Familiarizing Students with the Empirically Supported Treatment Approaches for Psychophysiological Disorders and Chronic Pain.

ERIC Educational Resources Information Center

Wilkins, Victoria; Chambliss, Catherine

In training counseling students, it is increasingly important to acquaint them with the clinical research literature exploring the efficacy of particular treatments. This review of empirically supported treatments (EST's) concerning psychophysiological disorders and chronic pain is intended to facilitate the educational process. EST's, or…

Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.

PubMed

Rouzé, Anahita; Loridant, Séverine; Poissy, Julien; Dervaux, Benoit; Sendid, Boualem; Cornu, Marjorie; Nseir, Saad

2017-11-01

The aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment. Prospective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment. In the biomarker group, early stop recommendation was determined using an algorithm based on the results of biomarkers. The primary outcome was the percentage of survivors discontinuing empirical antifungal treatment early, defined as a discontinuation strictly before day 7. A total of 109 patients were analyzed (one patient withdraw consent). Empirical antifungal treatment was discontinued early in 29 out of 54 patients in the biomarker strategy group, compared with one patient out of 55 in the routine strategy group [54% vs 2%, p < 0.001, OR (95% CI) 62.6 (8.1-486)]. Total duration of antifungal treatment was significantly shorter in the biomarker strategy compared with routine strategy [median (IQR) 6 (4-13) vs 13 (12-14) days, p < 0.0001). No significant difference was found in the percentage of patients with subsequent proven invasive Candida infection, mechanical ventilation-free days, length of ICU stay, cost, and ICU mortality between the two study groups. The use of a biomarker-based strategy increased the percentage of early discontinuation of empirical antifungal treatment among critically ill patients with suspected invasive Candida infection. These results confirm previous findings suggesting that early discontinuation of empirical antifungal treatment had no negative impact on outcome. However, further studies are needed to confirm the safety of this strategy. This trial was registered at Clinical

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

PubMed

Nissan, Batel; Lachish, Tamar; Schwartz, Eli

2018-01-01

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

Identifying Empirically Supported Treatments for Phobic Avoidance in Individuals with Intellectual Disabilities

ERIC Educational Resources Information Center

Jennett, Heather K.; Hagopian, Louis P.

2008-01-01

This paper reviews the literature regarding the treatment of phobic avoidance in individuals with intellectual disabilities. Criteria for classifying interventions as empirically supported, developed by the American Psychological Association (APA) Division 12 Task Force on Promotion and Dissemination of Psychological Procedures, were used. For…

Factors influencing the utilization of empirically supported treatments for eating disorders.

PubMed

Simmons, Angela M; Milnes, Suzanne M; Anderson, Drew A

2008-01-01

This study expands upon previous research investigating the use of empirically supported treatments (ESTs) for eating disorders by surveying a large sample of clinicians who specialize in treating eating disorders. Surveys developed for this study were sent to 698 members of a large, professional, eating disorder organization who were listed as treatment providers on the organization's website. Despite clinicians reporting frequently using CBT techniques, most identified something other than CBT or IPT as their primary approach to treatment. In contrast with previous research, the majority had received prior training in the use of manual-based treatments. However, consistent with previous investigations, most denied regular use of such treatments. Although manual-based CBT and IPT are referred to as "treatments of choice," professional clinicians in the field are not consistently using them. Responses suggest several barriers to the utilization of ESTs in practice.

An empirical review of treatment and rehabilitation approaches used in the acute, sub-acute, and chronic phases of recovery following sports-related concussion.

PubMed

Elbin, R J; Schatz, Phil; Lowder, Harrison B; Kontos, Anthony P

2014-11-01

Several treatment and rehabilitation approaches for sport-related concussion have been mentioned in recent consensus and position statements. These options range from the more conservative behavioral management approaches to aggressive pharmacological and therapeutic interventions. Moreover, clinical decision-making for sport-related concussion changes as symptoms and impairments persist throughout recovery. The current article provides an empirical review of proposed treatment and rehabilitation options for sport-related concussion during the acute, subacute, and chronic phases of injury.

A content analysis of advertisements for psychotherapy workshops: implications for disseminating empirically supported treatments.

PubMed

Cook, Joan M; Weingardt, Kenneth R; Jaszka, Jacqueline; Wiesner, Michael

2008-03-01

This study involved a content analysis of 261 unique advertisements for psychotherapy workshops that appeared in two bimonthly clinical magazines, Psychotherapy Networker and Counselor, during a 2-year period. Two independent judges coded each advertisement and documented the type and prevalence of advertising appeals used. From the seminal diffusion of innovations model, Rogers' (2003) five perceived characteristics of innovations found to influence adoption in diverse fields were not well represented in these workshops appeals, appearing less than 10% each. Few advertisements cited specific empirically supported treatments or presented any evidence of treatment effectiveness beyond expert testimonials. The most frequently noted appeals were to benefit the clinician (e.g., earning education credit or developing skills), characteristics that enhance credibility of the workshop (e.g., reference to storied history or mention of faculty), and features of the advertisements itself (e.g., use of superlatives and exclamation points). Promotional strategies to advertise psychotherapy workshops can be used to inform the dissemination of empirically supported treatments.

Changing Heterosexuals' Attitudes toward Homosexuals: A Systematic Review of the Empirical Literature

ERIC Educational Resources Information Center

Tucker, Edmon W.; Potocky-Tripodi, Miriam

2006-01-01

Objective: This article systematically reviews evidence for interventions that change attitudes toward homosexuals. Method: In all, 17 empirical studies using college and/or university student samples and interventions intended to improve heterosexuals' attitudes toward lesbian, gay, or bisexual individuals are reviewed. Characteristics of the…

Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence.

PubMed

Palsson, Olafur S

2015-10-01

Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain's handling of sensory signals from the GI tract.

Perspectives on empirical approaches for ocean color remote sensing of chlorophyll in a changing climate.

PubMed

Dierssen, Heidi M

2010-10-05

Phytoplankton biomass and productivity have been continuously monitored from ocean color satellites for over a decade. Yet, the most widely used empirical approach for estimating chlorophyll a (Chl) from satellites can be in error by a factor of 5 or more. Such variability is due to differences in absorption and backscattering properties of phytoplankton and related concentrations of colored-dissolved organic matter (CDOM) and minerals. The empirical algorithms have built-in assumptions that follow the basic precept of biological oceanography--namely, oligotrophic regions with low phytoplankton biomass are populated with small phytoplankton, whereas more productive regions contain larger bloom-forming phytoplankton. With a changing world ocean, phytoplankton composition may shift in response to altered environmental forcing, and CDOM and mineral concentrations may become uncoupled from phytoplankton stocks, creating further uncertainty and error in the empirical approaches. Hence, caution is warranted when using empirically derived Chl to infer climate-related changes in ocean biology. The Southern Ocean is already experiencing climatic shifts and shows substantial errors in satellite-derived Chl for different phytoplankton assemblages. Accurate global assessments of phytoplankton will require improved technology and modeling, enhanced field observations, and ongoing validation of our "eyes in space."

Estimating the effect of treatment rate changes when treatment benefits are heterogeneous: antibiotics and otitis media.

PubMed

Park, Tae-Ryong; Brooks, John M; Chrischilles, Elizabeth A; Bergus, George

2008-01-01

Contrast methods to assess the health effects of a treatment rate change when treatment benefits are heterogeneous across patients. Antibiotic prescribing for children with otitis media (OM) in Iowa Medicaid is the empirical example. Instrumental variable (IV) and linear probability model (LPM) are used to estimate the effect of antibiotic treatments on cure probabilities for children with OM in Iowa Medicaid. Local area physician supply per capita is the instrument in the IV models. Estimates are contrasted in terms of their ability to make inferences for patients whose treatment choices may be affected by a change in population treatment rates. The instrument was positively related to the probability of being prescribed an antibiotic. LPM estimates showed a positive effect of antibiotics on OM patient cure probability while IV estimates showed no relationship between antibiotics and patient cure probability. Linear probability model estimation yields the average effects of the treatment on patients that were treated. IV estimation yields the average effects for patients whose treatment choices were affected by the instrument. As antibiotic treatment effects are heterogeneous across OM patients, our estimates from these approaches are aligned with clinical evidence and theory. The average estimate for treated patients (higher severity) from the LPM model is greater than estimates for patients whose treatment choices are affected by the instrument (lower severity) from the IV models. Based on our IV estimates it appears that lowering antibiotic use in OM patients in Iowa Medicaid did not result in lost cures.

Dispelling myths about dissociative identity disorder treatment: an empirically based approach.

PubMed

Brand, Bethany L; Loewenstein, Richard J; Spiegel, David

2014-01-01

Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful. We review the empirical support for both arguments. Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia. The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.

Estimation of treatment effect in a subpopulation: An empirical Bayes approach.

PubMed

Shen, Changyu; Li, Xiaochun; Jeong, Jaesik

2016-01-01

It is well recognized that the benefit of a medical intervention may not be distributed evenly in the target population due to patient heterogeneity, and conclusions based on conventional randomized clinical trials may not apply to every person. Given the increasing cost of randomized trials and difficulties in recruiting patients, there is a strong need to develop analytical approaches to estimate treatment effect in subpopulations. In particular, due to limited sample size for subpopulations and the need for multiple comparisons, standard analysis tends to yield wide confidence intervals of the treatment effect that are often noninformative. We propose an empirical Bayes approach to combine both information embedded in a target subpopulation and information from other subjects to construct confidence intervals of the treatment effect. The method is appealing in its simplicity and tangibility in characterizing the uncertainty about the true treatment effect. Simulation studies and a real data analysis are presented.

Rape Treatment Outcome Research: Empirical Findings and State of the Literature

PubMed Central

Vickerman, Katrina A.; Margolin, Gayla

2009-01-01

This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery. PMID:19442425

Mindfulness-based treatment to prevent addictive behavior relapse: theoretical models and hypothesized mechanisms of change.

PubMed

Witkiewitz, Katie; Bowen, Sarah; Harrop, Erin N; Douglas, Haley; Enkema, Matthew; Sedgwick, Carly

2014-04-01

Mindfulness-based treatments are growing in popularity among addiction treatment providers, and several studies suggest the efficacy of incorporating mindfulness practices into the treatment of addiction, including the treatment of substance use disorders and behavioral addictions (i.e., gambling). The current paper provides a review of theoretical models of mindfulness in the treatment of addiction and several hypothesized mechanisms of change. We provide an overview of mindfulness-based relapse prevention (MBRP), including session content, treatment targets, and client feedback from participants who have received MBRP in the context of empirical studies. Future research directions regarding operationalization and measurement, identifying factors that moderate treatment effects, and protocol adaptations for specific populations are discussed.

Mindfulness-Based Treatment to Prevent Addictive Behavior Relapse: Theoretical Models and Hypothesized Mechanisms of Change

PubMed Central

Witkiewitz, Katie; Bowen, Sarah; Harrop, Erin N.; Douglas, Haley; Enkema, Matthew; Sedgwick, Carly

2017-01-01

Mindfulness-based treatments are growing in popularity among addiction treatment providers, and several studies suggest the efficacy of incorporating mindfulness practices into the treatment of addiction, including the treatment of substance use disorders and behavioral addictions (i.e., gambling). The current paper provides a review of theoretical models of mindfulness in the treatment of addiction and several hypothesized mechanisms of change. We provide an overview of mindfulness-based relapse prevention (MBRP), including session content, treatment targets, and client feedback from participants who have received MBRP in the context of empirical studies. Future research directions regarding operationalization and measurement, identifying factors that moderate treatment effects, and protocol adaptations for specific populations are discussed. PMID:24611847

Patients presenting to the hospital with MRSA pneumonia: differentiating characteristics and outcomes with empiric treatment.

PubMed

Minejima, Emi; Lou, Mimi; Nieberg, Paul; Wong-Beringer, Annie

2014-05-10

Concern for MRSA in patients presented to the hospital with pneumonia may be overestimated leading to excessive prescribing of empiric anti-MRSA therapy. This study aims to identify at-risk patients and treatment outcomes. Adults hospitalized during 2005-2011 with pneumonia diagnosed within 48 h of admission were included. Medical charts were retrospectively reviewed for relevant data. Patients with MRSA were matched 1:1 to those with non-MRSA pathogen or negative culture. A published risk scoring system for MRSA pneumonia was applied. 268 elderly patients were included, 134 patients in each group. Compared to non-MRSA group, MRSA patients presented more acutely ill (p < 0.0001) (pneumonia severity index score, 150 vs 93; vasopressor therapy, 34% vs 6%; ICU admission, 47% vs 13%; and mechanical ventilation, 35% vs 10%) and had worse outcomes (p < 0.0001) (time to reach clinical stability, 6 vs 2.5d; length of stay, 10 vs 5d; clinical failure, 28% vs 4%; 28-day mortality, 22% vs 3%). When applied to our patients, a published risk scoring scheme had 93% sensitivity but lacked specificity at 55%; 40% of medium-risk patients did not have MRSA. A history of MRSA infection or pneumonia differentiated the latter group. Most MRSA patients (66%, 88/134) were treated empirically (primarily vancomycin) but outcome was not improved by receipt of empiric therapy. Use of a published risk scoring scheme with additional variables from this study can potentially reduce overprescribing of anti-MRSA empiric therapy in patients presented to the hospital with pneumonia. Prospective studies evaluating the treatment benefit of non-vancomycin alternatives as empiric therapy are needed.

Patients presenting to the hospital with MRSA pneumonia: differentiating characteristics and outcomes with empiric treatment

PubMed Central

2014-01-01

Background Concern for MRSA in patients presented to the hospital with pneumonia may be overestimated leading to excessive prescribing of empiric anti-MRSA therapy. This study aims to identify at-risk patients and treatment outcomes. Methods Adults hospitalized during 2005–2011 with pneumonia diagnosed within 48 h of admission were included. Medical charts were retrospectively reviewed for relevant data. Patients with MRSA were matched 1:1 to those with non-MRSA pathogen or negative culture. A published risk scoring system for MRSA pneumonia was applied. Results 268 elderly patients were included, 134 patients in each group. Compared to non-MRSA group, MRSA patients presented more acutely ill (p < 0.0001) (pneumonia severity index score, 150 vs 93; vasopressor therapy, 34% vs 6%; ICU admission, 47% vs 13%; and mechanical ventilation, 35% vs 10%) and had worse outcomes (p < 0.0001) (time to reach clinical stability, 6 vs 2.5d; length of stay, 10 vs 5d; clinical failure, 28% vs 4%; 28-day mortality, 22% vs 3%). When applied to our patients, a published risk scoring scheme had 93% sensitivity but lacked specificity at 55%; 40% of medium-risk patients did not have MRSA. A history of MRSA infection or pneumonia differentiated the latter group. Most MRSA patients (66%, 88/134) were treated empirically (primarily vancomycin) but outcome was not improved by receipt of empiric therapy. Conclusions Use of a published risk scoring scheme with additional variables from this study can potentially reduce overprescribing of anti-MRSA empiric therapy in patients presented to the hospital with pneumonia. Prospective studies evaluating the treatment benefit of non-vancomycin alternatives as empiric therapy are needed. PMID:24885158

A Survey of Graduate Training in Empirically Supported and Manualized Treatments: A Preliminary Report

ERIC Educational Resources Information Center

Karekla, Maria; Lundgren, Jennifer D.; Forsyth, John P.

2004-01-01

The promotion and dissemination of empirically supported (ESTs) and manualized therapies are important, albeit controversial, developments within clinical science and practice. To date, studies evaluating training opportunities and attitudes about such treatments at the graduate, predoctoral internship, and postdoctoral levels have focused on the…

Predictive vs. Empiric Assessment of Schistosomiasis: Implications for Treatment Projections in Ghana

PubMed Central

Kabore, Achille; Biritwum, Nana-Kwadwo; Downs, Philip W.; Soares Magalhaes, Ricardo J.; Zhang, Yaobi; Ottesen, Eric A.

2013-01-01

Background Mapping the distribution of schistosomiasis is essential to determine where control programs should operate, but because it is impractical to assess infection prevalence in every potentially endemic community, model-based geostatistics (MBG) is increasingly being used to predict prevalence and determine intervention strategies. Methodology/Principal Findings To assess the accuracy of MBG predictions for Schistosoma haematobium infection in Ghana, school surveys were evaluated at 79 sites to yield empiric prevalence values that could be compared with values derived from recently published MBG predictions. Based on these findings schools were categorized according to WHO guidelines so that practical implications of any differences could be determined. Using the mean predicted values alone, 21 of the 25 empirically determined ‘high-risk’ schools requiring yearly praziquantel would have been undertreated and almost 20% of the remaining schools would have been treated despite empirically-determined absence of infection – translating into 28% of the children in the 79 schools being undertreated and 12% receiving treatment in the absence of any demonstrated need. Conclusions/Significance Using the current predictive map for Ghana as a spatial decision support tool by aggregating prevalence estimates to the district level was clearly not adequate for guiding the national program, but the alternative of assessing each school in potentially endemic areas of Ghana or elsewhere is not at all feasible; modelling must be a tool complementary to empiric assessments. Thus for practical usefulness, predictive risk mapping should not be thought of as a one-time exercise but must, as in the current study, be an iterative process that incorporates empiric testing and model refining to create updated versions that meet the needs of disease control operational managers. PMID:23505584

Change of signs, symptoms and voice quality evaluations throughout a 3- to 6-month empirical treatment for laryngopharyngeal reflux disease.

PubMed

Lechien, J R; Finck, C; Khalife, M; Huet, K; Delvaux, V; Picalugga, M; Harmegnies, B; Saussez, S

2018-05-16

To assess the usefulness of voice quality measurements as a treatment outcome in patients with laryngopharyngeal reflux (LPR)-related symptoms. Prospective uncontrolled multi-centre study. A total of 80 clinically diagnosed LPR patients with a reflux finding score (RFS)>7 and a reflux symptom index (RSI)>13 were treated with pantoprazole and diet recommendations during 3 or 6 months, according to their evolution. RSI; RFS; blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) and aerodynamic and acoustic measurements were evaluated at baseline, 3 months (n = 80), and 6 months (n = 41) post-treatment. We conducted a correlation analysis between the adherence to the diet, and the evolution of both signs and symptoms and between videolaryngostroboscopic signs and acoustic measurements. Reflux symptom index, RFS, perceptual voice quality evaluations (dysphonia, roughness, strain and instability), and aerodynamic and acoustic measurements (ie, percent jitter and percent shimmer) were significantly improved at 3 months post-treatment but not at 6 months. Percent jitter was the most useful outcome for evaluating the clinical evolution of patients throughout the treatment course. A significant relationship between globus sensation and posterior commissure hypertrophy was documented; both seemed to significantly improve from 3 to 6 months. The correlation analysis revealed correlations between adherence to diet recommendations and the improvement of symptoms and between posterior commissure granulation severity and acoustic measurement impairments. Voice quality improved in a manner similar to both signs and symptoms throughout a 6-month empirical treatment with better improvement the 3 first months. Voice quality assessments can be used as indicators of treatment effectiveness in patients with LPR-related symptoms. © 2018 John Wiley & Sons Ltd.

Organizational Readiness for Change and Opinions toward Treatment Innovations

PubMed Central

Fuller, Bret E.; Rieckmann, Traci; Nunes, Edward V.; Miller, Michael; Arfken, Cynthia; Edmundson, Eldon; McCarty, Dennis

2007-01-01

Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC’s utility in assessing agency strengths and needs during the implementation of evidence-based practices. PMID:17434708

Training addiction professionals in empirically supported treatments: perspectives from the treatment community.

PubMed

Hartzler, Bryan; Rabun, Carl

2014-01-01

Large-scale dissemination efforts seek to expand opportunities for the addiction treatment community to receive training in empirically supported treatments (ESTs). Prospective consumers of such training are valuable sources of input about content of interest, preferences for how training events are structured, and obstacles that deter receipt of training. In this mixed-method study, data were collected in 64 semistructured individual interviews with personnel during site visits to 16 community opioid treatment programs (OTPs). At each OTP, interviews were completed with the executive director, a clinical supervisor, and 2 direct-service clinicians. Topical interests were analyzed qualitatively in a cultural domain analysis. Likert ratings of training event preferences were analyzed via generalized linear mixed models (GLMMs), and unstructured interviewee comments were analyzed via narrative analysis. Obstacles to training receipt were analyzed qualitatively with both content coding and narrative analysis. Based on topics of reported interest, cultural domain analysis suggests as ESTs of note: Multidimensional Family Therapy, Motivational Enhancement Therapy, Relapse Prevention Therapy, "Seeking Safety," and broad addiction-focused pharmacotherapy. Regarding training event preferences, GLMMs and narrative analysis revealed clear preferences for time-distributed trainings and use of participatory activities (e.g., trainer demonstrations, role plays, small group exercises). Content coding identified cost as the primary obstacle to receipt of EST trainings, followed by lack of time, logistical challenges, and disinterest, and narrative analysis elaborated on contextual issues underlying these obstacles. As primary consumers of EST technologies, the treatment community has valuable input to offer. Dissemination efforts may be enhanced by greater consideration of their preferences for training content and event structure, as well as practical obstacles that challenge

Attachment-Based Family Therapy: A Review of the Empirical Support.

PubMed

Diamond, Guy; Russon, Jody; Levy, Suzanne

2016-09-01

Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT. © 2016 Family Process Institute.

An empirical, hierarchical typology of tree species assemblages for assessing forest dynamics under global change scenarios

Treesearch

Jennifer K. Costanza; John W. Coulston; David N. Wear

2017-01-01

The composition of tree species occurring in a forest is important and can be affected by global change drivers such as climate change. To inform assessment and projection of global change impacts at broad extents, we used hierarchical cluster analysis and over 120,000 recent forest inventory plots to empirically define forest tree assemblages across the U.S., and...

Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections.

PubMed

Linsenmeyer, Katherine; Strymish, Judith; Gupta, Kalpana

2015-12-01

The emergence of multidrug-resistant (MDR) uropathogens is making the treatment of urinary tract infections (UTIs) more challenging. We sought to evaluate the accuracy of empiric therapy for MDR UTIs and the utility of prior culture data in improving the accuracy of the therapy chosen. The electronic health records from three U.S. Department of Veterans Affairs facilities were retrospectively reviewed for the treatments used for MDR UTIs over 4 years. An MDR UTI was defined as an infection caused by a uropathogen resistant to three or more classes of drugs and identified by a clinician to require therapy. Previous data on culture results, antimicrobial use, and outcomes were captured from records from inpatient and outpatient settings. Among 126 patient episodes of MDR UTIs, the choices of empiric therapy against the index pathogen were accurate in 66 (52%) episodes. For the 95 patient episodes for which prior microbiologic data were available, when empiric therapy was concordant with the prior microbiologic data, the rate of accuracy of the treatment against the uropathogen improved from 32% to 76% (odds ratio, 6.9; 95% confidence interval, 2.7 to 17.1; P < 0.001). Genitourinary tract (GU)-directed agents (nitrofurantoin or sulfa agents) were equally as likely as broad-spectrum agents to be accurate (P = 0.3). Choosing an agent concordant with previous microbiologic data significantly increased the chance of accuracy of therapy for MDR UTIs, even if the previous uropathogen was a different species. Also, GU-directed or broad-spectrum therapy choices were equally likely to be accurate. The accuracy of empiric therapy could be improved by the use of these simple rules. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

The costs of the soviet empire.

PubMed

Wolf, C

1985-11-29

A comprehensive framework is developed and applied to estimate the economic costs incurred by the Soviet Union in acquiring, maintaining, and expanding its empire. The terms "empire" and "costs" are explicitly defined. Between 1971 and 1980, the average ratio between empire costs and Soviet gross national product was about 3.5 percent; as a ratio to Soviet military spending, empire costs averaged about 28 percent. The burden imposed on Soviet economic growth by empire costs is also considered, as well as rates of change in these costs, and the important political, military, and strategic benefits associated by the Soviet leadership with maintenance and expansion of the empire. Prospective empire costs and changes in Soviet economic constraints resulting from the declining performance of the domestic economy are also considered.

Identity: empirical contribution. Changes in the identity integration of adolescents in treatment for personality disorders.

PubMed

Feenstra, Dine J; Hutsebaut, Joost; Verheul, Roel; van Limbeek, Jacques

2014-02-01

A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.

Quantifying uncertainty in climate change science through empirical information theory.

PubMed

Majda, Andrew J; Gershgorin, Boris

2010-08-24

Quantifying the uncertainty for the present climate and the predictions of climate change in the suite of imperfect Atmosphere Ocean Science (AOS) computer models is a central issue in climate change science. Here, a systematic approach to these issues with firm mathematical underpinning is developed through empirical information theory. An information metric to quantify AOS model errors in the climate is proposed here which incorporates both coarse-grained mean model errors as well as covariance ratios in a transformation invariant fashion. The subtle behavior of model errors with this information metric is quantified in an instructive statistically exactly solvable test model with direct relevance to climate change science including the prototype behavior of tracer gases such as CO(2). Formulas for identifying the most sensitive climate change directions using statistics of the present climate or an AOS model approximation are developed here; these formulas just involve finding the eigenvector associated with the largest eigenvalue of a quadratic form computed through suitable unperturbed climate statistics. These climate change concepts are illustrated on a statistically exactly solvable one-dimensional stochastic model with relevance for low frequency variability of the atmosphere. Viable algorithms for implementation of these concepts are discussed throughout the paper.

An Empirical Investigation of Group Treatment for a Clinical Population of Adult Female Incest Survivors.

ERIC Educational Resources Information Center

Saxe, Brenda J.; Johnson, Susan M.

1999-01-01

Empirically assesses the effectiveness of a group treatment program on intrapersonal symptomatology and interpersonal difficulties in a clinical population of women with a history of incest. Results indicate that a time-limited group, which focuses on the original trauma, is effective in reducing intrapersonal symptomatology for women with a…

Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions

PubMed Central

Mitchell, John T.; Zylowska, Lidia; Kollins, Scott H.

2015-01-01

Research examining nonpharmacological interventions for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) has expanded in recent years and provides patients with more treatment options. Mindfulness-based training is an example of an intervention that is gaining promising preliminary empirical support and is increasingly administered in clinical settings. The aim of this review is to provide a rationale for the application of mindfulness to individuals diagnosed with ADHD, describe the current state of the empirical basis for mindfulness training in ADHD, and summarize a treatment approach specific to adults diagnosed with ADHD: the Mindful Awareness Practices (MAPs) for ADHD Program. Two case study examples are provided to demonstrate relevant clinical issues for practitioners interested in this approach. Directions for future research, including mindfulness meditation as a standalone treatment and as a complementary approach to cognitive-behavioral therapy, are provided. PMID:25908900

National Trainers’ Perspectives on Challenges to Implementation of an Empirically-Supported Mental Health Treatment

PubMed Central

Hanson, Rochelle F.; Gros, Kirstin Stauffacher; Davidson, Tatiana M.; Barr, Simone; Cohen, Judith; Deblinger, Esther; Mannarino, Anthony P.; Ruggiero, Kenneth J.

2013-01-01

This study examined perceived challenges to implementation of an empirically supported mental health treatment for youth (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) and explored the potential use of technology-based resources in treatment delivery. Thematic interviews were conducted with 19 approved national TF-CBT trainers to assess their perspectives about challenges to implementation of TF-CBT and to explore their perceptions about the potential value of innovative, technology-based solutions to enhance provider fidelity and improve quality of care. These data offer some important insights and implications for training in evidence-based treatments, provider fidelity and competence, and patient engagement, particularly for those interventions targeting trauma-related symptoms among youth. PMID:23605292

Empirically-supported and non-empirically supported therapies for bulimia nervosa: retrospective patient ratings

PubMed Central

2013-01-01

Background Empirically supported therapies for bulimia nervosa include cognitive behaviour therapy and interpersonal therapy. Whilst these treatments have been shown to be effective in multiple randomised controlled trials, little research has investigated how they are perceived by patients who receive them. This study investigated whether empirically-supported psychological therapies (ESTs) are associated with superior self-rated treatment outcomes in clients with Bulimia Nervosa (BN). Results 98 adults who had received psychological therapy for BN in the United Kingdom completed a questionnaire which retrospectively assessed the specific contents of their psychological therapy and self-rated treatment outcomes. Around half the sample, fifty three participants reported receiving an EST. Fifty of these received Cognitive Behaviour Therapy (CBT) and three Interpersonal Therapy (IPT). Where therapy met expert criteria for Cognitive Behaviour Therapy for Bulimia Nervosa (CBT-BN, an EST) participants reported superior treatment outcomes than those who appeared to receive non-specialist cognitive-behavioural therapy. However, self-rated treatment outcomes were similar overall between those whose therapy met criteria for ESTs and those whose therapy did not. Conclusions The findings offer tentative support for the perceived helpfulness of CBT-BN as evaluated in controlled research trials. Cognitive-behavioural therapies for BN, as they are delivered in the UK, may not necessarily be perceived as more beneficial by clients with BN than psychological therapies which currently have less empirical support. PMID:24999419

Empirically Supported Treatment's Impact on Organizational Culture and Climate.

PubMed

Patterson-Silver Wolf, David A; Dulmus, Catherine N; Maguin, Eugene

2012-11-01

OBJECTIVES: With the continued push to implement empirically supported treatments (ESTs) into community-based organizations, it is important to investigate whether working condition disruptions occur during this process. While there are many studies investigating best practices and how to adopt them, the literature lacks studies investigating the working conditions in programs that currently use ESTs. METHOD: This study compared the culture and climate scores of a large organization's programs that use ESTs and those programs indicating no EST usage. RESULTS: Of the total 55 different programs (1,273 frontline workers), 27 programs used ESTs. Results indicate that the programs offering an EST had significantly more rigid and resistant cultures, compared to those without any ESTs. In regard to climate, programs offering an EST were significantly less engaged, less functional, and more stressed. CONCLUSION: Outcomes indicate a significant disruption in organizational culture and climate for programs offering ESTs.

Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study

PubMed Central

van der Eerden, M M; Vlaspolder, F; de Graaff, C S; Groot, T; Bronsveld, W; Jansen, H; Boersma, W

2005-01-01

Background: There is much controversy about the ideal approach to the management of community acquired pneumonia (CAP). Recommendations differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics. Methods: In a prospective randomised open study performed between 1998 and 2000, a pathogen directed treatment (PDT) approach was compared with an empirical broad spectrum antibiotic treatment (EAT) strategy according to the ATS guidelines of 1993 in 262 hospitalised patients with CAP. Clinical efficacy was primarily determined by the length of hospital stay (LOS). Secondary outcome parameters for clinical efficacy were assessment of therapeutic failure on antibiotics, 30 day mortality, duration of antibiotic treatment, resolution of fever, side effects, and quality of life. Results: Three hundred and three patients were enrolled in the study; 41 were excluded, leaving 262 with results available for analysis. No significant differences were found between the two treatment groups in LOS, 30 day mortality, clinical failure, or resolution of fever. Side effects, although they did not have a significant influence on the outcome parameters, occurred more frequently in patients in the EAT group than in those in the PDT group (60% v 17%, 95% CI –0.5 to –0.3; p<0.001). Conclusions: An EAT strategy with broad spectrum antibiotics for the management of hospitalised patients with CAP has comparable clinical efficacy to a PDT approach. PMID:16061709

Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

PubMed

Zuccaro, Valentina; Columpsi, Paola; Sacchi, Paolo; Lucà, Maria Grazia; Fagiuoli, Stefano; Bruno, Raffaele

2017-06-01

The aim of this review is to focus on the recent knowledge on antibiotic stewardship and empiric antibiotic treatment in cirrhotic patients. The application of antimicrobial stewardship (AMS) rules appears to be the most appropriate strategy to globally manage cirrhotic patients with infectious complications: indeed they represent a unique way to provide both early diagnosis and appropriate therapy in order to avoid not only antibiotic over-prescription but, more importantly, selection and spread of antimicrobial resistance. Moreover, cirrhotic patients must be considered "frail" and susceptible to healthcare associated infections: applying AMS policies would assure a cost reduction and thus contribute to the improvement of public health strategies. Copyright © 2017. Published by Elsevier Ltd.

An empirical perspective for understanding climate change impacts in Switzerland

USGS Publications Warehouse

Henne, Paul; Bigalke, Moritz; Büntgen, Ulf; Colombaroli, Daniele; Conedera, Marco; Feller, Urs; Frank, David; Fuhrer, Jürg; Grosjean, Martin; Heiri, Oliver; Luterbacher, Jürg; Mestrot, Adrien; Rigling, Andreas; Rössler, Ole; Rohr, Christian; Rutishauser, This; Schwikowski, Margit; Stampfli, Andreas; Szidat, Sönke; Theurillat, Jean-Paul; Weingartner, Rolf; Wilcke, Wolfgan; Tinner, Willy

2018-01-01

Planning for the future requires a detailed understanding of how climate change affects a wide range of systems at spatial scales that are relevant to humans. Understanding of climate change impacts can be gained from observational and reconstruction approaches and from numerical models that apply existing knowledge to climate change scenarios. Although modeling approaches are prominent in climate change assessments, observations and reconstructions provide insights that cannot be derived from simulations alone, especially at local to regional scales where climate adaptation policies are implemented. Here, we review the wealth of understanding that emerged from observations and reconstructions of ongoing and past climate change impacts in Switzerland, with wider applicability in Europe. We draw examples from hydrological, alpine, forest, and agricultural systems, which are of paramount societal importance, and are projected to undergo important changes by the end of this century. For each system, we review existing model-based projections, present what is known from observations, and discuss how empirical evidence may help improve future projections. A particular focus is given to better understanding thresholds, tipping points and feedbacks that may operate on different time scales. Observational approaches provide the grounding in evidence that is needed to develop local to regional climate adaptation strategies. Our review demonstrates that observational approaches should ideally have a synergistic relationship with modeling in identifying inconsistencies in projections as well as avenues for improvement. They are critical for uncovering unexpected relationships between climate and agricultural, natural, and hydrological systems that will be important to society in the future.

Changes in Anatomy Instruction and USMLE Performance: Empirical Evidence on the Absence of a Relationship

ERIC Educational Resources Information Center

Cuddy, Monica M.; Swanson, David B.; Drake, Richard L.; Pawlina, Wojciech

2013-01-01

Anatomy instruction has evolved over the past two decades as many medical schools have undergone various types of curricular reform. To provide empirical evidence about whether or not curricular changes impact the acquisition and retention of anatomy knowledge, this study investigated the effect of variation in gross anatomy course hours,…

Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients.

PubMed

Secondo, Giovanni; Vassallo, Francesca; Solari, Nicola; Moresco, Luciano; Percivale, Pierluigi; Zappi, Lucia; Cafiero, Ferdinando; De Maria, Andrea

2010-11-01

Cancer patients with complicated infections following abdominal surgery represent one of the worst clinical scenarios that is useful for testing the efficacy of empirical antimicrobial therapy. No study so far has evaluated the performance of tigecycline (TIG) when administered as empirical first-line treatment in a homogeneous population of surgical cancer patients with a febrile episode. An observational review of the data records of 24 sequential patients receiving TIG for a febrile episode following a major abdominal procedure in a single cancer institute was performed. Large bowel surgery represented 68% of all procedures, followed by gastric surgery (16%) and urinary-gynaecologic-biliary surgery (16%). Complications following surgery were observed in 68% of febrile episodes, with peritonitis and sepsis accounting for 59% and 24% of complications, respectively. Eight patients needed repeat surgery for source control. The mean duration of TIG treatment was 8 days. Causative pathogens were detected in 16 episodes (64%), and a total of 44 microorganisms were recovered (29% Escherichia coli, 9% Enterococcus faecalis and 9% coagulase-negative staphylococci). TIG was effective in 12 episodes (48%). The success rate was 67% when infectious episodes sustained by intrinsically resistant bacteria and fungi were excluded. Treatment failure was associated with the presence of complications and with microbiologically documented infection. TIG may be useful as a first-line treatment option in cancer patients requiring antibiotic treatment following surgery when complications are not present or suspected on clinical grounds and when local microbial epidemiology shows a low incidence of primary resistant bacteria. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Using change-point models to estimate empirical critical loads for nitrogen in mountain ecosystems.

PubMed

Roth, Tobias; Kohli, Lukas; Rihm, Beat; Meier, Reto; Achermann, Beat

2017-01-01

To protect ecosystems and their services, the critical load concept has been implemented under the framework of the Convention on Long-range Transboundary Air Pollution (UNECE) to develop effects-oriented air pollution abatement strategies. Critical loads are thresholds below which damaging effects on sensitive habitats do not occur according to current knowledge. Here we use change-point models applied in a Bayesian context to overcome some of the difficulties when estimating empirical critical loads for nitrogen (N) from empirical data. We tested the method using simulated data with varying sample sizes, varying effects of confounding variables, and with varying negative effects of N deposition on species richness. The method was applied to the national-scale plant species richness data from mountain hay meadows and (sub)alpine scrubs sites in Switzerland. Seven confounding factors (elevation, inclination, precipitation, calcareous content, aspect as well as indicator values for humidity and light) were selected based on earlier studies examining numerous environmental factors to explain Swiss vascular plant diversity. The estimated critical load confirmed the existing empirical critical load of 5-15 kg N ha -1 yr -1 for (sub)alpine scrubs, while for mountain hay meadows the estimated critical load was at the lower end of the current empirical critical load range. Based on these results, we suggest to narrow down the critical load range for mountain hay meadows to 10-15 kg N ha -1 yr -1 . Copyright © 2016 Elsevier Ltd. All rights reserved.

Treatments for Sleep Changes

MedlinePlus

... Paradise Tau Kappa Epsilon (TKE) Sigma Alpha Mu Shop Local Resources Search close go back close Find ... that may outweigh the benefits of treatment. Non-drug treatments for sleep changes Non-drug treatments aim ...

How good is the evidence for the recommended empirical antimicrobial treatment of patients hospitalized because of community-acquired pneumonia? A systematic review.

PubMed

Oosterheert, J J; Bonten, M J M; Hak, E; Schneider, M M E; Hoepelman, I M

2003-10-01

For years, monotherapy with a beta-lactam antibiotic (penicillin, amoxicillin or second-generation cephalosporin) was recommended as empirical therapy for patients with community-acquired pneumonia (CAP). A combination of a beta-lactam and a macrolide antibiotic was only recommended for patients with severe CAP needing intensive care treatment or when atypical pathogens, i.e. Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae, were strongly suspected. However, new guidelines recommend a combination of a beta-lactam antibiotic plus a macrolide or monotherapy with a fluoroquinolone for all patients hospitalized with CAP. We evaluated whether treatment with a beta-lactam plus macrolide or quinolone monotherapy is truly superior to beta-lactam treatment alone. We systematically reviewed available studies, retrieved from MEDLINE and by hand-searching reference lists from recent reviews and guidelines on the effectiveness of recommended empirical antimicrobial treatment of patients hospitalized because of CAP. Eight relevant studies were selected. In six studies significant reductions in mortality were found, in one study a reduction in hospital length of stay was found and in one study no beneficial effects could be demonstrated for treatment regimens with fluoroquinolone monotherapy or combinations of beta-lactams and macrolides. The beneficial value of macrolides or fluoroquinolones might be the result of a large and mainly unrecognized role of atypical pathogens in the aetiology of CAP, anti-inflammatory effects of macrolides or resistance to beta-lactams of the most important pathogens. However, the studies supporting the recommended treatment regimen were designed as non-experimental cohort studies. As a consequence, the results may have been influenced by confounding by indication. In addition, the outcomes showed several inconsistencies. A randomized controlled trial is warranted to circumvent the methodological flaws in the designs of the

The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial.

PubMed

Piano, Salvatore; Fasolato, Silvano; Salinas, Freddy; Romano, Antonietta; Tonon, Marta; Morando, Filippo; Cavallin, Marta; Gola, Elisabetta; Sticca, Antonietta; Loregian, Arianna; Palù, Giorgio; Zanus, Giacomo; Senzolo, Marco; Burra, Patrizia; Cillo, Umberto; Angeli, Paolo

2016-04-01

Spontaneous bacterial peritonitis (SBP) is a common, life-threatening complication of liver cirrhosis. Third-generation cephalosporins have been considered the first-line treatment of SBP. In 2014, a panel of experts suggested a broader spectrum antibiotic regimen for nosocomial SBP, according to the high rate of bacteria resistant to third-generation cephalosporins found in these patients. However, a broader-spectrum antibiotic regimen has never been compared to third-generation cephalosporins in the treatment of nosocomial SBP. The aim of our study was to compare meropenem plus daptomycin versus ceftazidime in the treatment of nosocomial SBP. Patients with cirrhosis and nosocomial SBP were randomized to receive meropenem (1 g/8 hours) plus daptomycin (6 mg/kg/day) or ceftazidime (2 g/8 hours). A paracentesis was performed after 48 hours of treatment. A reduction in ascitic fluid neutrophil count <25% of pretreatment value was considered a treatment failure. The primary outcome was the efficacy of treatment defined by the resolution of SBP after 7 days of treatment. Thirty-two patients were randomized and 31 were analyzed. The combination of meropenem plus daptomycin was significantly more effective than ceftazidime in the treatment of nosocomial SBP (86.7 vs. 25%; P < 0.001). Ninety-day transplant-free survival (TFS) was not significantly different between the two groups. In the multivariate analysis, ineffective response to first-line treatment (hazard ratio [HR]: 20.6; P = 0.01), development of acute kidney injury during hospitalization (HR: 23.2; P = 0.01), and baseline mean arterial pressure (HR: 0.92; P = 0.01) were found to be independent predictors of 90-day TFS. The combination of meropenem plus daptomycin is more effective than ceftazidime as empirical antibiotic treatment of nosocomial SBP. Efficacy of the empirical antibiotic treatment is a strong predictor of 90-day survival in patients with nosocomial SBP. © 2015 by the American

Should the patients colonized with extended-spectrum beta-lactamase-producing Gram-negative bacilli (E-GNB) coming to hospital from the community with pneumonia get anti-E-GNB active empirical treatment?

