CO 2 laser in treatment of stable non-segmental vitiligo and to detect their effects on IL-17 and MMP-9 levels. Thirty patients with stable vitiligo were recruited in a randomized controlled study. They were randomly categorized into three equal groups. Group 1: TCA peel, Group 2: dermapen machine, and Group 3: Fractional CO 2 laser. Skin biopsies were taken from treated areas and from control areas for which MMP-9 and IL-17 tissue levels were measured using ELISA. The 30 vitiligo patients had low basal tissue MMP-9 levels and high baseline IL-17 tissue levels. As regards the three different used modalities, all of them caused rise in MMP-9 as well as IL-17 levels and almost their levels were much more elevated with repetition of the previously mentioned traumatic procedures. TCA 25% peel proved to be the most effective modality both clinically and laboratory and it can be used prior or with other conventional therapies in the treatment of vitiligo. © 2016 Wiley Periodicals, Inc.

[Study on high temperature oxidation of Ni-Cr ceramic alloys. Effects of Cr and Mo].

PubMed

Mizutani, M

1990-03-01

The effects of Cr and Mo addition to Ni-Cr alloys on high temperature oxidation were investigated. The alloys were prepared with the composition of Cr ranging from 5 to 40 wt%. Also 2, 4 and 9 wt% of Mo was added to both Ni-5% Cr and Ni-20% Cr binary alloys. The alloys were heated at 800 degrees C, 900 degrees C and 1000 degrees C for 15 minutes in air, and the weight change after heat treatment was measured by electric automatic balance. The weight change during heating was measured by thermogravimetric measurement (TG). The products after heat treatment were characterized by X-ray diffraction and scanning electron microscopy (SEM). The results are summarized as follows: The Ni-Cr binary alloys were classified into three types of Cr ranging from 5 to 20 wt%, Cr 25% and Cr from 30 wt% to 40 wt% according to the weight gains with oxidation. In the case of the more than 25 wt% Cr content of the Ni-Cr binary alloys, the weight gain was extremely low and the heating temperature effects on the weight change were also small. X-ray diffraction study showed that NiO, NiCr2O4 and Cr2O3 formed on the surface of the Ni-Cr binary alloys whose composition of Cr ranged from 5 to 25 wt%, whereas NiO and NiCr2O4 rarely formed on the Ni-Cr binary alloys whose composition of Cr ranged from 30 to 40 wt%. This suggests that the formation of Cr2O3 prevents the formation of NiO on the alloy with a high Cr content. The weight gain of the Ni-Cr-Mo ternary alloys was smaller than that of the Ni-Cr binary alloys without Mo, and the temperature effects on the weight gain of the Ni-Cr-Mo ternary alloys were different for each Cr content. However, the effect of the amounts of Mo was small. NiO, NiCr2O4, Cr2O3 and MoO2 were identified by X-ray diffraction on the surface of the Ni-Cr-Mo ternary alloys. According to the SEM observation, it seems that NiO was formed at the outermost layer, both NiCr2O4 and Cr2O3 at the inside layer, and MoO2 at the innermost layer. The formation of both NiO and Cr2O3 on the Ni-Cr-Mo ternary alloys was restrained compared with that of the Ni-Cr binary alloys. However, the adhesion of oxides to the Ni-Cr-Mo ternary alloys was lower than that of the Ni-Cr binary alloys.

Monte Carlo treatment planning with modulated electron radiotherapy: framework development and application

NASA Astrophysics Data System (ADS)

Alexander, Andrew William

Within the field of medical physics, Monte Carlo radiation transport simulations are considered to be the most accurate method for the determination of dose distributions in patients. The McGill Monte Carlo treatment planning system (MMCTP), provides a flexible software environment to integrate Monte Carlo simulations with current and new treatment modalities. A developing treatment modality called energy and intensity modulated electron radiotherapy (MERT) is a promising modality, which has the fundamental capabilities to enhance the dosimetry of superficial targets. An objective of this work is to advance the research and development of MERT with the end goal of clinical use. To this end, we present the MMCTP system with an integrated toolkit for MERT planning and delivery of MERT fields. Delivery is achieved using an automated "few leaf electron collimator" (FLEC) and a controller. Aside from the MERT planning toolkit, the MMCTP system required numerous add-ons to perform the complex task of large-scale autonomous Monte Carlo simulations. The first was a DICOM import filter, followed by the implementation of DOSXYZnrc as a dose calculation engine and by logic methods for submitting and updating the status of Monte Carlo simulations. Within this work we validated the MMCTP system with a head and neck Monte Carlo recalculation study performed by a medical dosimetrist. The impact of MMCTP lies in the fact that it allows for systematic and platform independent large-scale Monte Carlo dose calculations for different treatment sites and treatment modalities. In addition to the MERT planning tools, various optimization algorithms were created external to MMCTP. The algorithms produced MERT treatment plans based on dose volume constraints that employ Monte Carlo pre-generated patient-specific kernels. The Monte Carlo kernels are generated from patient-specific Monte Carlo dose distributions within MMCTP. The structure of the MERT planning toolkit software and optimization algorithms are demonstrated. We investigated the clinical significance of MERT on spinal irradiation, breast boost irradiation, and a head and neck sarcoma cancer site using several parameters to analyze the treatment plans. Finally, we investigated the idea of mixed beam photon and electron treatment planning. Photon optimization treatment planning tools were included within the MERT planning toolkit for the purpose of mixed beam optimization. In conclusion, this thesis work has resulted in the development of an advanced framework for photon and electron Monte Carlo treatment planning studies and the development of an inverse planning system for photon, electron or mixed beam radiotherapy (MBRT). The justification and validation of this work is found within the results of the planning studies, which have demonstrated dosimetric advantages to using MERT or MBRT in comparison to clinical treatment alternatives.