PubMed

Peterlin, Lara; Žagar, Mateja; Lejko Zupanc, Tatjana; Paladin, Marija; Beović, Bojana

2017-10-01

Extended-spectrum beta-lactamases are responsible for resistance of Gram-negative bacilli to several beta-lactam antibiotics, including those prescribed for treatment pneumonia. To evaluate the importance of colonization with E-GNB for the choice of empirical treatment we performed a retrospective case-control study including 156 patients, hospitalized for treatment of pneumonia from 2009 through 2013. Empirical treatment success and in-hospital survival were significantly lower in patients colonized with E-GNB compared to non-colonized (p = 0.002, p = 0.035). When comparing subgroups of colonized patients, treatment success was significantly lower in patients who were colonized with E-GNB resistant to empirical antibiotic (p = 0.010), but not in those colonized by E-GNB susceptible to empirically given antibiotic (p = 0.104). Difference in in-hospital mortality was insignificant in both subgroups (p = 0.056, p = 0.331). The results of study suggest that an anti-E-GNB active antibiotic should be used for empirical treatment of pneumonia in E-GNB colonized patients.

Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues.

PubMed

De Jongh, A; Ten Broeke, E; Renssen, M R

1999-01-01

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.

Economic analysis of empiric versus diagnostic-driven strategies for immunocompromised patients with suspected fungal infections in the People's Republic of China.

PubMed

Mao, Ningying; Lesher, Beth; Liu, Qifa; Qin, Lei; Chen, Yixi; Gao, Xin; Earnshaw, Stephanie R; McDade, Cheryl L; Charbonneau, Claudie

2016-01-01

Invasive fungal infections (IFIs) require rapid diagnosis and treatment. A decision-analytic model was used to estimate total costs and survival associated with a diagnostic-driven (DD) or an empiric treatment approach in neutropenic patients with hematological malignancies receiving chemotherapy or autologous/allogeneic stem cell transplants in Shanghai, Beijing, Chengdu, and Guangzhou, the People's Republic of China. Treatment initiation for the empiric approach occurred after clinical suspicion of an IFI; treatment initiation for the DD approach occurred after clinical suspicion and a positive IFI diagnostic test result. Model inputs were obtained from the literature; treatment patterns and resource use were based on clinical opinion. Total costs were lower for the DD versus the empiric approach in Shanghai (¥3,232 vs ¥4,331), Beijing (¥3,894 vs ¥4,864), Chengdu, (¥4,632 vs ¥5,795), and Guangzhou (¥8,489 vs ¥9,795). Antifungal administration was lower using the DD (5.7%) than empiric (9.8%) approach, with similar survival rates. Results from one-way and probabilistic sensitivity analyses were most sensitive to changes in diagnostic test sensitivity and IFI incidence; the DD approach dominated the empiric approach in 88% of scenarios. These results suggest that a DD compared to an empiric treatment approach in the People's Republic of China may be cost saving, with similar overall survival in immunocompromised patients with suspected IFIs.

Psychodynamic therapy from the perspective of self-organization. a concept of change and a methodological approach for empirical examination.

PubMed

Gumz, Antje; Geyer, Michael; Brähler, Elmar

2014-01-01

Observations from therapeutic practice and a series of empirical findings, for example, those on discontinuous change in psychotherapeutic processes, suggest modelling the therapeutic process as a self-organizing system with stable and critical instable phases and abrupt transitions. Here, a concept of psychotherapeutic change is presented that applies self-organization theory to psychodynamic principles. The authors explain the observations and considerations that form the basis of the concept and present some connections with existing findings and concepts. On the basis of this model, they generated two hypotheses regarding the co-occurrence of instability and discontinuous change and the degree of synchrony between the therapist and patient. A study design to test these hypotheses was developed and applied to a single case (psychodynamic therapy). After each session, patient and therapist rated their interaction. A measure of instability was calculated across the resulting time series. Sequences of destabilization were observed. On the basis of points of extreme instability, the process was divided into phases. Local instability maxima were accompanied by significant discontinuous change. Destabilization was highly synchronous in therapist and patient ratings. The authors discussed the concept and the methodological procedure. The approach enables the operationalization of crises and to empirically assess the significance of critical phases and developments within the therapeutic relationship. We present a concept of change that applies self-organization theory to psychodynamic therapy. We empirically tested the hypotheses formulated in the concept based on an extract of 125 long-term psychodynamic therapy sessions. We continuously monitored the therapeutic interaction and calculated a measure of the instability of the assessments. We identified several sequences of stable and unstable episodes. Episodes of high instability were accompanied by discontinuous

Interesting Practitioners in Training in Empirically Supported Treatments: Research Reviews versus Case Studies

PubMed Central

Stewart, Rebecca E.; Chambless, Dianne L.

2010-01-01

It has been repeatedly demonstrated that clinicians rely more on clinical judgment than on research findings. We hypothesized that psychologists in practice might be more open to adopting empirically supported treatments (ESTs) if outcome results were presented with a case study. Psychologists in private practice (N = 742) were randomly assigned to receive a research review of data from randomized controlled trials of cognitive-behavioral treatment (CBT) and medication for bulimia, a case study of CBT for a fictional patient with bulimia, or both. Results indicated that the inclusion of case examples renders ESTs more compelling and interests clinicians in gaining training. Despite these participants’ training in statistics, the inclusion of the statistical information had no influence on attitudes or training willingness beyond that of the anecdotal case information. PMID:19899142

Moving Clinical Deliberations on Administrative Discharge in Drug Addiction Treatment Beyond Moral Rhetoric to Empirical Ethics.

PubMed

Williams, Izaak L

2016-01-01

Patients' admission to modern substance use disorder treatment comes with the attendant risk of being discharged from treatment-a widespread practice. This article describes the three mainstream theories of addiction that operate as a reference point for clinicians in reasoning about a decision to discharge a patient from treatment. The extant literature is reviewed to highlight the pathways that patients follow after administrative discharge. Little scientific research has been done to investigate claims and hypotheses about the therapeutic function of AD, which points to the need for empirical ethics to inform clinical addictions practice. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

An Analysis of Functional Communication Training as an Empirically Supported Treatment for Problem Behavior Displayed by Individuals with Intellectual Disabilities

ERIC Educational Resources Information Center

Kurtz, Patricia F.; Boelter, Eric W.; Jarmolowicz, David P.; Chin, Michelle D.; Hagopian, Louis P.

2011-01-01

This paper examines the literature on the use of functional communication training (FCT) as a treatment for problem behavior displayed by individuals with intellectual disabilities (ID). Criteria for empirically supported treatments developed by Divisions 12 and 16 of the American Psychological Association (Kratochwill & Stoiber, 2002; Task Force,…

Youth Top Problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy.

PubMed

Weisz, John R; Chorpita, Bruce F; Frye, Alice; Ng, Mei Yi; Lau, Nancy; Bearman, Sarah Kate; Ugueto, Ana M; Langer, David A; Hoagwood, Kimberly E

2011-06-01

To complement standardized measurement of symptoms, we developed and tested an efficient strategy for identifying (before treatment) and repeatedly assessing (during treatment) the problems identified as most important by caregivers and youths in psychotherapy. A total of 178 outpatient-referred youths, 7-13 years of age, and their caregivers separately identified the 3 problems of greatest concern to them at pretreatment and then rated the severity of those problems weekly during treatment. The Top Problems measure thus formed was evaluated for (a) whether it added to the information obtained through empirically derived standardized measures (e.g., the Child Behavior Checklist [CBCL; Achenbach & Rescorla, 2001] and the Youth Self-Report [YSR; Achenbach & Rescorla, 2001]) and (b) whether it met conventional psychometric standards. The problems identified were significant and clinically relevant; most matched CBCL/YSR items while adding specificity. The top problems also complemented the information yield of the CBCL/YSR; for example, for 41% of caregivers and 79% of youths, the identified top problems did not correspond to any items of any narrowband scales in the clinical range. Evidence on test-retest reliability, convergent and discriminant validity, sensitivity to change, slope reliability, and the association of Top Problems slopes with standardized measure slopes supported the psychometric strength of the measure. The Top Problems measure appears to be a psychometrically sound, client-guided approach that complements empirically derived standardized assessment; the approach can help focus attention and treatment planning on the problems that youths and caregivers consider most important and can generate evidence on trajectories of change in those problems during treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Stability of an empirical psychosocial taxonomy across type of diabetes and treatment.

PubMed

Nouwen, A; Breton, M-C; Urquhart Law, G; Descôteaux, J

2007-01-01

The aims of the study were (i) to examine whether an empirical psychosocial taxonomy, based on key diabetes-related variables, is independent of type of diabetes and treatment, and (ii) to further establish the external validation of the taxonomy. In a cross-sectional study, 82 patients with Type 1 and 86 patients with Type 2 diabetes mellitus were assigned to one of three psychosocial patient profiles based on their Multidimensional Diabetes Questionnaire (MDQ) scores. General psychological and diabetes-specific measures were obtained through self-report and HbA(1c) was measured. Equal proportions of Type 1 and Type 2 patients, and of patients using insulin and oral medication/diet only were classified within each of the three psychosocial profiles. External validation confirmed the validity and distinctiveness of the patients' profiles. The patient profiles were independent of demographic variables, body mass index, duration of diabetes, complexity of treatment, number of complications, social desirability, and major stress levels. The Psychosocial Taxonomy for Patients with Diabetes provides a new way to categorize individuals who may have more in common than just their type of diabetes and/or its treatment and can help target interventions to individual patients' needs.

Climate change and the collapse of the Akkadian empire: Evidence from the deep sea

NASA Astrophysics Data System (ADS)

Cullen, H. M.; Demenocal, P. B.; Hemming, S.; Hemming, G.; Brown, F. H.; Guilderson, T.; Sirocko, F.

2000-04-01

The Akkadian empire ruled Mesopotamia from the headwaters of the Tigris-Euphrates Rivers to the Persian Gulf during the late third millennium B.C. Archeological evidence has shown that this highly developed civilization collapsed abruptly near 4170 ± 150 calendar yr B.P., perhaps related to a shift to more arid conditions. Detailed paleoclimate records to test this assertion from Mesopotamia are rare, but changes in regional aridity are preserved in adjacent ocean basins. We document Holocene changes in regional aridity using mineralogic and geochemical analyses of a marine sediment core from the Gulf of Oman, which is directly downwind of Mesopotamian dust source areas and archeological sites. Our results document a very abrupt increase in eolian dust and Mesopotamian aridity, accelerator mass spectrometer radiocarbon dated to 4025 ± 125 calendar yr B.P., which persisted for ˜300 yr. Radiogenic (Nd and Sr) isotope analyses confirm that the observed increase in mineral dust was derived from Mesopotamian source areas. Geochemical correlation of volcanic ash shards between the archeological site and marine sediment record establishes a direct temporal link between Mesopotamian aridification and social collapse, implicating a sudden shift to more arid conditions as a key factor contributing to the collapse of the Akkadian empire.

Waiting time distribution in public health care: empirics and theory.

PubMed

Dimakou, Sofia; Dimakou, Ourania; Basso, Henrique S

2015-12-01

Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997-2005. We observe important differences on the 'scale' and on the 'shape' of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently. JEL Classification I11; I18; H51.

Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit.

PubMed

Pagès, Arnaud; Iriart, Xavier; Molinier, Laurent; Georges, Bernard; Berry, Antoine; Massip, Patrice; Juillard-Condat, Blandine

2017-12-01

Mortality from intra-abdominal candidiasis in intensive care units (ICUs) is high. It takes many days for peritoneal-fluid fungal culture to become positive, and the recommended empirical antifungal therapy involves excessive costs. Polymerase chain reaction (PCR) should produce results more rapidly than fungal culture. To perform a cost-effectiveness analysis of the combination of several diagnostic and therapeutic strategies to manage Candida peritonitis in non-neutropenic adult patients in ICUs. We constructed a decision tree model to evaluate the cost effectiveness. Cost and effectiveness were taken into account in a 1-year time horizon and from the French National Health Insurance perspective. Six strategies were compared: fluconazole or echinocandin as an empirical therapy, plus diagnosis by fungal culture or detection by PCR of all Candida species, or use of PCR to detect most fluconazole-resistant Candida species (i.e., Candida krusei and Candida glabrata). The use of fluconazole empirical treatment and PCR to detect all Candida species is more cost effective than using fluconazole empirical treatment without PCR (incremental cost-effectiveness ratio of €40,055/quality-adjusted life-year). Empirical treatment with echinocandin plus PCR to detect C. krusei and C. glabrata is the most effective strategy, but has an incremental cost-effectiveness ratio of €93,776/quality-adjusted life-year. If the cost of echinocandin decreases, then strategies involving PCR plus empirical echinocandin become more cost-effective. Detection by PCR of all Candida species and of most fluconazole-resistant Candida species could improve the cost-effectiveness of fluconazole and echinocandin given to non-neutropenic patients with suspected peritoneal candidiasis in ICUs. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Empirically Guided Coordination of Multiple Evidence-Based Treatments: An Illustration of Relevance Mapping in Children's Mental Health Services

ERIC Educational Resources Information Center

Chorpita, Bruce F.; Bernstein, Adam; Daleiden, Eric L.

2011-01-01

Objective: Despite substantial progress in the development and identification of psychosocial evidence-based treatments (EBTs) in mental health, there is minimal empirical guidance for selecting an optimal "set" of EBTs maximally applicable and generalizable to a chosen service sample. Relevance mapping is a proposed methodology that…

Clindamycin resistance among Staphylococcus aureus strains in Israel: implications for empirical treatment of skin and soft tissue infections.

PubMed

Stein, Michal; Komerska, Jacqueline; Prizade, Miriam; Sheinberg, Bracha; Tasher, Diana; Somekh, Eli

2016-05-01

The objectives of this study were to characterize isolates of Staphylococcus aureus obtained from skin and soft tissue infections in the community in Israel and to document the sensitivity patterns for commonly used antimicrobial agents. The susceptibilities of S. aureus isolates from skin and soft tissue infections in the community in Israel were reviewed to determine the appropriate empirical therapy for these infections. A total of 7221 isolates were collected during the period 2009-2012; 39% were from children (age 0-18 years). In children, S. aureus oxacillin resistance dropped from 8.4% to 3.8% (p=0.073). While inducible clindamycin resistance increased slightly from 20% to 25%, there was a prominent increase in constitutive clindamycin resistance from 0.1% to 26.8% (p=0.012). In adults, oxacillin resistance increased from 16% to 23% (p<0.001) and constitutive clindamycin resistance increased notably from 5% to 29% (p<0.001). These findings demonstrate a dramatic increase in clindamycin resistance among S. aureus isolates and suggest against the usage of clindamycin as empirical treatment for suspected S. aureus infections in Israel. Beta-lactam anti-staphylococcal agents may be given as empirical treatment for children, but should be considered according to risk factors for adults in Israel. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Comparison of Full and Empirical Bayes Techniques for Inferring Sea Level Changes from Tide Gauge Records

NASA Astrophysics Data System (ADS)

Piecuch, C. G.; Huybers, P. J.; Tingley, M.

2016-12-01

Sea level observations from coastal tide gauges are some of the longest instrumental records of the ocean. However, these data can be noisy, biased, and gappy, featuring missing values, and reflecting land motion and local effects. Coping with these issues in a formal manner is a challenging task. Some studies use Bayesian approaches to estimate sea level from tide gauge records, making inference probabilistically. Such methods are typically empirically Bayesian in nature: model parameters are treated as known and assigned point values. But, in reality, parameters are not perfectly known. Empirical Bayes methods thus neglect a potentially important source of uncertainty, and so may overestimate the precision (i.e., underestimate the uncertainty) of sea level estimates. We consider whether empirical Bayes methods underestimate uncertainty in sea level from tide gauge data, comparing to a full Bayes method that treats parameters as unknowns to be solved for along with the sea level field. We develop a hierarchical algorithm that we apply to tide gauge data on the North American northeast coast over 1893-2015. The algorithm is run in full Bayes mode, solving for the sea level process and parameters, and in empirical mode, solving only for the process using fixed parameter values. Error bars on sea level from the empirical method are smaller than from the full Bayes method, and the relative discrepancies increase with time; the 95% credible interval on sea level values from the empirical Bayes method in 1910 and 2010 is 23% and 56% narrower, respectively, than from the full Bayes approach. To evaluate the representativeness of the credible intervals, empirical Bayes and full Bayes methods are applied to corrupted data of a known surrogate field. Using rank histograms to evaluate the solutions, we find that the full Bayes method produces generally reliable error bars, whereas the empirical Bayes method gives too-narrow error bars, such that the 90% credible interval

New GRACE-Derived Storage Change Estimates Using Empirical Mode Extraction

NASA Astrophysics Data System (ADS)

Aierken, A.; Lee, H.; Yu, H.; Ate, P.; Hossain, F.; Basnayake, S. B.; Jayasinghe, S.; Saah, D. S.; Shum, C. K.

2017-12-01

Estimated mass change from GRACE spherical harmonic solutions have north/south stripes and east/west banded errors due to random noise and modeling errors. Low pass filters like decorrelation and Gaussian smoothing are typically applied to reduce noise and errors. However, these filters introduce leakage errors that need to be addressed. GRACE mascon estimates (JPL and CSR mascon solutions) do not need decorrelation or Gaussian smoothing and offer larger signal magnitudes compared to the GRACE spherical harmonics (SH) filtered results. However, a recent study [Chen et al., JGR, 2017] demonstrated that both JPL and CSR mascon solutions also have leakage errors. We developed a new postprocessing method based on empirical mode decomposition to estimate mass change from GRACE SH solutions without decorrelation and Gaussian smoothing, the two main sources of leakage errors. We found that, without any post processing, the noise and errors in spherical harmonic solutions introduced very clear high frequency components in the spatial domain. By removing these high frequency components and reserve the overall pattern of the signal, we obtained better mass estimates with minimum leakage errors. The new global mass change estimates captured all the signals observed by GRACE without the stripe errors. Results were compared with traditional methods over the Tonle Sap Basin in Cambodia, Northwestern India, Central Valley in California, and the Caspian Sea. Our results provide larger signal magnitudes which are in good agreement with the leakage corrected (forward modeled) SH results.

Empirical Evaluation of Adaptive Annotation in Hypermedia.

ERIC Educational Resources Information Center

Specht, Marcus

Empirical evaluations of learning with hypertext have shown contradictory results. Adaptive hypertext was introduced to solve some problems when learning with hypertext. This paper reports on two empirical studies comparing different forms of adaptive hypertext. In the first experiment, four treatments were realized by a combination of adaptive…

Future scenarios of land change based on empirical data and demographic trends

USGS Publications Warehouse

Sleeter, Benjamin M.; Wilson, Tamara; Sharygin, Ethan; Sherba, Jason

2017-01-01

Changes in land use and land cover (LULC) have important and fundamental interactions with the global climate system. Top-down global scale projections of land use change have been an important component of climate change research; however, their utility at local to regional scales is often limited. The goal of this study was to develop an approach for projecting changes in LULC based on land use histories and demographic trends. We developed a set of stochastic, empirical-based projections of LULC change for the state of California, for the period 2001–2100. Land use histories and demographic trends were used to project a “business-as-usual” (BAU) scenario and three population growth scenarios. For the BAU scenario, we projected developed lands would more than double by 2100. When combined with cultivated areas, we projected a 28% increase in anthropogenic land use by 2100. As a result, natural lands were projected to decline at a rate of 139 km2 yr−1; grasslands experienced the largest net decline, followed by shrublands and forests. The amount of cultivated land was projected to decline by approximately 10%; however, the relatively modest change masked large shifts between annual and perennial crop types. Under the three population scenarios, developed lands were projected to increase 40–90% by 2100. Our results suggest that when compared to the BAU projection, scenarios based on demographic trends may underestimate future changes in LULC. Furthermore, regardless of scenario, the spatial pattern of LULC change was likely to have the greatest negative impacts on rangeland ecosystems.

Future Scenarios of Land Change Based on Empirical Data and Demographic Trends

NASA Astrophysics Data System (ADS)

Sleeter, Benjamin M.; Wilson, Tamara S.; Sharygin, Ethan; Sherba, Jason T.

2017-11-01

Changes in land use and land cover (LULC) have important and fundamental interactions with the global climate system. Top-down global scale projections of land use change have been an important component of climate change research; however, their utility at local to regional scales is often limited. The goal of this study was to develop an approach for projecting changes in LULC based on land use histories and demographic trends. We developed a set of stochastic, empirical-based projections of LULC change for the state of California, for the period 2001-2100. Land use histories and demographic trends were used to project a "business-as-usual" (BAU) scenario and three population growth scenarios. For the BAU scenario, we projected developed lands would more than double by 2100. When combined with cultivated areas, we projected a 28% increase in anthropogenic land use by 2100. As a result, natural lands were projected to decline at a rate of 139 km2 yr-1; grasslands experienced the largest net decline, followed by shrublands and forests. The amount of cultivated land was projected to decline by approximately 10%; however, the relatively modest change masked large shifts between annual and perennial crop types. Under the three population scenarios, developed lands were projected to increase 40-90% by 2100. Our results suggest that when compared to the BAU projection, scenarios based on demographic trends may underestimate future changes in LULC. Furthermore, regardless of scenario, the spatial pattern of LULC change was likely to have the greatest negative impacts on rangeland ecosystems.

An Empirical Approach to Predicting Effects of Climate Change on Stream Water Chemistry

NASA Astrophysics Data System (ADS)

Olson, J. R.; Hawkins, C. P.

2014-12-01

Climate change may affect stream solute concentrations by three mechanisms: dilution associated with increased precipitation, evaporative concentration associated with increased temperature, and changes in solute inputs associated with changes in climate-driven weathering. We developed empirical models predicting base-flow water chemistry from watershed geology, soils, and climate for 1975 individual stream sites across the conterminous USA. We then predicted future solute concentrations (2065 and 2099) by applying down-scaled global climate model predictions to these models. The electrical conductivity model (EC, model R2 = 0.78) predicted mean increases in EC of 19 μS/cm by 2065 and 40 μS/cm by 2099. However predicted responses for individual streams ranged from a 43% decrease to a 4x increase. Streams with the greatest predicted decreases occurred in the southern Rocky Mountains and Mid-West, whereas southern California and Sierra Nevada streams showed the greatest increases. Generally, streams in dry areas underlain by non-calcareous rocks were predicted to be the most vulnerable to increases in EC associated with climate change. Predicted changes in other water chemistry parameters (e.g., Acid Neutralization Capacity (ANC), SO4, and Ca) were similar to EC, although the magnitude of ANC and SO4 change was greater. Predicted changes in ANC and SO4 are in general agreement with those changes already observed in seven locations with long term records.

Antimicrobial sensitivity patterns of cerebrospinal fluid (CSF) isolates in Namibia: implications for empirical antibiotic treatment of meningitis.

PubMed

Mengistu, Assegid; Gaeseb, Johannes; Uaaka, Gottfried; Ndjavera, Christophine; Kambyambya, Kennedy; Indongo, Lazarus; Kalemeera, Francis; Ntege, Christopher; Mabirizi, David; Joshi, Mohan P; Sagwa, Evans

2013-01-01

Bacterial meningitis is a medical emergency associated with high mortality rates. Cerebrospinal fluid (CSF) culture is the "gold standard" for diagnosis of meningitis and it is important to establish the susceptibility of the causative microorganism to rationalize treatment. The Namibia Standard Treatment Guidelines (STGs) recommends initiation of empirical antibiotic treatment in patients with signs and symptoms of meningitis after taking a CSF sample for culture and sensitivity. The objective of this study was to assess the antimicrobial sensitivity patterns of microorganisms isolated from CSF to antibiotics commonly used in the empirical treatment of suspected bacterial meningitis in Namibia. This was a cross-sectional descriptive study of routinely collected antibiotic susceptibility data from the Namibia Institute of Pathology (NIP) database. Results of CSF culture and sensitivity from January 1, 2009 to May 31, 2012, from 33 state hospitals throughout Namibia were analysed. The most common pathogens isolated were Streptococcus species, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and Escherichia coli. The common isolates from CSF showed high resistance (34.3% -73.5%) to penicillin. Over one third (34.3%) of Streptococcus were resistance to penicillin which was higher than 24.8% resistance in the United States. Meningococci were susceptible to several antimicrobial agents including penicillin. The sensitivity to cephalosporins remained high for Streptococcus, Neisseria, E. coli and Haemophilus. The highest percentage of resistance to cephalosporins was seen among ESBL K. pneumoniae (n = 7, 71%-100%), other Klebsiella species (n = 7, 28%-80%), and Staphylococcus (n = 36, 25%-40%). The common organisms isolated from CSF were Streptococcus Pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus, and E. coli. All common organisms isolated from CSF showed high sensitivity to cephalosporins used in the empirical

Impact of climate change on human infectious diseases: Empirical evidence and human adaptation.

PubMed

Wu, Xiaoxu; Lu, Yongmei; Zhou, Sen; Chen, Lifan; Xu, Bing

2016-01-01

Climate change refers to long-term shifts in weather conditions and patterns of extreme weather events. It may lead to changes in health threat to human beings, multiplying existing health problems. This review examines the scientific evidences on the impact of climate change on human infectious diseases. It identifies research progress and gaps on how human society may respond to, adapt to, and prepare for the related changes. Based on a survey of related publications between 1990 and 2015, the terms used for literature selection reflect three aspects--the components of infectious diseases, climate variables, and selected infectious diseases. Humans' vulnerability to the potential health impacts by climate change is evident in literature. As an active agent, human beings may control the related health effects that may be effectively controlled through adopting proactive measures, including better understanding of the climate change patterns and of the compound disease-specific health effects, and effective allocation of technologies and resources to promote healthy lifestyles and public awareness. The following adaptation measures are recommended: 1) to go beyond empirical observations of the association between climate change and infectious diseases and develop more scientific explanations, 2) to improve the prediction of spatial-temporal process of climate change and the associated shifts in infectious diseases at various spatial and temporal scales, and 3) to establish locally effective early warning systems for the health effects of predicated climate change. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of Evidence-Based Practice Resources and Empirically Supported Treatments for Posttraumatic Stress Disorder among University Counseling Center Psychologists

ERIC Educational Resources Information Center

Juel, Morgen Joray

2012-01-01

In the present study, an attempt was made to determine the degree to which psychologists at college and university counseling centers (UCCs) utilized empirically supported treatments with their posttraumatic stress disorder (PTSD) clients. In addition, an attempt was made to determine how frequently UCC psychologists utilized a number of…

Empirical likelihood inference in randomized clinical trials.

PubMed

Zhang, Biao

2017-01-01

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

Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review.

PubMed

Thomaes, Kathleen; Dorrepaal, Ethy; Draijer, Nel; Jansma, Elise P; Veltman, Dick J; van Balkom, Anton J

2014-03-01

While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during childhood. We systematically reviewed PTSD treatment effect studies on structural and functional brain changes from PubMed, EMBASE, PsycINFO, PILOTS and the Cochrane Library. We included studies on adults with (partial) PTSD in Randomized Controlled Trials (RCT) or pre-post designs (excluding case studies) on pharmacotherapy and psychotherapy. Risk of bias was evaluated independently by two raters. Brain coordinates and effect sizes were standardized for comparability. We included 15 studies (6 RCTs, 9 pre-post), four of which were on child abuse. Results showed that pharmacotherapy improved structural abnormalities (i.e., increased hippocampus volume) in both adult-trauma and child abuse related PTSD (3 pre-post studies). Functional changes were found to distinguish between groups. Adult-trauma PTSD patients showed decreased amygdala and increased dorsolateral prefrontal activations post-treatment (4 RCTs, 5 pre-post studies). In one RCT, child abuse patients showed no changes in the amygdala, but decreased dorsolateral prefrontal, dorsal anterior cingulate and insula activation post-treatment. In conclusion, pharmacotherapy may reduce structural abnormalities in PTSD, while psychotherapy may decrease amygdala activity and increase prefrontal, dorsal anterior cingulate and hippocampus activations, that may relate to extinction learning and re-appraisal. There is some evidence for a distinct activation pattern in child abuse patients, which clearly awaits further empirical testing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Empirically derived pain-patient MMPI subgroups: prediction of treatment outcome.

PubMed

Moore, J E; Armentrout, D P; Parker, J C; Kivlahan, D R

1986-02-01

Fifty-seven male chronic pain patients admitted to an inpatient multimodal pain treatment program at a Midwestern Veterans Administration hospital completed the MMPI, Profile of Mood States (POMS), Tennessee Self-Concept Scale (TSCS), Rathus Assertiveness Schedule (RAS), activity diaries, and an extensive pain questionnaire. All patients were assessed both before and after treatment, and most also were assessed 2-5 months prior to treatment. No significant changes occurred during the baseline period, but significant improvements were evident at posttreatment on most variables: MMPI, POMS, TSCS, RAS, pain severity, sexual functioning, and activity diaries. MMPI subgroup membership, based on a hierarchical cluster analysis in a larger sample, was not predictive of differential treatment outcome. Possible reasons for comparable treatment gains among these subgroups, which previously have been shown to differ on many psychological and behavioral factors, are discussed.

Predictors of change among male batterers: application of theories and review of empirical findings.

PubMed

Scott, Katreena L

2004-07-01

The efficacy of batterer treatment is a concern of clinicians, researchers, and policy makers. Most past research on batterer treatment has defined success as a cessation of men's physical abuse against their intimate partner. Although clearly an important outcome, focus on assault leaves many questions unanswered about the broader impact of batterer treatment and the processes through which successful change may be promoted. With the aim of encouraging complexity in the consideration of change among batterers, the current article reviews studies that go beyond dichotomous outcomes. First, evidence for the success of batterer treatment is considered from multiple perspectives: men's, women's, and the intervention system. Next, an in-depth review of research on factors relating to change in abusive men is completed using feminist, family systems, individual, and typology theories as an organizing framework. Numerous recommendations are made for integrating theories of change with investigations of treatment success in future work. Copyright 2004 Sage Publications

Adult bacterial meningitis: aetiology, penicillin susceptibility, risk factors, prognostic factors and guidelines for empirical antibiotic treatment.

PubMed

Meyer, C N; Samuelsson, I S; Galle, M; Bangsborg, J M

2004-08-01

Episodes of adult bacterial meningitis (ABM) at a Danish hospital in 1991-2000 were identified from the databases of the Department of Clinical Microbiology, and compared with data from the Danish National Patient Register and the Danish National Notification System. Reduced penicillin susceptibility occurred in 21 (23%) of 92 cases of known aetiology, compared to an estimated 6% in nationally notified cases (p < 0.001). Ceftriaxone plus penicillin as empirical treatment was appropriate in 97% of ABM cases in the study population, and in 99.6% of nationally notified cases. The notification rate was 75% for penicillin-susceptible episodes, and 24% for penicillin-non-susceptible episodes (p < 0.001). Cases involving staphylococci, Pseudomonas spp. and Enterobacteriaceae were under-reported. Among 51 ABM cases with no identified risk factors, nine of 11 cases with penicillin-non-susceptible bacteria were community-acquired. Severe sequelae correlated independently with age, penicillin non-susceptibility, mechanical ventilation and non-transferral to a tertiary hospital (p < 0.05; logistic regression). Other factors that correlated with severe sequelae by univariate analysis only were inappropriate clinical handling, abnormal consciousness, convulsions and nosocomial infection. Overall, the data indicated that neither age alone, community-acquired infection nor absence of identified risk factors can predict susceptibility to penicillin accurately. Recommendations for empirical antibiotic treatment for ABM should not be based exclusively on clinical notification systems with possible unbalanced under-reporting.

Colonialism, Education and Social Change in the British Empire: The Cases of Australia, Papua New Guinea and Ireland

ERIC Educational Resources Information Center

O'Donoghue, Tom

2009-01-01

This paper focuses on the history of relations between colonialism, schooling and social change in Australia, Papua New Guinea and Ireland, countries that were once part of the British Empire. It indicates that responses to schooling ranged from acceptance and tolerance, to modification and rejection, depending on the country, the issue, and the…

The Role of Empirical Research in Bioethics

PubMed Central

Kon, Alexander A.

2010-01-01

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics. PMID:19998120

The role of empirical research in bioethics.

PubMed

Kon, Alexander A

2009-01-01

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics.

Promoting Behavioral Change in Psychoanalytic Treatments.

PubMed

Busch, Fredric N

2017-01-01

One of the shibboleths of psychoanalysis is that treatment should not target behavioral change, focusing instead on gaining insight and the therapeutic relationship (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). Such an approach is believed to be accompanied by disruptions of exploration or problematic distortions of the transference (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). However, ignoring behavioral change can put patients at increased risk for stalemates in treatment and persistent problematic behaviors that interfere with improvement and impair relationships. This article suggests that rather than being at odds or disruptive, efforts at behavioral change can be part of the development and employment of a psychodynamic formulation, and can be used to enhance self-understanding and exploration of the transference. Psychoanalytic approaches provide strategies for behavioral change not included in other psychotherapeutic treatments. This article describes a variety of ways in which efforts at behavioral change can be integrated with and enhanced by psychodynamic exploration.

ECT treatment outcomes following performance improvement changes.

PubMed

Pulia, Kathy; Vaidya, Punit; Jayaram, Geetha; Hayat, Matthew J; Reti, Irving M

2013-11-01

Differences in electroconvulsive therapy (ECT) outcomes were explored following changes in ECT administration at our institution. Two changes were introduced: (a) switching the anesthetic agent from propofol to methohexital, and (b) using a more aggressive ECT charge dosing regimen for right unilateral (RUL) electrode placement. Length of stay (LOS) and number of treatments administered per patient were monitored. A retrospective analysis was performed of two inpatient groups treated on our Mood Disorders Unit: those who underwent ECT in the 12 months prior to the changes (n = 40) and those who underwent treatment in the 12 months after the changes (n = 38). Compared with patients receiving ECT with RUL placement prior to the changes, patients who received RUL ECT after the changes had a significantly shorter inpatient LOS (27.4 versus 18 days, p = 0.028). Treatment efficacy monitored by the Montgomery Asberg Depression Rating Scale was not impacted. The change in anesthetic agent and charge dosing each accounted for 11% of the variance in LOS among patients receiving RUL ECT. The implemented changes in ECT administration positively impacted outcome for patients receiving treatment with RUL electrode placement. Copyright 2013, SLACK Incorporated.

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

ERIC Educational Resources Information Center

Sburlati, Elizabeth S.; Schniering, Carolyn A.; Lyneham, Heidi J.; Rapee, Ronald M.

2011-01-01

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods,…

Empiric Auto-Titrating CPAP in People with Suspected Obstructive Sleep Apnea

PubMed Central

Drummond, Fitzgerald; Doelken, Peter; Ahmed, Qanta A.; Gilbert, Gregory E.; Strange, Charlie; Herpel, Laura; Frye, Michael D.

2010-01-01

Objective: Efficient diagnosis and treatment of obstructive sleep apnea (OSA) can be difficult because of time delays imposed by clinic visits and serial overnight polysomnography. In some cases, it may be desirable to initiate treatment for suspected OSA prior to polysomnography. Our objective was to compare the improvement of daytime sleepiness and sleep-related quality of life of patients with high clinical likelihood of having OSA who were randomly assigned to receive empiric auto-titrating continuous positive airway pressure (CPAP) while awaiting polysomnogram versus current usual care. Methods: Serial patients referred for overnight polysomnography who had high clinical likelihood of having OSA were randomly assigned to usual care or immediate initiation of auto-titrating CPAP. Epworth Sleepiness Scale (ESS) scores and the Functional Outcomes of Sleep Questionnaire (FOSQ) scores were obtained at baseline, 1 month after randomization, and again after initiation of fixed CPAP in control subjects and after the sleep study in auto-CPAP patients. Results: One hundred nine patients were randomized. Baseline demographics, daytime sleepiness, and sleep-related quality of life scores were similar between groups. One-month ESS and FOSQ scores were improved in the group empirically treated with auto-titrating CPAP. ESS scores improved in the first month by a mean of −3.2 (confidence interval −1.6 to −4.8, p < 0.001) and FOSQ scores improved by a mean of 1.5, (confidence interval 0.5 to 2.7, p = 0.02), whereas scores in the usual-care group did not change (p = NS). Following therapy directed by overnight polysomnography in the control group, there were no differences in ESS or FOSQ between the groups. No adverse events were observed. Conclusion: Empiric auto-CPAP resulted in symptomatic improvement of daytime sleepiness and sleep-related quality of life in a cohort of patients awaiting polysomnography who had a high pretest probability of having OSA. Additional

Flood risk changes over centuries in Rome: an empirical study

NASA Astrophysics Data System (ADS)

Di Baldassarre, Giuliano; Saccà, Smeralda; Tito Aronica, Giuseppe; Grimaldi, Salvatore; Crisci, Massimiliano

2015-04-01

Over centuries, the development of the historical city of Rome -close to one of the largest Italian rivers, the Tiber- has been intertwined with the magnitude and frequency of flooding events. The ancient Rome mostly developed on the (seven) hills, while the Tiber's floodplain was mainly exploited for agricultural purposes. A few small communities did settle in the riparian areas of the Tiber, but they had a relatively peaceful relationships with the frequent occurrence of flooding events. Nowadays, numerous people live in modern districts in the Tiber's floodplain, unaware of their exposure to potentially catastrophic flooding. The main goal of this research is to explore the dynamics of changing flood risk over the centuries between these two extreme pictures of the ancient and contemporary Rome. To this end, we carried out a socio-hydrological study by exploiting long time series of physical (flooding, river morphology) and social (urbanization, population dynamics) processes together with information about human interactions with the environment (flood defense structures). This empirical analysis showed how human and physical systems have been co-evolving over time, while being abruptly altered by the occurrence of extreme events. For instance, a large flooding event occurred in 1870 and contributed to the constructions of levees, which in turn facilitated the development of new urban areas in the Tiber's floodplain, while changed the societal memory of floods as well as the communities' perception of risk. This research work was also used to test the hypotheses of recent-developed models conceptualizing the interplay between floods and societies and simulating the long-term behavior of coupled human-water systems. The outcomes of this test provided interesting insights about the dynamics of flood risk, which are expected to support a better anticipation of future changes.

An empirical test of the relative and combined effects of land-cover and climate change on local colonization and extinction.

PubMed

Yalcin, Semra; Leroux, Shawn James

2018-04-14

Land-cover and climate change are two main drivers of changes in species ranges. Yet, the majority of studies investigating the impacts of global change on biodiversity focus on one global change driver and usually use simulations to project biodiversity responses to future conditions. We conduct an empirical test of the relative and combined effects of land-cover and climate change on species occurrence changes. Specifically, we examine whether observed local colonization and extinctions of North American birds between 1981-1985 and 2001-2005 are correlated with land-cover and climate change and whether bird life history and ecological traits explain interspecific variation in observed occurrence changes. We fit logistic regression models to test the impact of physical land-cover change, changes in net primary productivity, winter precipitation, mean summer temperature, and mean winter temperature on the probability of Ontario breeding bird local colonization and extinction. Models with climate change, land-cover change, and the combination of these two drivers were the top ranked models of local colonization for 30%, 27%, and 29% of species, respectively. Conversely, models with climate change, land-cover change, and the combination of these two drivers were the top ranked models of local extinction for 61%, 7%, and 9% of species, respectively. The quantitative impacts of land-cover and climate change variables also vary among bird species. We then fit linear regression models to test whether the variation in regional colonization and extinction rate could be explained by mean body mass, migratory strategy, and habitat preference of birds. Overall, species traits were weakly correlated with heterogeneity in species occurrence changes. We provide empirical evidence showing that land-cover change, climate change, and the combination of multiple global change drivers can differentially explain observed species local colonization and extinction. © 2018 John Wiley

An update on the "empirical turn" in bioethics: analysis of empirical research in nine bioethics journals.

PubMed

Wangmo, Tenzin; Hauri, Sirin; Gennet, Eloise; Anane-Sarpong, Evelyn; Provoost, Veerle; Elger, Bernice S

2018-02-07

A review of literature published a decade ago noted a significant increase in empirical papers across nine bioethics journals. This study provides an update on the presence of empirical papers in the same nine journals. It first evaluates whether the empirical trend is continuing as noted in the previous study, and second, how it is changing, that is, what are the characteristics of the empirical works published in these nine bioethics journals. A review of the same nine journals (Bioethics; Journal of Medical Ethics; Journal of Clinical Ethics; Nursing Ethics; Cambridge Quarterly of Healthcare Ethics; Hastings Center Report; Theoretical Medicine and Bioethics; Christian Bioethics; and Kennedy Institute of Ethics Journal) was conducted for a 12-year period from 2004 to 2015. Data obtained was analysed descriptively and using a non-parametric Chi-square test. Of the total number of original papers (N = 5567) published in the nine bioethics journals, 18.1% (n = 1007) collected and analysed empirical data. Journal of Medical Ethics and Nursing Ethics led the empirical publications, accounting for 89.4% of all empirical papers. The former published significantly more quantitative papers than qualitative, whereas the latter published more qualitative papers. Our analysis reveals no significant difference (χ2 = 2.857; p = 0.091) between the proportion of empirical papers published in 2004-2009 and 2010-2015. However, the increasing empirical trend has continued in these journals with the proportion of empirical papers increasing from 14.9% in 2004 to 17.8% in 2015. This study presents the current state of affairs regarding empirical research published nine bioethics journals. In the quarter century of data that is available about the nine bioethics journals studied in two reviews, the proportion of empirical publications continues to increase, signifying a trend towards empirical research in bioethics. The growing volume is mainly attributable to two

Empiric auto-titrating CPAP in people with suspected obstructive sleep apnea.

PubMed

Drummond, Fitzgerald; Doelken, Peter; Ahmed, Qanta A; Gilbert, Gregory E; Strange, Charlie; Herpel, Laura; Frye, Michael D

2010-04-15

Efficient diagnosis and treatment of obstructive sleep apnea (OSA) can be difficult because of time delays imposed by clinic visits and serial overnight polysomnography. In some cases, it may be desirable to initiate treatment for suspected OSA prior to polysomnography. Our objective was to compare the improvement of daytime sleepiness and sleep-related quality of life of patients with high clinical likelihood of having OSA who were randomly assigned to receive empiric auto-titrating continuous positive airway pressure (CPAP) while awaiting polysomnogram versus current usual care. Serial patients referred for overnight polysomnography who had high clinical likelihood of having OSA were randomly assigned to usual care or immediate initiation of auto-titrating CPAP. Epworth Sleepiness Scale (ESS) scores and the Functional Outcomes of Sleep Questionnaire (FOSQ) scores were obtained at baseline, 1 month after randomization, and again after initiation of fixed CPAP in control subjects and after the sleep study in auto-CPAP patients. One hundred nine patients were randomized. Baseline demographics, daytime sleepiness, and sleep-related quality of life scores were similar between groups. One-month ESS and FOSQ scores were improved in the group empirically treated with auto-titrating CPAP. ESS scores improved in the first month by a mean of -3.2 (confidence interval -1.6 to -4.8, p < 0.001) and FOSQ scores improved by a mean of 1.5, (confidence interval 0.5 to 2.7, p = 0.02), whereas scores in the usual-care group did not change (p = NS). Following therapy directed by overnight polysomnography in the control group, there were no differences in ESS or FOSQ between the groups. No adverse events were observed. Empiric auto-CPAP resulted in symptomatic improvement of daytime sleepiness and sleep-related quality of life in a cohort of patients awaiting polysomnography who had a high pretest probability of having OSA. Additional studies are needed to evaluate the applicability

Empirical Likelihood-Based Estimation of the Treatment Effect in a Pretest-Posttest Study.

PubMed

Huang, Chiung-Yu; Qin, Jing; Follmann, Dean A

2008-09-01

The pretest-posttest study design is commonly used in medical and social science research to assess the effect of a treatment or an intervention. Recently, interest has been rising in developing inference procedures that improve efficiency while relaxing assumptions used in the pretest-posttest data analysis, especially when the posttest measurement might be missing. In this article we propose a semiparametric estimation procedure based on empirical likelihood (EL) that incorporates the common baseline covariate information to improve efficiency. The proposed method also yields an asymptotically unbiased estimate of the response distribution. Thus functions of the response distribution, such as the median, can be estimated straightforwardly, and the EL method can provide a more appealing estimate of the treatment effect for skewed data. We show that, compared with existing methods, the proposed EL estimator has appealing theoretical properties, especially when the working model for the underlying relationship between the pretest and posttest measurements is misspecified. A series of simulation studies demonstrates that the EL-based estimator outperforms its competitors when the working model is misspecified and the data are missing at random. We illustrate the methods by analyzing data from an AIDS clinical trial (ACTG 175).

Empirical Likelihood-Based Estimation of the Treatment Effect in a Pretest–Posttest Study

PubMed Central

Huang, Chiung-Yu; Qin, Jing; Follmann, Dean A.

2013-01-01

The pretest–posttest study design is commonly used in medical and social science research to assess the effect of a treatment or an intervention. Recently, interest has been rising in developing inference procedures that improve efficiency while relaxing assumptions used in the pretest–posttest data analysis, especially when the posttest measurement might be missing. In this article we propose a semiparametric estimation procedure based on empirical likelihood (EL) that incorporates the common baseline covariate information to improve efficiency. The proposed method also yields an asymptotically unbiased estimate of the response distribution. Thus functions of the response distribution, such as the median, can be estimated straightforwardly, and the EL method can provide a more appealing estimate of the treatment effect for skewed data. We show that, compared with existing methods, the proposed EL estimator has appealing theoretical properties, especially when the working model for the underlying relationship between the pretest and posttest measurements is misspecified. A series of simulation studies demonstrates that the EL-based estimator outperforms its competitors when the working model is misspecified and the data are missing at random. We illustrate the methods by analyzing data from an AIDS clinical trial (ACTG 175). PMID:23729942

Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

PubMed

Salomonsson, Petra; von Linstow, Marie-Louise; Knudsen, Jenny Dahl; Heiberg, Ida; Mola, Gylli; Wenger, Therese Ramstad; Cortes, Dina; Nygaard, Ulrikka

2016-10-01

Pyelonephritis is a common infection in childhood and may cause renal scarring. The aim was to determine an effective oral antibiotic treatment of first time pyelonephritis in children. The study is a retrospective analysis of positive urine cultures collected at a Danish paediatric department from 2010-2013. Urine samples from 378 children aged 0-15.9 years, without renal anomalies and treated for first time pyelonephritis, were included. The urine pathogens and antimicrobial susceptibilities were analysed. The most common aetiologic agents found were Escherichia coli (85%), Klebsiella species and other Enterobacteriaecea (9.7%) and Enterococcus species (5.3%). Escherichia coli was significantly more common in girls than in boys (90% vs 74%, p < 0.001) and in children older than 6 months (89% vs 77%, p < 0.001). Children younger than 6 months had a higher prevalence of other Gram-negative rods (16% vs 7%, p < 0.001). These differences may be due to boys representing 63% of patients in the youngest age group compared to 16% of older children (p < 0.001). For all urine isolates, piv-mecillinam and amoxicillin-clavulanate had the lowest resistance rates of 6.9% and 7.2%, respectively, and 6% for both antimicrobials in patients older than 6 months. Uropathogens from boys above 6 months of age were more resistant to piv-mecillinam compared to girls (25% vs 2.4%, p < 0.001). This study recommends piv-mecillinam or amoxicillin-clavulanate as empirical treatment of first time pyelonephritis in Danish children from 6 months of age. Age and gender of patients should be taken into consideration when initiating empirical treatment.

The importance of education, understanding, and empirical research in social work: the nuts and bolts of the business.

PubMed

Long, Kimberly; Wodarski, John S

2010-05-01

Over the past three decades, existing literature has demanded, and continues to demand, accountability in the delivery of social services through empirically based research and implementation of established norms: this is, and of itself, the true basis of social work. It is through these norms and empirically established models and theories of treatment that a social worker can really do what he/she wants to do: help the client. This article will describe the nuts and bolts of social work; i.e. those theories, models, and the established norms of practice. It is the desire of the author's that all social workers be educated in the nuts and bolts (basics) and that education will be based on empirical evidence that supports behavioral change through intervention and modification.

Empirically Derived Personality Subtyping for Predicting Clinical Symptoms and Treatment Response in Bulimia Nervosa

PubMed Central

Haynos, Ann F.; Pearson, Carolyn M.; Utzinger, Linsey M.; Wonderlich, Stephen A.; Crosby, Ross D.; Mitchell, James E.; Crow, Scott J.; Peterson, Carol B.

2016-01-01

Objective Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Methods Using variables from the Dimensional Assessment of Personality Pathology–Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). Results There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = .03) and purging (p = .01) frequency at EOT and binge eating frequency at follow-up (p = .045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = .04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Discussion Empirically derived personality subtyping is appears to be a valid classification system with potential to guide eating disorder treatment decisions. PMID:27611235

Empirically Supported Treatments in Psychotherapy: Towards an Evidence-Based or Evidence-Biased Psychology in Clinical Settings?

PubMed Central

Castelnuovo, Gianluca

2010-01-01

The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented. PMID:21833197

Empirical likelihood based detection procedure for change point in mean residual life functions under random censorship.

PubMed

Chen, Ying-Ju; Ning, Wei; Gupta, Arjun K

2016-05-01

The mean residual life (MRL) function is one of the basic parameters of interest in survival analysis that describes the expected remaining time of an individual after a certain age. The study of changes in the MRL function is practical and interesting because it may help us to identify some factors such as age and gender that may influence the remaining lifetimes of patients after receiving a certain surgery. In this paper, we propose a detection procedure based on the empirical likelihood for the changes in MRL functions with right censored data. Two real examples are also given: Veterans' administration lung cancer study and Stanford heart transplant to illustrate the detecting procedure. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Consensus guidelines for the use of empiric and diagnostic-driven antifungal treatment strategies in haematological malignancy, 2014.

PubMed

Morrissey, C O; Gilroy, N M; Macesic, N; Walker, P; Ananda-Rajah, M; May, M; Heath, C H; Grigg, A; Bardy, P G; Kwan, J; Kirsa, S W; Slavin, M; Gottlieb, T; Chen, S

2014-12-01

Invasive fungal disease (IFD) causes significant morbidity and mortality in patients undergoing allogeneic haemopoietic stem cell transplantation or chemotherapy for haematological malignancy. Much of these adverse outcomes are due to the limited ability of traditional diagnostic tests (i.e. culture and histology) to make an early and accurate diagnosis. As persistent or recurrent fevers of unknown origin (PFUO) in neutropenic patients despite broad-spectrum antibiotics have been associated with the development of IFD, most centres have traditionally administered empiric antifungal therapy (EAFT) to patients with PFUO. However, use of an EAFT strategy has not been shown to have an overall survival benefit and is associated with excessive antifungal therapy use. As a result, the focus has shifted to developing more sensitive and specific diagnostic tests for early and more targeted antifungal treatment. These tests, including the galactomannan enzyme-linked immunosorbent assay and Aspergillus polymerase chain reaction (PCR), have enabled the development of diagnostic-driven antifungal treatment (DDAT) strategies, which have been shown to be safe and feasible, reducing antifungal usage. In addition, the development of effective antifungal prophylactic strategies has changed the landscape in terms of the incidence and types of IFD that clinicians have encountered. In this review, we examine the current role of EAFT and provide up-to-date data on the newer diagnostic tests and algorithms available for use in EAFT and DDAT strategies, within the context of patient risk and type of antifungal prophylaxis used. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Fringes of the empire: Diet and cultural change at the Roman to post-Roman transition in NW Iberia.

PubMed

López-Costas, Olalla; Müldner, Gundula

2016-09-01

A growing number of paleodiet investigations over recent years have begun to reveal the stark dietary differences that existed between regions of the Roman Empire, as well as significant changes in subsistence strategies after its fall. The present study explores the dietary changes at the Roman to post-Roman (Germanic) transition in the Northwest Iberian Peninsula, in order to improve our understanding of the changes that occurred at end of the Roman Empire in different regions across Europe and to also consider the influence of climate had on them. The carbon and nitrogen stable isotope investigation in bone collagen from A Lanzada, NW Spain (100-700 AD), which was an important commercial, coastal settlement has been presented. A human sample of 59 individuals, 6 of them subadults, is compared with 31 faunal specimens, which include a number of marine fish. Isotope data for the terrestrial fauna reveal the influence of the sea on the local isotope baseline. Analysis of the human samples indicates a mixed marine-terrestrial diet. A shift in mean human δ(13) C values from -16.7‰ to -14.3‰ provides clear evidence for a significant change in diet in the post-Roman period, probably through the intensification of both marine resources exploitation and C4 -plant consumption (presumably millet). A deterioration of paleoenvironmental conditions, together with a poor socioeconomic situation and the arrival of new people, the Sueves, who brought a new political and socioeconomic system have been discussed as the main causes for the dietary modification in post-Roman times. © 2016 Wiley Periodicals, Inc.

Motivation Change in Therapeutic Community Residential Treatment

ERIC Educational Resources Information Center

Morgen, Keith; Kressel, David

2010-01-01

Latent growth curve analysis was used to assess motivation change across 3 time points for 120 therapeutic community residents. Models included the time-invariant predictor of readiness for treatment, which significantly predicted initial treatment motivation but not the rate of motivation change over time. (Contains 1 figure and 2 tables.)

The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change.

PubMed

Julien, Dominic; O'Connor, Kieron; Aardema, Frederick

2016-09-15

The inference-based approach (IBA) postulates that individuals with obsessive-compulsive disorder (OCD) confuse a possibility with reality (inferential confusion) according to specific inductive reasoning devices and act as if this possibility were true. A new treatment modality, the inference-based therapy (IBT), was developed. The aim of this study was to critically review empirical evidence regarding the etiological model, treatment efficacy, and model of change of IBA. A search of the literature was conducted using PsycINFO and Medline. Thirty-four articles were included in the review. The review reveals that intrusive thoughts of non-clinical and OCD individuals may occur in different contexts. There is support for a specific inductive reasoning style in OCD. Inferential confusion is associated with OCD symptoms. There is good evidence that IBT is an efficacious treatment for OCD, including two randomized controlled trials showing that IBT was as efficacious as cognitive-behavior therapy. There is some but limited evidence that the process of change during treatment is coherent with IBA's assumptions. Key premises were investigated in only a few studies. Some of these studies were conducted in non-clinical samples or did not include an anxious control group. IBA's etiological model, treatment modality, and model of change make a significant contribution to OCD. Copyright © 2016 Elsevier B.V. All rights reserved.

Post-treatment Stage of Change Predicts 12-month Outcome of Treatment for Alcohol Problems

PubMed Central

Heather, Nick; McCambridge, Jim

2013-01-01

Aims: To evaluate relationships between clients' self-reported ‘stage of change’ and outcomes after treatment for alcohol problems. Methods: Using data from the ‘United Kingdom Alcohol Treatment Trial’, clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change—which in good clinical practice often occurs in informal ways—and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a ‘common factors’ perspective on effective treatment for alcohol problems. PMID:23408241

Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.

PubMed

Haynos, Ann F; Pearson, Carolyn M; Utzinger, Linsey M; Wonderlich, Stephen A; Crosby, Ross D; Mitchell, James E; Crow, Scott J; Peterson, Carol B

2017-05-01

Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514). © 2016 Wiley Periodicals, Inc.

Comparison of cefepime versus ceftriaxone-amikacin as empirical regimens for the treatment of febrile neutropenia in acute leukemia patients.

PubMed

Borbolla, J R; López-Hernández, M A; González-Avante, M; DeDiego, J; Trueba, E; Alvarado, M L; Jiménez, R M

2001-01-01

High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate. We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/microl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started. Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity. Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides. Copyright 2001 S. Karger AG, Basel

Climate change and associated spatial heterogeneity of Pakistan: Empirical evidence using multidisciplinary approach.

PubMed

Ali, Ghaffar

2018-09-01

Climate change is a multidimensional phenomenon, which has various implications for the environment and socio-economic conditions of the people. Its effects are deeper in an agrarian economy which is susceptible to the vagaries of nature. Therefore, climate change directly impacts the society in different ways, and society must pay the cost. Focusing on this truth, the main objective of this research was to investigate the empirical changes and spatial heterogeneity in the climate of Pakistan in real terms using time series data. Climate change and variability in Pakistan, over time, were estimated from 1961 to 2014 using all the climate variables for the very first time. Several studies were available on climate change impacts, mitigation, and adaptation; however, it was difficult to observe exactly how much change occurred in which province and when. A multidisciplinary approach was utilized to estimate the absolute change through a combination of environmental, econometric, and remote sensing methods. Moreover, the Autoregressive Distributed Lag (ARDL) model was used to ascertain the extent of variability in climate change and information was digitalized through ground truthing. Results showed that the average temperature of Pakistan increased by 2°C between 1960 and 1987 and 4°C between 1988 and 2014, and R 2 was 0.978. The rate of temperature increased 0.09°C between 1960 and 2014. The mean annual precipitation of Pakistan increased by 478mm, and its R 2 were 0.34-0.64. The mean annual humidity of Pakistan increased by 2.94%, and the rate of humidity has been increased by 0.97% from 1988 to 2014. Notably, Sindh and Balochistan provinces have shown a significant spatial heterogeneity regarding the increase in precipitation. Statistically all variables are significant. This would serve as a baseline information for climate change-related studies in Pakistan and its application in different sectors. This would also serve the plant breeders and policymakers of

On the gap between an empirical distribution and an exponential distribution of waiting times for price changes in a financial market

NASA Astrophysics Data System (ADS)

Sazuka, Naoya

2007-03-01

We analyze waiting times for price changes in a foreign currency exchange rate. Recent empirical studies of high-frequency financial data support that trades in financial markets do not follow a Poisson process and the waiting times between trades are not exponentially distributed. Here we show that our data is well approximated by a Weibull distribution rather than an exponential distribution in the non-asymptotic regime. Moreover, we quantitatively evaluate how much an empirical data is far from an exponential distribution using a Weibull fit. Finally, we discuss a transition between a Weibull-law and a power-law in the long time asymptotic regime.

Reasons for Treatment Changes in Patients With Moderate to Severe Psoriasis.

PubMed

Anderson, Kathryn L; Feldman, Steven R

2015-01-01

Psoriasis treatment involves multiple treatment arms. Treatment choice depends on many factors and may change, due to the chronicity of psoriasis. The purpose of our study is to explore reasons for treatment changes in patients with moderate to severe psoriasis. Ten charts of patients with moderate to severe psoriasis were reviewed. The medication changes and reasons for change were extracted. A "treatment change" was defined as switching between medication classes, adding or removing a medication class, or switching medications within the oral or biologic medication class. Seventy-seven treatment changes were identified. On average, 1 treatment change occurred per year of follow-up. The most common reason for treatment change was inadequate disease control. Inadequate disease control with current therapy is the most common reason a physician changes treatment for moderate to severe psoriasis. More efficacious treatments or ways to improve efficacy may help improve the long-term outcomes of psoriasis. © The Author(s) 2015.

Modes of response to environmental change and the elusive empirical evidence for bet hedging

PubMed Central

Simons, Andrew M.

2011-01-01

Uncertainty is a problem not only in human decision-making, but is a prevalent quality of natural environments and thus requires evolutionary response. Unpredictable natural selection is expected to result in the evolution of bet-hedging strategies, which are adaptations to long-term fluctuating selection. Despite a recent surge of interest in bet hedging, its study remains mired in conceptual and practical difficulties, compounded by confusion over what constitutes evidence for its existence. Here, I attempt to resolve misunderstandings about bet hedging and its relationship with other modes of response to environmental change, identify the challenges inherent to its study and assess the state of existing empirical evidence. The variety and distribution of plausible bet-hedging traits found across 16 phyla in over 100 studies suggest their ubiquity. Thus, bet hedging should be considered a specific mode of response to environmental change. However, the distribution of bet-hedging studies across evidence categories—defined according to potential strength—is heavily skewed towards weaker categories, underscoring the need for direct appraisals of the adaptive significance of putative bet-hedging traits in nature. PMID:21411456

The birth of the empirical turn in bioethics.

PubMed

Borry, Pascal; Schotsmans, Paul; Dierickx, Kris

2005-02-01

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.

Identification of sudden stiffness changes in the acceleration response of a bridge to moving loads using ensemble empirical mode decomposition

NASA Astrophysics Data System (ADS)

Aied, H.; González, A.; Cantero, D.

2016-01-01

The growth of heavy traffic together with aggressive environmental loads poses a threat to the safety of an aging bridge stock. Often, damage is only detected via visual inspection at a point when repairing costs can be quite significant. Ideally, bridge managers would want to identify a stiffness change as soon as possible, i.e., as it is occurring, to plan for prompt measures before reaching a prohibitive cost. Recent developments in signal processing techniques such as wavelet analysis and empirical mode decomposition (EMD) have aimed to address this need by identifying a stiffness change from a localised feature in the structural response to traffic. However, the effectiveness of these techniques is limited by the roughness of the road profile, the vehicle speed and the noise level. In this paper, ensemble empirical mode decomposition (EEMD) is applied by the first time to the acceleration response of a bridge model to a moving load with the purpose of capturing sudden stiffness changes. EEMD is more adaptive and appears to be better suited to non-linear signals than wavelets, and it reduces the mode mixing problem present in EMD. EEMD is tested in a variety of theoretical 3D vehicle-bridge interaction scenarios. Stiffness changes are successfully identified, even for small affected regions, relatively poor profiles, high vehicle speeds and significant noise. The latter is due to the ability of EEMD to separate high frequency components associated to sudden stiffness changes from other frequency components associated to the vehicle-bridge interaction system.

78 FR 6316 - Empire Pipeline, Inc. (Empire); Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-30

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. AC13-22-000] Empire Pipeline, Inc. (Empire); Notice of Filing Take notice that on November 29, 2012 Empire Pipeline Company (Empire) submitted a request for a waiver of the reporting requirement to file the FERC Form 2 CPA Certification for...

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder

ERIC Educational Resources Information Center

Schreibman, Laura; Dawson, Geraldine; Stahmer, Aubyn C.; Landa, Rebecca; Rogers, Sally J.; McGee, Gail G.; Kasari, Connie; Ingersoll, Brooke; Kaiser, Ann P.; Bruinsma, Yvonne; McNerney, Erin; Wetherby, Amy; Halladay, Alycia

2015-01-01

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. "Naturalistic Developmental Behavioral Interventions…

Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior.

PubMed

Feldstein Ewing, Sarah W; Chung, Tammy

2013-06-01

Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors. 2013 APA, all rights reserved

Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: Emerging translational approaches that bridge biology and behavior

PubMed Central

Feldstein Ewing, Sarah W.; Chung, Tammy

2013-01-01

Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examined brain-based mechanisms of change, whereas others examined brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors. PMID:23815447

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-06-01

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

Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration.

PubMed

Sung, Hung-En; Belenko, Steven; Feng, Li; Tabachnick, Carrie

2004-01-01

Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

Efficacy of sequential three-step empirical therapy for chronic cough.

PubMed

Yu, Li; Xu, Xianghuai; Hang, Jingqing; Cheng, Kewen; Jin, Xiaoyan; Chen, Qiang; Lv, Hanjing; Qiu, Zhongmin

2017-06-01

Empirical three-step therapy has been proved in just one hospital. This study aimed to demonstrate applicability of the sequential empirical three-step therapy for chronic cough in different clinical settings. Sequential empirical three-step therapy was given to patients with chronic cough in one tertiary and three secondary care respiratory clinics. Recruiters were initially treated with methoxyphenamine compound as the first-step therapy, followed by corticosteroids as the second-step therapy and the combination of a proton-pump inhibitor and a prokinetic agent as the third-step therapy. The efficacy of the therapy was verified according to the changes in cough symptom score between pre- and post-treatment, and compared among the different clinics. In total 155 patients in one tertiary clinic and 193 patients in secondary care clinics were recruited. The total dropout ratio is significantly higher in the secondary care clinics than that in the tertiary clinic (9.3% versus 3.2%, p = 0.023). The therapeutic success rate for cough was 38.7% at first-step therapy, 32.3% at second-step therapy and 20.0% at third-step therapy in the tertiary clinic, and comparable to corresponding 49.7%, 31.1% and 4.1% in secondary care clinics. Furthermore, the overall cough resolution rate was not significantly different (91.0% versus 85.0%, p = 0.091). However, the efficacy of the third-step therapy is much higher (20.0% versus 4.1%, p = 0.001) in the tertiary clinic than in the secondary care clinics. Sequential empirical three-step therapy is universally efficacious and useful for management of chronic cough in different clinical settings.

Evaluating guideline adherence regarding empirical vancomycin use in patients with neutropenic fever.

PubMed

Chastain, Daniel B; Wheeler, Sarah; Franco-Paredes, Carlos; Olubajo, Babatunde; Hawkins, W Anthony

2018-04-01

The purpose of this study was to evaluate the use of empirical vancomycin for patients with neutropenic fever (NF) with regard to adherence to treatment guidelines. Adult patients with a diagnosis of neutropenia, who met the definition of NF as per treatment guidelines, were identified. Use of vancomycin was evaluated as part of empirical therapy and again after 72h. Outcomes were assessed using descriptive statistics, the Chi-square or Fisher's exact test, and univariate exact logistic regression analyses. Sixty-four patients were included. Overall, inappropriate empirical vancomycin use was observed in more than 30% of patients. Of 35 patients with indications for empirical vancomycin, only 68% received it. At 72h, appropriate vancomycin continuation, de-escalation, or discontinuation occurred in 21 of 33 patients. On univariate regression, hematological malignancy was associated with appropriate empirical vancomycin prescribing, whether initiating or withholding (odds ratio 4.0, 95% confidence interval 1.31-12.1). No variable was independently associated with inappropriate continuation at 72h. There is poor guideline adherence to vancomycin prescribing as empirical therapy and at 72-h reassessment in patients with NF. Further efforts are needed to foster a more rational use of vancomycin in patients with NF. Copyright © 2018. Published by Elsevier Ltd.

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

PubMed Central

Wachholtz, Amy; Gonzalez, Gerardo; Boyer, Edward; Naqvi, Zafar N; Rosenbaum, Christopher; Ziedonis, Douglas

2011-01-01

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain. PMID:24474854

Empirical data and moral theory. A plea for integrated empirical ethics.

PubMed

Molewijk, Bert; Stiggelbout, Anne M; Otten, Wilma; Dupuis, Heleen M; Kievit, Job

2004-01-01

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: "the prescriptive applied ethicists," "the theorists," "the critical applied ethicists," and "the particularists." The main aim of this paper is to introduce a fifth approach of more recent date (i.e. "integrated empirical ethics") and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic purposes. The table consists of eight columns: "view on distinction descriptive-prescriptive sciences," "location of moral authority," "central goal(s)," "types of normativity," "use of empirical data," "method," "interaction empirical data and moral theory," and "cooperation with descriptive sciences." Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics.

Cost-effectiveness of micafungin as an alternative to fluconazole empiric treatment of suspected ICU-acquired candidemia among patients with sepsis: a model simulation

PubMed Central

Zilberberg, Marya D; Kothari, Smita; Shorr, Andrew F

2009-01-01

Introduction Recent epidemiologic literature indicates that candidal species resistant to azoles are becoming more prevalent in the face of increasing incidence of hospitalizations with candidemia. Echinocandins, a new class of antifungal agents, are effective against resistant candidal species. As delaying appropriate antifungal coverage leads to increased mortality, we evaluated the cost-effectiveness of 100 mg daily empiric micafungin (MIC) vs. 400 mg daily fluconazole (FLU) for suspected intensive care unit-acquired candidemia (ICU-AC) among septic patients. Methods We designed a decision model with inputs from the literature in a hypothetical 1000-patient cohort with suspected ICU-AC treated empirically with either MIC or FLU or no treatment accompanied by a watchful waiting strategy. We examined the differences in the number of survivors, acquisition costs of antifungals, and lifetime costs among survivors in the cohort under each scenario, and calculated cost per quality adjusted life year (QALY). We conducted Monte Carlo simulations and sensitivity analyses to determine the stability of our estimates. Results In the base case analysis, assuming ICU-AC attributable mortality of 0.40 and a 52% relative risk reduction in mortality with appropriate timely therapy, compared with FLU (total deaths 31), treatment with MIC (total deaths 27) would result in four fewer deaths at an incremental cost/death averted of $61,446. Similarly, in reference case, incremental cost-effectiveness of MIC over FLU was $34,734 (95% confidence interval $26,312 to $49,209) per QALY. The estimates were most sensitive to the QALY adjustment factor and the risk of candidemia among septic patients. Conclusions Given the increasing likelihood of azole resistance among candidal isolates, empiric treatment of ICU-AC with 100 mg daily MIC is a cost-effective alternative to FLU. PMID:19545361

An empirically derived composite cognitive test score with improved power to track and evaluate treatments for preclinical Alzheimer's disease.

PubMed

Langbaum, Jessica B; Hendrix, Suzanne B; Ayutyanont, Napatkamon; Chen, Kewei; Fleisher, Adam S; Shah, Raj C; Barnes, Lisa L; Bennett, David A; Tariot, Pierre N; Reiman, Eric M

2014-11-01

There is growing interest in the evaluation of preclinical Alzheimer's disease (AD) treatments. As a result, there is a need to identify a cognitive composite that is sensitive to track preclinical AD decline to be used as a primary endpoint in treatment trials. Longitudinal data from initially cognitively normal, 70- to 85-year-old participants in three cohort studies of aging and dementia from the Rush Alzheimer's Disease Center were examined to empirically define a composite cognitive endpoint that is sensitive to detect and track cognitive decline before the onset of cognitive impairment. The mean-to-standard deviation ratios (MSDRs) of change over time were calculated in a search for the optimal combination of cognitive tests/subtests drawn from the neuropsychological battery in cognitively normal participants who subsequently progressed to clinical stages of AD during 2- and 5-year periods, using data from those who remained unimpaired during the same period to correct for aging and practice effects. Combinations that performed well were then evaluated for representation of relevant cognitive domains, robustness across individual years before diagnosis, and occurrence of selected items within top performing combinations. The optimal composite cognitive test score comprised seven cognitive tests/subtests with an MSDR = 0.964. By comparison, the most sensitive individual test score was Logical Memory Delayed Recall with an MSDR = 0.64. We have identified a composite cognitive test score representing multiple cognitive domains that has improved power compared with the most sensitive single test item to track preclinical AD decline and evaluate preclinical AD treatments. We are confirming the power of the composite in independent cohorts and with other analytical approaches, which may result in refinements, have designated it as the primary endpoint in the Alzheimer's Prevention Initiative's preclinical treatment trials for individuals at high imminent risk

Brain volume changes over the first year of treatment in schizophrenia: relationships to antipsychotic treatment.

PubMed

Emsley, R; Asmal, L; du Plessis, S; Chiliza, B; Phahladira, L; Kilian, S

2017-09-01

Progressive brain volume reductions have been described in schizophrenia, and an association with antipsychotic exposure has been reported. We compared percentage changes in grey and white matter volume from baseline to month 12 in 23 previously antipsychotic-naïve patients with a first episode of schizophrenia or schizophreniform disorder who were treated with the lowest effective dose of flupenthixol decanoate depot formulation, with 53 matched healthy individuals. Total antipsychotic dose was precisely calculated and its relationship with brain volume changes investigated. Relationships between volumetric changes and treatment were further investigated in terms of treatment response (changes in psychopathology and functionality) and treatment-related adverse-events (extrapyramidal symptoms and weight gain). Excessive cortical volume reductions were observed in patients [-4.6 (6.6)%] v. controls [-1.12 (4.0)%] (p = 0.009), with no significant group differences for changes in subcortical grey matter and white matter volumes. In a multiple regression model, the only significant predictor of cortical volume change was total antipsychotic dose received (p = 0.04). Cortical volume change was not significantly associated with the changes in psychopathology, functionality, extrapyramidal symptoms and body mass index or age, gender and duration of untreated psychosis. Brain volume reductions associated with antipsychotic treatment are not restricted to poor outcome patients and occur even with the lowest effective dose of antipsychotic. The lack of an association with poor treatment response or treatment-related adverse effects counts against cortical volume reductions reflecting neurotoxicity, at least in the short term. On the other hand, the volume reductions were not linked to the therapeutic benefits of antipsychotics.

Addiction Treatment Professionals Are Not the Gatekeepers of Recovery.

PubMed

Humphreys, Keith

2015-01-01

Addiction treatment is beneficial to many individuals who have substance use disorders. However, only a minority of individuals who recover from addiction receive it. Despite this, addiction treatment is sometimes granted the status of the "gatekeeper of recovery." The myth that treatment is necessary for recovery has no empirical support. It also undermines the confidence of individuals in their ability to change on their own and is unduly dismissive of the efforts of nonprofessional helpers.

Promoting Behavior Change from Alcohol Use through Mobile Technology: The Future of Ecological Momentary Assessment

PubMed Central

Cohn, Amy M.; Hunter-Reel, Dorian; Hagman, Brett T.; Mitchell, Jessica

2011-01-01

Background Interactive and mobile technologies (i.e., smartphones such as Blackberries, iPhones, and palm-top computers) show promise as an efficacious and cost-effective means of communicating health-behavior risks, improving public health outcomes, and accelerating behavior change (Abroms and Maibach, 2008). The present study was conducted as a “needs assessment” to examine the current available mobile smartphone applications (e.g., apps) that utilize principles of ecological momentary assessment (EMA) -- daily self-monitoring or near real-time self-assessment of alcohol use behavior -- to promote positive behavior change, alcohol harm reduction, psycho-education about alcohol use, or abstinence from alcohol. Methods Data were collected and analyzed from iTunes for Apple iPhone©. An inventory assessed the number of available apps that directly addressed alcohol use and consumption, alcohol treatment, or recovery, and whether these apps incorporated empirically-based components of alcohol treatment. Results Findings showed that few apps addressed alcohol use behavior change or recovery. Aside from tracking drinking consumption, a minority utilized empirically-based components of alcohol treatment. Some apps claimed they could serve as an intervention, however no empirical evidence was provided. Conclusions More studies are needed to examine the efficacy of mobile technology in alcohol intervention studies. The large gap between availability of mobile apps and their use in alcohol treatment programs indicate several important future directions for research. PMID:21689119

Meta-Analysis and Cost Comparison of Empirical versus Pre-Emptive Antifungal Strategies in Hematologic Malignancy Patients with High-Risk Febrile Neutropenia.

PubMed

Fung, Monica; Kim, Jane; Marty, Francisco M; Schwarzinger, Michaël; Koo, Sophia

2015-01-01

Invasive fungal disease (IFD) causes significant morbidity and mortality in hematologic malignancy patients with high-risk febrile neutropenia (FN). These patients therefore often receive empirical antifungal therapy. Diagnostic test-guided pre-emptive antifungal therapy has been evaluated as an alternative treatment strategy in these patients. We conducted an electronic search for literature comparing empirical versus pre-emptive antifungal strategies in FN among adult hematologic malignancy patients. We systematically reviewed 9 studies, including randomized-controlled trials, cohort studies, and feasibility studies. Random and fixed-effect models were used to generate pooled relative risk estimates of IFD detection, IFD-related mortality, overall mortality, and rates and duration of antifungal therapy. Heterogeneity was measured via Cochran's Q test, I2 statistic, and between study τ2. Incorporating these parameters and direct costs of drugs and diagnostic testing, we constructed a comparative costing model for the two strategies. We conducted probabilistic sensitivity analysis on pooled estimates and one-way sensitivity analyses on other key parameters with uncertain estimates. Nine published studies met inclusion criteria. Compared to empirical antifungal therapy, pre-emptive strategies were associated with significantly lower antifungal exposure (RR 0.48, 95% CI 0.27-0.85) and duration without an increase in IFD-related mortality (RR 0.82, 95% CI 0.36-1.87) or overall mortality (RR 0.95, 95% CI 0.46-1.99). The pre-emptive strategy cost $324 less (95% credible interval -$291.88 to $418.65 pre-emptive compared to empirical) than the empirical approach per FN episode. However, the cost difference was influenced by relatively small changes in costs of antifungal therapy and diagnostic testing. Compared to empirical antifungal therapy, pre-emptive antifungal therapy in patients with high-risk FN may decrease antifungal use without increasing mortality. We

Empirically Based Myths: Astrology, Biorhythms, and ATIs.

ERIC Educational Resources Information Center

Ragsdale, Ronald G.

1980-01-01

A myth may have an empirical basis through chance occurrence; perhaps Aptitude Treatment Interactions (ATIs) are in this category. While ATIs have great utility in describing, planning, and implementing instruction, few disordinal interactions have been found. Article suggests narrowing of ATI research with replications and estimates of effect…

Developing empirically supported theories of change for housing investment and health

PubMed Central

Thomson, Hilary; Thomas, Sian

2015-01-01

The assumption that improving housing conditions can lead to improved health may seem a self-evident hypothesis. Yet evidence from intervention studies suggests small or unclear health improvements, indicating that further thought is required to refine this hypothesis. Articulation of a theory can help avoid a black box approach to research and practice and has been advocated as especially valuable for those evaluating complex social interventions like housing. This paper presents a preliminary theory of housing improvement and health based on a systematic review conducted by the authors. Following extraction of health outcomes, data on all socio-economic impacts were extracted by two independent reviewers from both qualitative and quantitative studies. Health and socio-economic outcome data from the better quality studies (n = 23/34) were mapped onto a one page logic models by two independent reviewers and a final model reflecting reviewer agreement was prepared. Where there was supporting evidence of links between outcomes these were indicated in the model. Two models of specific improvements (warmth & energy efficiency; and housing led renewal), and a final overall model were prepared. The models provide a visual map of the best available evidence on the health and socio-economic impacts of housing improvement. The use of a logic model design helps to elucidate the possible pathways between housing improvement and health and as such might be described as an empirically based theory. Changes in housing factors were linked to changes in socio-economic determinants of health. This points to the potential for longer term health impacts which could not be detected within the lifespan of the evaluations. The developed theories are limited by the available data and need to be tested and refined. However, in addition to providing one page summaries for evidence users, the theory may usefully inform future research on housing and health. PMID:25461878

The Role of Empirical Evidence for Transferring a New Technology to Industry

NASA Astrophysics Data System (ADS)

Baldassarre, Maria Teresa; Bruno, Giovanni; Caivano, Danilo; Visaggio, Giuseppe

Technology transfer and innovation diffusion are key success factors for an enterprise. The shift to a new software technology involves, on one hand, inevitable changes to ingrained and familiar processes and, on the other, requires training, changes in practices and commitment on behalf of technical staff and management. Nevertheless, industry is often reluctant to innovation due to the changes it determines. The process of innovation diffusion is easier if the new technology is supported by empirical evidence. In this sense our conjecture is that Empirical Software Engineering (ESE) serves as means for validating and transferring a new technology within production processes. In this paper, the authors report their experience of a method, Multiview Framework, defined in the SERLAB research laboratory as support for designing and managing a goal oriented measurement program that has been validated through various empirical studies before being transferred to an Italian SME. Our discussion points out the important role of empirical evidence for obtaining management commitment and buy-in on behalf of technical staff, and for making technological transfer possible.

Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review.

PubMed

Ponniah, Kathryn; Hollon, Steven D

2009-01-01

Acute stress disorder (ASD) predicts the development of posttraumatic stress disorder (PTSD), which in some sufferers can persist for years and lead to significant disability. We carried out a review of randomized controlled trials to give an update on which psychological treatments are empirically supported for these disorders, and used the criteria set out by Chambless and Hollon [1998: J Consult Clin Psychol 66:7-18] to draw conclusions about efficacy, first irrespective of trauma type and second with regard to particular populations. The PsycINFO and PubMed databases were searched electronically to identify suitable articles published up to the end of 2008. Fifty-seven studies satisfied our inclusion criteria. Looking at the literature undifferentiated by trauma type, there was evidence that trauma-focused cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are efficacious and specific for PTSD, stress inoculation training, hypnotherapy, interpersonal psychotherapy, and psychodynamic therapy are possibly efficacious for PTSD and trauma-focused CBT is possibly efficacious for ASD. Not one of these treatments has been tested with the full range of trauma groups, though there is evidence that trauma-focused CBT is established in efficacy for assault- and road traffic accident-related PTSD. Trauma-focused CBT and to a lesser extent EMDR (due to fewer studies having been conducted and many having had a mixed trauma sample) are the psychological treatments of choice for PTSD, but further research of these and other therapies with different populations is needed.

Identifying patients with depression who require a change in treatment and implementing that change.

PubMed

Papakostas, George I

2016-02-01

Creating an effective treatment regimen for patients diagnosed with major depressive disorder (MDD) can be a challenge for clinicians. With each treatment trial, only 20% to 30% of patients achieve remission, and many of those who do reach remission experience residual symptoms. Patients with treatment-resistant depression or with residual symptoms are candidates for a change in treatment. Other patients requiring treatment changes are those who experience intolerable adverse effects and those who experience an illness recurrence. Because early detection can lead to improved outcomes, clinicians must be vigilant about assessing patients to identify when one or more of these situations occur. Clinicians must also communicate effectively with their patients to ensure that they understand the treatment strategies, goals, and potential adverse effects; have realistic expectations of treatment; and express their treatment preferences. Timely and appropriate treatment adjustment is necessary to help patients with MDD achieve recovery. © Copyright 2016 Physicians Postgraduate Press, Inc.

Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.

PubMed

Khawcharoenporn, Thana; Tice, Alan

2010-10-01

Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded. Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin. Risk factors for treatment failure were evaluated using multivariate logistic regression analysis. Of 544 patients with cellulitis, 405 met the inclusion criteria. The overall treatment success rate of trimethoprim-sulfamethoxazole was significantly higher than the rate of cephalexin (91% vs 74%; P<.001), whereas clindamycin success rates were higher than those of cephalexin in patients who had subsequently culture-confirmed MRSA infections (P=.01), had moderately severe cellulitis (P=.03), and were obese (P=.04). Methicillin-resistant S. aureus was recovered in 72 of 117 positive culture specimens (62%). Compliance and adverse drug reaction rates were not significantly different among patients who received these 3 antibiotics. Factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA (adjusted odds ratio 4.22; 95% confidence interval, 2.25-7.92; P<.001) and severity of cellulitis (adjusted odds ratio 3.74; 95% confidence interval, 2.06-6.79; P<.001). Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting. Copyright © 2010 Elsevier Inc. All rights reserved.

Empirical psychology, common sense, and Kant's empirical markers for moral responsibility.