A randomized trial of cognitive-behavioral therapy or selective serotonin reuptake inhibitor or both combined for panic disorder with or without agoraphobia: treatment results through 1-year follow-up.

PubMed

van Apeldoorn, Franske J; Timmerman, Marieke E; Mersch, Peter Paul A; van Hout, Wiljo J P J; Visser, Sako; van Dyck, Richard; den Boer, Johan A

2010-05-01

To establish the long-term effectiveness of 3 treatments for DSM-IV panic disorder with or without agoraphobia: cognitive-behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT + SSRI). As a secondary objective, the relationship between treatment outcome and 7 predictor variables was investigated. Patients were enrolled between April 2001 and September 2003 and were randomly assigned to treatment. Academic and nonacademic clinical sites participated. Each treatment modality lasted 1 year. Pharmacotherapists were free to choose between 5 SSRIs currently marketed in The Netherlands. Outcome was assessed after 9 months of treatment (posttest 1), after discontinuation of treatment (posttest 2), and 6 and 12 months after treatment discontinuation (follow-up 1 and follow-up 2). In the sample (N = 150), 48% did not suffer from agoraphobia or suffered from only mild agoraphobia, while 52% suffered from moderate or severe agoraphobia. Patients in each treatment group improved significantly from pretest to posttest 1 on the primary outcome measures of level of anxiety (P < .001), degree of coping (P < .001), and remitter status (P < .001), as well as on the secondary outcome measures of depressive symptomatology (P < .001), and from pretest to posttest 2 for health-related quality of life (P < .001). Gains were preserved from posttest 2 throughout the follow-up period. Some superiority of CBT + SSRI and SSRI as compared with CBT was observed at posttest 1. However, at both follow-ups, differences between treatment modalities proved nonsignificant. Client satisfaction appeared to be high at treatment endpoint, while patients receiving CBT + SSRI appeared slightly (P < .05) more satisfied than those receiving CBT only. No fall-off in gains was observed for either treatment modality after treatment discontinuation. SSRIs were associated with adverse events. Gains produced by CBT were slower to emerge than those produced by CBT + SSRI and SSRI, but CBT ended sooner. Netherlands Trial Register (www.trialregister.nl) Identifier: ISRCTN8156869. ©Copyright 2010 Physicians Postgraduate Press, Inc.

Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

PubMed Central

Lazarovici, Julien; Dartigues, Peggy; Brice, Pauline; Obéric, Lucie; Gaillard, Isabelle; Hunault-Berger, Mathilde; Broussais-Guillaumot, Florence; Gyan, Emmanuel; Bologna, Serge; Nicolas-Virelizier, Emmanuelle; Touati, Mohamed; Casasnovas, Olivier; Delarue, Richard; Orsini-Piocelle, Frédérique; Stamatoullas, Aspasia; Gabarre, Jean; Fornecker, Luc-Matthieu; Gastinne, Thomas; Peyrade, Fréderic; Roland, Virginie; Bachy, Emmanuel; André, Marc; Mounier, Nicolas; Fermé, Christophe

2015-01-01

Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320–1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting (HR 0.388 [0.234–0.643], P=0.0002). Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent. PMID:26430172

Combination treatment of pediatric coats' disease: a bicenter study in Taiwan.