PubMed

Frierson, Patrick

2008-12-01

This paper explains the empirical markers by which Kant thinks that one can identify moral responsibility. After explaining the problem of discerning such markers within a Kantian framework I briefly explain Kant's empirical psychology. I then argue that Kant's empirical markers for moral responsibility--linked to higher faculties of cognition--are not sufficient conditions for moral responsibility, primarily because they are empirical characteristics subject to natural laws. Next. I argue that these markers are not necessary conditions of moral responsibility. Given Kant's transcendental idealism, even an entity that lacks these markers could be free and morally responsible, although as a matter of fact Kant thinks that none are. Given that they are neither necessary nor sufficient conditions, I discuss the status of Kant's claim that higher faculties are empirical markers of moral responsibility. Drawing on connections between Kant's ethical theory and 'common rational cognition' (4:393), I suggest that Kant's theory of empirical markers can be traced to ordinary common sense beliefs about responsibility. This suggestion helps explain both why empirical markers are important and what the limits of empirical psychology are within Kant's account of moral responsibility.

Evaluating the Validity of Systematic Reviews to Identify Empirically Supported Treatments

ERIC Educational Resources Information Center

Slocum, Timothy A.; Detrich, Ronnie; Spencer, Trina D.

2012-01-01

The "best available evidence" is one of the three basic inputs into evidence-based practice. This paper sets out a framework for evaluating the quality of systematic reviews that are intended to identify empirically supported interventions as a way of summarizing the best available evidence. The premise of this paper is that the process of…

Theoretical and Empirical Descriptions of Thermospheric Density

NASA Astrophysics Data System (ADS)

Solomon, S. C.; Qian, L.

2004-12-01

The longest-term and most accurate overall description the density of the upper thermosphere is provided by analysis of change in the ephemeris of Earth-orbiting satellites. Empirical models of the thermosphere developed in part from these measurements can do a reasonable job of describing thermospheric properties on a climatological basis, but the promise of first-principles global general circulation models of the coupled thermosphere/ionosphere system is that a true high-resolution, predictive capability may ultimately be developed for thermospheric density. However, several issues are encountered when attempting to tune such models so that they accurately represent absolute densities as a function of altitude, and their changes on solar-rotational and solar-cycle time scales. Among these are the crucial ones of getting the heating rates (from both solar and auroral sources) right, getting the cooling rates right, and establishing the appropriate boundary conditions. However, there are several ancillary issues as well, such as the problem of registering a pressure-coordinate model onto an altitude scale, and dealing with possible departures from hydrostatic equilibrium in empirical models. Thus, tuning a theoretical model to match empirical climatology may be difficult, even in the absence of high temporal or spatial variation of the energy sources. We will discuss some of the challenges involved, and show comparisons of simulations using the NCAR Thermosphere-Ionosphere-Electrodynamics General Circulation Model (TIE-GCM) to empirical model estimates of neutral thermosphere density and temperature. We will also show some recent simulations using measured solar irradiance from the TIMED/SEE instrument as input to the TIE-GCM.

Program closure and change among VA substance abuse treatment programs.

PubMed

Floyd, A S

1999-10-01

The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

A cost analysis of a broad-spectrum antibiotic therapy in the empirical treatment of health care-associated infections in cirrhotic patients

PubMed Central

Lucidi, Cristina; Di Gregorio, Vincenza; Ceccarelli, Giancarlo; Venditti, Mario; Riggio, Oliviero; Merli, Manuela

2017-01-01

Background Early diagnosis and appropriate treatment of infections in cirrhosis are crucial. As new guidelines in this context, particularly for health care-associated (HCA) infections, would be needed, we performed a trial documenting whether an empirical broad-spectrum antibiotic therapy is more effective than the standard one for these infections. Because of the higher daily cost of broad-spectrum than standard antibiotics, we performed a cost analysis to compare: 1) total drug costs, 2) profitability of hospital admissions. Methods This retrospective observational analysis was performed on patients enrolled in the trial NCT01820026, in which consecutive cirrhotic patients with HCA infections were randomly assigned to a standard vs a broad-spectrum treatment. Antibiotic daily doses, days of treatment, length of hospital stay, and DRG (diagnosis-related group) were recorded from the clinical trial medical records. The profitability of hospitalizations was calculated considering DRG tariffs divided by length of hospital stay. Results We considered 84 patients (42 for each group). The standard therapy allowed to obtain a first-line treatment cost lower than in the broad-spectrum therapy. Anyway, the latter, being related to a lower failure rate (19% vs 57.1%), resulted in cost saving in terms of cumulative antibiotic costs (first- and second-line treatments). The mean cost saving per patient for the broad-spectrum arm was €44.18 (−37.6%), with a total cost saving of about €2,000. Compared to standard group, we observed a statistically significant reduction in hospital stay from 17.8 to 11.8 days (p<0.002) for patients treated with broad-spectrum antibiotics. The distribution of DRG tariffs was similar in the two groups. According to DRG, the shorter length of hospital stay of the broad-spectrum group involved a higher mean profitable daily cost than standard group (€345.61 vs €252.23; +37%). Conclusion Our study supports the idea that the use of a broad

A cost analysis of a broad-spectrum antibiotic therapy in the empirical treatment of health care-associated infections in cirrhotic patients.

PubMed

Lucidi, Cristina; Di Gregorio, Vincenza; Ceccarelli, Giancarlo; Venditti, Mario; Riggio, Oliviero; Merli, Manuela

2017-01-01

Early diagnosis and appropriate treatment of infections in cirrhosis are crucial. As new guidelines in this context, particularly for health care-associated (HCA) infections, would be needed, we performed a trial documenting whether an empirical broad-spectrum antibiotic therapy is more effective than the standard one for these infections. Because of the higher daily cost of broad-spectrum than standard antibiotics, we performed a cost analysis to compare: 1) total drug costs, 2) profitability of hospital admissions. This retrospective observational analysis was performed on patients enrolled in the trial NCT01820026, in which consecutive cirrhotic patients with HCA infections were randomly assigned to a standard vs a broad-spectrum treatment. Antibiotic daily doses, days of treatment, length of hospital stay, and DRG (diagnosis-related group) were recorded from the clinical trial medical records. The profitability of hospitalizations was calculated considering DRG tariffs divided by length of hospital stay. We considered 84 patients (42 for each group). The standard therapy allowed to obtain a first-line treatment cost lower than in the broad-spectrum therapy. Anyway, the latter, being related to a lower failure rate (19% vs 57.1%), resulted in cost saving in terms of cumulative antibiotic costs (first- and second-line treatments). The mean cost saving per patient for the broad-spectrum arm was €44.18 (-37.6%), with a total cost saving of about €2,000. Compared to standard group, we observed a statistically significant reduction in hospital stay from 17.8 to 11.8 days ( p <0.002) for patients treated with broad-spectrum antibiotics. The distribution of DRG tariffs was similar in the two groups. According to DRG, the shorter length of hospital stay of the broad-spectrum group involved a higher mean profitable daily cost than standard group (€345.61 vs €252.23; +37%). Our study supports the idea that the use of a broad-spectrum empirical treatment for HCA

The structure, correlates, and treatment related changes of mindfulness facets across the anxiety disorders and obsessive compulsive disorder.

PubMed

Hawley, Lance L; Rogojanski, Jenny; Vorstenbosch, Valerie; Quilty, Lena C; Laposa, Judith M; Rector, Neil A

2017-06-01

Research with non-clinical and clinical samples has examined how mindfulness concepts relate to psychological symptom presentations. However, there is less clarity when examining treatment-seeking patients who experience DSM-diagnosed anxiety and obsessional disorders - both cross-sectionally, and following empirically-supported treatments. The Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) conceptualizes mindfulness as consisting of five facets: Observing, Describing, Acting with Awareness, Nonreactivity, and Nonjudging. The current study examines the factor structure and predictive validity of the FFMQ in a large sample of treatment-seeking individuals with obsessive compulsive disorder (OCD), panic disorder with or without agoraphobia (PD/A), social anxiety disorder (SAD), and generalized anxiety disorder (GAD). Confirmatory factor analyses (CFA) established that both four and five-factor models (i.e., with and without inclusion of the Observing factor) provided an acceptable representation of the underlying FFMQ structure, but did not support a one-factor solution. For each of these diagnostic groups, hierarchical regression analyses clarified the association between specific FFMQ facets and diagnosis specific symptom change during CBT treatment. These findings are discussed in the context of the possible transdiagnostic relevance of specific mindfulness facets, and how these facets are differentially associated with diagnosis specific symptom alleviation during CBT. Copyright © 2017 Elsevier Ltd. All rights reserved.

Darwinism and cultural change.

PubMed

Godfrey-Smith, Peter

2012-08-05

Evolutionary models of cultural change have acquired an important role in attempts to explain the course of human evolution, especially our specialization in knowledge-gathering and intelligent control of environments. In both biological and cultural change, different patterns of explanation become relevant at different 'grains' of analysis and in contexts associated with different explanatory targets. Existing treatments of the evolutionary approach to culture, both positive and negative, underestimate the importance of these distinctions. Close attention to grain of analysis motivates distinctions between three possible modes of cultural evolution, each associated with different empirical assumptions and explanatory roles.

Chymopapain chemonucleolysis: CT changes after treatment

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

Gentry, L.R.; Turski, P.A.; Strother, C.M.

1985-08-01

Chymopapain chemonucleolysis is now used extensively in this country to treat lumbar disk herniation. Despite increasing experience in patient selection, there continue to be patients who do not respond to treatment and require diagnostic reevaluation. Interpretation of postchemonucleolysis computed tomographic (CT) scans in these patients requires a knowledge of the CT changes that normally occur after treatment with chemonucleolysis. To define these temporal changes, a prospective CT evaluation was performed of 29 treated interspaces in 26 patients who returned for routine postchemonucleolysis follow-up. Despite a successful clinical response in 17 of 21 patients, changes in the size, location, shape, homogeneity,more » and density of the disk herniation were uncommon at the 6 week follow-up. In 24 treated interspaces, the most common changes at 6 week CT follow-up were the development of vacuum phenomenon in three (12.5%) and a slight decrease in the size of two (8.3%) disk herniations. A successful response was noted in 17 of 21 patients scanned at 6 month follow-up, with five (22.7%) of 22 injected interspaces exhibiting vacuum phenomenon and 13 (59.1%) interspaces showing an observable decrease in the size of the disk herniation.« less

Treatment Changes in Patients With Moderate to Severe Psoriasis: A Retrospective Chart Review.

PubMed

Smith, Jaclyn A; Wehausen, Brooke; Richardson, Irma; Zhao, Yang; Li, Yunfeng; Herrera, Vivian; Feldman, Steven R

Psoriasis treatment involves topical medications, oral medications, phototherapy, and/or biologics. The treatments used depend on a myriad of factors that change over time. To characterise the frequency of and reasons for treatment changes in patients with moderate to severe psoriasis. A chart review examined treatment changes at 902 visits by 116 patients seen between January 1, 2010, and June 30, 2015, for moderate to severe psoriasis and the physicians' justifications for those changes. 'Treatment change' was defined as switching between, adding, or removing medication classes or switching within the oral or biologic class. There were 221 visits with treatment changes identified, and a change occurred every 4.1 visits. On average, there were 1.2 treatment changes per year. Patients treated for at least 1 year averaged 1 treatment change every 16 months. The most common type of change was from one biologic to another biologic (24.9%), followed by adding a nonbiologic to a biologic (18.6%). The most common reason for switching was poor control or flare of psoriasis. Affordability was a more common problem for biologics than for nonbiologic treatments. Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.

Improving Substance Abuse Treatment: The National Treatment Plan Initiative. Changing the Conversation.

ERIC Educational Resources Information Center

Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

This report is the result of five expert panels and six regional public hearings around the country that focused on key persistent issues that have characterized discussions of substance abuse over the years: closing the treatment gap; reducing stigma and changing attitudes; improving and strengthening treatment systems; connecting services and…

Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections.

PubMed

Zirk, Matthias; Buller, Johannes; Goeddertz, Peter; Rothamel, Daniel; Dreiseidler, Timo; Zöller, Joachim E; Kreppel, Matthias

2016-08-01

Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics. Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p < 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p < 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%). This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives. Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co

Empirical estimation of present-day Antarctic glacial isostatic adjustment and ice mass change

NASA Astrophysics Data System (ADS)

Gunter, B. C.; Didova, O.; Riva, R. E. M.; Ligtenberg, S. R. M.; Lenaerts, J. T. M.; King, M. A.; van den Broeke, M. R.; Urban, T.

2014-04-01

This study explores an approach that simultaneously estimates Antarctic mass balance and glacial isostatic adjustment (GIA) through the combination of satellite gravity and altimetry data sets. The results improve upon previous efforts by incorporating a firn densification model to account for firn compaction and surface processes as well as reprocessed data sets over a slightly longer period of time. A range of different Gravity Recovery and Climate Experiment (GRACE) gravity models were evaluated and a new Ice, Cloud, and Land Elevation Satellite (ICESat) surface height trend map computed using an overlapping footprint approach. When the GIA models created from the combination approach were compared to in situ GPS ground station displacements, the vertical rates estimated showed consistently better agreement than recent conventional GIA models. The new empirically derived GIA rates suggest the presence of strong uplift in the Amundsen Sea sector in West Antarctica (WA) and the Philippi/Denman sectors, as well as subsidence in large parts of East Antarctica (EA). The total GIA-related mass change estimates for the entire Antarctic ice sheet ranged from 53 to 103 Gt yr-1, depending on the GRACE solution used, with an estimated uncertainty of ±40 Gt yr-1. Over the time frame February 2003-October 2009, the corresponding ice mass change showed an average value of -100 ± 44 Gt yr-1 (EA: 5 ± 38, WA: -105 ± 22), consistent with other recent estimates in the literature, with regional mass loss mostly concentrated in WA. The refined approach presented in this study shows the contribution that such data combinations can make towards improving estimates of present-day GIA and ice mass change, particularly with respect to determining more reliable uncertainties.

Law of Empires.

ERIC Educational Resources Information Center

Martz, Carlton

2001-01-01

This issue of "Bill of Rights in Action" explores issues raised by empires and imperial law. The first article, "Clash of Empires: The Fight for North America," looks at the clash of empires and the fight for North America during the 18th century. The second article, "When Roman Law Ruled the Western World," examines…

An Empirical Assessment of an Activity to Teach Sensory Change in Aging

ERIC Educational Resources Information Center

Dickinson, Paige E.; Schwarzmueller, April; Martin, Bret

2014-01-01

This study empirically tested the effectiveness of a brief, inexpensive aging simulation activity to educate traditional-aged students about sensory declines and their potential causes in older adulthood development. Students in a life-span development course wore specific props (e.g., thick gloves, earplugs, and obscured glasses) to simulate…

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers' Views of the Role of Technology and Web-Based Resources.

PubMed

Orengo-Aguayo, Rosaura E; Hanson, Rochelle F; Moreland, Angela D; Jobe-Shields, Lisa; Adams, Zachary W

2018-07-01

This mixed-methods study assessed providers' views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.

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

PubMed

Ballesteros, Francisco; Labrador, Francisco J

2014-10-27

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

Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load.

PubMed

Odenwald, Michael; Semrau, Peter

2013-03-21

Motivation to change has been proposed as a prerequisite for behavioral change, although empirical results are contradictory. Traumatic experiences are frequently found amongst patients in alcohol treatment, but this has not been systematically studied in terms of effects on treatment outcomes. This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change. Over the course of two months in 2009, 55 patients admitted to an alcohol detoxification unit of a psychiatric hospital were enrolled in this study. At treatment entry, we assessed lifetime Trauma Load and motivation to change. Mode of discharge was taken from patient files following therapy. We tested whether Trauma Load moderates the effect of motivation to change on dropout from alcohol detoxification using multivariate methods. 55.4% dropped out of detoxification treatment, while 44.6% completed the treatment. Age, gender and days in treatment did not differ between completers and dropouts. Patients who dropped out reported more traumatic event types on average than completers. Treatment completers had higher scores in the URICA subscale Maintenance. Multivariate methods confirmed the moderator effect of Trauma Load: among participants with high Trauma Load, treatment completion was related to higher Maintenance scores at treatment entry; this was not true among patients with low Trauma Load. We found evidence that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load: among patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, who a priori have a greater risk of dropping out, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to change.

Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load

PubMed Central

2013-01-01

Background Motivation to change has been proposed as a prerequisite for behavioral change, although empirical results are contradictory. Traumatic experiences are frequently found amongst patients in alcohol treatment, but this has not been systematically studied in terms of effects on treatment outcomes. This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change. Methods Over the course of two months in 2009, 55 patients admitted to an alcohol detoxification unit of a psychiatric hospital were enrolled in this study. At treatment entry, we assessed lifetime Trauma Load and motivation to change. Mode of discharge was taken from patient files following therapy. We tested whether Trauma Load moderates the effect of motivation to change on dropout from alcohol detoxification using multivariate methods. Results 55.4% dropped out of detoxification treatment, while 44.6% completed the treatment. Age, gender and days in treatment did not differ between completers and dropouts. Patients who dropped out reported more traumatic event types on average than completers. Treatment completers had higher scores in the URICA subscale Maintenance. Multivariate methods confirmed the moderator effect of Trauma Load: among participants with high Trauma Load, treatment completion was related to higher Maintenance scores at treatment entry; this was not true among patients with low Trauma Load. Conclusions We found evidence that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load: among patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, who a priori have a greater risk of dropping out, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to

Developing empirically supported theories of change for housing investment and health.

PubMed

Thomson, Hilary; Thomas, Sian

2015-01-01

The assumption that improving housing conditions can lead to improved health may seem a self-evident hypothesis. Yet evidence from intervention studies suggests small or unclear health improvements, indicating that further thought is required to refine this hypothesis. Articulation of a theory can help avoid a black box approach to research and practice and has been advocated as especially valuable for those evaluating complex social interventions like housing. This paper presents a preliminary theory of housing improvement and health based on a systematic review conducted by the authors. Following extraction of health outcomes, data on all socio-economic impacts were extracted by two independent reviewers from both qualitative and quantitative studies. Health and socio-economic outcome data from the better quality studies (n = 23/34) were mapped onto a one page logic models by two independent reviewers and a final model reflecting reviewer agreement was prepared. Where there was supporting evidence of links between outcomes these were indicated in the model. Two models of specific improvements (warmth & energy efficiency; and housing led renewal), and a final overall model were prepared. The models provide a visual map of the best available evidence on the health and socio-economic impacts of housing improvement. The use of a logic model design helps to elucidate the possible pathways between housing improvement and health and as such might be described as an empirically based theory. Changes in housing factors were linked to changes in socio-economic determinants of health. This points to the potential for longer term health impacts which could not be detected within the lifespan of the evaluations. The developed theories are limited by the available data and need to be tested and refined. However, in addition to providing one page summaries for evidence users, the theory may usefully inform future research on housing and health. Copyright © 2014 The Authors

An empirical, hierarchical typology of tree species assemblages for assessing forest dynamics under global change scenarios

PubMed Central

Coulston, John W.; Wear, David N.

2017-01-01

The composition of tree species occurring in a forest is important and can be affected by global change drivers such as climate change. To inform assessment and projection of global change impacts at broad extents, we used hierarchical cluster analysis and over 120,000 recent forest inventory plots to empirically define forest tree assemblages across the U.S., and identified the indicator and dominant species associated with each. Cluster typologies in two levels of a hierarchy of forest assemblages, with 29 and 147 groups respectively, were supported by diagnostic criteria. Groups in these two levels of the hierarchy were labeled based on the top indicator species in each, and ranged widely in size. For example, in the 29-cluster typology, the sugar maple-red maple assemblage contained the largest number of plots (30,068), while the butternut-sweet birch and sourwood-scarlet oak assemblages were both smallest (6 plots each). We provide a case-study demonstration of the utility of the typology for informing forest climate change impact assessment. For five assemblages in the 29-cluster typology, we used existing projections of changes in importance value (IV) for the dominant species under one low and one high climate change scenario to assess impacts to the assemblages. Results ranged widely for each scenario by the end of the century, with each showing an average decrease in IV for dominant species in some assemblages, including the balsam fir-quaking aspen assemblage, and an average increase for others, like the green ash-American elm assemblage. Future work should assess adaptive capacity of these forest assemblages and investigate local population- and community-level dynamics in places where dominant species may be impacted. This typology will be ideal for monitoring, assessing, and projecting changes to forest communities within the emerging framework of macrosystems ecology, which emphasizes hierarchies and broad extents. PMID:28877258

[Strategies of treatment for febrile neutropenia].

PubMed

Terui, Yasuhito

2013-06-01

The guideline on febrile neutropenia(FN)was published by the Japanese Society of Medical Oncology(JSMO)in 2012. Based on this guideline, the treatment strategy for febrile neutropenia that is discussed in this paper includes empiric treatment strategies, methicillin-resistant Staphylococcus aureus antibiotics in the initial treatment, treatment for severe FN, treatment for outpatients, duration of FN treatment, treatment after recovery from fever associated with neutropenia, and empiric treatment with anti-fungal drugs in patients with prolonged FN.

Rapid treatment-induced brain changes in pediatric CRPS.

PubMed

Erpelding, Nathalie; Simons, Laura; Lebel, Alyssa; Serrano, Paul; Pielech, Melissa; Prabhu, Sanjay; Becerra, Lino; Borsook, David

2016-03-01

To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.

Consensus on diagnosis and empiric antibiotic therapy of febrile neutropenia

PubMed Central

Giurici, Nagua; Zanazzo, Giulio A.

2011-01-01

Controversial issues on the management of empiric therapy and diagnosis of febrile neutropenia (FN) were faced by a Consensus Group of the Italian Association of Pediatric Hematology-Oncology (AIEOP). In this paper we report the suggestions of the consensus process regarding the role of aminoglycosides, glycopeptides and oral antibiotics in empiric therapy of FN, the rules for changing or discontinuing the therapy as well as the timing of the blood cultures. PMID:21647277

Pluvials, Droughts, Energetics, and the Mongol Empire

NASA Astrophysics Data System (ADS)

Hessl, A. E.; Pederson, N.; Baatarbileg, N.

2012-12-01

consistent with a well-documented volcanic eruption that caused massive crop damage and famine throughout much of Europe. In Mongol history, this abrupt cooling also coincides with the move of the capital from Central Mongolia (Karakorum) to China (Beijing). In combination, the tree-ring records of water and temperature suggest that 1) the rise of the Mongol Empire occurred during an unusually consistent warm and wet climate and 2) the disintegration of the Empire occurred following a plunge into cold and dry conditions in Central Mongolia. These results represent the first step of a larger project integrating physical science and history to understand the role of energy in the evolution of the Mongol Empire. Using data from historic documents, ecological modeling, tree rings, and sediment cores, we will investigate whether the expansion and contraction of the empire was related to moisture and temperature availability and thus grassland productivity associated with climate change in the Orkhon Valley.

Dissociative identity disorder: An empirical overview.

PubMed

Dorahy, Martin J; Brand, Bethany L; Sar, Vedat; Krüger, Christa; Stavropoulos, Pam; Martínez-Taboas, Alfonso; Lewis-Fernández, Roberto; Middleton, Warwick

2014-05-01

Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to

Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections.

PubMed

Kauf, Teresa L; Prabhu, Vimalanand S; Medic, Goran; Borse, Rebekah H; Miller, Benjamin; Gaultney, Jennifer; Sen, Shuvayu S; Basu, Anirban

2017-04-28

A challenge in the empiric treatment of complicated urinary tract infection (cUTI) is identifying the initial appropriate antibiotic therapy (IAAT), which is associated with reduced length of stay and mortality compared with initial inappropriate antibiotic therapy (IIAT). We evaluated the cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam (one of the standard of care antibiotics), for the treatment of hospitalized patients with cUTI. A decision-analytic Monte Carlo simulation model was developed to compare the costs and effectiveness of empiric treatment with either ceftolozane/tazobactam or piperacillin/tazobactam in hospitalized adult patients with cUTI infected with Gram-negative pathogens in the US. The model applies the baseline prevalence of resistance as reported by national in-vitro surveillance data. In a cohort of 1000 patients, treatment with ceftolozane/tazobactam resulted in higher total costs compared with piperacillin/tazobactam ($36,413 /patient vs. $36,028/patient, respectively), greater quality-adjusted life years (QALYs) (9.19/patient vs. 9.13/patient, respectively) and an incremental cost-effectiveness ratio (ICER) of $6128/QALY. Ceftolozane/tazobactam remained cost-effective at a willingness to pay of $100,000 per QALY compared to piperacillin/tazobactam over a range of input parameter values during one-way and probabilistic sensitivity analysis. Model results show that ceftolozane/tazobactam is likely to be cost-effective compared with piperacillin/tazobactam for the empiric treatment of hospitalized cUTI patients in the United States.

Recent Advances in Behavioral Addiction Treatments: Focusing on Mechanisms of Change

PubMed Central

Longabaugh, Richard; Magill, Molly

2012-01-01

In the latter half of the 20th century, research on behavioral treatments for addictions aimed to develop and test effective treatments. Among treatments found to be at least moderately effective, direct comparisons failed to reveal consistent superiority of one approach over another. This ubiquitous finding held true despite underlying theories that differed markedly in their proposed causal processes related to patient change. In the 21st century the focus of treatment research is increasingly on how treatment works for whom, rather than whether it works. Studies of active treatment ingredients and mechanisms of behavioral change, while promising, have yielded inconsistent results. Simple mediation analysis may need to be expanded by inclusion of models testing for moderated mediation, mediated moderation, and conditional indirect effects. Examples are offered as to how these more complex models can lead to increased understanding of the conditions under which specific treatment interventions will be effective and mechanisms of change operative in improving behavioral treatments for addictions. PMID:21750958

Recent advances in behavioral addiction treatments: focusing on mechanisms of change.

PubMed

Longabaugh, Richard; Magill, Molly

2011-10-01

In the latter half of the 20th century, research on behavioral treatments for addictions aimed to develop and test effective treatments. Among the treatments found to be at least moderately effective, direct comparisons failed to reveal consistent superiority of one approach over another. This ubiquitous finding held true despite underlying theories that differed markedly in their proposed causal processes related to patient change. In the 21st century, the focus of treatment research is increasingly on how treatment works for whom rather than whether it works. Studies of active treatment ingredients and mechanisms of behavioral change, while promising, have yielded inconsistent results. Simple mediation analysis may need to be expanded via inclusion of models testing for moderated mediation, mediated moderation, and conditional indirect effects. Examples are offered as to how these more complex models can lead to increased understanding of the conditions under which specific treatment interventions will be effective and mechanisms of change operative in improving behavioral treatments for addictions.

Empirical research in medical ethics: how conceptual accounts on normative-empirical collaboration may improve research practice.

PubMed

Salloch, Sabine; Schildmann, Jan; Vollmann, Jochen

2012-04-13

The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis.

Functional Measurement in the Field of Empirical Bioethics

ERIC Educational Resources Information Center

Mullet, Etienne; Sorum, Paul C.; Teysseire, Nathalie; Nann, Stephanie; Martinez, Guadalupe Elizabeth Morales; Ahmed, Ramadan; Kamble, Shanmukh; Olivari, Cecilia; Sastre, Maria Teresa Munoz

2012-01-01

We present, in a synthetic way, some of the main findings from five studies that were conducted in the field of empirical bioethics, using the Functional Measurement framework. These studies were about (a) the rationing of rare treatments, (b) adolescents' abortions, (c) end-of-life decision-making regarding damaged neonates, (d) end-of-life…

Changes in tobacco use among adolescent smokers in substance abuse treatment.

PubMed

Shelef, Karni; Diamond, Guy S; Diamond, Gary M; Myers, Mark G

2009-06-01

Adolescents with substance use disorders (SUDs) smoke cigarettes more than youth in the general population. Little is known about changes in smoking patterns during and after outpatient SUD treatment. We examined whether receiving SUD treatment had a differential impact on cigarette smoking behaviors of mild (<10 cigarettes per day [CPD]), moderate (10-19 CPD), and heavy (>or=20 CPD) smokers (smoked on >or=60 days in the past 90). Our sample included 378 adolescents from the Cannabis Youth Treatment study, who were assessed at intake, and after 3, 6, 9, and 12 months. Results indicate that after controlling for the effect of changes in cannabis use, mild smokers decreased days of smoking during treatment and follow-up, whereas moderate and heavy smokers demonstrated a small decrease over treatment, and no change over follow-up. Heavy smokers demonstrated a slight decrease in CPD during the treatment phase. These results suggest that, whereas cigarette smoking may decrease for mild smokers while in SUD treatment, the addition of specialized smoking interventions may be necessary to effect change in cigarette smoking for moderate and heavy smokers. Copyright (c) 2009 APA, all rights reserved.

Reflective equilibrium and empirical data: third person moral experiences in empirical medical ethics.

PubMed

De Vries, Martine; Van Leeuwen, Evert

2010-11-01

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This 'empirical turn' is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self-justification and bias and can increase the credibility of the RE reached. © 2009 Blackwell Publishing Ltd.

Evidence for the Effectiveness of Jungian Psychotherapy: A Review of Empirical Studies

PubMed Central

Roesler, Christian

2013-01-01

Since the 1990s several research projects and empirical studies (process and outcome) on Jungian Psychotherapy have been conducted mainly in Germany and Switzerland. Prospective, naturalistic outcome studies and retrospective studies using standardized instruments and health insurance data as well as several qualitative studies of aspects of the psychotherapeutic process will be summarized. The studies are diligently designed and the results are well applicable to the conditions of outpatient practice. All the studies show significant improvements not only on the level of symptoms and interpersonal problems, but also on the level of personality structure and in every day life conduct. These improvements remain stable after completion of therapy over a period of up to six years. Several studies show further improvements after the end of therapy, an effect which psychoanalysis has always claimed. Health insurance data show that, after Jungian therapy, patients reduce health care utilization to a level even below the average of the total population. Results of several studies show that Jungian treatment moves patients from a level of severe symptoms to a level where one can speak of psychological health. These significant changes are reached by Jungian therapy with an average of 90 sessions, which makes Jungian psychotherapy an effective and cost-effective method. Process studies support Jungian theories on psychodynamics and elements of change in the therapeutic process. So finally, Jungian psychotherapy has reached the point where it can be called an empirically proven, effective method. PMID:25379256

Empirical research in medical ethics: How conceptual accounts on normative-empirical collaboration may improve research practice

PubMed Central

2012-01-01

Background The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. Discussion A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. Summary High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. PMID:22500496

Empirical support for global integrated assessment modeling: Productivity trends and technological change in developing countries' agriculture and electric power sectors

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

Sathaye, Jayant A.

2000-04-01

Integrated assessment (IA) modeling of climate policy is increasingly global in nature, with models incorporating regional disaggregation. The existing empirical basis for IA modeling, however, largely arises from research on industrialized economies. Given the growing importance of developing countries in determining long-term global energy and carbon emissions trends, filling this gap with improved statistical information on developing countries' energy and carbon-emissions characteristics is an important priority for enhancing IA modeling. Earlier research at LBNL on this topic has focused on assembling and analyzing statistical data on productivity trends and technological change in the energy-intensive manufacturing sectors of five developing countries,more » India, Brazil, Mexico, Indonesia, and South Korea. The proposed work will extend this analysis to the agriculture and electric power sectors in India, South Korea, and two other developing countries. They will also examine the impact of alternative model specifications on estimates of productivity growth and technological change for each of the three sectors, and estimate the contribution of various capital inputs--imported vs. indigenous, rigid vs. malleable-- in contributing to productivity growth and technological change. The project has already produced a data resource on the manufacturing sector which is being shared with IA modelers. This will be extended to the agriculture and electric power sectors, which would also be made accessible to IA modeling groups seeking to enhance the empirical descriptions of developing country characteristics. The project will entail basic statistical and econometric analysis of productivity and energy trends in these developing country sectors, with parameter estimates also made available to modeling groups. The parameter estimates will be developed using alternative model specifications that could be directly utilized by the existing IAMs for the manufacturing

Disentangling the effects of climate variability and functional change on ecosystem carbon dynamics using semi-empirical modelling

NASA Astrophysics Data System (ADS)

Wu, J.; van der Linden, L.; Lasslop, G.; Carvalhais, N.; Pilegaard, K.; Beier, C.; Ibrom, A.

2012-04-01

The ecosystem carbon balance is affected by both external climatic forcing (e.g. solar radiation, air temperature and humidity) and internal dynamics in the ecosystem functional properties (e.g. canopy structure, leaf photosynthetic capacity and carbohydrate reserve). In order to understand to what extent and at which temporal scale, climatic variability and functional changes regulated the interannual variation (IAV) in the net ecosystem exchange of CO2 (NEE), data-driven analysis and semi-empirical modelling (Lasslop et al. 2010) were performed based on a 13 year NEE record in a temperate deciduous forest (Pilegaard et al 2011, Wu et al. 2012). We found that the sensitivity of carbon fluxes to climatic variability was significantly higher at shorter than at longer time scales and changed seasonally. This implied that the changing distribution of climate anomalies during the vegetation period could have stronger impacts on future ecosystem carbon balances than changes in average climate. At the annual time scale, approximately 80% of the interannual variability in NEE was attributed to the variation in the model parameters, indicating the observed IAV in the carbon dynamics at the investigated site was dominated by changes in ecosystem functioning. In general this study showed the need for understanding the mechanisms of ecosystem functional change. The method can be applied at other sites to explore ecosystem behavior across different plant functional types and climate gradients. Incorporating ecosystem functional change into process based models will reduce the uncertainties in long-term predictions of ecosystem carbon balances in global climate change projections. Acknowledgements. This work was supported by the EU FP7 project CARBO-Extreme, the DTU Climate Centre and the Danish national project ECOCLIM (Danish Council for Strategic Research).

Distribution of permanent plots to evaluate silvicultural treatments in the Inland Empire

Treesearch

John C. Byrne; Albert R. Stage; David L. Renner

1988-01-01

To assess the adequacy of a permanent-plot data base for estimating growth and yield, one first needs to know how the plots in the data base are distributed in relation to the population they are presumed to represent. The distribution of permanent plots to study forest growth in the Inland Empire (northeastern Washington, northern Idaho, and western Montana) is...

Diagnostic classification of eating disorders in children and adolescents: How does DSM-IV-TR compare to empirically-derived categories?

PubMed Central

Eddy, Kamryn T.; le Grange, Daniel; Crosby, Ross D.; Hoste, Renee Rienecke; Doyle, Angela Celio; Smyth, Angela; Herzog, David B.

2009-01-01

Objective The purpose of this study was to empirically derive eating disorder phenotypes in a clinical sample of children and adolescents using latent profile analysis (LPA) and compare these latent profile (LP) groups to the DSM-IV-TR eating disorder categories. Method Eating disorder symptom data collected from 401 youth (ages 7–19; mean 15.14 ± 2.35y) seeking eating disorder treatment were included in LPA; general linear models were used to compare LP groups to DSM-IV-TR eating disorder categories on pre-treatment and outcome indices. Results Three LP groups were identified: LP1 (n=144), characterized binge eating and purging (“Binge/purge”); LP2 (n=126), characterized by excessive exercise and extreme eating disorder cognitions (“Exercise-extreme cognitions”); and LP3 (n=131), characterized by minimal eating disorder behaviors and cognitions (“Minimal behaviors/cognitions”). Identified LPs imperfectly resembled DSM-IV-TR eating disorders. LP1 resembled bulimia nervosa; LP2 and LP3 broadly resembled anorexia nervosa with a relaxed weight criterion, differentiated by excessive exercise and severity of eating disorder cognitions. LP groups were more differentiated than the DSM-IV-TR categories across pre-treatment eating disorder and general psychopathology indices, as well as weight change at follow-up. Neither LP nor DSM-IV-TR categories predicted change in binge/purge behaviors. Validation analyses suggest these empirically-derived groups improve upon the current DSM-IV-TR categories. Conclusions In children and adolescents, revisions for DSM-V should consider recognition of patients with minimal cognitive eating disorder symptoms. PMID:20410717

Empirical fitness landscapes and the predictability of evolution.

PubMed

de Visser, J Arjan G M; Krug, Joachim

2014-07-01

The genotype-fitness map (that is, the fitness landscape) is a key determinant of evolution, yet it has mostly been used as a superficial metaphor because we know little about its structure. This is now changing, as real fitness landscapes are being analysed by constructing genotypes with all possible combinations of small sets of mutations observed in phylogenies or in evolution experiments. In turn, these first glimpses of empirical fitness landscapes inspire theoretical analyses of the predictability of evolution. Here, we review these recent empirical and theoretical developments, identify methodological issues and organizing principles, and discuss possibilities to develop more realistic fitness landscape models.

Motivation for change as a predictor of treatment response for dysthymia.

PubMed

Frías Ibáñez, Álvaro; González Vallespí, Laura; Palma Sevillano, Carol; Farriols Hernando, Núria

2016-05-01

Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck’s Depression Inventory) and treatment attendance. Stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted.

Patterns of osteoporosis treatment change and treatment discontinuation among commercial and Medicare Advantage Prescription Drug members in a national health plan.

PubMed

Xu, Yihua; Viswanathan, Hema N; Ward, Melea A; Clay, Brad; Adams, John L; Stolshek, Bradley S; Kallich, Joel D; Fine, Shari; Saag, Kenneth G

2013-02-01

Multiple treatments are available for osteoporosis; however, little is known about treatment change patterns and associated factors. Osteoporosis treatment change patterns, discontinuation and factors associated with treatment change in members of a large national health plan were examined. A retrospective cohort study was conducted in 7315 commercial and 34 146 Medicare Advantage Prescription Drug (MAPD) members newly initiated on an osteoporosis medication between 2006 and 2008. Osteoporosis treatment change, discontinuation and re-initiation patterns were assessed. Multivariate logistic regression was used to examine factors associated with treatment change. Commercial and MAPD members were assessed separately because of differences in demographics and insurance benefits. Approximately 12% of members had a change in index therapy within 12 months. Almost 60% of members discontinued the index medication at least once, based on a 90-day refill gap. Over 40% of members discontinued all osteoporosis medications by the end of 12 months post-index. Among MAPD and commercial members, women and those with risedronate, ibandronate or calcitonin at index, index therapy in 2008 and an osteoporosis diagnosis were more likely to have a treatment change while members with health plans other than health maintenance organizations and generic alendronate at index were less likely to have a treatment change. Osteoporosis treatment change occurred in approximately 12% of members, while a greater proportion of members discontinued treatment completely within 12 months. Member characteristics may be used to predict therapy change for evaluation and quality initiatives within a health plan. © 2011 Blackwell Publishing Ltd.

Electrocortical changes associated with minocycline treatment in fragile X syndrome.

PubMed

Schneider, Andrea; Leigh, Mary Jacena; Adams, Patrick; Nanakul, Rawi; Chechi, Tasleem; Olichney, John; Hagerman, Randi; Hessl, David

2013-10-01

Minocycline normalizes synaptic connections and behavior in the knockout mouse model of fragile X syndrome (FXS). Human-targeted treatment trials with minocycline have shown benefits in behavioral measures and parent reports. Event-related potentials (ERPs) may provide a sensitive method of monitoring treatment response and changes in coordinated brain activity. Measurement of electrocortical changes due to minocycline was done in a double-blind, placebo-controlled crossover treatment trial in children with FXS. Children with FXS (Meanage 10.5 years) were randomized to minocycline or placebo treatment for 3 months then changed to the other treatment for 3 months. The minocycline dosage ranged from 25-100 mg daily, based on weight. Twelve individuals with FXS (eight male, four female) completed ERP studies using a passive auditory oddball paradigm. Current source density (CSD) and ERP analysis at baseline showed high-amplitude, long-latency components over temporal regions. After 3 months of treatment with minocycline, the temporal N1 and P2 amplitudes were significantly reduced compared with placebo. There was a significant amplitude increase of the central P2 component on minocycline. Electrocortical habituation to auditory stimuli improved with minocycline treatment. Our study demonstrated improvements of the ERP in children with FXS treated with minocycline, and the potential feasibility and sensitivity of ERPs as a cognitive biomarker in FXS treatment trials.

Health Status and Health Dynamics in an Empirical Model of Expected Longevity*

PubMed Central

Benítez-Silva, Hugo; Ni, Huan

2010-01-01

Expected longevity is an important factor influencing older individuals’ decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman (1972), has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics. PMID:18187217

Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital: A Retrospective Review.

PubMed

Erwin, Beth L; Kyle, Jeffrey A; Allen, Leland N

2016-08-01

The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision (ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy. Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55. Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP. © The Author(s) 2015.

Forecasting land cover change impacts on drinking water treatment costs in Minneapolis, Minnesota

NASA Astrophysics Data System (ADS)

Woznicki, S. A.; Wickham, J.

2017-12-01

Source protection is a critical aspect of drinking water treatment. The benefits of protecting source water quality in reducing drinking water treatment costs are clear. However, forecasting the impacts of environmental change on source water quality and its potential to influence future treatment processes is lacking. The drinking water treatment plant in Minneapolis, MN has recognized that land cover change threatens water quality in their source watershed, the Upper Mississippi River Basin (UMRB). Over 1,000 km2 of forests, wetlands, and grasslands in the UMRB were lost to agriculture from 2008-2013. This trend, coupled with a projected population increase of one million people in Minnesota by 2030, concerns drinking water treatment plant operators in Minneapolis with respect to meeting future demand for clean water in the UMRB. The objective of this study is to relate land cover change (forest and wetland loss, agricultural expansion, urbanization) to changes in treatment costs for the Minneapolis, MN drinking water utility. To do this, we first developed a framework to determine the relationship between land cover change and water quality in the context of recent historical changes and projected future changes in land cover. Next we coupled a watershed model, the Soil and Water Assessment Tool (SWAT) to projections of land cover change from the FOREcasting SCEnarios of Land-use Change (FORE-SCE) model for the mid-21st century. Using historical Minneapolis drinking water treatment data (chemical usage and costs), source water quality in the UMRB was linked to changes in treatment requirements as a function of projected future land cover change. These analyses will quantify the value of natural landscapes in protecting drinking water quality and future treatment processes requirements. In addition, our study provides the Minneapolis drinking water utility with information critical to their planning and capital improvement process.

The Problem of Empirical Redundancy of Constructs in Organizational Research: An Empirical Investigation

ERIC Educational Resources Information Center

Le, Huy; Schmidt, Frank L.; Harter, James K.; Lauver, Kristy J.

2010-01-01

Construct empirical redundancy may be a major problem in organizational research today. In this paper, we explain and empirically illustrate a method for investigating this potential problem. We applied the method to examine the empirical redundancy of job satisfaction (JS) and organizational commitment (OC), two well-established organizational…

Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers.

PubMed

Jennings, Jerry L; Deming, Adam

2017-12-01

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

Assessing differential expression in two-color microarrays: a resampling-based empirical Bayes approach.

PubMed

Li, Dongmei; Le Pape, Marc A; Parikh, Nisha I; Chen, Will X; Dye, Timothy D

2013-01-01

Microarrays are widely used for examining differential gene expression, identifying single nucleotide polymorphisms, and detecting methylation loci. Multiple testing methods in microarray data analysis aim at controlling both Type I and Type II error rates; however, real microarray data do not always fit their distribution assumptions. Smyth's ubiquitous parametric method, for example, inadequately accommodates violations of normality assumptions, resulting in inflated Type I error rates. The Significance Analysis of Microarrays, another widely used microarray data analysis method, is based on a permutation test and is robust to non-normally distributed data; however, the Significance Analysis of Microarrays method fold change criteria are problematic, and can critically alter the conclusion of a study, as a result of compositional changes of the control data set in the analysis. We propose a novel approach, combining resampling with empirical Bayes methods: the Resampling-based empirical Bayes Methods. This approach not only reduces false discovery rates for non-normally distributed microarray data, but it is also impervious to fold change threshold since no control data set selection is needed. Through simulation studies, sensitivities, specificities, total rejections, and false discovery rates are compared across the Smyth's parametric method, the Significance Analysis of Microarrays, and the Resampling-based empirical Bayes Methods. Differences in false discovery rates controls between each approach are illustrated through a preterm delivery methylation study. The results show that the Resampling-based empirical Bayes Methods offer significantly higher specificity and lower false discovery rates compared to Smyth's parametric method when data are not normally distributed. The Resampling-based empirical Bayes Methods also offers higher statistical power than the Significance Analysis of Microarrays method when the proportion of significantly differentially

Root-induced changes of Zn and Pb dynamics in the rhizosphere of sunflower with different plant growth promoting treatments in a heavily contaminated soil.

PubMed

Mousavi, Seyed Majid; Motesharezadeh, Babak; Hosseini, Hossein Mirseyed; Alikhani, Hoseinali; Zolfaghari, Ali Asghar

2018-01-01

Root induced changes are deemed to have an important role in the success of remediation techniques in contaminated soils. Here, the effects of two nano-particles [SiO 2 and zeolite] with an application rate of 200mgkg -1 , and two bacteria [Bacillus safensis FO-036b(T) and Pseudomonas fluorescens p.f.169] in the rhizosphere of sunflower on Zn and Pb dynamics were studied in greenhouse conditions. The treatments reduced the exchangeable Zn (from 13.68% to 30.82%) and Pb (from 10.34% to 25.92%) in the rhizosphere compared to the control. The EC and microbial respiration/population of the rhizosphere and bulk soil had an opposite trend with the exchangeable fraction of Zn and Pb, but dissolved organic carbon followed a similar trend with the more bioavailable fractions. As a result, the accumulation of Pb and Zn in the plant tissues was significantly (p < 0.05) reduced by the application of amendments, which might be due to the shift of the metals to immobile forms induced by the nature of the treatments and changes in the rhizosphere process. The empirical conditions of this research produced the intensification of the rhizosphere process because the findings highlight those changes in the rhizosphere EC, pH and dissolved organic carbon can affect the efficiency of zeolite/SiO 2 NPs and bacteria to immobilize Pb and Zn in the soil, depending on the chemical character of the metals and the treatments. Generally, the affinity of the biotic treatment for Pb was more than the abiotic and conversely, the abiotic treatment showed a higher ability to immobilize Zn than the biotic treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

AN EMPIRICAL METHOD FOR MATERIALITY: WOULD CONFLICT OF INTEREST DISCLOSURES CHANGE PATIENT DECISIONS?

PubMed

Spece, Roy; Yokum, David; Okoro, Andrea-Gale; Robertson Christopher

2014-01-01

The law has long been concerned with the agency problems that arise when advisors, such as attorneys or physicians, put themselves in financial relationships that create conflicts of interest. If the financial relationship is "material" to the transactions proposed by the advisor, then non-disclosure of the relationship may be pertinent to claims of malpractice, informed consent, and even fraud, as well as to professional discipline. In these sorts of cases, materiality is closely related to the question of causation, roughly turning on whether the withheld information might have changed the decision of a reasonable advisee (i.e., a patient). The injured plaintiff will predictably testify that the information would have impacted his or her choice, but that self-serving testimony may be unreliable. The fact finder is left to speculate about the counterfactual world in which the information was disclosed. This Article shows how randomized vignette-based experimentation may create a valuable form of evidence to address these questions, for both litigation and policymaking. To demonstrate this method and investigate conflicts of interest in healthcare in particular, we recruited 691 human subjects and asked them to imagine themselves as patients facing a choice about whether to undergo a cardiac stenting procedure recommended by a cardiologist. We manipulated the vignettes in a 2 x 3 between-subjects design, where we systematically varied the appropriateness of the proposed treatment, which was described in terms of patient risk without the procedure (low or high), and manipulated the type of disclosure provided by the physician (none, standard, or enhanced). We used physician ownership of the specialty hospital where the surgery would be performed as the conflict of interest, disclosed or not, and the "enhanced" disclosure included notice that such relationships have been associated with biases in prescribing behavior. We found that the mock patients were

The Ebb and Flow of Educational Change: Change Agents as Negotiators of Change

ERIC Educational Resources Information Center

McGrath, Cormac; Barman, Linda; Stenfors-Hayes, Terese; Roxå, Torgny; Silén, Charlotte; Laksov, Klara Bolander

2016-01-01

In this paper, we are concerned with how change agents go about and experience change implementation in higher education. We identified change agents and interviewed them about how they implement change. Empirical data was analysed using a theoretical framework of change. The findings suggest that change in the university is enacted through a…

On the importance of prompt oxygen changes for hypofractionated radiation treatments.

PubMed

Kissick, Michael; Campos, David; van der Kogel, Albert; Kimple, Randall

2013-10-21

This discussion is motivated by observations of prompt oxygen changes occurring prior to a significant number of cancer cells dying (permanently stopping their metabolic activity) from therapeutic agents like large doses of ionizing radiation. Such changes must be from changes in the vasculature that supplies the tissue or from the metabolic changes in the tissue itself. An adapted linear-quadratic treatment is used to estimate the cell survival variation magnitudes from repair and reoxygenation from a two-fraction treatment in which the second fraction would happen prior to significant cell death from the first fraction, in the large fraction limit. It is clear the effects of oxygen changes are likely to be the most significant factor for hypofractionation because of large radiation doses. It is a larger effect than repair. Optimal dose timing should be determined by the peak oxygen timing. A call is made to prioritize near real time measurements of oxygen dynamics in tumors undergoing hypofractionated treatments in order to make these treatments adaptable and patient-specific.

Braking the bandwagon: scrutinizing the science and politics of empirically supported therapies.

PubMed

Hagemoser, Steven D

2009-12-01

Proponents of empirically supported therapies (ESTs) argue that because manualized ESTs have demonstrated efficacy in treating a range of psychological disorders, they should be the treatments of choice. In this article, the author uses a hypothetical treatment for obesity to highlight numerous flaws in EST logic and argues for common factors as a more clinically relevant but empirically challenging approach. The author then explores how political variables may be contributing to the expansion of EST and the resulting restriction of practitioner autonomy. Last, the author argues that EST is best viewed as 1 component of a more comprehensive evidence-based practice framework. The author concludes with some cautionary statements about the perils of equating the EST paradigm with the scientist-practitioner ideal.

Pre-treatment predictors and in-treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobia.

PubMed

Borge, Finn-Magnus; Hoffart, Asle; Sexton, Harold; Martinsen, Egil; Gude, Tore; Hedley, Liv Margaret; Abrahamsen, Gun

2010-01-01

We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained significant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.

The place for itraconazole in treatment.

PubMed

Maertens, Johan; Boogaerts, Marc

2005-09-01

The incidence of systemic fungal infections has risen sharply in the last two decades, reflecting a rise in the number of patients who are predisposed to these diseases because they are immunosuppressed or immunocompromised. The growing use of intensive chemotherapy to treat cancer, highly immunosuppressive drug regimens (not only in transplant recipients), widespread prophylactic or empirical broad-spectrum antibiotics, prolonged parenteral nutrition, long-term indwelling lines, improved survival in neonatal and other intensive care units, together with the AIDS epidemic have led to an upsurge in the number of patients at risk. In addition, there have been changes in the epidemiology of systemic fungal infections, with Aspergillus spp. and Candida spp. other than Candida albicans becoming increasingly common causes. These changes have affected the selection of drugs for first-line or prophylactic use, as not all agents have the critical spectrum of activity required. The management of systemic fungal infections can be divided into four main strategies: prophylaxis, early empirical use, pre-emptive and definite therapy. Antifungal prophylaxis is given based on the patient risk factors, but in the absence of infection. Empirical antifungal therapy is given in patients at risk with signs of infection of unclear aetiology (usually persistent fever) but of possible fungal origin. Therapy is given pre-emptively in patients at risk with additional evidence for the presence of an infective agent in a way predisposing for infection (e.g. Aspergillus colonization; high Candida colonization index). Finally, definite treatment is used in patients with confirmed fungal infection. The distinction between risk-adapted prophylaxis, early empirical therapy, and pre-emptive use of antifungals often becomes unclear and clinical decision making depends largely on local epidemiology and resistance patterns, adequate definition of patient risk categories, early diagnosis and the

Changes in mRNA expression precede changes in microRNA expression in lesional psoriatic skin during treatment with adalimumab.

PubMed

Raaby, L; Langkilde, A; Kjellerup, R B; Vinter, H; Khatib, S H; Hjuler, K F; Johansen, C; Iversen, L

2015-08-01

Tumour necrosis factor (TNF)-α inhibition is an effective treatment for moderate to severe plaque-type psoriasis. A change in the cytokine expression profile occurs in the skin after 4 days of treatment, preceding any clinical or histological improvements. MicroRNAs (miRNAs) are important post-transcriptional regulators of gene expression, but miRNA expression has never been studied in psoriatic skin during treatment. To investigate changes in miRNA expression in psoriatic skin during adalimumab treatment and to compare results with changes in miRNA expression in a mouse model of Aldara-induced psoriasis-like skin inflammation. Punch biopsies were obtained from nonlesional and lesional psoriatic skin during adalimumab treatment. In the mouse model of Aldara-induced skin inflammation, biopsies were obtained from TNF-α knockout (KO), IL-17A KO and wild-type mice. miRNA expression levels were analysed with microarray, reverse transcriptase quantitative polymerase chain reaction and in situ hybridization. In psoriatic skin, no changes in miRNA expression were seen 4 days after treatment initiation. After 14 days of treatment, the expression of several miRNAs was normalized towards the level seen in nonlesional skin before treatment. miR-23b expression increased after 14 days of treatment and remained high for 84 days, despite unaltered levels at baseline. In the mouse model of Aldara-induced skin inflammation, the level of miR-146a increased, whereas no regulation was seen for miR-203, miR-214-3p, miR-125a, miR-23b or let-7d-5p. This study demonstrates that the changes seen in the cytokine expression levels after 4 days of treatment with adalimumab are not facilitated by early changes in miRNA expression. © 2015 British Association of Dermatologists.

Empirical evidence for site coefficients in building code provisions

USGS Publications Warehouse

Borcherdt, R.D.

2002-01-01

Site-response coefficients, Fa and Fv, used in U.S. building code provisions are based on empirical data for motions up to 0.1 g. For larger motions they are based on theoretical and laboratory results. The Northridge earthquake of 17 January 1994 provided a significant new set of empirical data up to 0.5 g. These data together with recent site characterizations based on shear-wave velocity measurements provide empirical estimates of the site coefficients at base accelerations up to 0.5 g for Site Classes C and D. These empirical estimates of Fa and Fnu; as well as their decrease with increasing base acceleration level are consistent at the 95 percent confidence level with those in present building code provisions, with the exception of estimates for Fa at levels of 0.1 and 0.2 g, which are less than the lower confidence bound by amounts up to 13 percent. The site-coefficient estimates are consistent at the 95 percent confidence level with those of several other investigators for base accelerations greater than 0.3 g. These consistencies and present code procedures indicate that changes in the site coefficients are not warranted. Empirical results for base accelerations greater than 0.2 g confirm the need for both a short- and a mid- or long-period site coefficient to characterize site response for purposes of estimating site-specific design spectra.

Infants under two months of age with urinary tract infections are showing increasing resistance to empirical and oral antibiotics.

PubMed

Segal, Zvi; Cohen, Matan J; Engelhard, Dan; Tenenbaum, Ariel; Simckes, Ari M; Benenson, Shmuel; Stepensky, Polina; Averbuch, Diana

2016-04-01

Data on antimicrobial resistance in uropathogens in infants up to the age of three months are limited. This study characterised resistance patterns in Gram-negative uropathogens in infants up to the age of two months. Previously healthy young infants with urinary tract infections (UTIs) were studied retrospectively. Antimicrobial susceptibility was evaluated. Multidrug resistance (MDR) was defined as resistance to at least three antibiotic classes. Clinical, laboratory and outcome data were compared between infants with UTIs caused by bacteria sensitive and resistant to empirical and to oral therapy. We evaluated 306 UTI episodes with 314 pathogens. The following resistance rates were observed: ampicillin 73.7%, cefazoline 22.1%, ampicillin/clavulanate 21.8%, cefuroxime 7.8%, gentamicin 7%; MDR 11.8%; resistant to empirical treatment 7.3% and resistant to available oral antibiotics 8.6%. Our study showed that pathogens resistant to empirical and oral therapy were more frequently isolated in non-Jewish (Arab) infants and in those of ≥30 days of age. Resistance to empirical treatment and oral antibiotics also resulted in longer mean hospital stays. Resistance to antibiotics challenges empirical therapy and compromises oral treatment options in young infants with UTIs. Antimicrobial resistance patterns should be monitored in infants to determine appropriate empirical antibiotic therapy protocols. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Facts and values in psychotherapy-A critique of the empirical reduction of psychotherapy within evidence-based practice.

PubMed

Berg, Henrik; Slaattelid, Rasmus

2017-10-01

This paper addresses an implicit presupposition in research-supported psychological treatments and evidence-based practice in psychology. It argues that the notion of research-supported psychological treatments is based on a reductive conceptualisation of psychotherapy. Research-supported psychological treatments hinge upon an empirical reduction where psychotherapy schools become conceptualized as mere collections of empirical propositions. However, this paper argues that the different psychotherapy schools have distinct ethoses that are constituted by normative claims. Consequently, the evaluation of the different psychotherapy schools and the practice of psychotherapy should include the underlying normative claims of these ethoses. © 2017 John Wiley & Sons, Ltd.

Health status and health dynamics in an empirical model of expected longevity.

PubMed

Benítez-Silva, Hugo; Ni, Huan

2008-05-01

Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study

PubMed Central

Mettler, Julian; Simcock, Mathew; Sendi, Pedram; Widmer, Andreas F; Bingisser, Roland; Battegay, Manuel; Fluckiger, Ursula; Bassetti, Stefano

2007-01-01

Background Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention. Methods A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines. Results 2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations

Renewed behavior produced by context change and its implications for treatment maintenance: A review.

PubMed

Podlesnik, Christopher A; Kelley, Michael E; Jimenez-Gomez, Corina; Bouton, Mark E

2017-07-01

Behavioral treatment gains established in one setting do not always maintain in other settings. The present review examines the relevance of basic and translational research to understanding failures to maintain treatment gains across settings. Specifically, studies of the renewal effect examine how transitioning away from a treatment setting could evoke a return of undesirable behavior, rather than newly trained appropriate behavior. Studies of renewal typically arrange three phases, with a response trained and reinforced under a particular set of contextual stimuli in the first phase. Next, that response is extinguished, often under a different set of contextual stimuli. Finally, that response returns despite extinction remaining in effect upon returning to the original training context or transitioning to a novel context. Thus, removing the extinction context is sufficient to produce a recurrence of the response. The findings suggest treatment effects can become specific to the context in which the treatment was delivered. This literature offers promising methods for systematically assessing the factors contributing to treatment maintenance and improving generalization of treatment gains across contexts. Therefore, the present review suggests basic and translational research on renewal provides an empirical literature to bring greater conceptual systematization to understanding generalization and maintenance of behavioral treatment. © 2017 Society for the Experimental Analysis of Behavior.

Family transitions following the birth of a sibling: an empirical review of changes in the firstborn's adjustment.

PubMed

Volling, Brenda L

2012-05-01

Nearly 80% of children in the United States have at least 1 sibling, indicating that the birth of a baby sibling is a normative ecological transition for most children. Many clinicians and theoreticians believe the transition is stressful, constituting a developmental crisis for most children. Yet, a comprehensive review of the empirical literature on children's adjustment over the transition to siblinghood (TTS) has not been done for several decades. The current review summarizes research examining change in first borns' adjustment to determine whether there is evidence that the TTS is disruptive for most children. Thirty studies addressing the TTS were found, and of those studies, the evidence did not support a crisis model of developmental transitions, nor was there overwhelming evidence of consistent changes in firstborn adjustment. Although there were decreases in children's affection and responsiveness toward mothers, the results were more equivocal for many other behaviors (e.g., sleep problems, anxiety, aggression, regression). An inspection of the scientific literature indicated there are large individual differences in children's adjustment and that the TTS can be a time of disruption, an occasion for developmental advances, or a period of quiescence with no noticeable changes. The TTS may be a developmental turning point for some children that portends future psychopathology or growth depending on the transactions between children and the changes in the ecological context over time. A developmental ecological systems framework guided the discussion of how child, parent, and contextual factors may contribute to the prediction of firstborn children's successful adaptation to the birth of a sibling. 2012 APA, all rights reserved

Sample Dilution and Bacterial Community Composition Influence Empirical Leucine-to-Carbon Conversion Factors in Surface Waters of the World's Oceans

PubMed Central

Hernando-Morales, Víctor; Cornejo-Castillo, Francisco M.; Alonso-Sáez, Laura; Sarmento, Hugo; Valencia-Vila, Joaquín; Serrano Catalá, Teresa; Hernández-Ruiz, Marta; Varela, Marta M.; Ferrera, Isabel; Gutiérrez Morán, Xosé Anxelu; Gasol, Josep M.

2015-01-01

The transformation of leucine incorporation rates to prokaryotic carbon production rates requires the use of either theoretical or empirically determined conversion factors. Empirical leucine-to-carbon conversion factors (eCFs) vary widely across environments, and little is known about their potential controlling factors. We conducted 10 surface seawater manipulation experiments across the world's oceans, where the growth of the natural prokaryotic assemblages was promoted by filtration (i.e., removal of grazers [F treatment]) or filtration combined with dilution (i.e., also relieving resource competition [FD treatment]). The impact of sunlight exposure was also evaluated in the FD treatments, and we did not find a significant effect on the eCFs. The eCFs varied from 0.09 to 1.47 kg C mol Leu−1 and were significantly lower in the FD than in the F samples. Also, changes in bacterial community composition during the incubations, as assessed by automated ribosomal intergenic spacer analysis (ARISA), were more pronounced in the FD than in the F treatments, compared to unmanipulated controls. Thus, we discourage the common procedure of diluting samples (in addition to filtration) for eCF determination. The eCFs in the filtered treatment were negatively correlated with the initial chlorophyll a concentration, picocyanobacterial abundance (mostly Prochlorococcus), and the percentage of heterotrophic prokaryotes with high nucleic acid content (%HNA). The latter two variables explained 80% of the eCF variability in the F treatment, supporting the view that both Prochlorococcus and HNA prokaryotes incorporate leucine in substantial amounts, although this results in relatively low carbon production rates in the oligotrophic ocean. PMID:26407885

Empirical prediction intervals improve energy forecasting

PubMed Central

Kaack, Lynn H.; Apt, Jay; Morgan, M. Granger; McSharry, Patrick

2017-01-01

Hundreds of organizations and analysts use energy projections, such as those contained in the US Energy Information Administration (EIA)’s Annual Energy Outlook (AEO), for investment and policy decisions. Retrospective analyses of past AEO projections have shown that observed values can differ from the projection by several hundred percent, and thus a thorough treatment of uncertainty is essential. We evaluate the out-of-sample forecasting performance of several empirical density forecasting methods, using the continuous ranked probability score (CRPS). The analysis confirms that a Gaussian density, estimated on past forecasting errors, gives comparatively accurate uncertainty estimates over a variety of energy quantities in the AEO, in particular outperforming scenario projections provided in the AEO. We report probabilistic uncertainties for 18 core quantities of the AEO 2016 projections. Our work frames how to produce, evaluate, and rank probabilistic forecasts in this setting. We propose a log transformation of forecast errors for price projections and a modified nonparametric empirical density forecasting method. Our findings give guidance on how to evaluate and communicate uncertainty in future energy outlooks. PMID:28760997

Cognitive Changes After Adjuvant Treatment in Older Adults with Early-Stage Breast Cancer.

PubMed

Lange, Marie; Heutte, Natacha; Noal, Sabine; Rigal, Olivier; Kurtz, Jean-Emmanuel; Lévy, Christelle; Allouache, Djelila; Rieux, Chantal; Lefel, Johan; Clarisse, Bénédicte; Leconte, Alexandra; Veyret, Corinne; Barthélémy, Philippe; Longato, Nadine; Tron, Laure; Castel, Hélène; Eustache, Francis; Giffard, Bénédicte; Joly, Florence

2018-06-22

Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls. Participants were patients ≥65 years of age with newly diagnosed EBC and healthy controls (age-, sex-, and education-matched). The pretreatment assessment was conducted before adjuvant therapy, and the post-treatment assessment after the end of the first adjuvant treatment. Objective cognitive changes before to after treatment were evaluated based on the Reliable Change Index for cognitive decline accounting for cognitive impairment status. The sample consisted of women newly diagnosed with EBC ( n  = 118) and healthy controls ( n  = 62). Five patterns of changes before to after treatment were identified based on the presence of cognitive decline and cognitive impairment. The distribution of these five change patterns was statistically significant ( p  = .0001). Thirty-six percent of patients had phase shift changes, 31% without initial objective cognitive impairment developed impairment, 15% had a normal aging, 12% had a nonpathological decline, and 6% experienced accelerated cognitive decline. This study described for the first time objective cognitive changes before to after treatment of older adults with EBC immediately after the end of adjuvant treatment. A longer-term remote follow-up of adjuvant treatment is needed to better understand the cognitive trajectories of older patients with EBC. The Oncologist IMPLICATIONS FOR PRACTICE: After the end of adjuvant treatment, 31% of older adults with early-stage breast cancer without initial objective cognitive impairment developed impairment, and 6% experienced

Integrating Empirical-Modeling Approaches to Improve Understanding of Terrestrial Ecology Processes

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

McCarthy, Heather; Luo, Yiqi; Wullschleger, Stan D

Recent decades have seen tremendous increases in the quantity of empirical ecological data collected by individual investigators, as well as through research networks such as FLUXNET (Baldocchi et al., 2001). At the same time, advances in computer technology have facilitated the development and implementation of large and complex land surface and ecological process models. Separately, each of these information streams provides useful, but imperfect information about ecosystems. To develop the best scientific understanding of ecological processes, and most accurately predict how ecosystems may cope with global change, integration of empirical and modeling approaches is necessary. However, true integration - inmore » which models inform empirical research, which in turn informs models (Fig. 1) - is not yet common in ecological research (Luo et al., 2011). The goal of this workshop, sponsored by the Department of Energy, Office of Science, Biological and Environmental Research (BER) program, was to bring together members of the empirical and modeling communities to exchange ideas and discuss scientific practices for increasing empirical - model integration, and to explore infrastructure and/or virtual network needs for institutionalizing empirical - model integration (Yiqi Luo, University of Oklahoma, Norman, OK, USA). The workshop included presentations and small group discussions that covered topics ranging from model-assisted experimental design to data driven modeling (e.g. benchmarking and data assimilation) to infrastructure needs for empirical - model integration. Ultimately, three central questions emerged. How can models be used to inform experiments and observations? How can experimental and observational results be used to inform models? What are effective strategies to promote empirical - model integration?« less

How to measure the impacts of antibiotic resistance and antibiotic development on empiric therapy: new composite indices.

PubMed

Hughes, Josie S; Hurford, Amy; Finley, Rita L; Patrick, David M; Wu, Jianhong; Morris, Andrew M

2016-12-16

We aimed to construct widely useable summary measures of the net impact of antibiotic resistance on empiric therapy. Summary measures are needed to communicate the importance of resistance, plan and evaluate interventions, and direct policy and investment. As an example, we retrospectively summarised the 2011 cumulative antibiogram from a Toronto academic intensive care unit. We developed two complementary indices to summarise the clinical impact of antibiotic resistance and drug availability on empiric therapy. The Empiric Coverage Index (ECI) measures susceptibility of common bacterial infections to available empiric antibiotics as a percentage. The Empiric Options Index (EOI) varies from 0 to 'the number of treatment options available', and measures the empiric value of the current stock of antibiotics as a depletable resource. The indices account for drug availability and the relative clinical importance of pathogens. We demonstrate meaning and use by examining the potential impact of new drugs and threatening bacterial strains. In our intensive care unit coverage of device-associated infections measured by the ECI remains high (98%), but 37-44% of treatment potential measured by the EOI has been lost. Without reserved drugs, the ECI is 86-88%. New cephalosporin/β-lactamase inhibitor combinations could increase the EOI, but no single drug can compensate for losses. Increasing methicillin-resistant Staphylococcus aureus (MRSA) prevalence would have little overall impact (ECI=98%, EOI=4.8-5.2) because many Gram-positives are already resistant to β-lactams. Aminoglycoside resistance, however, could have substantial clinical impact because they are among the few drugs that provide coverage of Gram-negative infections (ECI=97%, EOI=3.8-4.5). Our proposed indices summarise the local impact of antibiotic resistance on empiric coverage (ECI) and available empiric treatment options (EOI) using readily available data. Policymakers and drug developers can use the

When complexity science meets implementation science: a theoretical and empirical analysis of systems change.

PubMed

Braithwaite, Jeffrey; Churruca, Kate; Long, Janet C; Ellis, Louise A; Herkes, Jessica

2018-04-30

Implementation science has a core aim - to get evidence into practice. Early in the evidence-based medicine movement, this task was construed in linear terms, wherein the knowledge pipeline moved from evidence created in the laboratory through to clinical trials and, finally, via new tests, drugs, equipment, or procedures, into clinical practice. We now know that this straight-line thinking was naïve at best, and little more than an idealization, with multiple fractures appearing in the pipeline. The knowledge pipeline derives from a mechanistic and linear approach to science, which, while delivering huge advances in medicine over the last two centuries, is limited in its application to complex social systems such as healthcare. Instead, complexity science, a theoretical approach to understanding interconnections among agents and how they give rise to emergent, dynamic, systems-level behaviors, represents an increasingly useful conceptual framework for change. Herein, we discuss what implementation science can learn from complexity science, and tease out some of the properties of healthcare systems that enable or constrain the goals we have for better, more effective, more evidence-based care. Two Australian examples, one largely top-down, predicated on applying new standards across the country, and the other largely bottom-up, adopting medical emergency teams in over 200 hospitals, provide empirical support for a complexity-informed approach to implementation. The key lessons are that change can be stimulated in many ways, but a triggering mechanism is needed, such as legislation or widespread stakeholder agreement; that feedback loops are crucial to continue change momentum; that extended sweeps of time are involved, typically much longer than believed at the outset; and that taking a systems-informed, complexity approach, having regard for existing networks and socio-technical characteristics, is beneficial. Construing healthcare as a complex adaptive system

Changes of wood cell walls in response to hygro-mechanical steam treatment.

PubMed

Guo, Juan; Song, Kunlin; Salmén, Lennart; Yin, Yafang

2015-01-22

The effects of compression combined with steam treatment (CS-treatment), i.e. a hygro-mechanical steam treatment on Spruce wood were studied on a cell-structure level to understand the chemical and physical changes of the secondary cell wall occurring under such conditions. Specially, imaging FT-IR microscopy, nanoindentation and dynamic vapour absorption were used to track changes in the chemical structure, in micromechanical and hygroscopic properties. It was shown that CS-treatment resulted in different changes in morphological, chemical and physical properties of the cell wall, in comparison with those under pure steam treatment. After CS-treatment, the cellular structure displayed significant deformations, and the biopolymer components, e.g. hemicellulose and lignin, were degraded, resulting in decreased hygroscopicity and increased mechanical properties of the wood compared to both untreated and steam treated wood. Moreover, CS-treatment resulted in a higher degree of degradation especially in earlywood compared to a more uniform behaviour of wood treated only by steam. Copyright © 2014 Elsevier Ltd. All rights reserved.

What do Internet-based alcohol treatment websites offer?

PubMed

Toll, Benjamin A; Sobell, Linda C; D'Arienzo, Justin; Sobell, Mark B; Eickleberry-Goldsmith, Lori; Toll, Heather J

2003-12-01

The Internet was searched for websites that advertised or provided treatment or help for alcohol problems. Websites were evaluated for the types of treatment offered and whether the treatment had an empirical basis. While a wide range of treatments were advertised, very few websites offered online services. In addition, very few sites provided or advertised alcohol treatment programs that were empirically based. Recommendations for future Internet-based health care and treatment are offered.

Cost-effectiveness of ceftolozane/tazobactam plus metronidazole compared with piperacillin/tazobactam as empiric therapy for the treatment of complicated intra-abdominal infections based on the in-vitro surveillance of bacterial isolates in the UK.

PubMed

Prabhu, Vimalanand; Foo, Jason; Ahir, Harblas; Sarpong, Eric; Merchant, Sanjay

2017-08-01

An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals. A decision-analytic Monte Carlo simulation model was used to compare costs (antibiotic and hospitalization costs) and quality-adjusted life years (QALYs) of patients infected with gram-negative cIAI and treated empirically with either ceftolozane/tazobactam + metronidazole or piperacillin/tazobactam. Bacterial isolates were randomly drawn from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database, a surveillance database of non-duplicate bacterial isolates collected from patients in the UK infected with gram-negative pathogens. Susceptibility to initial empiric therapy was based on the measured susceptibilities reported in the PACTS database. Ceftolozane/tazobactam + metronidazole was cost-effective when compared with piperacillin/tazobactam, with an incremental cost-effectiveness ratio (ICER) of £4,350/QALY and 0.36 hospitalization days/patient saved. Costs in the ceftolozane/tazobactam + metronidazole arm were £2,576/patient, compared with £2,168/patient in the piperacillin/tazobactam arm. The ceftolozane/tazobactam + metronidazole arm experienced a greater number of QALYs than the piperacillin/tazobactam arm (14.31/patient vs 14.21/patient, respectively). Ceftolozane/tazobactam + metronidazole remained cost-effective in one-way sensitivity and probabilistic sensitivity analyses. Economic models can help to identify the appropriate choice of

Interpreting change from patient reported outcome (PRO) endpoints: patient global ratings of concept versus patient global ratings of change, a case study among osteoporosis patients.

PubMed

Nixon, Annabel; Doll, Helen; Kerr, Cicely; Burge, Russel; Naegeli, April N

2016-02-19

Regulatory guidance recommends anchor-based methods for interpretation of treatment effects measured by PRO endpoints. Methodological pros and cons of patient global ratings of change vs. patient global ratings of concept have been discussed but empirical evidence in support of either approach is lacking. This study evaluated the performance of patient global ratings of change and patient global ratings of concept for interpreting patient stability and patient improvement. Patient global ratings of change and patient global ratings of concept were included in a psychometric validation study of an osteoporosis-targeted PRO instrument (the OPAQ-PF) to assess its ability to detect change and to derive responder definitions. 144 female osteoporosis patients with (n = 37) or without (n = 107) a recent (within 6 weeks) fragility fracture completed the OPAQ-PF and global items at baseline, 2 weeks (no recent fracture), and 12 weeks (recent fracture) post-baseline. Results differed between the two methods. Recent fracture patients reported more improvement while patients without recent fracture reported more stability on ratings of change than ratings of concept. However, correlations with OPAQ-PF score change were stronger for ratings of concept than ratings of change (both groups). Effect sizes for OPAQ-PF score change increased consistently with level of change in ratings of concept but inconsistently with ratings of change, with the mean AUC for prediction of a one-point change being 0.72 vs. 0.56. This study provides initial empirical support for methodological and regulatory recommendations to use patient global ratings of concept rather than ratings of change when interpreting change captured by PRO instruments in studies evaluating treatment effects. These findings warrant being confirmed in a purpose-designed larger scale analysis.

Berry composition and climate: responses and empirical models.

PubMed

Barnuud, Nyamdorj N; Zerihun, Ayalsew; Gibberd, Mark; Bates, Bryson

2014-08-01

Climate is a strong modulator of berry composition. Accordingly, the projected change in climate is expected to impact on the composition of berries and of the resultant wines. However, the direction and extent of climate change impact on fruit composition of winegrape cultivars are not fully known. This study utilised a climate gradient along a 700 km transect, covering all wine regions of Western Australia, to explore and empirically describe influences of climate on anthocyanins, pH and titratable acidity (TA) levels in two or three cultivars of Vitis vinifera (Cabernet Sauvignon, Chardonnay and Shiraz). The results showed that, at a common maturity of 22° Brix total soluble solids, berries from the warmer regions had low levels of anthocyanins and TA as well as high pH compared to berries from the cooler regions. Most of these regional variations in berry composition reflected the prevailing climatic conditions of the regions. Thus, depending on cultivar, 82-87 % of TA, 83 % of anthocyanins and about half of the pH variations across the gradient were explained by climate-variable-based empirical models. Some of the variables that were relevant in describing the variations in berry attributes included: diurnal ranges and ripening period temperature (TA), vapour pressure deficit in October and growing degree days (pH), and ripening period temperatures (anthocyanins). Further, the rates of change in these berry attributes in response to climate variables were cultivar dependent. Based on the observed patterns along the climate gradient, it is concluded that: (1) in a warming climate, all other things being equal, berry anthocyanins and TA levels will decline whereas pH levels will rise; and (2) despite variations in non-climatic factors (e.g. soil type and management) along the sampling transect, variations in TA and anthocyanins were satisfactorily described using climate-variable-based empirical models, indicating the overriding impact of climate on berry

Berry composition and climate: responses and empirical models

NASA Astrophysics Data System (ADS)

Barnuud, Nyamdorj N.; Zerihun, Ayalsew; Gibberd, Mark; Bates, Bryson

2014-08-01

Climate is a strong modulator of berry composition. Accordingly, the projected change in climate is expected to impact on the composition of berries and of the resultant wines. However, the direction and extent of climate change impact on fruit composition of winegrape cultivars are not fully known. This study utilised a climate gradient along a 700 km transect, covering all wine regions of Western Australia, to explore and empirically describe influences of climate on anthocyanins, pH and titratable acidity (TA) levels in two or three cultivars of Vitis vinifera (Cabernet Sauvignon, Chardonnay and Shiraz). The results showed that, at a common maturity of 22° Brix total soluble solids, berries from the warmer regions had low levels of anthocyanins and TA as well as high pH compared to berries from the cooler regions. Most of these regional variations in berry composition reflected the prevailing climatic conditions of the regions. Thus, depending on cultivar, 82-87 % of TA, 83 % of anthocyanins and about half of the pH variations across the gradient were explained by climate-variable-based empirical models. Some of the variables that were relevant in describing the variations in berry attributes included: diurnal ranges and ripening period temperature (TA), vapour pressure deficit in October and growing degree days (pH), and ripening period temperatures (anthocyanins). Further, the rates of change in these berry attributes in response to climate variables were cultivar dependent. Based on the observed patterns along the climate gradient, it is concluded that: (1) in a warming climate, all other things being equal, berry anthocyanins and TA levels will decline whereas pH levels will rise; and (2) despite variations in non-climatic factors (e.g. soil type and management) along the sampling transect, variations in TA and anthocyanins were satisfactorily described using climate-variable-based empirical models, indicating the overriding impact of climate on berry

Estimating evapotranspiration change due to forest treatment and fire at the basin scale in the Sierra Nevada, California

NASA Astrophysics Data System (ADS)

Roche, J. W.; Goulden, M.; Bales, R. C.

2017-12-01

Increased forest evapotranspiration (ET) coupled with snowpack decreases in a warming climate is likely to decrease runoff and increase forest drought stress. Field experiments and modeling suggest that forest thinning can reduce ET and thus increase potential runoff relative to untreated areas. We investigated the potential magnitude and duration of ET decreases resulting from forest-thinning treatments and fire using a robust empirical relation between Landsat-derived mean-annual normalized difference vegetation index (NDVI) and annual ET measured at flux towers. Among forest treatments, the minimum observed NDVI change required to produce a significant departure from control plots with NDVI of about 0.70 was -0.07 units, corresponding to a basal-area reduction of 3.1 m2 ha-1, and equivalent to an estimated ET reduction of -102 mm yr-1. Intensive thinning in highly productive forests that approached pre-fire-exclusion densities reduced basal area by 40-50%, generating estimated ET reductions of 152-216 mm yr-1 over five years following treatment. Between 1990 and 2008, fires in the American River basin generated more than twice the ET reduction per unit area than those in the Kings River basin, corresponding to greater water and energy limitations in the latter and greater fire severity in the former. A rough extrapolation of these results to the entire American River watershed, much of which would have burned naturally during this 19-year period, could result in ET reductions that approach 10% of full natural flows for drought years and 5% averaged over all years. This work demonstrates the potential utility to estimate forest ET change at the patch scale, which in turn may allow managers to estimate thinning benefits in areas lacking detailed hydrologic measurements.

An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette's Disorder

PubMed Central

Peterson, Alan L.; McGuire, Joseph F.; Wilhelm, Sabine; Piacentini, John; Woods, Douglas W.; Walkup, John T.; Hatch, John P.; Villarreal, Robert; Scahill, Lawrence

2018-01-01

Over the past 6 decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a longstanding concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using 4 methods: (1) the onset of new tic symptoms; (2) the occurrence of adverse events; (3) change in tic medications; and (4) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of 8 sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the longstanding concern of symptom substitution in response to behavior therapy for individuals with Tourette's Disorder. PMID:26763495

Neural and behavioural changes in male periadolescent mice after prolonged nicotine-MDMA treatment.

PubMed

Adeniyi, Philip A; Ishola, Azeez O; Laoye, Babafemi J; Olatunji, Babawale P; Bankole, Oluwamolakun O; Shallie, Philemon D; Ogundele, Olalekan M

2016-02-01

The interaction between MDMA and Nicotine affects multiple brain centres and neurotransmitter systems (serotonin, dopamine and glutamate) involved in motor coordination and cognition. In this study, we have elucidated the effect of prolonged (10 days) MDMA, Nicotine and a combined Nicotine-MDMA treatment on motor-cognitive neural functions. In addition, we have shown the correlation between the observed behavioural change and neural structural changes induced by these treatments in BALB/c mice. We observed that MDMA (2 mg/Kg body weight; subcutaneous) induced a decline in motor function, while Nicotine (2 mg/Kg body weight; subcutaneous) improved motor function in male periadolescent mice. In combined treatment, Nicotine reduced the motor function decline observed in MDMA treatment, thus no significant change in motor function for the combined treatment versus the control. Nicotine or MDMA treatment reduced memory function and altered hippocampal structure. Similarly, a combined Nicotine-MDMA treatment reduced memory function when compared with the control. Ultimately, the metabolic and structural changes in these neural systems were seen to vary for the various forms of treatment. It is noteworthy to mention that a combined treatment increased the rate of lipid peroxidation in brain tissue.

A multicenter phase 2 study of empirical low-dose liposomal amphotericin B in patients with refractory febrile neutropenia.

PubMed

Miyao, Kotaro; Sawa, Masashi; Kurata, Mio; Suzuki, Ritsuro; Sakemura, Reona; Sakai, Toshiyasu; Kato, Tomonori; Sahashi, Satomi; Tsushita, Natsuko; Ozawa, Yukiyasu; Tsuzuki, Motohiro; Kohno, Akio; Adachi, Tatsuya; Watanabe, Keisuke; Ohbayashi, Kaneyuki; Inagaki, Yuichiro; Atsuta, Yoshiko; Emi, Nobuhiko

2017-01-01

Invasive fungal infection (IFI) is a major life-threatening problem encountered by patients with hematological malignancies receiving intensive chemotherapy. Empirical antifungal agents are therefore important. Despite the availability of antifungal agents for such situations, the optimal agents and administration methods remain unclear. We conducted a prospective phase 2 study of empirical 1 mg/kg/day liposomal amphotericin B (L-AMB) in 80 patients receiving intensive chemotherapy for hematological malignancies. All enrolled patients were high-risk and had recurrent prolonged febrile neutropenia despite having received broad-spectrum antibacterial therapy for at least 72 hours. Fifty-three patients (66.3 %) achieved the primary endpoint of successful treatment, thus exceeding the predefined threshold success rate. No patients developed IFI. The treatment completion rate was 73.8 %, and only two cases ceased treatment because of adverse events. The most frequent events were reversible electrolyte abnormalities. We consider low-dose L-AMB to provide comparable efficacy and improved safety and cost-effectiveness when compared with other empirical antifungal therapies. Additional large-scale randomized studies are needed to determine the clinical usefulness of L-AMB relative to other empirical antifungal therapies.