PubMed

Lin, Chun-Ju; Chen, San-Ni; Hwang, Jiunn-Feng; Yang, Chung-May

2013-01-01

To present the clinical outcome of different combination treatment modalities in pediatric Coats' disease in two Taiwan medical centers. A retrospective review of clinical records was done of pediatric patients with Coats' disease treated at National Taiwan University Hospital and Changhua Christian Hospital. Data regarding the age at the time of diagnosis, initial presentation, methods of treatment, visual and anatomic results, and complications were recorded. Changes in vision and retinal status with the different methods of treatment were specifically evaluated. From 2005 through 2011, 10 eyes of 9 patients were treated under the diagnosis of Coats' disease. The clinical manifestations varied from localized vascular abnormalities with subretinal fluid and hard exudates to extensive detachment with massive exudates and retinal hemorrhage. The main treatment modalities include argon laser photocoagulation, micropulse laser, and cryotherapy. The adjunctive therapies included intravitreal triamcinolone, bevacizumab, and ranibizumab. The mean follow-up was 40.50 ± 20.52 months (range: 14 to 72 months). Best corrected visual acuity at last follow-up was light perception to 1.0 (20/20 Snellen). Anatomic improvement was achieved in 9 eyes (90%). Visual improvement was noted in 7 eyes (70%), visual stabilization in 2 eyes (20%), and visual deterioration in 1 eye (10%). Vitreous fibrosis evolving into tractional retinal detachment occurred in 1 patient receiving cryotherapy combined with intravitreal bevacizumab injections. No enucleation was ultimately necessary. Pediatric Coats' disease varies greatly in severity. Carefully selected treatment modalities can improve most eyes with different conditions. Intravitreal anti-vascular endothelial growth factor agents may act as useful adjuncts to improve anatomic and functional outcome. Cryotherapy combined with the intravitreal bevacizumab injection in severe cases of exudative retinal detachment may carry the risk of vitreoretinal traction and tractional retinal detachment.

Fractional carbon dioxide laser versus low-dose UVA-1 phototherapy for treatment of localized scleroderma: a clinical and immunohistochemical randomized controlled study.

PubMed

Shalaby, S M; Bosseila, M; Fawzy, M M; Abdel Halim, D M; Sayed, S S; Allam, R S H M

2016-11-01

Morphea is a rare fibrosing skin disorder that occurs as a result of abnormal homogenized collagen synthesis. Fractional ablative laser resurfacing has been used effectively in scar treatment via abnormal collagen degradation and induction of healthy collagen synthesis. Therefore, fractional ablative laser can provide an effective modality in treatment of morphea. The study aimed at evaluating the efficacy of fractional carbon dioxide laser as a new modality for the treatment of localized scleroderma and to compare its results with the well-established method of UVA-1 phototherapy. Seventeen patients with plaque and linear morphea were included in this parallel intra-individual comparative randomized controlled clinical trial. Each with two comparable morphea lesions that were randomly assigned to either 30 sessions of low-dose (30 J/cm 2 ) UVA-1 phototherapy (340-400 nm) or 3 sessions of fractional CO 2 laser (10,600 nm-power 25 W). The response to therapy was then evaluated clinically and histopathologically via validated scoring systems. Immunohistochemical analysis of TGF-ß1 and MMP1 was done. Patient satisfaction was also assessed. Wilcoxon signed rank test for paired (matched) samples and Spearman rank correlation equation were used as indicated. Comparing the two groups, there was an obvious improvement with fractional CO 2 laser that was superior to that of low-dose UVA-1 phototherapy. Statistically, there was a significant difference in the clinical scores (p = 0.001), collagen homogenization scores (p = 0.012), and patient satisfaction scores (p = 0.001). In conclusion, fractional carbon dioxide laser is a promising treatment modality for cases of localized morphea, with proved efficacy of this treatment on clinical and histopathological levels.

Tumor responsive targeted multifunctional nanosystems for cancer imaging, chemo- and siRNA therapy

NASA Astrophysics Data System (ADS)

Savla, Ronak

Cancer is one of the most insidious diseases. Compromising of over 100 different types and sharing the unifying factors of uncontrolled growth and metastasis, unmet clinical needs in terms of cancer diagnosis and treatment continue to exist. It is widely accepted that most forms of cancer are treatable or even curable if detected before widespread metastasis occurs. Nearly a quarter of deaths in the United States is the result of cancer and it only trails heart disease in terms of annual mortality. Surgery, chemotherapy, and radiation therapy are the primary treatment modalities for cancer. Research in these procedures has resulted in substantial benefits for cancer patients, but there is still room for an improvement. However, a time has been reached at which it appears that the benefits from these modalities have been reached the maximum. Therefore, it is vital to develop new strategies for the diagnosis and treatment of cancer. The field of nanotechnology is concerned with structures in the nanometer size range and holds the potential to drastically impact and improve the lives of patients suffering from cancer. Not only can nanotechnology improve current methods of diagnosis and treatment, it has a possibility of introducing newer and better modalities. The overall purpose of this work is to develop novel nanotechnology-based methodologies for the diagnosis and treatment of various forms of cancers. The first aim of the project is the development of a multifunctional targeted nanosystem for the delivery of siRNA to overcome drug resistance. The second aspect is the synthesis of a quantum dot-based delivery system that releases drug in response to pH changes. The third aim is the development of a targeted, tumor environment responsive magnetic resonance nanoparticle contrast agent coupled with a nanoparticle-based treatment.

Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes.

PubMed

Soyupek, Feray; Yesildag, Ahmet; Kutluhan, Suleyman; Askin, Ayhan; Ozden, Ahmet; Uslusoy, Gokcen Ay; Demirci, Seden

2012-10-01

Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen's and Tinel's signs. We could find reduction in CSA of MN in PCS group (P < 0.001). The CSA of MN was inversely correlated with motor sensory and median nerve conduction velocity (NCV) (r = 0.421, r = 0.213, respectively). Statistically significant correlations were not detected between ultrasonographic parameters and clinical evaluation parameters (P > 0.05) and also between ultrasonographic parameters and BQ scores (P > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.

Beyond the Barriers of Light Penetration: Strategies, Perspectives and Possibilities for Photodynamic Therapy

PubMed Central

Mallidi, Srivalleesha; Anbil, Sriram; Bulin, Anne-Laure; Obaid, Girgis; Ichikawa, Megumi; Hasan, Tayyaba

2016-01-01

Photodynamic therapy (PDT) is a photochemistry based treatment modality that involves the generation of cytotoxic species through the interactions of a photosensitizer molecule with light irradiation of an appropriate wavelength. PDT is an approved therapeutic modality for several cancers globally and in several cases has proved to be effective where traditional treatments have failed. The key parameters that determine PDT efficacy are 1. the photosensitizer (nature of the molecules, selectivity, and macroscopic and microscopic localization etc.), 2. light application (wavelength, fluence, fluence rate, irradiation regimes etc.) and 3. the microenvironment (vascularity, hypoxic regions, stromal tissue density, molecular heterogeneity etc.). Over the years, several groups aimed to monitor and manipulate the components of these critical parameters to improve the effectiveness of PDT treatments. However, PDT is still misconstrued to be a surface treatment primarily due to the limited depths of light penetration. In this review, we present the recent advances, strategies and perspectives in PDT approaches, particularly in cancer treatment, that focus on increasing the 'damage zone' beyond the reach of light in the body. This is enabled by a spectrum of approaches that range from innovative photosensitizer excitation strategies, increased specificity of phototoxicity, and biomodulatory approaches that amplify the biotherapeutic effects induced by photodynamic action. Along with the increasing depth of understanding of the underlying physical, chemical and physiological mechanisms, it is anticipated that with the convergence of these strategies, the clinical utility of PDT will be expanded to a powerful modality in the armamentarium for the management of cancer. PMID:27877247

Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature.

PubMed

Jacobson, J S; Workman, S B; Kronenberg, F

2000-02-01

This article reviews English-language articles published in the biomedical literature from 1980 to 1997 that reported results of clinical research on complementary and alternative medical treatments (CAM) of interest to patients with breast cancer. We searched 12 electronic databases and the bibliographies of the retrieved papers, review articles, and books on CAM and breast cancer. The retrieved articles were grouped by end point: breast cancer (eg, tumor size, survival), disease-related symptoms, side effects of treatment, and immune function. Within each end point, we organized the articles by modality and assessed study design, findings, and qualitative aspects. Of the more than 1,000 citations retrieved, 51 fit our criteria for review. Of the articles reviewed, 17 were randomized clinical trials; three of these were trials of cancer-directed interventions, two of which involved the same treatment (melatonin). Seven articles described observational studies, and the remainder were reports of phase I or II trials. Relatively few CAM modalities reportedly used by many breast cancer patients were mentioned in articles retrieved by this process. Most articles had shortcomings. Although many studies had encouraging results, none showed definitively that a CAM treatment altered disease progression in patients with breast cancer. Several modalities seemed to improve other outcomes (eg, acupuncture for nausea, pressure treatments for lymphedema). If CAM studies are well-founded, well-designed, and meticulously conducted, and their hypotheses, methods, and results are reported clearly and candidly, research in this controversial area should acquire credibility both in the scientific community and among advocates of unconventional medicine.

Treatment options for Primary CNS Lymphoma.

PubMed

Laghari, Altaf Ali; Ahmed, Syed Ijlal; Jabbar, Adnan; Shamim, Muhammad Shahzad

2018-03-01

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Differences in Normal Tissue Response in the Esophagus Between Proton and Photon Radiation Therapy for Non-Small Cell Lung Cancer Using In Vivo Imaging Biomarkers.