A heuristic model linking yoga philosophy and self-reflection to examine underlying mechanisms of add-on yoga treatment in schizophrenia.

PubMed

Rao, Naren; Menon, Sangeetha

2016-06-01

Preliminary evidence suggests efficacy of yoga as add-on treatment for schizophrenia, but the underlying mechanism by which yoga improves the symptoms of schizophrenia is not completely understood. Yoga improves self-reflection in healthy individuals, and self-reflection abnormalities are typically seen in schizophrenia. However, whether yoga treatment improves impairments in self-reflection typically seen in patients with schizophrenia is not examined. This paper discusses the potential mechanism of yoga in the treatment of schizophrenia and proposes a testable hypothesis for further empirical studies. It is proposed that self-reflection abnormalities in schizophrenia improve with yoga and the neurobiological changes associated with this can be examined using empirical behavioural measures and neuroimaging measures such as magnetic resonance imaging.

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes.

PubMed

Schlegl, Sandra; Quadflieg, Norbert; Löwe, Bernd; Cuntz, Ulrich; Voderholzer, Ulrich

2014-09-06

Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients.

Rapid Molecular Diagnostics, Antibiotic Treatment Decisions, and Developing Approaches to Inform Empiric Therapy: PRIMERS I and II.

PubMed

Evans, Scott R; Hujer, Andrea M; Jiang, Hongyu; Hujer, Kristine M; Hall, Thomas; Marzan, Christine; Jacobs, Michael R; Sampath, Rangarajan; Ecker, David J; Manca, Claudia; Chavda, Kalyan; Zhang, Pan; Fernandez, Helen; Chen, Liang; Mediavilla, Jose R; Hill, Carol B; Perez, Federico; Caliendo, Angela M; Fowler, Vance G; Chambers, Henry F; Kreiswirth, Barry N; Bonomo, Robert A

2016-01-15

Rapid molecular diagnostic (RMD) platforms may lead to better antibiotic use. Our objective was to develop analytical strategies to enhance the interpretation of RMDs for clinicians. We compared the performance characteristics of 4 RMD platforms for detecting resistance against β-lactams in 72 highly resistant isolates of Escherichia coli and Klebsiella pneumoniae (PRIMERS I). Subsequently, 2 platforms were used in a blinded study in which a heterogeneous collection of 196 isolates of E. coli and K. pneumoniae (PRIMERS II) were examined. We evaluated the genotypic results as predictors of resistance or susceptibility against β-lactam antibiotics. We designed analytical strategies and graphical representations of platform performance, including discrimination summary plots and susceptibility and resistance predictive values, that are readily interpretable by practitioners to inform decision-making. In PRIMERS I, the 4 RMD platforms detected β-lactamase (bla) genes and identified susceptibility or resistance in >95% of cases. In PRIMERS II, the 2 platforms identified susceptibility against extended-spectrum cephalosporins and carbapenems in >90% of cases; however, against piperacillin/tazobactam, susceptibility was identified in <80% of cases. Applying the analytical strategies to a population with 15% prevalence of ceftazidime-resistance and 5% imipenem-resistance, RMD platforms predicted susceptibility in >95% of cases, while prediction of resistance was 69%-73% for ceftazidime and 41%-50% for imipenem. RMD platforms can help inform empiric β-lactam therapy in cases where bla genes are not detected and the prevalence of resistance is known. Our analysis is a first step in bridging the gap between RMDs and empiric treatment decisions. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The Empirically Supported Status of Acceptance and Commitment Therapy: An Update

ERIC Educational Resources Information Center

Smout, Matthew F.; Hayes, Louise; Atkins, Paul W. B.; Klausen, Jessica; Duguid, James E.

2012-01-01

Acceptance and commitment therapy (ACT) is a transdiagnostic cognitive behavioural therapy that predominantly teaches clients acceptance and mindfulness skills, as well as values clarification and enactment skills. Australian treatment guideline providers have been cautious in recognising ACT as empirically supported. This article reviews evidence…

Current Clinical Interventions for Smoking Cessation: A Review of Empirical Studies.

ERIC Educational Resources Information Center

Marcellino, Robert Leonard, Jr.

This document reviews all empirical studies on clinically-based smoking cessation interventions that were reported in "Psychological Abstracts" between January 1982 and March 1990. Interventions are categorized as either physiological or psychological in orientation and are further grouped according to specific treatment type:…

Change in expressed emotion and treatment outcome in adolescent anorexia nervosa.

PubMed

Moskovich, Ashley A; Timko, C Alix; Honeycutt, Lisa K; Zucker, Nancy L; Merwin, Rhonda M

2017-01-01

Expressed emotion (EE) has been associated with poor outcomes in anorexia nervosa (AN); however, whether changes in EE predict superior treatment outcomes is unknown. The current study examined whether decreases in EE during an open trial of a novel family-based treatment for AN predicted symptoms at end of treatment. Forty-seven adolescents (12-18 years of age) with AN or sub-threshold AN and their parents (mothers: n = 47, fathers: n = 39) participated in 6 months of family treatment. Measures of AN symptomatology (Eating Disorder Examination completed by adolescent and end of treatment recovery status) and parental EE (Family Questionnaire completed by parents which measures two facets of EE: critical communication [CC] and emotional over-involvement [EOI]) were collected at baseline and end of treatment. Parental EOI, but not CC, significantly decreased during the course of treatment. Change in mothers', but not fathers', EE accounted for additional variance in AN symptomatology at end of treatment above baseline EE and baseline AN symptom levels. Findings suggest a greater emphasis on parent support during treatment may improve outcomes.

A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression

ERIC Educational Resources Information Center

Sburlati, Elizabeth S.; Lyneham, Heidi J.; Mufson, Laura H.; Schniering, Carolyn A.

2012-01-01

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist…

Trajectories of change across outcomes in intensive treatment for adolescent panic disorder and agoraphobia.

PubMed

Gallo, Kaitlin P; Cooper-Vince, Christine E; Hardway, Christina L; Pincus, Donna B; Comer, Jonathan S

2014-01-01

Much remains to be learned about typical and individual growth trajectories across treatment for adolescent panic disorder with and without agoraphobia and about critical treatment points associated with key changes. The present study examined the rate and shape of change across an 8-day intensive cognitive behavioral therapy for adolescent panic disorder with and without agoraphobia (N = 56). Participants ranged in age from 12 to 17 (M = 15.14, SD = 1.70; 58.9% female, 78.6% Caucasian). Multilevel modeling evaluated within-treatment linear and nonlinear changes across three treatment outcomes: panic severity, fear, and avoidance. Overall panic severity showed linear change, decreasing throughout treatment. In contrast, fear and avoidance ratings both showed cubic change, peaking slightly at the first session of treatment, starting to decrease at the second session of treatment, and with large gains continuing then plateauing at the fourth session. Findings are considered with regard to the extent to which they may elucidate critical treatment components and sessions for adolescents with panic disorder with and without agoraphobia.

Changing the approach to treatment choice in epilepsy using big data.

PubMed

Devinsky, Orrin; Dilley, Cynthia; Ozery-Flato, Michal; Aharonov, Ranit; Goldschmidt, Ya'ara; Rosen-Zvi, Michal; Clark, Chris; Fritz, Patty

2016-03-01

A UCB-IBM collaboration explored the application of machine learning to large claims databases to construct an algorithm for antiepileptic drug (AED) choice for individual patients. Claims data were collected between January 2006 and September 2011 for patients with epilepsy > 16 years of age. A subset of patient claims with a valid index date of AED treatment change (new, add, or switch) were used to train the AED prediction model by retrospectively evaluating an index date treatment for subsequent treatment change. Based on the trained model, a model-predicted AED regimen with the lowest likelihood of treatment change was assigned to each patient in the group of test claims, and outcomes were evaluated to test model validity. The model had 72% area under receiver operator characteristic curve, indicating good predictive power. Patients who were given the model-predicted AED regimen had significantly longer survival rates (time until a treatment change event) and lower expected health resource utilization on average than those who received another treatment. The actual prescribed AED regimen at the index date matched the model-predicted AED regimen in only 13% of cases; there were large discrepancies in the frequency of use of certain AEDs/combinations between model-predicted AED regimens and those actually prescribed. Chances of treatment success were improved if patients received the model-predicted treatment. Using the model's prediction system may enable personalized, evidence-based epilepsy care, accelerating the match between patients and their ideal therapy, thereby delivering significantly better health outcomes for patients and providing health-care savings by applying resources more efficiently. Our goal will be to strengthen the predictive power of the model by integrating diverse data sets and potentially moving to prospective data collection. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

A retrospective analysis of the change in anti-malarial treatment policy: Peru.

PubMed

Williams, Holly Ann; Vincent-Mark, Arlene; Herrera, Yenni; Chang, O Jaime

2009-04-28

National malaria control programmes must deal with the complex process of changing national malaria treatment guidelines, often without guidance on the process of change. Selecting a replacement drug is only one issue in this process. There is a paucity of literature describing successful malaria treatment policy changes to help guide control programs through this process. To understand the wider context in which national malaria treatment guidelines were formulated in a specific country (Peru). Using qualitative methods (individual and focus group interviews, stakeholder analysis and a review of documents), a retrospective analysis of the process of change in Peru's anti-malarial treatment policy from the early 1990's to 2003 was completed. The decision to change Peru's policies resulted from increasing levels of anti-malarial drug resistance, as well as complaints from providers that the drugs were no longer working. The context of the change occurred in a time in which Peru was changing national governments, which created extreme challenges in moving the change process forward. Peru utilized a number of key strategies successfully to ensure that policy change would occur. This included a) having the process directed by a group who shared a common interest in malaria and who had long-established social and professional networks among themselves, b) engaging in collaborative teamwork among nationals and between nationals and international collaborators, c) respect for and inclusion of district-level staff in all phases of the process, d) reliance on high levels of technical and scientific knowledge, e) use of standardized protocols to collect data, and f) transparency. Although not perfectly or fully implemented by 2003, the change in malaria treatment policy in Peru occurred very quickly, as compared to other countries. They identified a problem, collected the data necessary to justify the change, utilized political will to their favor, approved the policy, and

Evolution of the empirical and theoretical foundations of eyewitness identification reform.

PubMed

Clark, Steven E; Moreland, Molly B; Gronlund, Scott D

2014-04-01

Scientists in many disciplines have begun to raise questions about the evolution of research findings over time (Ioannidis in Epidemiology, 19, 640-648, 2008; Jennions & Møller in Proceedings of the Royal Society, Biological Sciences, 269, 43-48, 2002; Mullen, Muellerleile, & Bryan in Personality and Social Psychology Bulletin, 27, 1450-1462, 2001; Schooler in Nature, 470, 437, 2011), since many phenomena exhibit decline effects-reductions in the magnitudes of effect sizes as empirical evidence accumulates. The present article examines empirical and theoretical evolution in eyewitness identification research. For decades, the field has held that there are identification procedures that, if implemented by law enforcement, would increase eyewitness accuracy, either by reducing false identifications, with little or no change in correct identifications, or by increasing correct identifications, with little or no change in false identifications. Despite the durability of this no-cost view, it is unambiguously contradicted by data (Clark in Perspectives on Psychological Science, 7, 238-259, 2012a; Clark & Godfrey in Psychonomic Bulletin & Review, 16, 22-42, 2009; Clark, Moreland, & Rush, 2013; Palmer & Brewer in Law and Human Behavior, 36, 247-255, 2012), raising questions as to how the no-cost view became well-accepted and endured for so long. Our analyses suggest that (1) seminal studies produced, or were interpreted as having produced, the no-cost pattern of results; (2) a compelling theory was developed that appeared to account for the no-cost pattern; (3) empirical results changed over the years, and subsequent studies did not reliably replicate the no-cost pattern; and (4) the no-cost view survived despite the accumulation of contradictory empirical evidence. Theories of memory that were ruled out by early data now appear to be supported by data, and the theory developed to account for early data now appears to be incorrect.

Time-varying volatility in Malaysian stock exchange: An empirical study using multiple-volatility-shift fractionally integrated model

NASA Astrophysics Data System (ADS)

Cheong, Chin Wen

2008-02-01

This article investigated the influences of structural breaks on the fractionally integrated time-varying volatility model in the Malaysian stock markets which included the Kuala Lumpur composite index and four major sectoral indices. A fractionally integrated time-varying volatility model combined with sudden changes is developed to study the possibility of structural change in the empirical data sets. Our empirical results showed substantial reduction in fractional differencing parameters after the inclusion of structural change during the Asian financial and currency crises. Moreover, the fractionally integrated model with sudden change in volatility performed better in the estimation and specification evaluations.

The Validity and Reliability of the Violence Risk Scale-Sexual Offender Version: Assessing Sex Offender Risk and Evaluating Therapeutic Change

ERIC Educational Resources Information Center

Olver, Mark E.; Wong, Stephen C. P.; Nicholaichuk, Terry; Gordon, Audrey

2007-01-01

The Violence Risk Scale-Sexual Offender version (VRS-SO) is a rating scale designed to assess risk and predict sexual recidivism, to measure and link treatment changes to sexual recidivism, and to inform the delivery of sexual offender treatment. The VRS-SO comprises 7 static and 17 dynamic items empirically or conceptually linked to sexual…

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

ERIC Educational Resources Information Center

Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

2011-01-01

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis.

PubMed

Brouwer, Matthijs C; Tunkel, Allan R; van de Beek, Diederik

2010-07-01

The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.

Empirical validation of guidelines for the management of pharyngitis in children and adults.

PubMed

McIsaac, Warren J; Kellner, James D; Aufricht, Peggy; Vanjaka, Anita; Low, Donald E

2004-04-07

Recent guidelines for management of pharyngitis vary in their recommendations concerning empirical antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS). To assess the impact of guideline recommendations and alternative approaches on identification and treatment of GAS pharyngitis in children and adults. Throat cultures and rapid antigen tests were performed on 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002. Recommendations from 2 guidelines (those of the Infectious Diseases Society of America and of the American College of Physicians-American Society of Internal Medicine/American Academy of Family Physicians/US Centers for Disease Control and Prevention) were compared with rapid testing alone, a clinical prediction rule (ie, the modified Centor score), and a criterion standard of treatment for positive throat culture results only. Sensitivity and specificity of each strategy for identifying GAS pharyngitis, total antibiotics recommended, and unnecessary antibiotic prescriptions. In children, sensitivity for streptococcal infection ranged from 85.8% (133/155; 95% confidence interval [CI], 79.3%-90.0%) for rapid testing to 100% for culturing all. In adults, sensitivity ranged from 76.7% (56/73; 95% CI, 65.4%-85.8%) for rapid testing without culture confirmation of negative results to 100% for culturing all. In children, specificity ranged from 90.3% (270/299; 95% CI, 86.4%-93.4%) for use of modified Centor score and throat culture to 100% for culturing all. In adults, specificity ranged from 43.8% (114/260; 95% CI, 37.7%-50.1%) for empirical treatment based on a modified Centor score of 3 or 4 to 100% for culturing all. Total antibiotic prescriptions were lowest with rapid testing (24.7% [194/787]; 95% CI, 21.7%-27.8%) and highest with empirical treatment of high-risk adults (45.7% [360/787]; 95% CI, 42.2%-49.3%), due

Robot Wars: US Empire and geopolitics in the robotic age

PubMed Central

Shaw, Ian GR

2017-01-01

How will the robot age transform warfare? What geopolitical futures are being imagined by the US military? This article constructs a robotic futurology to examine these crucial questions. Its central concern is how robots – driven by leaps in artificial intelligence and swarming – are rewiring the spaces and logics of US empire, warfare, and geopolitics. The article begins by building a more-than-human geopolitics to de-center the role of humans in conflict and foreground a worldly understanding of robots. The article then analyzes the idea of US empire, before speculating upon how and why robots are materializing new forms of proxy war. A three-part examination of the shifting spaces of US empire then follows: (1) Swarm Wars explores the implications of miniaturized drone swarming; (2) Roboworld investigates how robots are changing US military basing strategy and producing new topological spaces of violence; and (3) The Autogenic Battle-Site reveals how autonomous robots will produce emergent, technologically event-ful sites of security and violence – revolutionizing the battlespace. The conclusion reflects on the rise of a robotic US empire and its consequences for democracy. PMID:29081605

Robot Wars: US Empire and geopolitics in the robotic age.

PubMed

Shaw, Ian Gr

2017-10-01

How will the robot age transform warfare? What geopolitical futures are being imagined by the US military? This article constructs a robotic futurology to examine these crucial questions. Its central concern is how robots - driven by leaps in artificial intelligence and swarming - are rewiring the spaces and logics of US empire, warfare, and geopolitics. The article begins by building a more-than-human geopolitics to de-center the role of humans in conflict and foreground a worldly understanding of robots. The article then analyzes the idea of US empire, before speculating upon how and why robots are materializing new forms of proxy war. A three-part examination of the shifting spaces of US empire then follows: (1) Swarm Wars explores the implications of miniaturized drone swarming; (2) Roboworld investigates how robots are changing US military basing strategy and producing new topological spaces of violence; and (3) The Autogenic Battle-Site reveals how autonomous robots will produce emergent, technologically event-ful sites of security and violence - revolutionizing the battlespace. The conclusion reflects on the rise of a robotic US empire and its consequences for democracy.

Treatment Response to an Intensive Summer Treatment Program for Adolescents with ADHD

ERIC Educational Resources Information Center

Sibley, Margaret H.; Smith, Bradley H.; Evans, Steven W.; Pelham, William E.; Gnagy, Elizabeth M.

2012-01-01

Objective: There are presently almost no empirically validated treatments for adolescents with ADHD. However, in childhood, behavioral treatments for ADHD typically include behavioral parent training, classroom interventions, and intensive child-directed interventions. Method: The present investigation examines treatment gains following an 8-week…

Sample dilution and bacterial community composition influence empirical leucine-to-carbon conversion factors in surface waters of the world's oceans.

PubMed

Teira, Eva; Hernando-Morales, Víctor; Cornejo-Castillo, Francisco M; Alonso-Sáez, Laura; Sarmento, Hugo; Valencia-Vila, Joaquín; Serrano Catalá, Teresa; Hernández-Ruiz, Marta; Varela, Marta M; Ferrera, Isabel; Gutiérrez Morán, Xosé Anxelu; Gasol, Josep M

2015-12-01

The transformation of leucine incorporation rates to prokaryotic carbon production rates requires the use of either theoretical or empirically determined conversion factors. Empirical leucine-to-carbon conversion factors (eCFs) vary widely across environments, and little is known about their potential controlling factors. We conducted 10 surface seawater manipulation experiments across the world's oceans, where the growth of the natural prokaryotic assemblages was promoted by filtration (i.e., removal of grazers [F treatment]) or filtration combined with dilution (i.e., also relieving resource competition [FD treatment]). The impact of sunlight exposure was also evaluated in the FD treatments, and we did not find a significant effect on the eCFs. The eCFs varied from 0.09 to 1.47 kg C mol Leu(-1) and were significantly lower in the FD than in the F samples. Also, changes in bacterial community composition during the incubations, as assessed by automated ribosomal intergenic spacer analysis (ARISA), were more pronounced in the FD than in the F treatments, compared to unmanipulated controls. Thus, we discourage the common procedure of diluting samples (in addition to filtration) for eCF determination. The eCFs in the filtered treatment were negatively correlated with the initial chlorophyll a concentration, picocyanobacterial abundance (mostly Prochlorococcus), and the percentage of heterotrophic prokaryotes with high nucleic acid content (%HNA). The latter two variables explained 80% of the eCF variability in the F treatment, supporting the view that both Prochlorococcus and HNA prokaryotes incorporate leucine in substantial amounts, although this results in relatively low carbon production rates in the oligotrophic ocean. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities.

PubMed

Sempértegui, Gabriela A; Karreman, Annemiek; Arntz, Arnoud; Bekker, Marrie H J

2013-04-01

Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences. Copyright © 2012 Elsevier Ltd. All rights reserved.

Family Transitions Following the Birth of a Sibling: An Empirical Review of Changes in the Firstborn’s Adjustment

PubMed Central

Volling, Brenda L.

2012-01-01

Nearly 80% of children in the U.S. have at least one sibling, indicating that the birth of a baby sibling is a normative ecological transition for most children. Many clinicians and theoreticians believe the transition is stressful, constituting a developmental crisis for most children. Yet, a comprehensive review of the empirical literature on children’s adjustment over the transition to siblinghood (TTS) has not been done for several decades. The current review summarized research examining change in firstborns’ adjustment to determine whether there was evidence that the TTS was disruptive for most children. Thirty studies addressing the transition to siblinghood were found and of those studies, the evidence did not support a crisis model of developmental transitions, nor was there overwhelming evidence of consistent changes in firstborn adjustment. Although there were decreases in children’s affection and responsiveness toward mothers, the results were more equivocal for many other behaviors (e.g., sleep problems, anxiety, aggression, regression). An inspection of the scientific literature indicated there are large individual differences in children’s adjustment and that the TTS can be a time of disruption, an occasion for developmental advances, or a period of quiescence with no noticeable changes. The TTS may be a developmental turning point for some children that portends future psychopathology or growth depending on the transactions between children and the changes in the ecological context over time. A developmental ecological systems framework guided the discussion of how child, parent, and contextual factors may contribute to the prediction of firstborn children’s successful adaptation to the birth of a sibling. PMID:22289107

Social workers and delivery of evidence-based psychosocial treatments for substance use disorders.

PubMed

Wells, Elizabeth A; Kristman-Valente, Allison N; Peavy, K Michelle; Jackson, T Ron

2013-01-01

Social workers encounter individuals with substance use disorders (SUDs) in a variety of settings. With changes in health care policy and a movement toward integration of health and behavioral health services, social workers will play an increased role vis-á-vis SUD. As direct service providers, administrators, care managers, and policy makers, they will select, deliver, or advocate for delivery of evidence-based SUD treatment practices. This article provides an overview of effective psychosocial SUD treatment approaches. In addition to describing the treatments, the article discusses empirical support, populations for whom the treatments are known to be efficacious, and implementation issues.

Land Use Change Impacts to Flows and Hydropower at the Southern Fringe of the Brazilian Amazon: A Regional, Empirical Study of Land-Water-Energy Nexus Dynamics

NASA Astrophysics Data System (ADS)

Levy, M. C.; Thompson, S. E.; Cohn, A.

2014-12-01

Land use/cover change (LUCC) has occurred extensively in the Brazilian Amazon rainforest-savanna transition. Agricultural development-driven LUCC at regional scales can alter surface energy budgets, evapotranspiration (ET) and rainfall; these hydroclimatic changes impact streamflows, and thus hydropower. To date, there is only limited empirical understanding of these complex land-water-energy nexus dynamics, yet understanding is important to developing countries where both agriculture and hydropower are expanding and intensifying. To observe these changes and their interconnections, we synthesize a novel combination of ground network, remotely sensed, and empirically modeled data for LUCC, rainfall, flows, and hydropower potential. We connect the extensive temporal and spatial trends in LUCC occurring from 2000-2012 (and thus observable in the satellite record) to long-term historical flow records and run-of-river hydropower generation potential estimates. Changes in hydrologic condition are observed in terms of dry and wet season moments, extremes, and flow duration curves. Run-of-river hydropower generation potential is modeled at basin gauge points using equation models parameterized with literature-based low-head turbine efficiencies, and simple algorithms establishing optimal head and capacity from elevation and flows, respectively. Regression analyses are used to demonstrate a preliminary causal analysis of LUCC impacts to flow and energy, and discuss extension of the analysis to ungauged basins. The results are transferable to tropical and transitional forest regions worldwide where simultaneous agricultural and hydropower development potentially compete for coupled components of regional water cycles, and where policy makers and planners require an understanding of LUCC impacts to hydroclimate-dependent industries and ecosystems.

Narrative and emotion process in psychotherapy: an empirical test of the Narrative-Emotion Process Coding System (NEPCS).

PubMed

Boritz, Tali Z; Bryntwick, Emily; Angus, Lynne; Greenberg, Leslie S; Constantino, Michael J

2014-01-01

While the individual contributions of narrative and emotion processes to psychotherapy outcome have been the focus of recent interest in psychotherapy research literature, the empirical analysis of narrative and emotion integration has rarely been addressed. The Narrative-Emotion Processes Coding System (NEPCS) was developed to provide researchers with a systematic method for identifying specific narrative and emotion process markers, for application to therapy session videos. The present study examined the relationship between NEPCS-derived problem markers (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) and change markers (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling), and treatment outcome (recovered versus unchanged at therapy termination) and stage of therapy (early, middle, late) in brief emotion-focused (EFT), client-centred (CCT), and cognitive (CT) therapies for depression. Hierarchical linear modelling analyses demonstrated a significant Outcome effect for inchoate storytelling (p = .037) and discovery storytelling (p = .002), a Stage × Outcome effect for abstract storytelling (p = .05), and a Stage × Outcome × Treatment effect for competing plotlines storytelling (p = .001). There was also a significant Stage × Outcome effect for NEPCS problem markers (p = .007) and change markers (p = .03). The results provide preliminary support for the importance of assessing the contribution of narrative-emotion processes to efficacious treatment outcomes in EFT, CCT, and CT treatments of depression.

Empirical ethics, context-sensitivity, and contextualism.

PubMed

Musschenga, Albert W

2005-10-01

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." Unlike descriptive ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position.

Empire matters: implications for pastoral care.

PubMed

LaMothe, Ryan

2007-01-01

In this essay, I argue that the American Empire matters for pastoral care. I begin with a discussion of the meaning of empire and the particular historical roots and characteristics of the American Empire. From this, I contend that the American Empire matters because the United States has had a long history of expansionist aims, which has been couched in idealized secular discourse as well as ensconced in theo-political discourse. These discourses, which have, implicitly or explicitly, supported foreign policies and actions aimed at political, economic, and military dominion, are joined to an empire psyche. This empire psyche and the actions of U.S. governments are matters for pastoral care because of a) the various physical, psychological, and spiritual harms that attend hubris, greed, entitlement, and the quest for hegemony, and b) the theological contradictions inherent in Christian discourse that supports the American Empire. These consequences and contradictions serve as reasons why pastoral theologians and caregivers ought to bring these matters to public reflection and conversation. I conclude with a brief depiction of possible pastoral actions given the reality of the American Empire.

Goal commitment and the goal-setting process: conceptual clarification and empirical synthesis.

PubMed

Klein, H J; Wesson, M J; Hollenbeck, J R; Alge, B J

1999-12-01

Goals are central to current treatments of work motivation, and goal commitment is a critical construct in understanding the relationship between goals and task performance. Despite this importance, there is confusion about the role of goal commitment and only recently has this key construct received the empirical attention it warrants. This meta-analysis, based on 83 independent samples, updates the goal commitment literature by summarizing the accumulated evidence on the antecedents and consequences of goal commitment. Using this aggregate empirical evidence, the role of goal commitment in the goal-setting process is clarified and key areas for future research are identified.

Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study

PubMed Central

Mäntynen, Raija; Vehviläinen-Julkunen, Katri; Partanen, Pirjo; Turunen, Hannele; Miettinen, Merja; Kvist, Tarja

2014-01-01

This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n 1 = 499, n 2 = 498) and patient safety culture (n 1 = 234, n 2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n 1 = 1176, n 2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n 1 = 678, n 2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes. PMID:25009744

Changes in the pattern of patients receiving surgical-orthodontic treatment

PubMed Central

Proffit, William R.; Jackson, Tate H.; Turvey, Timothy A.

2014-01-01

Introduction The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. Methods Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. Results Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. Conclusions A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients. PMID:23726329

Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates.

PubMed

Butler, Christopher C; O'Brien, Kathryn; Wootton, Mandy; Pickles, Timothy; Hood, Kerenza; Howe, Robin; Waldron, Cherry-Ann; Thomas-Jones, Emma; Dudley, Jan; Van Der Voort, Judith; Rumsby, Kate; Little, Paul; Downing, Harriet; Harman, Kim; Hay, Alastair D

2016-04-01

Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment. To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children. Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort]. The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5-47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7-88.3%); cephalexin 95.1% (93.9-96.1%); trimethoprim 74.0% (71.7-76.2%) and nitrofurantoin 98.2% (97.4-98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8-61.4%); co-amoxiclav using the systemic BP 83.5% (73.9-90.1%); co-amoxiclav using the urinary BP 94.9% (87.7-98.4%); cephalexin 98.7% (93.2-99.8%); trimethoprim 70.9% (60.1-80.0%); nitrofurantoin 100% (95.3-100.0%) and ciprofloxacin 96.2% (89.4-98.7%). Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Transient sex change in the immature Malabar grouper, Epinephelus malabaricus, androgen treatment.

PubMed

Murata, Ryosuke; Kobayashi, Yasuhisa; Karimata, Hirofumi; Kishimoto, Kazuo; Kimura, Motofumi; Nakamura, Masaru

2014-07-01

To clarify the cause of sex change recovery after the withdrawal of androgen treatment, immature female Malabar grouper were fed a diet containing 17alpha-methyltestosterone (MT) at 50 μg/g for 7 mo and then a normal diet for 6 mo. The MT brought about precocious sex change from immature ovaries to mature testes with active spermatogenesis, including the development of spermatozoa, and sex change reversed soon after MT treatment withdrawal. This result indicates that precocious sex change in immature Malabar grouper with oral MT treatment is impermanent. The expression of three steroidogenic enzymes (Cyp11a, Cyp19a1a, and Cyp11b) in the gonads of the Malabar grouper were analyzed immunohistochemically at the end of the 7-mo treatment. No apparent differences were seen in the expression pattern of these enzymes between the mature testes of MT-treated fish and the immature ovaries of control fish. In addition, serum estradiol-17beta and 11-ketotestosterone levels in treated fish were the same as those in control fish. These results indicate that in the case of immature Malabar grouper MT might have little effect on endogenous steroidogenesis during precocious sex change even though it induced active spermatogenesis in the gonads of treated fish. From these results, we also concluded that MT might have little effect on the steroidogenic endocrine pathway, and this is one cause of sex change recovery after treatment withdrawal. © 2014 by the Society for the Study of Reproduction, Inc.

Empirical Estimation of Climate Impacts Under Adaptation

NASA Astrophysics Data System (ADS)

Rising, J. A.; Jina, A.; Hsiang, S. M.

2016-12-01

Estimating the impacts of climate change requires a careful account of both the present levels of adaptation observed in different regions and the adaptive capacity those regions might show under climate change. To date, little empirical evidence on either of these components. We present a general approach for empirically estimating the impacts of climate change under both forms of adaptation, applied to the United States. We draw upon relationships between daily temperatures and impacts on mortality, agriculture, and crime, from the econometric climate impacts literature. These are estimated using year-to-year temperature variation within each location. The degree to which regions are vulnerable to high temperatures varies across the US, with warmer regions generally showing less vulnerability. As climate changes, cooler regions will adopt behaviors from warmer regions, such as greater use of air conditioning, and their impact relationships will change accordingly. The rate at which regions have adapted is estimated from changes in these relationships over recent decades. We use these results to model future changes in each US county. as they are exposed to warmer temperatures and adopt characteristics of currently warmer areas. We do this across a full range of climate and statistical uncertainty. The median degree to which adaptation alleviates impacts varies by sector, with 10% lower rates of temperature-induced crime, 15% lower yield losses to maize, to 80% lower rates of heat-related mortality. However, the uncertainty in adaptive capacity remains greater than these changes. Uncertainty in regional response relationships and the rate of adaptation dominate the uncertainty in our total result. We perform two thought experiments to explore the extreme potential for adaptation in light of this uncertainty. We replace the regional relationships with a uniform approach to complete temperature insensitivity, using the normal estimated rate of adaptation. We also

Equine-related treatments for mental disorders lack empirical support: a systematic review of empirical investigations.

PubMed

Anestis, Michael D; Anestis, Joye C; Zawilinski, Laci L; Hopkins, Tiffany A; Lilienfeld, Scott O

2014-12-01

Equine-related treatments (ERT) for mental disorders are becoming increasingly popular for a variety of diagnoses; however, they have been subjected only to limited systematic investigation. To examine the quality of and results from peer-reviewed research on ERT for mental disorders and related outcomes. Peer-reviewed studies (k = 14) examining treatments for mental disorders or closely related outcomes were identified from databases and article reference sections. All studies were compromised by a substantial number of threats to validity, calling into question the meaning and clinical significance of their findings. Additionally, studies failed to provide consistent evidence that ERT is superior to the mere passage of time in the treatment of any mental disorder. The current evidence base does not justify the marketing and utilization of ERT for mental disorders. Such services should not be offered to the public unless and until well-designed studies provide evidence that justify different conclusions. © 2014 Wiley Periodicals, Inc.

[Diagnosis and treatment of child and adolescent depression].

PubMed

Bunge, Eduardo L; Carrea, Gabriela; Tosas de Molina, Mar; Soto, Natalie

2011-01-01

The present paper reviews the available literature on the current state of knowledge regarding depression in children and adolescents. Empirically supported psychotherapeutic treatment adjustments for children are described, such as the Self-Control Therapy (CBT), Penn Prevention Program; and other treatments that are experimental phase. Similarly empirically supported psychotherapeutic treatment adjustments for adolescents are described, such as Adolescent Coping with Depression, Interpersonal Psychotherapy; and other treatments that are experimental phase as Biblotherapy and Attachment-Based Family Therapy.

[Chronic pain patients' readiness to change after multimodal treatment. Short- and long-term effects].

PubMed

Küchler, A; Sabatowski, R; Kaiser, U

2012-12-01

Patients' readiness to behavioural changes according to the transtheoretical model (TTM) and criteria of treatment outcome are positively associated and have in part already been confirmed. For a stable effect of therapeutic treatment, patients' readiness to change seems indispensable for an independent and active pain management. Thus, in addition to an enhanced quality of life, increasing patients' motivation is a declared objective of the treatment at Dresden's Comprehensive Pain Center. In this study, it was examined how the readiness to change develops in the course of and during the 2 years following the multimodal treatment program. Furthermore, associations between outcome criteria of the treatment and patients' readiness to change were explored. The database constitutes 169 patients who took part in a 4-week interdisciplinary, partially residential pain treatment. Beside the Freiburg Pain Stages questionnaire ("Frieburger Fragebogen - Stadien der Bewältigung chronischer Schmerzen", FF-STABS), a comprehensive pain diagnostic inventory including the Pain Disability Index (PDI), the SF-36 questionnaire, and the Hospital Anxiety and Depression Scale (HADS) was completed at six different time points (beginning of treatment, end of treatment, booster session after 10 weeks, after 6, 12, and 24 months). The statistical analyses were performed with SPSS 16.0 including nonparametric analyses and variance analyses. Significant differences in the level of readiness to change between the beginning of treatment and all follow-up measures were observed. The average patients' readiness to change was still higher after 2 years than at the first measurement. However, a differentiated consideration revealed a small portion of patients who showed no change or even a reduction of motivation. After an additional week (booster session), the stages of readiness to change remained stable, irrespective of the direction of the previous change. Regarding therapeutic outcome

What we know and what we need to learn about the treatment of dissociative disorders.

PubMed

Brand, Bethany L

2012-01-01

In this editorial, I briefly review research design issues and the current treatment research for dissociative disorders (DD), discuss the limitations and challenges of conducting treatment studies for patients with DD, and conclude by describing what I see as the first wave and second wave in the field of dissociation. Insurers and federally funded programs are increasingly requiring that treatment be empirically supported in order for treatment to be reimbursed. For example, psychoanalysis will no longer be reimbursed in The Netherlands because of what is perceived as a lack of empirical support. Other countries have also established standards about the treatments that have sufficient empirical support to merit government payment. I believe it is only a matter of time before it is common for patients with DD to be required to seek out empirically supported treatment if they want treatment to be reimbursed. We need to financially support treatment studies in order to develop a more solid empirical basis for the treatment of DD.

Translucency changes of direct esthetic restorative materials after curing, aging and treatment

PubMed Central

2016-01-01

The purpose of this article was to review the changes in translucency of direct esthetic restorative materials after curing, aging and treatment. As a criterion for the evaluation of clinical translucency changes, visual perceptibility threshold in translucency parameter difference (ΔTP) of 2 was used. Translucency changes after curing were perceivable depending on experimental methods and products (largest ΔTP in resin composites = 15.9). Translucency changes after aging were reported as either relatively stable or showed perceivable changes by aging protocols (largest ΔTP in resin composites = -3.8). Translucency changes after curing, aging and treatment were perceivable in several products and experimental methods. Therefore, shade matching of direct esthetic materials should be performed considering these instabilities of translucency in direct esthetic materials. PMID:27847744

Microscopic morphological changes of the tooth surface in relation to fixed orthodontic treatment.

PubMed

Preoteasa, Cristina Teodora; NiŢoi, Dan Florin; Preoteasa, Elena

2015-01-01

Orthodontic treatment has, as any other medical intervention, in addition to its benefits, side effects, some of them being perceived as unavoidable. The aim of this case series was to microscopically evaluate the changes of the tooth surface in relation to fixed orthodontic treatment. A case series study was implemented by the usage of four extracted first maxillary premolars, from patients with previous orthodontic treatment, of 12 and 23 months. Analysis was performed using the high precision stereomicroscope (Axiovert, Carl Zeiss, Germany), at magnifications from 10× to 50×. The tooth surface corresponding to the bracket bonding area registered numerous disorderly grooves and cracks, with various directions and depths, and was flattened, having lower convexity compared to teeth surfaces where brackets were not bonded. Root resorption lacunae were more frequently observed in teeth under orthodontic treatment, these having various depths, and sizes considerably larger than those observed in teeth without orthodontic treatment. Following orthodontic treatment, teeth exhibit changes that can be perceived as being directly linked to this medical intervention. These teeth changes usually have low or moderate severity, which can be influenced at some degree by the clinical conduct of the orthodontic treatment. The stereomicroscope proved to be a high sensitivity tool for the analysis of morphological changes of teeth in relation to the fixed orthodontic treatment.

Gram-negative bacteraemia; a multi-centre prospective evaluation of empiric antibiotic therapy and outcome in English acute hospitals.

PubMed

Fitzpatrick, J M; Biswas, J S; Edgeworth, J D; Islam, J; Jenkins, N; Judge, R; Lavery, A J; Melzer, M; Morris-Jones, S; Nsutebu, E F; Peters, J; Pillay, D G; Pink, F; Price, J R; Scarborough, M; Thwaites, G E; Tilley, R; Walker, A S; Llewelyn, M J

2016-03-01

Increasing antibiotic resistance makes choosing antibiotics for suspected Gram-negative infection challenging. This study set out to identify key determinants of mortality among patients with Gram-negative bacteraemia, focusing particularly on the importance of appropriate empiric antibiotic treatment. We conducted a prospective observational study of 679 unselected adults with Gram-negative bacteraemia at ten acute english hospitals between October 2013 and March 2014. Appropriate empiric antibiotic treatment was defined as intravenous treatment on the day of blood culture collection with an antibiotic to which the cultured organism was sensitive in vitro. Mortality analyses were adjusted for patient demographics, co-morbidities and illness severity. The majority of bacteraemias were community-onset (70%); most were caused by Escherichia coli (65%), Klebsiella spp. (15%) or Pseudomonas spp. (7%). Main foci of infection were urinary tract (51%), abdomen/biliary tract (20%) and lower respiratory tract (14%). The main antibiotics used were co-amoxiclav (32%) and piperacillin-tazobactam (30%) with 34% receiving combination therapy (predominantly aminoglycosides). Empiric treatment was inappropriate in 34%. All-cause mortality was 8% at 7 days and 15% at 30 days. Independent predictors of mortality (p <0.05) included older age, greater burden of co-morbid disease, severity of illness at presentation and inflammatory response. Inappropriate empiric antibiotic therapy was not associated with mortality at either time-point (adjusted OR 0.82; 95% CI 0.35-1.94 and adjusted OR 0.92; 95% CI 0.50-1.66, respectively). Although our study does not exclude an impact of empiric antibiotic choice on survival in Gram-negative bacteraemia, outcome is determined primarily by patient and disease factors. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Ocular haemodynamic changes after single treatment with photodynamic therapy assessed with non-invasive techniques.

PubMed

Maar, Noemi; Pemp, Berthold; Kircher, Karl; Luksch, Alexandra; Weigert, Günther; Polska, Elzbieta; Tittl, Michael; Stur, Michael; Schmetterer, Leopold

2009-09-01

To investigate in patients with neovascular age-related macular degeneration (ARMD) the changes in ocular perfusion caused by single treatment with photodynamic therapy (PDT) by different non-invasive methods; to evaluate correlations between relative changes of ocular haemodynamic parameters after PDT among each other and compared to morphological parameters; and to assess this in relation to early changes of visual acuity. 17 consecutive patients with subfoveal choroidal neovascularization (CNV) caused by ARMD scheduled for PDT without previous PDT treatment (four patients with predominantly classic CNV and 13 patients with occult CNV). best-corrected visual acuity (before PDT, 6 and 8 weeks after PDT), fundus photography, fluorescein angiography, haemodynamic measurements with laser Doppler flowmetry (LDF), laser interferometry and ocular blood flow (OBF) tonometry (baseline and 1, 2, 6 and 8 weeks after treatment). choroidal blood flow (CHBF), fundus pulsation amplitude (FPA), pulsatile ocular blood flow (POBF), visual acuity. Changes smaller than 20% were considered clinically irrelevant. Ocular haemodynamic parameters did not change significantly in the follow-up period. Changes of haemodynamic parameters showed no correlation to treatment spot, morphological changes or visual acuity. Changes of visual acuity were comparable to results of earlier studies. Single treatment with PDT did not modify ocular blood flow parameters above 20% as assessed with different non-invasive methods.

Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review.

PubMed

Gregory, Bree; Peters, Lorna

2017-03-01

A consistent feature across cognitive-behavioural models of social anxiety disorder (SAD) is the central role of the self in the emergence and maintenance of the disorder. The strong emphasis placed on the self in these models and related empirical research has also been reflected in evidence-based treatments for the disorder. This systematic review provides an overview of the empirical literature investigating the role of self-related constructs (e.g., self-beliefs, self-images, self-focused attention) proposed in cognitive models of SAD, before examining how these constructs are modified during and following CBT for SAD. Forty-one studies met the inclusion criteria. Guided by Stopa's (2009a, b) model of self, most studies examined change in self-related content, followed by change in self-related processing. No study examined change in self-structure. Pre- to post-treatment reductions were observed in self-related thoughts and beliefs, self-esteem, self-schema, self-focused attention, and self-evaluation. Change in self-related constructs predicted and/or mediated social anxiety reduction, however relatively few studies examined this. Papers were limited by small sample sizes, failure to control for depression symptoms, lack of waitlist, and some measurement concerns. Future research directions are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Graduate Employability: A Review of Conceptual and Empirical Themes

ERIC Educational Resources Information Center

Tomlinson, Michael

2012-01-01

The purpose of this paper is to provide an overview of some of the dominant empirical and conceptual themes in the area of graduate employment and employability over the past decade. The paper considers the wider context of higher education (HE) and labour market change, and the policy thinking towards graduate employability. It draws upon various…

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

PubMed Central

Brouwer, Matthijs C.; Tunkel, Allan R.; van de Beek, Diederik

2010-01-01

Summary: The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease. PMID:20610819

School-Based Anxiety Treatments for Children and Adolescents

PubMed Central

Herzig-Anderson, Kathleen; Colognori, Daniela; Fox, Jeremy K.; Stewart, Catherine E.; Warner, Carrie Masia

2012-01-01

SUMMARY School-based empirically supported treatments for anxiety disorders are a promising avenue for providing necessary intervention to distressed youth who would otherwise never receive treatment. Sustaining such programs in school settings should be viewed as a multiple-stage process, from integration of the program into the institution and maintenance of the intervention to responding to institutional change and ownership of the program by the school.51 Given the scarce resources available to schools, additional research on embedding programs into the school culture and maximizing existing resources is essential to enhancing the sustainability of school-based interventions for anxiety disorders and reaching youth in need. PMID:22801000

"Next Time, Just Remember the Story": Unlearning Empire in Silko's "Ceremony"

ERIC Educational Resources Information Center

Akins, Adrienne

2012-01-01

In this article, the author discusses the unlearning empire in Leslie Marmon Silko's novel titled "Ceremony." "Ceremony' has received a wealth of critical attention. A number of scholars have identified the novel's treatment of education as a colonizing force used by the white American power structure to coerce assimilation of American Indians.…

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.

A Review on Attachment and Adolescent Substance Abuse: Empirical Evidence and Implications for Prevention and Treatment.

PubMed

Schindler, Andreas; Bröning, Sonja

2015-01-01

This paper reviews research on the relation of attachment and substance use disorders (SUD) in adolescence. Based on a theoretical introduction, we review evidence for a possible general link between SUD and insecure attachment, for links between specific forms of SUD and specific patterns of attachment, and for studies on family patterns of attachment in adolescence. Using medical and psychological databases, we identified 10 studies on adolescent SUD and another 13 studies on adult SUD. Empirical evidence strongly supports the assumption of insecure attachment in SUD samples. With regard to specific patterns of attachment, results mainly point towards fearful and dismissing-avoidance, whereas single studies report preoccupied and unresolved patterns. Results indicate different patterns of attachment in different groups of substance abusers, that is, fearful-avoidant attachment in heroin addicts and more heterogeneous results in abusers of other substances. Explorative data suggest different types of insecure family attachment patterns, which might imply different functions of substance abuse and lead to different treatment recommendations. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. Although a lot of research is still needed to address the unknowns in the relation between attachment and SUD, there is strong evidence for a general link between SUD and insecure attachment. Data on connections between different patterns of attachment and different pathways towards SUD are less conclusive but mainly point to disorganized and externalizing pathways. Evidence suggests that fostering attachment security might improve the outcome of state-of-the-art approaches in both early interventional treatment and prevention. Implications for individual and family approaches are outlined.

Integrated treatment options for male perpetrators of intimate partner violence.

PubMed

Crane, Cory A; Easton, Caroline J

2017-01-01

Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach. We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered. Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options. We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models. Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Parent predictors of child weight change in family based behavioral obesity treatment.

PubMed

Boutelle, Kerri N; Cafri, Guy; Crow, Scott J

2012-07-01

Family based behavioral treatment for overweight and obese children includes parenting skills targeting the modification of child eating and activity change. The purpose of this study was to examine parenting skills and parent weight change as predictors of child weight change in a sample of 80 parent/child dyads who were enrolled in a family based behavioral weight loss program for childhood obesity. Eighty overweight and obese children and their parents who enrolled in treatment in two sites were included in the study. Variables included those related to parent modeling (parent BMI), home food environment, parenting (parent and child report), and demographics. Results suggested that parent BMI change was a significant predictor of child weight, in that a reduction of 1 BMI unit in the parent was associated with a 0.255 reduction in child BMI. None of the other variables were significant in the final model. This study is consistent with other research showing that parent weight change is a key contributor to child weight change in behavioral treatment for childhood obesity. Researchers and clinicians should focus on encouraging parents to lose weight to assist their overweight and obese child in weight management.

Empirical equations for viscosity and specific heat capacity determination of paraffin PCM and fatty acid PCM

NASA Astrophysics Data System (ADS)

Barreneche, C.; Ferrer, G.; Palacios, A.; Solé, A.; Inés Fernández, A.; Cabeza, L. F.

2017-10-01

Phase change materials (PCM) used in thermal energy storage (TES) systems have been presented, over recent years, as one of the most effective options in energy storage. Paraffin and fatty acids are some of the most used PCM in TES systems, as they have high phase change enthalpy and in addition they do not present subcooling nor hysteresis and have proper cycling stability. The simulations and design of TES systems require the knowledge of the thermophysical properties of PCM. Thermal conductivity, viscosity, specific heat capacity (Cp) can be experimentally determined, but these are material and time consuming tasks. To avoid or to reduce them, and to have reliable data without the need of experimentation, thermal properties can be calculated by empirical equations. In this study, five different equations are given to calculate the viscosity and specific heat capacity of fatty acid PCM and paraffin PCM. Two of these equations concern, respectively, the empirical calculation of the viscosity and liquid Cp of the whole paraffin PCM family, while the other three equations presented are for the corresponding calculation of viscosity, solid Cp, liquid Cp of the whole fatty acid family of PCM. Therefore, this study summarize the work performed to obtain the main empirical equations to measure the above mentioned properties for whole fatty acid PCM family and whole paraffin PCM family. Moreover, empirical equations have been obtained to calculate these properties for other materials of these PCM groups and these empirical equations can be extrapolated for PCM with higher or lower phase change temperatures within a lower relative error 4%.

Comparison of binding energies of SrcSH2-phosphotyrosyl peptides with structure-based prediction using surface area based empirical parameterization.

PubMed Central

Henriques, D. A.; Ladbury, J. E.; Jackson, R. M.

2000-01-01

The prediction of binding energies from the three-dimensional (3D) structure of a protein-ligand complex is an important goal of biophysics and structural biology. Here, we critically assess the use of empirical, solvent-accessible surface area-based calculations for the prediction of the binding of Src-SH2 domain with a series of tyrosyl phosphopeptides based on the high-affinity ligand from the hamster middle T antigen (hmT), where the residue in the pY+ 3 position has been changed. Two other peptides based on the C-terminal regulatory site of the Src protein and the platelet-derived growth factor receptor (PDGFR) are also investigated. Here, we take into account the effects of proton linkage on binding, and test five different surface area-based models that include different treatments for the contributions to conformational change and protein solvation. These differences relate to the treatment of conformational flexibility in the peptide ligand and the inclusion of proximal ordered solvent molecules in the surface area calculations. This allowed the calculation of a range of thermodynamic state functions (deltaCp, deltaS, deltaH, and deltaG) directly from structure. Comparison with the experimentally derived data shows little agreement for the interaction of SrcSH2 domain and the range of tyrosyl phosphopeptides. Furthermore, the adoption of the different models to treat conformational change and solvation has a dramatic effect on the calculated thermodynamic functions, making the predicted binding energies highly model dependent. While empirical, solvent-accessible surface area based calculations are becoming widely adopted to interpret thermodynamic data, this study highlights potential problems with application and interpretation of this type of approach. There is undoubtedly some agreement between predicted and experimentally determined thermodynamic parameters: however, the tolerance of this approach is not sufficient to make it ubiquitously applicable

Ethical and Epistemic Dilemmas in Empirically-Engaged Philosophy of Education

ERIC Educational Resources Information Center

Newman, Anne; Glass, Ronald David

2015-01-01

This essay examines several ethical and epistemological issues that arise when philosophers conduct empirical research focused on, or in collaboration with, community groups seeking to bring about systemic change. This type of research can yield important policy lessons about effective community-driven reform and how to incorporate the voices of…

Pattern of Changes during Treatment: A Comparison between a Positive Psychology Intervention and a Cognitive Behavioral Treatment for Clinical Depression.

PubMed

Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo

2017-10-26

Research on psychotherapy has traditionally focused on analyzing changes between the beginning and the end of a treatment. Few studies have addressed the pattern of therapeutic change during treatment. The aim of this study was to examine the pattern of changes in clinical and well-being variables during a cognitive behavioral therapy (CBT) program compared with an integrative positive psychology interventions program for clinical depression IPPI-D. 128 women with a diagnosis of major depression or dysthymia were assigned to the CBT or PPI group. A measure of depressive symptoms (i.e., Beck Depression Inventory) and well-being (i.e., Pemberton Happiness Index) were administered four times: at the beginning and end of the treatment, as well as during treatment (at sessions 4 and 7). Through mixed-model repeated measures ANOVAs, both depressive symptoms (p .08). The percentage of improvement in depressive symptoms in the first treatment period was higher than in the later ones (ps < .005). On the contrary, well-being showed a more gradual improvement (p = .15). These results highlight the importance of assessing the pattern of changes in symptoms and well-being separately.

Response in the water quality of the Salton Sea, California, to changes in phosphorus loading: An empirical modeling approach

USGS Publications Warehouse

Robertson, Dale M.; Schladow, S.G.

2008-01-01

Salton Sea, California, like many other lakes, has become eutrophic because of excessive nutrient loading, primarily phosphorus (P). A Total Maximum Daily Load (TMDL) is being prepared for P to reduce the input of P to the Sea. In order to better understand how P-load reductions should affect the average annual water quality of this terminal saline lake, three different eutrophication programs (BATHTUB, WiLMS, and the Seepage Lake Model) were applied. After verifying that specific empirical models within these programs were applicable to this saline lake, each model was calibrated using water-quality and nutrient-loading data for 1999 and then used to simulate the effects of specific P-load reductions. Model simulations indicate that a 50% decrease in external P loading would decrease near-surface total phosphorus concentrations (TP) by 25-50%. Application of other empirical models demonstrated that this decrease in loading should decrease near-surface chlorophyll a concentrations (Chl a) by 17-63% and increase Secchi depths (SD) by 38-97%. The wide range in estimated responses in Chl a and SD were primarily caused by uncertainty in how non-algal turbidity would respond to P-load reductions. If only the models most applicable to the Salton Sea are considered, a 70-90% P-load reduction is required for the Sea to be classified as moderately eutrophic (trophic state index of 55). These models simulate steady-state conditions in the Sea; therefore, it is difficult to ascertain how long it would take for the simulated changes to occur after load reductions. ?? 2008 Springer Science+Business Media B.V.

Opinion formation on social media: An empirical approach

NASA Astrophysics Data System (ADS)

Xiong, Fei; Liu, Yun

2014-03-01

Opinion exchange models aim to describe the process of public opinion formation, seeking to uncover the intrinsic mechanism in social systems; however, the model results are seldom empirically justified using large-scale actual data. Online social media provide an abundance of data on opinion interaction, but the question of whether opinion models are suitable for characterizing opinion formation on social media still requires exploration. We collect a large amount of user interaction information from an actual social network, i.e., Twitter, and analyze the dynamic sentiments of users about different topics to investigate realistic opinion evolution. We find two nontrivial results from these data. First, public opinion often evolves to an ordered state in which one opinion predominates, but not to complete consensus. Second, agents are reluctant to change their opinions, and the distribution of the number of individual opinion changes follows a power law. Then, we suggest a model in which agents take external actions to express their internal opinions according to their activity. Conversely, individual actions can influence the activity and opinions of neighbors. The probability that an agent changes its opinion depends nonlinearly on the fraction of opponents who have taken an action. Simulation results show user action patterns and the evolution of public opinion in the model coincide with the empirical data. For different nonlinear parameters, the system may approach different regimes. A large decay in individual activity slows down the dynamics, but causes more ordering in the system.

ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI.

PubMed

Lingenfelter, Erin; Drapkin, Zachary; Fritz, Kelly; Youngquist, Scott; Madsen, Troy; Fix, Megan

2016-08-01

We sought to determine whether an emergency department (ED) pharmacist could aid in the monitoring and correction of inappropriate empiric antibiotic selection for urinary tract infections in an outpatient ED population. Urine cultures with greater than 100 000 CFU/mL bacteria from the University of Utah Emergency Department over 1 year (October 2011-Sept 2012) were identified using our electronic medical record system. Per ED protocol, an ED pharmacist reviews all cultures and performs a chart review of patient symptoms, diagnosis, and discharge antibiotics to determine whether the treatment was appropriate. A retrospective review of this process was performed to identify how often inappropriate treatment was recognized and intervened on by an ED pharmacist. Of the 180 cultures included, a total of 42 (23%) of empiric discharge treatments were considered inappropriate and required intervention. In 35 (83%) of 42 patients, the ED pharmacist was able to contact the patient and make appropriate changes; the remaining 7 patients were unable to be contacted, and no change could be made in their treatment. A chart review of all urine cultures with greater than 100 000 CFU/mL performed by an ED pharmacist helped identify inappropriate treatment in 23% of patients discharged to home with the diagnosis of urinary tract infection. Of these patients who had received inappropriate treatment, an ED pharmacist was able to intervene in 83% of cases. These data highlight the role of ED pharmacists in improving patient care after discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

A model of therapist competencies for the empirically supported interpersonal psychotherapy for adolescent depression.

PubMed

Sburlati, Elizabeth S; Lyneham, Heidi J; Mufson, Laura H; Schniering, Carolyn A

2012-06-01

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89-109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89-109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.

Empirical population and public health ethics: A review and critical analysis to advance robust empirical-normative inquiry.

PubMed

Knight, Rod

2016-05-01

The field of population and public health ethics (PPHE) has yet to fully embrace the generation of evidence as an important project. This article reviews the philosophical debates related to the 'empirical turn' in clinical bioethics, and critically analyses how PPHE has and can engage with the philosophical implications of generating empirical data within the task of normative inquiry. A set of five conceptual and theoretical issues pertaining to population health that are unresolved and could potentially benefit from empirical PPHE approaches to normative inquiry are discussed. Each issue differs from traditional empirical bioethical approaches, in that they emphasize (1) concerns related to the population, (2) 'upstream' policy-relevant health interventions - within and outside of the health care system and (3) the prevention of illness and disease. Within each theoretical issue, a conceptual example from population and public health approaches to HIV prevention and health promotion is interrogated. Based on the review and critical analysis, this article concludes that empirical-normative approaches to population and public health ethics would be most usefully pursued as an iterative project (rather than as a linear project), in which the normative informs the empirical questions to be asked and new empirical evidence constantly directs conceptualizations of what constitutes morally robust public health practices. Finally, a conceptualization of an empirical population and public health ethics is advanced in order to open up new interdisciplinary 'spaces', in which empirical and normative approaches to ethical inquiry are transparently (and ethically) integrated. © The Author(s) 2015.

The response of substance use disorder treatment providers to changes in macroeconomic conditions.

PubMed

Cantor, Jonathan; Stoller, Kenneth B; Saloner, Brendan

2017-10-01

To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. Secondary data analysis in the N-SSATS. Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models. Copyright © 2017 Elsevier Inc. All rights reserved.

The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD

ERIC Educational Resources Information Center

Lang, Ariel J.; Strauss, Jennifer L.; Bomyea, Jessica; Bormann, Jill E.; Hickman, Steven D.; Good, Raquel C.; Essex, Michael

2012-01-01

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness.…

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome.

PubMed

Agüera, Zaida; Romero, Xandra; Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C; Fernández-Real, José M; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J; Crujeiras, Ana B; Casanueva, Felipe F; Menchón, José M; Fernández-Aranda, Fernando

2015-01-01

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.

Empire: An Analytical Category for Educational Research

ERIC Educational Resources Information Center

Coloma, Roland Sintos

2013-01-01

In this article Roland Sintos Coloma argues for the relevance of empire as an analytical category in educational research. He points out the silence in mainstream studies of education on the subject of empire, the various interpretive approaches to deploying empire as an analytic, and the importance of indigeneity in research on empire and…

Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

PubMed Central

Retamar, Pilar; Portillo, María M.; López-Prieto, María Dolores; Rodríguez-López, Fernando; de Cueto, Marina; García, María V.; Gómez, María J.; del Arco, Alfonso; Muñoz, Angel; Sánchez-Porto, Antonio; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, Ascensión; García-Figueras, Carolina; Acosta, Federico; Corzo, Juan E.; León-Ruiz, Laura; Escobar-Lara, Trinidad

2012-01-01

The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented. PMID:22005999

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology

PubMed Central

Forbes, Miriam K.; Baillie, Andrew J.; Eaton, Nicholas R.; Krueger, Robert F.

2017-01-01

Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or “spectra”). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research. PMID:28121167

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology.

PubMed

Forbes, Miriam K; Baillie, Andrew J; Eaton, Nicholas R; Krueger, Robert F

Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or "spectra"). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research.

Soil C and N minimum detectable changes and treatment differences in a multi-treatment forest experiment.

Treesearch

P.S. Homann; B.T. Bormann; J.R. Boyle; R.L. Darbyshire; R. Bigley

2008-01-01

Detecting changes in forest soil C and N is vital to the study of global budgets and long-term ecosystem productivity. Identifying differences among land-use practices may guide future management. Our objective was to determine the relation of minimum detectable changes (MDCs) and minimum detectable differences between treatments (MDDs) to soil C and N variability at...

The importance of culture in treating abused and neglected children: an empirical review.

PubMed

Cohen, J A; Deblinger, E; Mannarino, A P; de Arellano, M A

2001-05-01

There is growing evidence that cultural factors may influence symptom development and treatment referral patterns among abused and neglected children. To date, few treatment outcome studies have specifically examined the impact of race, culture, or ethnicity on treatment response among maltreated children. Those that have attempted to include these factors have typically suffered from lack of clarity of the meaning of these terms. This article reviews the available empirical evidence that addresses the influence of culture on symptom formation, treatment-seeking behaviors, treatment preference, and response following child maltreatment. Hypotheses regarding these findings are addressed, and implications for practice, research, and public policy are discussed.

Patterns Exploration on Patterns of Empirical Herbal Formula of Chinese Medicine by Association Rules

PubMed Central

Huang, Li; Yuan, Jiamin; Yang, Zhimin; Xu, Fuping; Huang, Chunhua

2015-01-01

Background. In this study, we use association rules to explore the latent rules and patterns of prescribing and adjusting the ingredients of herbal decoctions based on empirical herbal formula of Chinese Medicine (CM). Materials and Methods. The consideration and development of CM prescriptions based on the knowledge of CM doctors are analyzed. The study contained three stages. The first stage is to identify the chief symptoms to a specific empirical herbal formula, which can serve as the key indication for herb addition and cancellation. The second stage is to conduct a case study on the empirical CM herbal formula for insomnia. Doctors will add extra ingredients or cancel some of them by CM syndrome diagnosis. The last stage of the study is to divide the observed cases into the effective group and ineffective group based on the assessed clinical effect by doctors. The patterns during the diagnosis and treatment are selected by the applied algorithm and the relations between clinical symptoms or indications and herb choosing principles will be selected by the association rules algorithm. Results. Totally 40 patients were observed in this study: 28 patients were considered effective after treatment and the remaining 12 were ineffective. 206 patterns related to clinical indications of Chinese Medicine were checked and screened with each observed case. In the analysis of the effective group, we used the algorithm of association rules to select combinations between 28 herbal adjustment strategies of the empirical herbal formula and the 190 patterns of individual clinical manifestations. During this stage, 11 common patterns were eliminated and 5 major symptoms for insomnia remained. 12 association rules were identified which included 5 herbal adjustment strategies. Conclusion. The association rules method is an effective algorithm to explore the latent relations between clinical indications and herbal adjustment strategies for the study on empirical herbal formulas

Validating Culturally Relevant Treatment Interventions: What Are We Trying To Change? or Challenges to the Development of Culturally Relevant or Specific Empirically Validated Treatment.

ERIC Educational Resources Information Center

Coleman, Hardin L. K.

This paper presents an example of a patient treated in a school-based clinic. The counselor used traditional diagnostic perspectives to come up with a diagnosis that would be understood by the patient's Health Maintenance Organization. This diagnosis reflects traditional understanding of mental health and psychological treatment, which promotes…

An empirical system for probabilistic seasonal climate prediction

NASA Astrophysics Data System (ADS)

Eden, Jonathan; van Oldenborgh, Geert Jan; Hawkins, Ed; Suckling, Emma

2016-04-01

Preparing for episodes with risks of anomalous weather a month to a year ahead is an important challenge for governments, non-governmental organisations, and private companies and is dependent on the availability of reliable forecasts. The majority of operational seasonal forecasts are made using process-based dynamical models, which are complex, computationally challenging and prone to biases. Empirical forecast approaches built on statistical models to represent physical processes offer an alternative to dynamical systems and can provide either a benchmark for comparison or independent supplementary forecasts. Here, we present a simple empirical system based on multiple linear regression for producing probabilistic forecasts of seasonal surface air temperature and precipitation across the globe. The global CO2-equivalent concentration is taken as the primary predictor; subsequent predictors, including large-scale modes of variability in the climate system and local-scale information, are selected on the basis of their physical relationship with the predictand. The focus given to the climate change signal as a source of skill and the probabilistic nature of the forecasts produced constitute a novel approach to global empirical prediction. Hindcasts for the period 1961-2013 are validated against observations using deterministic (correlation of seasonal means) and probabilistic (continuous rank probability skill scores) metrics. Good skill is found in many regions, particularly for surface air temperature and most notably in much of Europe during the spring and summer seasons. For precipitation, skill is generally limited to regions with known El Niño-Southern Oscillation (ENSO) teleconnections. The system is used in a quasi-operational framework to generate empirical seasonal forecasts on a monthly basis.

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma.

PubMed

Markoff, Laurie S; Finkelstein, Norma; Kammerer, Nina; Kreiner, Peter; Prost, Carol A

2005-01-01

This article describes the "relational systems change" model developed by the Institute for Health and Recovery, and the implementation of the model in Massachusetts from 1998-2002 to facilitate systems change to support the delivery of integrated and trauma-informed services for women with co-occurring substance abuse and mental health disorders and histories of violence and empirical evidence of resulting systems changes. The federally funded Women Embracing Life and Living (WELL) Project utilized relational strategies to facilitate systems change within and across 3 systems levels: local treatment providers, community (or region), and state. The WELL Project demonstrates that a highly collaborative, inclusive, and facilitated change process can effect services integration within agencies (intra-agency), strengthen integration within a regional network of agencies (interagency), and foster state support for services integration.

Empiric validation of a process for behavior change.

PubMed

Elliot, Diane L; Goldberg, Linn; MacKinnon, David P; Ranby, Krista W; Kuehl, Kerry S; Moe, Esther L

2016-09-01

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.

Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative?

PubMed

Brand, Bethany; Loewenstein, Richard J

2014-01-01

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.

[Changes in psychopathological symptoms during the waiting period for outpatient psychotherapy].

PubMed

Huckert, Thomas Frank; Hank, Petra; Krampen, Günter

2012-08-01

This study empirically tests symptom changes in a sample of 106 psychotherapy outpatients during a 6-month waiting period before treatment commencement. Using indirect measurement of change, the patients improve in psychopathological symptoms. Using direct measurement of change, 48% of the outpatients show no significant change in psychopathological symptoms. However, the symptoms of 29% improve and 23% worsen. Using multinomial logistic regression, group membership (no change, positive change, negative change) can be predicted by personality traits for 60% of the patients. Social trust negatively predicts changes for the worse. Liberal gender-role orientation positively predicts improvement. A positive self-concept of ability positively predicts changes for the worse. Moreover sociodemographic variables correctly predict group membership for 57% of the patients. Age positively predicts changes for the worse. Female gender negatively predicts improvement. © Georg Thieme Verlag KG Stuttgart · New York.

Economic Comparison of an Empirical Versus Diagnostic-Driven Strategy for Treating Invasive Fungal Disease in Immunocompromised Patients.

PubMed

Barnes, Rosemary; Earnshaw, Stephanie; Herbrecht, Raoul; Morrissey, Orla; Slavin, Monica; Bow, Eric; McDade, Cheryl; Charbonneau, Claudie; Weinstein, David; Kantecki, Michal; Schlamm, Haran; Maertens, Johan

2015-06-01

Patients with persistent or recurrent neutropenic fevers at risk of invasive fungal disease (IFD) are treated empirically with antifungal therapy (AFT). Early treatment using a diagnostic-driven (DD) strategy may reduce clinical and economic burdens. We compared costs and outcomes of both strategies from a UK perspective. An empirical strategy with conventional amphotericin B deoxycholate (C-AmB), liposomal amphotericin B (L-AmB), or caspofungin was compared with a DD strategy (initiated based on positive ELISA results for galactomannan antigen) and/or positive results for Aspergillus species on polymerase chain reaction assay) using C-AmB, voriconazole, or L-AmB in a decision-analytic model. Rates of IFD incidence, overall mortality, and IFD-related mortality in adults expected to be neutropenic for ≥10 days were obtained. The empirical strategy was assumed to identify 30% of IFD and targeted AFT to improve survival by a hazard ratio of 0.589. AFT-specific adverse events were obtained from a summary of product characteristics. Resource use was obtained, and costs were estimated by using standard UK costing sources. All costs are presented in 2012 British pounds sterling. Total costs were 32% lower for the DD strategy (£1561.29) versus the empirical strategy (£2301.93) due to a reduced incidence of adverse events and decreased use of AFT. Administration of AFT was reduced by 41% (DD strategy, 74 of 1000; empirical strategy, 125 of 1000), with similar survival rates. This study suggests that a DD strategy is likely to be cost-saving versus empirical treatment for immunocompromised patients with persistent or recurrent neutropenic fevers. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

What Have We Learned about Treatment Failure in Empirically Supported Treatments? Some Suggestions for Practice

ERIC Educational Resources Information Center

Lambert, Michael J.

2011-01-01

The examination of treatment failure has substantial value in advancing psychological practice as illustrated by the articles in this special issue. Treatment failure is not well defined and includes at least two independent phenomena: nonresponse and deterioration. After discussing the important distinction between nonresponse to treatment and…

Comparing the model-simulated global warming signal to observations using empirical estimates of unforced noise.

PubMed

Brown, Patrick T; Li, Wenhong; Cordero, Eugene C; Mauget, Steven A

2015-04-21

The comparison of observed global mean surface air temperature (GMT) change to the mean change simulated by climate models has received much public and scientific attention. For a given global warming signal produced by a climate model ensemble, there exists an envelope of GMT values representing the range of possible unforced states of the climate system (the Envelope of Unforced Noise; EUN). Typically, the EUN is derived from climate models themselves, but climate models might not accurately simulate the correct characteristics of unforced GMT variability. Here, we simulate a new, empirical, EUN that is based on instrumental and reconstructed surface temperature records. We compare the forced GMT signal produced by climate models to observations while noting the range of GMT values provided by the empirical EUN. We find that the empirical EUN is wide enough so that the interdecadal variability in the rate of global warming over the 20(th) century does not necessarily require corresponding variability in the rate-of-increase of the forced signal. The empirical EUN also indicates that the reduced GMT warming over the past decade or so is still consistent with a middle emission scenario's forced signal, but is likely inconsistent with the steepest emission scenario's forced signal.

Comparing the model-simulated global warming signal to observations using empirical estimates of unforced noise

PubMed Central

Brown, Patrick T.; Li, Wenhong; Cordero, Eugene C.; Mauget, Steven A.

2015-01-01

The comparison of observed global mean surface air temperature (GMT) change to the mean change simulated by climate models has received much public and scientific attention. For a given global warming signal produced by a climate model ensemble, there exists an envelope of GMT values representing the range of possible unforced states of the climate system (the Envelope of Unforced Noise; EUN). Typically, the EUN is derived from climate models themselves, but climate models might not accurately simulate the correct characteristics of unforced GMT variability. Here, we simulate a new, empirical, EUN that is based on instrumental and reconstructed surface temperature records. We compare the forced GMT signal produced by climate models to observations while noting the range of GMT values provided by the empirical EUN. We find that the empirical EUN is wide enough so that the interdecadal variability in the rate of global warming over the 20th century does not necessarily require corresponding variability in the rate-of-increase of the forced signal. The empirical EUN also indicates that the reduced GMT warming over the past decade or so is still consistent with a middle emission scenario's forced signal, but is likely inconsistent with the steepest emission scenario's forced signal. PMID:25898351

Routine Treatment of Cervical Cytological Cell Changes

PubMed Central

Huber, J.; Pötsch, B.; Gantschacher, M.; Templ, M.

2016-01-01

Introduction: Diagnosis and treatment of vaginal and cervical cytological cell changes are described in European and national guidelines. The aim of this data collection was to evaluate the remission rates of PAP III and PAP III D cytological findings in patients over a period of 3–4 months. Method: The current state of affairs in managing suspicious and cytological findings (PAP III, and III D) in gynecological practice was assessed in the context of a data collection survey. An evaluation over a period of 24 months was conducted on preventative measures, the occurrence and changes to normal/suspect/pathological findings and therapy management (for suspicious or pathological findings). Results: 307 female patients were included in the analysis. At the time of the survey 186 patients (60.6 %) had PAP III and 119 (38.8 %) had PAP III D findings. The spontaneous remission rate of untreated PAP III patients was 6 % and that of untreated PAP III D patients was 11 %. The remission rates of patients treated with a vaginal gel were 77 % for PAP III and 71 % for PAP III D. Conclusion: A new treatment option was used in gynecological practice on patients with PAP III and PAP III D findings between confirmation and the next follow-up with excellent success. PMID:27761030

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

DOE PAGES

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

2017-07-10

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981–2004 hindcast yields over the coterminous United States (US) against US Departmentmore » of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. In conclusion, this disparity is largely attributable to heterogeneity in GGCMs' responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.« less

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

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

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981–2004 hindcast yields over the coterminous United States (US) against US Departmentmore » of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. In conclusion, this disparity is largely attributable to heterogeneity in GGCMs' responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.« less

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

NASA Astrophysics Data System (ADS)

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

2017-07-01

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981-2004 hindcast yields over the coterminous United States (US) against US Department of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. This disparity is largely attributable to heterogeneity in GGCMs’ responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.

Changing attitudes about spanking among conservative Christians using interventions that focus on empirical research evidence and progressive biblical interpretations.

PubMed

Miller-Perrin, Cindy; Perrin, Robin

2017-09-01

This study examined how interventions that include either empirical research evidence about spanking, progressive biblical interpretations, or both, affect attitudes and intentions about spanking. A sample of 129 college students (70% female; 30% male; M age =19) attending a private, Christian university was randomly assigned to one of three intervention conditions: (1) Research Only, (2) Religion Only, or (3) Research and Religion. Four weeks prior to the intervention sessions, students completed a Demographic Form, the Religious Fundamentalism Scale, and the Attitudes Toward Spanking (ATS) scale. Following the intervention, students completed the ATS scale a second time. A two-way ANOVA indicated a significant main effect for the intervention condition and an interaction effect between intervention condition and religious fundamentalism, indicating that positive spanking attitudes declined most significantly in the Research and Religion intervention condition (F(2, 123)=4.05, p=.02, hp 2 =.06) with the greatest change in attitudes among the Religious Fundamentalism Group in that condition (F(2, 123)=4.50, p=.01, hp 2 =.07). A second two-way ANOVA indicated a significant main effect for Conservative Protestant Affiliation (F(2, 123)=4.39, p=.04, hp 2 =.03) indicating that positive spanking attitudes declined most significantly for participants identifying with a conservative religious affiliation. Overall, the findings suggest that, especially among Conservative Protestants, interventions that focus on both empirical research and progressive biblical interpretations of scripture can reduce positive attitudes toward, and intentions to use, spanking. This study has implications for decreasing spanking use among Conservative Christians and for the development of training programs to reduce parents' use of spanking. Copyright © 2017 Elsevier Ltd. All rights reserved.

Plausibility Judgments in Conceptual Change and Epistemic Cognition

ERIC Educational Resources Information Center

Lombardi, Doug; Nussbaum, E. Michael; Sinatra, Gale M.

2016-01-01

Plausibility judgments rarely have been addressed empirically in conceptual change research. Recent research, however, suggests that these judgments may be pivotal to conceptual change about certain topics where a gap exists between what scientists and laypersons find plausible. Based on a philosophical and empirical foundation, this article…

Changes in personal networks of women in residential and outpatient substance abuse treatment.

PubMed

Min, Meeyoung O; Tracy, Elizabeth M; Kim, Hyunsoo; Park, Hyunyong; Jun, Minkyoung; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre

2013-10-01

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment. Copyright © 2013 Elsevier Inc. All rights reserved.

Changes in Personal Networks of Women in Residential and Outpatient Substance Abuse Treatment

PubMed Central

Min, Meeyoung O.; Tracy, Elizabeth M.; Kim, Hyunsoo; Park, Hyunyong; Jun, MinKyong; Brown, Suzanne; McCarty, Christopher; Laudet, Alexandre

2013-01-01

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment. PMID:23755971

Data-driven regions of interest for longitudinal change in frontotemporal lobar degeneration.

PubMed

Pankov, Aleksandr; Binney, Richard J; Staffaroni, Adam M; Kornak, John; Attygalle, Suneth; Schuff, Norbert; Weiner, Michael W; Kramer, Joel H; Dickerson, Bradford C; Miller, Bruce L; Rosen, Howard J

2016-01-01

Current research is investigating the potential utility of longitudinal measurement of brain structure as a marker of drug effect in clinical trials for neurodegenerative disease. Recent studies in Alzheimer's disease (AD) have shown that measurement of change in empirically derived regions of interest (ROIs) allows more reliable measurement of change over time compared with regions chosen a-priori based on known effects of AD on brain anatomy. Frontotemporal lobar degeneration (FTLD) is a devastating neurodegenerative disorder for which there are no approved treatments. The goal of this study was to identify an empirical ROI that maximizes the effect size for the annual rate of brain atrophy in FTLD compared with healthy age matched controls, and to estimate the effect size and associated power estimates for a theoretical study that would use change within this ROI as an outcome measure. Eighty six patients with FTLD were studied, including 43 who were imaged twice at 1.5 T and 43 at 3 T, along with 105 controls (37 imaged at 1.5 T and 67 at 3 T). Empirically-derived maps of change were generated separately for each field strength and included the bilateral insula, dorsolateral, medial and orbital frontal, basal ganglia and lateral and inferior temporal regions. The extent of regions included in the 3 T map was larger than that in the 1.5 T map. At both field strengths, the effect sizes for imaging were larger than for any clinical measures. At 3 T, the effect size for longitudinal change measured within the empirically derived ROI was larger than the effect sizes derived from frontal lobe, temporal lobe or whole brain ROIs. The effect size derived from the data-driven 1.5 T map was smaller than at 3 T, and was not larger than the effect size derived from a-priori ROIs. It was estimated that measurement of longitudinal change using 1.5 T MR systems requires approximately a 3-fold increase in sample size to obtain effect sizes equivalent to those seen at

On the treatment of ℓ-changing proton-hydrogen Rydberg atom collisions

NASA Astrophysics Data System (ADS)

Vrinceanu, D.; Onofrio, R.; Sadeghpour, H. R.

2017-11-01

Energy-conserving, angular momentum changing collisions between protons and highly excited Rydberg hydrogen atoms are important for precise understanding of atomic recombination at the photon decoupling era and the elemental abundance after primordial nucleosynthesis. Early approaches to ℓ-changing collisions used perturbation theory only for dipole-allowed (Δℓ = ±1) transitions. An exact non-perturbative quantum mechanical treatment is possible, but it comes at a computational cost for highly excited Rydberg states. In this paper, we show how to obtain a semiclassical limit that is accurate and simple, and develop further physical insights afforded by the non-perturbative quantum mechanical treatment.

On the Treatment of l-changing Proton-hydrogen Rydberg Atom Collisions

NASA Astrophysics Data System (ADS)

Vrinceanu, Daniel; Onofrio, Roberto; Sadeghpour, Hossein

2018-01-01

Energy-conserving, angular momentum-changing collisions between protons and highly excited Rydberg hydrogen atoms are important for precise understanding of the primordial recombination cascade, and the elemental abundance.Early approaches to l-changing collisions used perturbation theory for only dipole-allowed (Δl = ±1) transitions. An exact non-perturbative quantum mechanical treatment is possible, but it comes at computational cost for highly excited Rydberg states. In this note we show how to obtain a semi-classical limit that is accurate and simple, and develop further physical insights afforded by the non-perturbative quantum mechanical treatment.

Mediators of Change in the Child/Adolescent Anxiety Multimodal Treatment Study

PubMed Central

Kendall, Philip C.; Cummings, Colleen M.; Villabø, Marianne A.; Narayanan, Martina K.; Treadwell, Kimberli; Birmaher, Boris; Compton, Scott; Piacentini, John; Sherrill, Joel; Walkup, John; Gosch, Elizabeth; Keeton, Courtney; Ginsburg, Golda; Suveg, Cindy; Albano, Anne Marie

2015-01-01

Objective Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met DSM-IV criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator. PMID:26460572

Do patterns of change during treatment for panic disorder predict future panic symptoms?

PubMed Central

Steinman, Shari A.; Hunter, Michael D.; Teachman, Bethany A.

2012-01-01

Background and Objectives Cognitive-behavioral therapies are currently the gold standard for panic disorder treatment, with well-documented treatment response. However, following interventions, some individuals continue to improve, while others experience a return of symptoms. The field lacks reliable ways to predict follow-up symptomology. In the current study, a cluster analysis with a repeated measures design was conducted to examine change patterns over 12 weeks of cognitive behavioral group therapy for panic disorder. The central aim of the study was to evaluate if change patterns predict level of panic symptom severity at a six month follow-up in this sample. Methods Individuals with panic disorder (N = 36) completed a measure of panic symptoms (Panic Disorder Severity Scale) at the outset of every therapy session and at a six month follow-up. Results Results revealed three patterns of change in this specific trial, which significantly predicted level of panic symptoms six months post-treatment, beyond initial or final level of panic symptoms, and beyond total symptom change. Limitations Given the relatively small, lab-based sample, replications in other settings and samples will be important. Conclusions Overall, results provide initial evidence that change patterns are meaningful predictors of panic symptom severity well after the final session of treatment. PMID:23187115

Motivation for Treatment and Motivation for Change in Substance-Dependent Patients with Co-Occurring Psychiatric Disorders.

PubMed

de Weert-van Oene, Gerdien H; Gongora, Vanesa; von Sternberg, Kirk; de Jong, Cor A J

2015-01-01

The aims of this study were to examine the relationship between motivation for treatment and for change, and to explore their role in the prediction of treatment completion. The sample was composed of 560 predominantly polydrug-using inpatients with co-occurring psychiatric disorders. Motivation for treatment was assessed with the Motivation for Treatment Scales, and motivation for change was measured with the Readiness to Change Questionnaire. Patients indicated strong motivation to change illegal drug and alcohol use. In initial factor analysis, motivation for treatment and for change did not load on the same factors, confirming that these are distinct domains. Four categories were discerned with respect to readiness for treatment and for change, with low agreement between the two. In performing survival analysis, we found that being in readiness category 4 (RT↑RC↑) was associated with a greater chance of remaining in treatment for a period of 105 days without premature attrition (Log Rank chi-sq=5.000; p=0.02). To a limited extent, intake measures of motivation can be used to predict attrition from treatment. Clinicians can use motivation assessment both for clinical purposes and in the prediction of those who need extra monitoring due to increased risk of premature attrition.

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome

PubMed Central

Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M.; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C.; Fernández-Real, José M.; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J.; Crujeiras, Ana B.; Casanueva, Felipe F.; Menchón, José M.; Fernández-Aranda, Fernando

2015-01-01

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome. PMID:26600309

The Changing Treatment Landscape for Metastatic Urothelial Carcinoma.

PubMed

Flaig, Thomas W

2018-05-01

Urothelial carcinoma is the predominant histologic type of bladder cancer. After 30 years of minimal progress in the treatment of advanced-stage disease, recent advances in the genomic characterization of urothelial cancer and breakthroughs in bladder cancer therapeutics have rejuvenated the field. Nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab are among the exciting recent novel therapeutic advances gaining approvals by the FDA for treatment of advanced-stage urothelial carcinoma. Yet the challenge for clinicians is to determine the optimal choice of agents as first-line or second-line therapy and which offers the best chance for overall survival for the individual patient in this rapidly changing field. Copyright © 2018 by the National Comprehensive Cancer Network.