PubMed

Niedzielski, Joshua S; Yang, Jinzhong; Mohan, Radhe; Titt, Uwe; Mirkovic, Dragan; Stingo, Francesco; Liao, Zhongxing; Gomez, Daniel R; Martel, Mary K; Briere, Tina M; Court, Laurence E

2017-11-15

To determine whether there exists any significant difference in normal tissue toxicity between intensity modulated radiation therapy (IMRT) or proton therapy for the treatment of non-small cell lung cancer. A total of 134 study patients (n=49 treated with proton therapy, n=85 with IMRT) treated in a randomized trial had a previously validated esophageal toxicity imaging biomarker, esophageal expansion, quantified during radiation therapy, as well as esophagitis grade (Common Terminology Criteria for Adverse Events version 3.0), on a weekly basis during treatment. Differences between the 2 modalities were statically analyzed using the imaging biomarker metric value (Kruskal-Wallis analysis of variance), as well as the incidence and severity of esophagitis grade (χ 2 and Fisher exact tests, respectively). The dose-response of the imaging biomarker was also compared between modalities using esophageal equivalent uniform dose, as well as delivered dose to an isotropic esophageal subvolume. No statistically significant difference in the distribution of esophagitis grade, the incidence of grade ≥3 esophagitis (15 and 11 patients treated with IMRT and proton therapy, respectively), or the esophageal expansion imaging biomarker between cohorts (P>.05) was found. The distribution of imaging biomarker metric values had similar distributions between treatment arms, despite a slightly higher dose volume in the proton arm (P>.05). Imaging biomarker dose-response was similar between modalities for dose quantified as esophageal equivalent uniform dose and delivered esophageal subvolume dose. Regardless of treatment modality, there was high variability in imaging biomarker response, as well as esophagitis grade, for similar esophageal doses between patients. There was no significant difference in esophageal toxicity from either proton- or photon-based radiation therapy as quantified by esophagitis grade or the esophageal expansion imaging biomarker. Copyright © 2017 Elsevier Inc. All rights reserved.

Descriptive analysis of spinal neuroaxial injections, surgical interventions and physical therapy utilization for degenerative lumbar spondylolisthesis within Medicare beneficiaries from 2000–2011

PubMed Central

Sclafani, Joseph A.; Constantin, Alexandra; Ho, Pei-Shu; Akuthota, Venu; Chan, Leighton

2016-01-01

Study Design Retrospective, observational study. Objective To determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. Summary of Background Data Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. Methods This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new ICD-9 diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. Results A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) compared to other racial demographics. Over 40% of beneficiaries underwent at least one injection, approximately one third (37%) participated in physical therapy, one in five (22%) underwent spinal surgery, and one third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation compared to the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. Conclusion Interventional techniques and physical therapy are frequently used treatment modalities for symptomatic degenerative spondylolisthesis. Understanding utilization of these techniques is important to determine relative clinical efficacies and to optimize future health care expenditures. PMID:28207664

Post Hoc Analysis of Passive Cavitation Imaging for Classification of Histotripsy-Induced Liquefaction in Vitro.

PubMed

Bader, Kenneth B; Haworth, Kevin J; Maxwell, Adam D; Holland, Christy K

2018-01-01

Histotripsy utilizes focused ultrasound to generate bubble clouds for transcutaneous tissue liquefaction. Bubble activity maps are under development to provide image guidance and monitor treatment progress. The aim of this paper was to investigate the feasibility of using plane wave B-mode and passive cavitation images to be used as binary classifiers of histotripsy-induced liquefaction. Prostate tissue phantoms were exposed to histotripsy pulses over a range of pulse durations (5- ) and peak negative pressures (12-23 MPa). Acoustic emissions were recorded during the insonation and beamformed to form passive cavitation images. Plane wave B-mode images were acquired following the insonation to detect the hyperechoic bubble cloud. Phantom samples were sectioned and stained to delineate the liquefaction zone. Correlation between passive cavitation and plane wave B-mode images and the liquefaction zone was assessed using receiver operating characteristic (ROC) curve analysis. Liquefaction of the phantom was observed for all the insonation conditions. The area under the ROC (0.94 versus 0.82), accuracy (0.90 versus 0.83), and sensitivity (0.81 versus 0.49) was greater for passive cavitation images relative to B-mode images ( ) along the azimuth of the liquefaction zone. The specificity was greater than 0.9 for both imaging modalities. These results demonstrate a stronger correlation between histotripsy-induced liquefaction and passive cavitation imaging compared with the plane wave B-mode imaging, albeit with limited passive cavitation image range resolution.

Thermal neutron flux mapping in a head phantom

NASA Astrophysics Data System (ADS)

Lee, C. L.; Zhou, X.-L.; Harmon, J. F.; Bartholomay, R. W.; Harker, Y. D.; Kudchadker, R. J.

1999-02-01

Boron neutron capture therapy (BNCT) is a binary cancer treatment modality in which a boron-containing compound is preferentially loaded into a tumor, followed by irradiation by thermal neutrons. In accelerator-based BNCT, neutrons are produced by charged particle-induced reactions such as 7Li(p, n) 7Be. For deeply seated brain tumors, epithermal (1 eV to 10 kev) neutrons are needed to penetrate the skull cap and subsequently thermalize at the tumor location. Cell damage in BNCT is caused by the high linear energy transfer (LET) products from the 10B(n, α) 7Li reaction. Because the cross section for this reaction is of 1/ v character, the dose due to 10B has essentially the same spatial distribution as the thermal neutron flux. A cylindrical acrylic head phantom (15.24 cm diameter by 21.59 cm length) has been constructed to simulate the patient's head and neck, and acrylic spacers of varying width allow placement of small (active sizes: 0.635 cm diameter by 1.27 cm length and 1.5875 cm diameter by 2.54 cm length) BF 3 proportional counters at nearly all radial and axial locations. Measurements of the thermal flux have also been benchmarked with gold and indium foils (bare and cadmium covered), as well as MCNP simulations. Measurement of the thermal neutron flux using these small BF 3 counters is shown to be adequate for experimentally determining the spatial variation of the 10B dose in head phantoms for accelerator-based BNCT.

Managing the pain of knee osteoarthritis.

PubMed

Hrnack, Scott A; Barber, F Alan

2014-09-01

Pain from knee osteoarthritis creates a significant burden for symptomatic patients, who are often forced to change their lifestyle because of their symptoms. Activity modification, therapy, weight loss, nonsteroidal anti-inflammatory drugs, shoe orthotics, bracing, and injections are the nonoperative options available. New technologies are also emerging in the treatment of knee osteoarthritis. Ultimately, these therapeutic modalities should reduce pain and increase the overall functioning of patients. These nonoperative modalities give the clinician several effective options before surgical management is considered.

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

Zoberi, J.

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Initial indication of treatment in 60 patients with sleep obstructive ventilatory disturbance.

PubMed

de Tarso Moura Borges, Paulo; Paschoal, Jorge Rizzato

2005-01-01

The author present a retrospective descriptive study of 60 patients with sleep obstructive ventilatory disturbance who have taken medical advice at the Centro Campinas de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço during a period of three years. All the patients have been examined after standardized protocol and decisions related to the treatment have been taken after systematic multidisciplinary discussion. clinical retrospective. The patients were distributed into two groups according to the proposal of surgical and non-surgical treatment. After so, they were studied according to the model of treatment proposed and the main propaedeutic findings: respiratory disturbance index (RDI), body mass index (BMI), cephalometric analysis and Müller maneuver. The main features were compared--isolated or in association--with the model of treatment proposed. Amongst several conclusions obtained, the most important were: surgical and non-surgical treatment were indicated almost in the same proportion for of snoring; surgical treatments were most indicated for snoring and Apnoea-Hipopnoea Syndrome, despite of its modality; RDI, BMI and cephalometric analysis and Müller maneuver had no influence at any therapeutic modality; the therapeutic decision was taken after standardized protocol and systematic multidisciplinary discussion, where each case was discussed individually.

Fluoroscopic-guided radiofrequency ablation of the basivertebral nerve: application and analysis with multiple imaging modalities in an ovine model (Invited Paper)

NASA Astrophysics Data System (ADS)

Bergeron, Jeffrey A.; Eskey, Cliff J.; Attawia, Mohammed; Patel, Samit J.; Ryan, Thomas P.; Pellegrino, Richard; Sutton, Jeffrey; Crombie, John; Paul, B. T.; Hoopes, P. J.

2005-04-01

Pathologic involvement of the basivertebral nerve, an intraosseous vertebral nerve found in humans and most mammalian species, may play a role in some forms of back pain. This study was designed to assess the feasibility and effects of the percutaneous delivery of radiofrequency (RF) energy to thermally ablate the basivertebral nerve in the lumbar vertebrae of mature sheep. Using fluoroscopic guidance, a RF bipolar device was placed and a thermal dose delivered to lumbar vertebral bodies in sheep. Post-treatment assessment included multiple magnetic resonance imaging (MRI) techniques and computed tomography (CT). These data were analyzed and correlated to histopathology and morphometry findings to describe the cellular and boney structural changes resulting from the treatment. Imaging modalities MRI and CT can be implemented to non-invasively describe treatment region and volume, marrow cellular effects, and bone density alterations immediately following RF treatment and during convalescence. Such imaging can be utilized to assess treatment effects and refine the thermal dose to vertebral body volume ratio used in treatment planning. This information will be used to improve the therapeutic ratio and develop a treatment protocol for human applications.

High energy devices versus low energy devices in orthopedics treatment modalities

NASA Astrophysics Data System (ADS)

Schultheiss, Reiner

2003-10-01

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

Improving Functioning of the Remarried Family System.

ERIC Educational Resources Information Center

Sager, Clifford J.; And Others

1981-01-01

Presents salient issues for therapists in understanding and treating the remarried (REM, second, blended, reconstituted or step) family. The structure of the remarried family is differentiated from that of the intact family. Specific treatment goals for REM families are elaborated and various treatment modalities advocated. (Author)

Electroconvulsive Therapy and Suicide.

ERIC Educational Resources Information Center

Tanney, Bryan L.

1986-01-01

When the effectiveness and mortality-morbidity of electroconvulsive therapy (ECT) are compared with those of drug therapies, it appears that ECT is an effective and preferred treatment strategy. It remains underutilized as a modality of suicide prevention. Addresses controversies that presently limit the use of this treatment. (Author/ABB)

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

NASA Astrophysics Data System (ADS)

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

2016-03-01

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

Health Related Quality of Life after ECT for depression: A study exploring the role of different electrode-placements and pulse-widths.

PubMed

Gálvez, Verònica; Li, Adrienne; Oxley, Cristal; Waite, Susan; De Felice, Nick; Hadzi-Pavlovic, Dusan; Kumar, Divya; Page, Andrew C; Hooke, Geoff; Loo, Colleen K

2016-12-01

Prior research has shown large improvements in HRQOL after a course of ECT for depression. However, the effect of different types of ECT on HRQOL outcomes has not been explored. This is important due to the considerable range of ECT treatment modalities that currently exist in clinical practice. HRQOL data from 355 depressed patients in three Australian clinical hospitals, who received ECT given with a range of treatment modalities (combinations of pulse-width and electrode-placement), were analysed. HRQOL was measured at baseline and after ECT, using the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). The association between type of ECT and HRQOL after ECT was examined by regression analysis, controlling for variables that may affect HRQOL outcomes. There was a significant increase in HRQOL scores after ECT (p<0.0001; t=-23.4). The magnitude of change was large (54% increase, Cohen's d=1.43). Multiple regression analysis yielded a significant model (P<0.001, R 2 =0.18). Baseline HRQOL score (t=4.83; p<0.0001), age (t=2.75, p<0.01) and type of ECT received [Right Unilateral brief vs Bitemporal Ultrabrief (t=-2.99; p<0.01) and Right Unilateral brief vs Bifrontal Ultrabrief (t=-2.70; p<0.01)] were significant predictors of HRQOL after the ECT course. Data was collected naturalistically from clinical services, thus ECT modality was not randomly assigned. Site could have confounded results. An acute course of ECT for depression produced statistically and clinically significant improvements in HRQOL. ECT treatment modality can substantially impact HRQOL outcomes, with the possibility of bilateral ultrabrief forms of ECT being less beneficial. Copyright © 2016 Elsevier B.V. All rights reserved.

Enhanced Energy Localization in Hyperthermia Treatment Based on Hybrid Electromagnetic and Ultrasonic System: Proof of Concept with Numerical Simulations.

PubMed

Nizam-Uddin, N; Elshafiey, Ibrahim

2017-01-01

This paper proposes a hybrid hyperthermia treatment system, utilizing two noninvasive modalities for treating brain tumors. The proposed system depends on focusing electromagnetic (EM) and ultrasound (US) energies. The EM hyperthermia subsystem enhances energy localization by incorporating a multichannel wideband setting and coherent-phased-array technique. A genetic algorithm based optimization tool is developed to enhance the specific absorption rate (SAR) distribution by reducing hotspots and maximizing energy deposition at tumor regions. The treatment performance is also enhanced by augmenting an ultrasonic subsystem to allow focused energy deposition into deep tumors. The therapeutic faculty of ultrasonic energy is assessed by examining the control of mechanical alignment of transducer array elements. A time reversal (TR) approach is then investigated to address challenges in energy focus in both subsystems. Simulation results of the synergetic effect of both modalities assuming a simplified model of human head phantom demonstrate the feasibility of the proposed hybrid technique as a noninvasive tool for thermal treatment of brain tumors.

HPV-Associated Head and Neck Cancer: Unique Features of Epidemiology and Clinical Management

PubMed Central

Maxwell, Jessica H.; Grandis, Jennifer R.; Ferris, Robert L.

2017-01-01

Human papillomavirus (HPV) is a recently identified causative agent for a subset of head and neck cancers, primarily in the oropharynx, and is largely responsible for the rising worldwide incidence of oropharyngeal cancer (OPC). Patients with HPV-positive OPC have distinct risk factor profiles and generally have a better prognosis than patients with traditional, HPV-negative, head and neck cancer. Concurrent chemotherapy and radiation is a widely accepted primary treatment modality for many patients with HPV-positive OPC. However, recent advances in surgical modalities, including transoral laser and robotic surgery, have led to the reemergence of primary surgical treatment for HPV-positive patients. Clinical trials are under way to determine optimal treatment strategies for the growing subset of patients with HPV-positive OPC. Similarly, identifying those patients with HPV-positive cancer who are at risk for recurrence and poor survival is critical in order to tailor individual treatment regimens and avoid potential undertreatment. PMID:26332002

Enhanced Energy Localization in Hyperthermia Treatment Based on Hybrid Electromagnetic and Ultrasonic System: Proof of Concept with Numerical Simulations

PubMed Central

Elshafiey, Ibrahim

2017-01-01

This paper proposes a hybrid hyperthermia treatment system, utilizing two noninvasive modalities for treating brain tumors. The proposed system depends on focusing electromagnetic (EM) and ultrasound (US) energies. The EM hyperthermia subsystem enhances energy localization by incorporating a multichannel wideband setting and coherent-phased-array technique. A genetic algorithm based optimization tool is developed to enhance the specific absorption rate (SAR) distribution by reducing hotspots and maximizing energy deposition at tumor regions. The treatment performance is also enhanced by augmenting an ultrasonic subsystem to allow focused energy deposition into deep tumors. The therapeutic faculty of ultrasonic energy is assessed by examining the control of mechanical alignment of transducer array elements. A time reversal (TR) approach is then investigated to address challenges in energy focus in both subsystems. Simulation results of the synergetic effect of both modalities assuming a simplified model of human head phantom demonstrate the feasibility of the proposed hybrid technique as a noninvasive tool for thermal treatment of brain tumors. PMID:28840125

Platelet-rich plasma—an ‘Elixir’ for treatment of alopecia: personal experience on 117 patients with review of literature

PubMed Central

Manchanda, Shweta

2017-01-01

Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery and dermatology. PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for hair loss and can be regarded as a valuable adjuvant treatment modality for androgenic alopecia and other types of non-scarring alopecias. Authors have proposed a hair model termed “Golden anchorage with ‘molecular locking’ of ectodermal and mesenchymal components for survival and integrity of hair follicle (HF)” in this article. Golden anchorage comprises of bulge stem cells, ectodermal basement membrane and bulge portion of APM. PRP with its autologous supply of millions of growth factors works on ‘Golden anchorage’ along with keratinocytes (PDGF), dermal papilla (IGF and fibroblast growth factor), vasculature (VEGF and PDGF) and neural cells (Nerve Growth Factor) in a multipronged manner serving as an ‘elixir’ for hair growth and improving overall environment. PMID:28815175

Diabetic Foot Ulcers: The Importance of Patient Comorbidity Recognition and Total Contact Casting in Successful Wound Care.

PubMed

Jagadish, Mayuri; McNally, Michael M; Heidel, R Eric; Teffeteller, Susan; Arnold, Joshua D; Freeman, Michael; Stevens, Scott L; Grandas, Oscar H; Goldman, Mitchell H

2016-08-01

Diabetic foot ulcers (DFUs) are a major burden on the health-care system. The purpose of this study is to investigate factors affecting the healing rate of DFU in a university wound care center. Records of DFU patients treated between July 2013 and February 2015 were reviewed. Demographics, comorbidities, wound characteristics, and treatment modalities including offloading, hyperbaric oxygen treatment, total contact casting, and bioengineered skin were investigated. All patients underwent weekly debridement regardless of treatment modality. A total of 114 patients ages 18 to 98 comprised the study population. Total contact casting was the only treatment associated with increased healing (P = 0.02). Smoking (P = 0.004) and deep vein thrombosis history (P = 0.001) significantly decreased the likelihood of wound healing. Patients with past vascular event trended toward longer healing times (P = 0.07). Total contact casting in combination with weekly wound debridement showed benefit in DFU wound healing, whereas patients with a history of deep vein thrombosis and smoking were less likely to heal.

Strategies for Incorporating Women-Specific Sexuality Education into Addiction Treatment Models

ERIC Educational Resources Information Center

James, Raven

2007-01-01

This paper advocates for the incorporation of a women-specific sexuality curriculum in the addiction treatment process to aid in sexual healing and provide for aftercare issues. Sexuality in addiction treatment modalities is often approached from a sex-negative stance, or that of sexual victimization. Sexual issues are viewed as addictive in and…

Treatment Options for Back Pain Provided Online in Canadian Magazines: Comparison against Evidence from a Clinical Practice Guideline

ERIC Educational Resources Information Center

Sniderman, Jhase A.; Roffey, Darren M.; Lee, Richard; Papineau, Gabrielle D.; Miles, Isabelle H.; Wai, Eugene K.; Kingwell, Stephen P.

2017-01-01

Background: Evidence-based treatments for adult back pain have long been confirmed, with research continuing to narrow down the scope of recommended practices. However, a tension exists between research-driven treatments and unsubstantiated modalities and techniques promoted to the public. This disparity in knowledge translation, which results in…