Rape: psychopathology, theory and treatment.

PubMed

Gannon, Theresa A; Collie, Rachael M; Ward, Tony; Thakker, Jo

2008-07-01

Whether treatment programs are effective at rehabilitating rapists is yet to be determined empirically. From a scientist-practitioner perspective, treatment should be based on an empirical understanding of rape and rapists, and evidence-based knowledge of treatment outcome with rapists. In this paper we comprehensively review the characteristics of rapists, etiological features implicated in the commission of rape, and relevant treatment outcome research. We pay particular attention to contemporary knowledge about the core vulnerabilities and features required to understand and treat rapists effectively, and, where possible, highlight similarities and differences between rapists, child molesters and non-sexual violent offenders. We use an epistemological framework to (a) critique the various etiological accounts of rape available and (b) help guide professionals' use of such knowledge in both treatment design and evaluation. Gaps in the understanding of rapists' characteristics and etiological features are highlighted, as are discrepancies between current knowledge and treatment approaches. We conclude by highlighting areas for future research and practice innovation.

Pluvials, Droughts, the Mongol Empire, and Modern Mongolia

NASA Astrophysics Data System (ADS)

Hessl, A. E.; Pederson, N.; Baatarbileg, N.; Anchukaitis, K. J.

2013-12-01

Understanding the connections between climate, ecosystems, and society during historical and modern climatic transitions requires annual resolution records with high fidelity climate signals. Many studies link the demise of complex societies with deteriorating climate conditions, but few have investigated the connection between climate, surplus energy, and the rise of empires. Inner Asia in the 13th century underwent a major political transformation requiring enormous energetic inputs that altered human history. The Mongol Empire, centered on the city of Karakorum, became the largest contiguous land empire in world history (Fig. 1 inset). Powered by domesticated grazing animals, the empire grew at the expense of sedentary agriculturalists across Asia, the Middle East, and Eastern Europe. Although some scholars and conventional wisdom agree that dry conditions spurred the Mongol conquests, little paleoenvironmental data at annual resolution are available to evaluate the role of climate in the development of the Mongol Empire. Here we present a 2600 year tree-ring reconstruction of warm-season, self-calibrating Palmer Drought Severity Index (scPDSI), a measure of water balance, derived from 107 live and dead Siberian pine (Pinus sibirica) trees growing on a Holocene lava flow in central Mongolia. Trees growing on the Khorgo lava flow today are stunted and widely spaced, occurring on microsites with little to no soil development. These trees are extremely water-stressed and their radial growth is well-correlated with both drought (scPDSI) and grassland productivity (Normalized Difference Vegetation Index (NDVI)). Our reconstruction, calibrated and validated on instrumental June-September scPDSI (1959-2009) accounts for 55.8% of the variability in the regional scPDSI when 73% of the annual rainfall occurs. Our scPDSI reconstruction places historic and modern social change in Mongolia in the context of the range of climatic variability during the Common Era. Our record

Alveolar bone level changes in maxillary expansion treatments assessed through CBCT.

PubMed

Pham, Vi; Lagravère, Manuel O

2017-03-01

Determine changes in alveolar bone levels during expansion treatments as assessed through cone-beam computer tomography (CBCT). Sixty-one patients from Edmonton, Canada, with maxillary transverse deficiencies were split into three groups. One group was treated with a bone-anchored expander, another group was treated with a tooth-borne maxillary expander (Hyrax) and one group was untreated. CBCTs were obtained from each patient at two time points (initialT 1 and at removal of appliance after 6 months T 2 ). CBCTs were analyzed using AVIZO software and landmarks were placed on different dental and skeletal structures. Intra-examiner reliability for landmarks was done by randomly selecting 10 images and measuring each landmark 3 times, 1 week apart. Descriptive statistics, intraclass correlation coefficients (ICC) and ANOVA analysis were used to determine if there were changes to the alveolar bone levels and if these changes were statistically significant within each group. Landmarks reliability showed an ICC of at least 0.99 with a 95% confidence interval and a mean measurement error of at least 0.2067mm. Descriptive statistics show that changes in alveolar bone levels were less than 1mm for all three groups and therefore clinically insignificant. Changes between groups were not statistically different (P<0.05) from one another with the exception of 8 distances. However, since the distances were small, they were not considered clinically significant. Alveolar bone level changes were similar in maxillary expansion treatments and in the control group. The effects of maxillary expansion treatments on alveolar bone levels are not clinically significant. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Treatment of Anxiety and Depression in the Preschool Period

PubMed Central

Luby, Joan L.

2013-01-01

Objective Empirical studies have now established that clinical anxiety and depressive disorders may arise in preschool children as early as age 3.0. As empirical studies validating and characterizing these disorders in preschoolers are relatively recent, less work has been done on the development and testing of age-appropriate treatments. Method A comprehensive literature search revealed several small randomized controlled trials (RCTs) of psychotherapeutic treatments for preschool anxiety and depression. The literature also contains case series of behavioral and psychopharmacologic interventions for specific anxiety disorders. However, to date, no large-scale RCTs of treatment for any anxiety or depressive disorder specifically targeting preschool populations have been published. Results Several age-adapted forms of cognitive behavioral therapy have been developed and preliminarily tested in small RCTs, and appear promising for a variety of forms of preschool anxiety disorders. Notably, these adaptations centrally involve primary caregivers and utilize age-adjusted methodology such as cartoon-based materials and co-constructed drawing or narratives. Modified forms of Parent Child Interaction Therapy (PCIT) have been tested and appear promising for both anxiety and depression. While preventive interventions that target parenting have shown significant promise in anxiety, these methods have not been explored in area of early childhood depression. Studies of the impact of parental treatment on infants suggest that direct treatment of the youngest children may be necessary to affect long-term change. Conclusions Recommendations are made for clinical treatment of these disorders where psychotherapy is the first line of intervention. PMID:23582866

Urban and regional change in Australia: an empirical introduction.

PubMed

O'connor, K

1984-08-01

Recent changes in the spatial distribution of the population in Australia are examined. In particular, changes in population by state are analyzed for the period 1971-1981. The relationship of these changes to shifts in economic activity, private investment, and banking activity is considered. "Results show there have been only small shifts toward population growth areas. These results are interpreted in part as a consequence of nonlocal multipliers and linkages back to established areas, but also as a reflection of the unique features of the Australian urban and regional system." excerpt

Empirical Investigation of Critical Transitions in Paleoclimate

NASA Astrophysics Data System (ADS)

Loskutov, E. M.; Mukhin, D.; Gavrilov, A.; Feigin, A.

2016-12-01

In this work we apply a new empirical method for the analysis of complex spatially distributed systems to the analysis of paleoclimate data. The method consists of two general parts: (i) revealing the optimal phase-space variables and (ii) construction the empirical prognostic model by observed time series. The method of phase space variables construction based on the data decomposition into nonlinear dynamical modes which was successfully applied to global SST field and allowed clearly separate time scales and reveal climate shift in the observed data interval [1]. The second part, the Bayesian approach to optimal evolution operator reconstruction by time series is based on representation of evolution operator in the form of nonlinear stochastic function represented by artificial neural networks [2,3]. In this work we are focused on the investigation of critical transitions - the abrupt changes in climate dynamics - in match longer time scale process. It is well known that there were number of critical transitions on different time scales in the past. In this work, we demonstrate the first results of applying our empirical methods to analysis of paleoclimate variability. In particular, we discuss the possibility of detecting, identifying and prediction such critical transitions by means of nonlinear empirical modeling using the paleoclimate record time series. The study is supported by Government of Russian Federation (agreement #14.Z50.31.0033 with the Institute of Applied Physics of RAS). 1. Mukhin, D., Gavrilov, A., Feigin, A., Loskutov, E., & Kurths, J. (2015). Principal nonlinear dynamical modes of climate variability. Scientific Reports, 5, 15510. http://doi.org/10.1038/srep155102. Ya. I. Molkov, D. N. Mukhin, E. M. Loskutov, A.M. Feigin, (2012) : Random dynamical models from time series. Phys. Rev. E, Vol. 85, n.3.3. Mukhin, D., Kondrashov, D., Loskutov, E., Gavrilov, A., Feigin, A., & Ghil, M. (2015). Predicting Critical Transitions in ENSO models. Part II

Review essay: empires, ancient and modern.

PubMed

Hall, John A

2011-09-01

This essay drews attention to two books on empires by historians which deserve the attention of sociologists. Bang's model of the workings of the Roman economy powerfully demonstrates the tributary nature of per-industrial tributary empires. Darwin's analysis concentrates on modern overseas empires, wholly different in character as they involved the transportation of consumption items for the many rather than luxury goods for the few. Darwin is especially good at describing the conditions of existence of late nineteenth century empires, noting that their demise was caused most of all by the failure of balance of power politics in Europe. Concluding thoughts are offered about the USA. © London School of Economics and Political Science 2011.

The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research

PubMed Central

McKnight, Patrick E.; Kashdan, Todd B.

2009-01-01

Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims–1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures. PMID:19269076

A clinical treatment intervention for dysphoria: externalizing metaphors therapy.

PubMed

McGuinty, Everett; Armstrong, David; Carrière, Anne-Marie

2014-01-01

The purpose of this article is to explore a novel, short-term treatment intervention for internalizing behaviours. This intervention is primarily based upon an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas. This article addresses the clinical population of children and youth, specifically through outlining the protocol, externalizing metaphors therapy. A selective review of significant works regarding the efficacy of short-term therapy was conducted, including the process of change within narrative therapy. It is proposed that two specific processes account for the mental health change experienced by clients who receive this new treatment intervention: (1) externalization of problems and (2) purposeful client-generated metaphor manipulation, impacting upon underlying schemas. From these theoretical constructs, the present article outlines a three-session treatment protocol that manualizes these key clinical processes. A case study is presented to illustrate this intervention for anxiety and depression. Further clinical research is underway to address the testable hypotheses resulting from the current theoretical model. Clinical trials in brief psychotherapy are suggested to empirically evaluate the efficacy of this new treatment intervention for dysphoria. This article outlines a short-term treatment intervention for anxiety and depression (dysphoira) through a novel 3-session model, where the clinician-practitioner can obtain competency through a one-day workshop.Its relevance for the clinical researcher and the mental health community is in its versatility in addressing internalizing behavior for four clinical populations: (1) children and adolescents; (2) children and adolescents on the autism spectrum; (3) adults in general; and, (4) adults with a dual-diagnosis. The treatment protocol described within is based upon the externalizing and deconstructive properties of Narrative Therapy, and the

Changes in North Atlantic Oscillation drove Population Migrations and the Collapse of the Western Roman Empire.

PubMed

Drake, B Lee

2017-04-27

Shifts in the North Atlantic Oscillation (NAO) from 1-2 to 0-1 in four episodes increased droughts on the Roman Empire's periphery and created push factors for migrations. These climatic events are associated with the movements of the Cimbri and Teutones from 113-101 B.C., the Marcomanni and Quadi from 164 to 180 A.D., the Goths in 376 A.D., and the broad population movements of the Migration Period from 500 to 600 A.D. Weakening of the NAO in the instrumental record of the NAO have been associated with a shift to drought in the areas of origin for the Cimbri, Quadi, Visigoths, Ostrogoths, Huns, and Slavs. While other climate indices indicate deteriorating climate after 200 A.D. and cooler conditions after 500 A.D., the NAO may indicate a specific cause for the punctuated history of migrations in Late Antiquity. Periodic weakening of the NAO caused drought in the regions of origin for tribes in antiquity, and may have created a powerful push factor for human migration. While climate change is frequently considered as a threat to sustainability, its role as a conflict amplifier in history may be one of its largest impacts on populations.

Forest canopy effects on snow accumulation and ablation: an integrative review of empirical results

Treesearch

Andres Varhola; Nicholas C. Coops; Markus Weiler; R. Dan Moore

2010-01-01

The past century has seen significant research comparing snow accumulation and ablation in forested and open sites. In this review we compile and standardize the results of previous empirical studies to generate statistical relations between changes in forest cover and the associated changes in snow accumulation and ablation rate. The analysis drew upon 33 articles...

Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis.

PubMed

Joshi, Lavnish; Talat, Lazha; Yaganti, Satish; Sandhu, Sartaj; Taylor, Simon R J; Wakefield, Denis; McCluskey, Peter; Lightman, Susan

2014-05-01

To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. Retrospective cohort study. Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia. Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained. For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined. A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients. Our data suggest that control of inflammation can be achieved after switching or combining ISAs. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Application of empirical and mechanistic-empirical pavement design procedures to Mn/ROAD concrete pavement test sections

DOT National Transportation Integrated Search

1997-05-01

Current pavement design procedures are based principally on empirical approaches. The current trend toward developing more mechanistic-empirical type pavement design methods led Minnesota to develop the Minnesota Road Research Project (Mn/ROAD), a lo...

Impact of drug classes and treatment availability on the rate of antiretroviral treatment change in the TREAT Asia HIV Observational Database (TAHOD)

PubMed Central

Srasuebkul, Preeyaporn; Calmy, Alexandra; Zhou, Jialun; Kumarasamy, Nagalingeswaran; Law, Matthew; Lim, Poh Lian

2007-01-01

Background It is critical to understand the pattern of antiretroviral treatment (ART) prescription in different regions of the world as ART procurement needs to be anticipated. We aimed at exploring rates and predictors of ART combination changes in clinical practice in Treat Asia HIV Observational Database (TAHOD). Methods Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least one follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen. Results A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year. In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category, the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 – 1.96), p < 0.001, RR 3.39 (2.76 – 4.16) p < 0.001, RR 6.37 (4.51 – 9.00), p < 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 – 0.99), p = 0.035, RR 0.77 (0.61 – 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 – 1.51), p < 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 – 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse

Enhancing motivation for change in treatment-resistant eating disorders.

PubMed

Vitousek, K; Watson, S; Wilson, G T

1998-06-01

Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.

Cognitive Neuroscience Approaches to Understanding Behavior Change in Alcohol Use Disorder Treatments.

PubMed

Naqvi, Nasir H; Morgenstern, Jon

2015-01-01

Researchers have begun to apply cognitive neuroscience concepts and methods to study behavior change mechanisms in alcohol use disorder (AUD) treatments. This review begins with an examination of the current state of treatment mechanisms research using clinical and social psychological approaches. It then summarizes what is currently understood about the pathophysiology of addiction from a cognitive neuroscience perspective. Finally, it reviews recent efforts to use cognitive neuroscience approaches to understand the neural mechanisms of behavior change in AUD, including studies that use neural functioning to predict relapse and abstinence; studies examining neural mechanisms that operate in current evidence-based behavioral interventions for AUD; as well as research on novel behavioral interventions that are being derived from our emerging understanding of the neural and cognitive mechanisms of behavior change in AUD. The article highlights how the regulation of subcortical regions involved in alcohol incentive motivation by prefrontal cortical regions involved in cognitive control may be a core mechanism that plays a role in these varied forms of behavior change in AUD. We also lay out a multilevel framework for integrating cognitive neuroscience approaches with more traditional methods for examining AUD treatment mechanisms.

Panic disorder and agoraphobia: an overview and commentary on DSM-5 changes.

PubMed

Asmundson, Gordon J G; Taylor, Steven; Smits, Jasper A J

2014-06-01

The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia into separate diagnoses, the addition of criteria and guidelines for distinguishing agoraphobia from specific phobia, the addition of a 6-month duration requirement for agoraphobia, the addition of panic attacks as a specifier to any DSM-5 diagnosis, changes to descriptors of panic attack types, as well as various changes to the descriptive text. It is crucial that clinicians and researchers working with individuals presenting with panic attacks and panic-like symptoms understand these changes. The purpose of the current paper is to provide a summary of the main changes, to critique the changes in the context of available empirical evidence, and to highlight clinical implications and potential impact on mental health service utilization. Several of the changes have the potential to improve access to evidence-based treatment; yet, although certain changes appear justified in that they were based on converging evidence from different empirical sources, other changes appear questionable, at least based on the information presented in the DSM-5 text and related publications. Ongoing research of DSM-5 panic disorder and agoraphobia as well as application of the new diagnostic criteria in clinical contexts is needed to further inform the strengths and limitations of DSM-5 conceptualizations of panic disorder and agoraphobia. © 2014 Wiley Periodicals, Inc.

Ecological Momentary Assessment and Alcohol Use Disorder Treatment

PubMed Central

Morgenstern, Jon; Kuerbis, Alexis; Muench, Frederick

2014-01-01

The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA). This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feedback as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts. PMID:26259004

Plant water potential improves prediction of empirical stomatal models.

PubMed

Anderegg, William R L; Wolf, Adam; Arango-Velez, Adriana; Choat, Brendan; Chmura, Daniel J; Jansen, Steven; Kolb, Thomas; Li, Shan; Meinzer, Frederick; Pita, Pilar; Resco de Dios, Víctor; Sperry, John S; Wolfe, Brett T; Pacala, Stephen

2017-01-01

Climate change is expected to lead to increases in drought frequency and severity, with deleterious effects on many ecosystems. Stomatal responses to changing environmental conditions form the backbone of all ecosystem models, but are based on empirical relationships and are not well-tested during drought conditions. Here, we use a dataset of 34 woody plant species spanning global forest biomes to examine the effect of leaf water potential on stomatal conductance and test the predictive accuracy of three major stomatal models and a recently proposed model. We find that current leaf-level empirical models have consistent biases of over-prediction of stomatal conductance during dry conditions, particularly at low soil water potentials. Furthermore, the recently proposed stomatal conductance model yields increases in predictive capability compared to current models, and with particular improvement during drought conditions. Our results reveal that including stomatal sensitivity to declining water potential and consequent impairment of plant water transport will improve predictions during drought conditions and show that many biomes contain a diversity of plant stomatal strategies that range from risky to conservative stomatal regulation during water stress. Such improvements in stomatal simulation are greatly needed to help unravel and predict the response of ecosystems to future climate extremes.

Department Chairs as Change Agents: Leading Change in Resistant Environments

ERIC Educational Resources Information Center

Gaubatz, Julie A.; Ensminger, David C.

2017-01-01

Change process research often discusses barriers that impede organizational change (e.g., Banta, 1997; Cavacuiti and Locke, 2013; Mutchler, 1990; Stewart et al., 2012); however, no empirical research has addressed how behaviors established in leadership models counteract these barriers. This study explored these two interconnected constructs of…

Problem Internet Overuse Behaviors in College Students: Readiness-to-Change and Receptivity to Treatment.

PubMed

O'Brien, Jennifer E; Li, Wen; Snyder, Susan M; Howard, Matthew O

2016-01-01

This mixed methods study explores college students' readiness-to-change and receptivity to treatment for problem Internet overuse behaviors. Focus groups were conducted with 27 college students who self-identified as Internet over-users, and had experienced biopsychosocial problems related to Internet overuse. Participants completed standardized questionnaires assessing their Internet use and sociodemographic forms. Focus groups explored readiness to change problem Internet overuse behaviors and receptivity to treatment. Similar to college students with other addictive behaviors, students with problem Internet overuse fall along a continuum vis-à-vis readiness-to-change their behaviors. Over half of the participants were receptive to treatment for their problem Internet overuse behaviors.

Very empirical treatment of solvation and entropy: a force field derived from Log Po/w

NASA Astrophysics Data System (ADS)

Kellogg, Glen Eugene; Burnett, James C.; Abraham, Donald J.

2001-04-01

A non-covalent interaction force field model derived from the partition coefficient of 1-octanol/water solubility is described. This model, HINT for Hydropathic INTeractions, is shown to include, in very empirical and approximate terms, all components of biomolecular associations, including hydrogen bonding, Coulombic interactions, hydrophobic interactions, entropy and solvation/desolvation. Particular emphasis is placed on: (1) demonstrating the relationship between the total empirical HINT score and free energy of association, ΔG interaction; (2) showing that the HINT hydrophobic-polar interaction sub-score represents the energy cost of desolvation upon binding for interacting biomolecules; and (3) a new methodology for treating constrained water molecules as discrete independent small ligands. An example calculation is reported for dihydrofolate reductase (DHFR) bound with methotrexate (MTX). In that case the observed very tight binding, ΔG interaction≤-13.6 kcal mol-1, is largely due to ten hydrogen bonds between the ligand and enzyme with estimated strength ranging between -0.4 and -2.3 kcal mol-1. Four water molecules bridging between DHFR and MTX contribute an additional -1.7 kcal mol-1 stability to the complex. The HINT estimate of the cost of desolvation is +13.9 kcal mol-1.

Self-Directed Gambling Changes: Trajectory of Problem Gambling Severity in Absence of Treatment.

PubMed

Kushnir, Vladyslav; Godinho, Alexandra; Hodgins, David C; Hendershot, Christian S; Cunningham, John A

2018-03-27

Most problem gamblers do not seek formal treatment, recovering on their own through cognitive re-appraisal or self-help strategies. Although barriers to treatment have been extensively studied, there is a paucity of research on self-directed changes in problem gambling and very few studies have examined these changes prospectively. The aim of this study was to examine the trajectory of gambling severity and behavior change over an 18-month period, among a sample of non-treatment seeking/attending problem gamblers recruited from the community (N = 204) interested in quitting or reducing gambling. Separate mixed effects models revealed that in absence of formal treatment, significant reductions in gambling severity, frequency, and amount gambled could be observed over the course of a 6 to 9-month period and that changes experienced within the first 12 months were maintained for an extended 6 months. Problem gambling severity at baseline was significantly associated with changes in severity over time, such that participants with more severe gambling problems demonstrated greater reductions in their gambling severity over time. A total of 11.1% of participants gambled within a low-risk threshold at 18 months, although 28.7% of the sample reported consecutive gambling severity scores below problem levels for the duration of 1 year or longer. The findings suggest that among problem gamblers motivated to quit or reduce their gambling, significant self-directed changes in gambling severity can occur over a relatively short time. Additional prospective studies are needed to document the role of specific self-help tools or thought processes in exacting gambling changes.

Trends of Empirical Research in South Korean Mental Health Social Work

ERIC Educational Resources Information Center

Song, In Han; Lee, Eun Jung

2017-01-01

Since the introduction of evidence-based practice in South Korea, it has gained significant attention for its potential to promote the efficacy of social work services and to integrate knowledge and practice in mental health social work. In order to see how empirical research in South Korean mental health social work has changed, we examined…

Innovative empirical approaches for inferring climate-warming impacts on plants in remote areas.

PubMed

De Frenne, Pieter

2015-02-01

The prediction of the effects of climate warming on plant communities across the globe has become a major focus of ecology, evolution and biodiversity conservation. However, many of the frequently used empirical approaches for inferring how warming affects vegetation have been criticized for decades. In addition, methods that require no electricity may be preferred because of constraints of active warming, e.g. in remote areas. Efforts to overcome the limitations of earlier methods are currently under development, but these approaches have yet to be systematically evaluated side by side. Here, an overview of the benefits and limitations of a selection of innovative empirical techniques to study temperature effects on plants is presented, with a focus on practicality in relatively remote areas without an electric power supply. I focus on methods for: ecosystem aboveground and belowground warming; a fuller exploitation of spatial temperature variation; and long-term monitoring of plant ecological and microevolutionary changes in response to warming. An evaluation of the described methodological set-ups in a synthetic framework along six axes (associated with the consistency of temperature differences, disturbance, costs, confounding factors, spatial scale and versatility) highlights their potential usefulness and power. Hence, further developments of new approaches to empirically assess warming effects on plants can critically stimulate progress in climate-change biology.

Empirical Comparison of Two Psychological Therapies: Self Psychology and Cognitive Orientation in the Treatment of Anorexia and Bulimia

PubMed Central

Bachar, Eytan; Latzer, Yael; Kreitler, Shulamit; Berry, Elliot M.

1999-01-01

The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. Thirty-three patients participated in this study. The bulimic patients (n = 25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (n = 8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected.(The Journal of Psychotherapy Practice and Research 1999; 8:115–128) PMID:10079459

Mechanistic-empirical Pavement Design Guide Implementation

DOT National Transportation Integrated Search

2010-06-01

The recently introduced Mechanistic-Empirical Pavement Design Guide (MEPDG) and associated computer software provides a state-of-practice mechanistic-empirical highway pavement design methodology. The MEPDG methodology is based on pavement responses ...

The treatment of adolescent transsexuals: changing insights.

PubMed

Cohen-Kettenis, Peggy T; Delemarre-van de Waal, Henriette A; Gooren, Louis J G

2008-08-01

Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of Psychiatrists. To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands. The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12-16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy. Results. The first results from the Amsterdam clinic show that this policy is promising. Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.

Trade liberalization, social policies and health: an empirical case study.

PubMed

McNamara, Courtney

2015-10-12

This study investigates the health impacts of a major liberalization episode in the textile and clothing (T&C) sector. This episode triggered substantial shifts in employment across a wide range of countries. It is the first study to empirically link trade liberalization to health via changes in employment and offers some of the first empirical insights on how trade liberalization interacts with social policies to influence health. Data from 32 T&C reliant countries were analysed in reference to the pre- and post-liberalization periods of 2000-2004 and 2005-2009. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the association between countries' a) level of development b) labour market and welfare state protections c) T&C employment changes and d) changes in adult female and infant mortality rates. Process tracing was used to further investigate these associations through twelve in-depth country studies. Results from the fsQCA relate changes in employment after the phase-out to both changing adult female and infant mortality rates. Findings from the in-depth country studies suggest that the worsening of adult female mortality rates is related to workers' lack of social protection, both in the context of T&C employment growth and loss. Overall, it is found that social protection is often inaccessible to the type of workers who may be the most vulnerable to processes of liberalization and that many workers are particularly vulnerable due to the structure of social protection policies. Social policies are therefore found to both moderate pathways to health and influence the type of health-related pathways resulting from trade liberalizing policies.

The impact of real life treatment strategies for Candida peritonitis-A retrospective analysis.

PubMed

Dubler, S; Laun, M; Koch, C; Hecker, A; Weiterer, S; Siegler, B H; Röhrig, R; Weigand, M A; Lichtenstern, C

2017-07-01

Candida species are commonly detected isolates from abdominal foci. The question remains as to who would benefit from early empiric treatment in cases of Candida peritonitis. This study collected real-life data on critically ill patients with Candida peritonitis to estimate the relevance of the chosen treatment strategy on the outcome of these patients. One hundred and thirty-seven surgical intensive care unit (ICU) patients with intra-abdominal invasive Candidiasis were included in the study. Fifty-six patients did not get any antifungal agent. Twenty-nine patients were empirically treated, and 52 patients were specifically treated. In the group without, with empiric and with specific antifungal treatment, the 30-day mortality rate was 33.9, 48.3 and 44.2 respectively. Candida albicans was the most frequently found species. Seven patients in the specific treatment group and one patient in the empiric treatment group emerged with candidaemia. Age, leucocyte count, APACHE II Score and acute liver failure were independent predictors of 30-day mortality in patients with Candida peritonitis. Not all patients with Candida peritonitis received antifungal treatment in real clinical practice. Patients with higher morbidity more often got antifungals. Early empirical therapy has not been associated with a better 30-day mortality. © 2017 Blackwell Verlag GmbH.

Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

PubMed

Jarbol, Dorte Ejg; Bech, Mickael; Kragstrup, Jakob; Havelund, Troels; Schaffalitzky de Muckadell, Ove B

2006-01-01

An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

An Empirical Test of Five Prominent Explanations for the Black-White Academic Performance Gap

ERIC Educational Resources Information Center

Oates, Gary L. St. C.

2009-01-01

The viability of five prominent explanations for the black-white performance gap ("academic engagement," "cultural capital," "social capital," "school quality" and "biased treatment") is examined using NELS data and a LISREL model that adjusts for clustering of students within schools. Empirical models have typically assessed these factors…

Personality and symptom change in treatment-refractory inpatients: evaluation of the phase model of change using Rorschach,TAT, and DSM-IV Axis V.

PubMed

Fowler, J Christopher; Ackerman, Steven J; Speanburg, Stefanie; Bailey, Adrian; Blagys, Matthew; Conklin, Adam C

2004-12-01

In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings.

A global empirical system for probabilistic seasonal climate prediction

NASA Astrophysics Data System (ADS)

Eden, J. M.; van Oldenborgh, G. J.; Hawkins, E.; Suckling, E. B.

2015-12-01

Preparing for episodes with risks of anomalous weather a month to a year ahead is an important challenge for governments, non-governmental organisations, and private companies and is dependent on the availability of reliable forecasts. The majority of operational seasonal forecasts are made using process-based dynamical models, which are complex, computationally challenging and prone to biases. Empirical forecast approaches built on statistical models to represent physical processes offer an alternative to dynamical systems and can provide either a benchmark for comparison or independent supplementary forecasts. Here, we present a simple empirical system based on multiple linear regression for producing probabilistic forecasts of seasonal surface air temperature and precipitation across the globe. The global CO2-equivalent concentration is taken as the primary predictor; subsequent predictors, including large-scale modes of variability in the climate system and local-scale information, are selected on the basis of their physical relationship with the predictand. The focus given to the climate change signal as a source of skill and the probabilistic nature of the forecasts produced constitute a novel approach to global empirical prediction. Hindcasts for the period 1961-2013 are validated against observations using deterministic (correlation of seasonal means) and probabilistic (continuous rank probability skill scores) metrics. Good skill is found in many regions, particularly for surface air temperature and most notably in much of Europe during the spring and summer seasons. For precipitation, skill is generally limited to regions with known El Niño-Southern Oscillation (ENSO) teleconnections. The system is used in a quasi-operational framework to generate empirical seasonal forecasts on a monthly basis.

Empirical research on the insanity defense and attempted reforms: evidence toward informed policy.

PubMed

Borum, R; Fulero, S M

1999-06-01

The paper addresses some common questions about the insanity defense and issues raised by commonly proposed "reforms." The first section begins with a brief description of the insanity defense and the reasons for its existence in the law. It then examines some of the popular myths and public misperceptions surrounding the insanity defense. The next three sections discuss proposed "reforms" and the empirical research that addresses their effect. These reforms, including various procedural changes in definitions, burden of proof, and expert testimony, the institution of a guilty but mentally ill verdict, and the abolition of the insanity defense itself, are reviewed, along with relevant research findings and policy issues. Finally, the development of sound conditional release programs for criminal defendants found not guilty by reason of insanity is proposed as a reform option which could serve the objectives of enhancing public safety and access to appropriate treatment while continuing to meet the objectives of the insanity defense within criminal jurisprudence.

Empirical research on the insanity defense and attempted reforms: evidence toward informed policy.

PubMed

Borum, R; Fulero, S M

1999-02-01

This paper addresses some common questions about the insanity defense and issues raised by commonly proposed "reforms." The first section begins with a brief description of the insanity defense and the reasons for its existence in the law. It then examines some of the popular myths and public misperceptions surrounding the insanity defense. The next three sections discuss proposed "reforms" and the empirical research that addresses their effect. These reforms, including various procedural changes in definitions, burden of proof, and expert testimony, the institution of a guilty but mentally ill verdict, and the abolition of the insanity defense itself, are reviewed, along with relevant research findings and policy issues. Finally, the development of sound conditional release programs for criminal defendants found not guilty by reason of insanity is proposed as a reform option which could serve the objectives of enhancing public safety and access to appropriate treatment while continuing to meet the objectives of the insanity defense within criminal jurisprudence.

CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non-responders.

PubMed

Legerstee, Jeroen S; Tulen, Joke H M; Dierckx, Bram; Treffers, Philip D A; Verhulst, Frank C; Utens, Elisabeth M W J

2010-02-01

This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. Ninety-one children with an anxiety disorder were included in the present study. Children received a standardized stepped-care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child-focused CBT), secondary responders (anxiety disorder free after phase two: child-parent-focused CBT), and treatment non-responders. Treatment response was determined using a semi-structured clinical interview. Children performed a pictorial dot-probe task before and after stepped-care CBT (i.e., before phase one and after phase two CBT). Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre-treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped-care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non-responders did not show any changes in selective attention due to CBT. Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non-responders did not show any changes in selective attention. The pictorial dot-probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.

Dietary changes and food intake in the first year after breast cancer treatment.

PubMed

Vance, Vivienne; Campbell, Sharon; McCargar, Linda; Mourtzakis, Marina; Hanning, Rhona

2014-06-01

Understanding dietary habits of women after breast cancer is a critical first step in developing nutrition guidelines that will support weight management and optimal health in survivorship; however, limited data are available. The objective of this study was to describe changes in diet among breast cancer survivors in the first year after treatment, and to evaluate these changes in the context of current dietary intake. Changes in diet were assessed in 28 early stage breast cancer survivors, using a self-reported survey in which women identified changes in food intake since their diagnosis. Current dietary intake was estimated from 3-day food records and described relative to current recommendations. The majority of women reported changes in diet after diagnosis, most common being an increase in vegetables/fruit and fish, lower intake of red meat, and reduced alcohol. Many women reported that these changes were initiated during active treatment. Dietary changes were largely consistent with current recommendations for cancer prevention; however, some women were still above the guidelines for total and saturated fat, and many were below recommendations for vegetables/fruit, milk/alternatives, calcium, and vitamin D. Evidence that some women are willing and able to initiate positive changes in diet early in the treatment trajectory suggests that early intervention may be effective in promoting dietary habits that will assist with weight management and overall health. Data on current dietary intake highlights several possible targets for dietary intervention in this population.

In vitro early changes in intercellular junctions by treatment with a chemical carcinogen.

PubMed

Tachikawa, T; Kohno, Y; Matsui, Y; Yoshiki, S

1986-06-01

To examine early intercellular junction changes caused by treatment with 9,10-dimethyl-1,2-benzanthracene (DMBA), rat lingual epithelium was cultivated in isolation and observed by electrophysiological, freeze-fracture and whole-mount electron microscopy. Electrophysiological measurements showed a transient decrease in membrane potential of -10.2 mV 6 h after the treatment. It returned to almost the same level as that of the control group 1 day later. Six hours after treatment, input resistance decreased rapidly to 5.3 M omega but increased to 18.0 M omega 12 h after treatment. Transient reduction of input resistance and membrane potential occurred prior to the decrease in the coupling ratio 6 h after treatment with DMBA. In freeze-fracture replicas, the number of gap junctions decreased by approximately 45% of the control value 6 h after treatment with DMBA. At 12 h and thereafter, the number and area of gap junctions subsequently decreased by 60-80% of the control value. Alterations in the number and area of desmosomes were similar to those of the gap junctions. The formation of epithelial cytoskeletons, partially devoid of the 2-4 and 5-8 nm filaments was also observed. A decrease in the density of filament networks beneath the plasma membranes was especially apparent. Treatment with a carcinogen brought about morphological cellular changes as early as 6 h after treatment, and such early changes might trigger metabolic cellular abnormalities. Affected cells appear to move away from normal cells in a process of repeated destruction and revision of intercellular junctions, and cytoskeletons.

Life changes among homeless persons with mental illness: a longitudinal study of housing first and usual treatment.

PubMed

Nelson, Geoffrey; Patterson, Michelle; Kirst, Maritt; Macnaughton, Eric; Isaak, Corinne A; Nolin, Danielle; McAll, Christopher; Stergiopoulos, Vicky; Townley, Greg; MacLeod, Timothy; Piat, Myra; Goering, Paula N

2015-06-01

This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes. Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes. The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense. Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.

Oseltamivir Treatment for Children with Influenza-Like Illness in China: A Cost-Effectiveness Analysis.

PubMed

Shen, Kunling; Xiong, Tengbin; Tan, Seng Chuen; Wu, Jiuhong

2016-01-01

Influenza is a common viral respiratory infection that causes epidemics and pandemics in the human population. Oseltamivir is a neuraminidase inhibitor-a new class of antiviral therapy for influenza. Although its efficacy and safety have been established, there is uncertainty regarding whether influenza-like illness (ILI) in children is best managed by oseltamivir at the onset of illness, and its cost-effectiveness in children has not been studied in China. To evaluate the cost-effectiveness of post rapid influenza diagnostic test (RIDT) treatment with oseltamivir and empiric treatment with oseltamivir comparing with no antiviral therapy against influenza for children with ILI. We developed a decision-analytic model based on previously published evidence to simulate and evaluate 1-year potential clinical and economic outcomes associated with three managing strategies for children presenting with symptoms of influenza. Model inputs were derived from literature and expert opinion of clinical practice and research in China. Outcome measures included costs and quality-adjusted life year (QALY). All the interventions were compared with incremental cost-effectiveness ratios (ICER). In base case analysis, empiric treatment with oseltamivir consistently produced the greatest gains in QALY. When compared with no antiviral therapy, the empiric treatment with oseltamivir strategy is very cost effective with an ICER of RMB 4,438. When compared with the post RIDT treatment with oseltamivir, the empiric treatment with oseltamivir strategy is dominant. Probabilistic sensitivity analysis projected that there is a 100% probability that empiric oseltamivir treatment would be considered as a very cost-effective strategy compared to the no antiviral therapy, according to the WHO recommendations for cost-effectiveness thresholds. The same was concluded with 99% probability for empiric oseltamivir treatment being a very cost-effective strategy compared to the post RIDT treatment with

Treating Pediatric Obesity Using an Empirically Supported Treatment: A Case Report

ERIC Educational Resources Information Center

Cunningham, Phillippe B.; Ellis, Deborah A.; Naar-King, Sylvie

2010-01-01

Overweight and obesity are increasing dramatically in the United States of America, especially among children. Effective treatment of the multiple risk factors that promote youth obesity requires treatment approaches that are flexible and comprehensive enough to address each of these factors. One such treatment approach is Multisystemic Therapy…

Diminished Wastewater Treatment: Evaluation of Septic System Performance Under a Climate Change Scenario

NASA Astrophysics Data System (ADS)

Cooper, J.; Loomis, G.; Kalen, D.; Boving, T. B.; Morales, I.; Amador, J.

2015-12-01

The effects of climate change are expected to reduce the ability of soil-based onsite wastewater treatment systems (OWTS), to treat domestic wastewater. In the northeastern U.S., the projected increase in atmospheric temperature, elevation of water tables from rising sea levels, and heightened precipitation will reduce the volume of unsaturated soil and oxygen available for treatment. Incomplete removal of contaminants may lead to transport of pathogens, nutrients, and biochemical oxygen demand (BOD) to groundwater, increasing the risk to public health and likelihood of eutrophying aquatic ecosystems. Advanced OWTS, which include pre-treatment steps and provide unsaturated drainfields of greater volume relative to conventional OWTS, are expected to be more resilient to climate change. We used intact soil mesocosms to quantify water quality functions for two advanced shallow narrow drainfield types and a conventional drainfield under a current climate scenario and a moderate climate change scenario of 30 cm rise in water table and 5°C increase in soil temperature. While no fecal coliform bacteria (FCB) was released under the current climate scenario, up to 109 CFU FCB/mL (conventional) and up to 20 CFU FCB/mL (shallow narrow) were released under the climate change scenario. Total P removal rates dropped from 100% to 54% (conventional) and 71% (shallow narrow) under the climate change scenario. Total N removal averaged 17% under both climate scenarios in the conventional, but dropped from 5.4% to 0% in the shallow narrow under the climate change scenario, with additional leaching of N in excess of inputs indicating release of previously held N. No significant difference was observed between scenarios for BOD removal. The initial data indicate that while advanced OWTS retain more function under the climate change scenario, all three drainfield types experience some diminished treatment capacity.

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change.

PubMed

Becan, Jennifer E; Knight, Danica K; Crawley, Rachel D; Joe, George W; Flynn, Patrick M

2015-03-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35 days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. Copyright © 2015 Elsevier Inc. All rights reserved.

Effectiveness of the Treatment Readiness and Induction Program for Increasing Adolescent Motivation for Change

PubMed Central

Becan, Jennifer E.; Knight, Danica K.; Crawley, Rachel D.; Joe, George W.; Flynn, Patrick M.

2014-01-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (Time 1) and 35 days after admission (Time 2). The design consisted of a comparison sample (n = 281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n = 238). Repeated measures ANCOVAs were conducted using each Time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. PMID:25456094

In vitro bacterial isolate susceptibility to empirically selected antimicrobials in 111 dogs with bacterial pneumonia.

PubMed

Proulx, Alexandre; Hume, Daniel Z; Drobatz, Kenneth J; Reineke, Erica L

2014-01-01

To determine the proportion of airway bacterial isolates resistant to both empirically selected and recently administered antimicrobials, and to assess the impact of inappropriate initial empiric antimicrobials selection on length of hospital stay and survival to discharge in dogs with bacterial pneumonia. Retrospective study. University veterinary teaching hospital. One hundred and eleven dogs with a clinical diagnosis of bacterial pneumonia that had aerobic bacterial culture and susceptibility testing performed from a tracheal wash sample. None. Overall, 26% (29/111) of the dogs had at least 1 bacterial isolate that was resistant to empirically selected antimicrobials. In dogs with a history of antimicrobial administration within the preceding 4 weeks, a high incidence (57.4%, 31/54) of in vitro bacterial resistance to those antimicrobials was found: 64.7% (11/17) in the community-acquired pneumonia group, 55.2% (16/29) in the aspiration pneumonia group, and 50.0% (4/8) in the other causes of bacterial pneumonia group. No statistically significant association was found between bacterial isolate resistance to empirically selected antimicrobials and length of hospital stay or mortality. The high proportion of in vitro airway bacterial resistance to empiric antimicrobials would suggest that airway sampling for bacterial culture and susceptibility testing may be helpful in guiding antimicrobial therapy and recently administered antimicrobials should be avoided when empirically selecting antimicrobials. Although no relationship was found between inappropriate initial empiric antimicrobial selection and length of hospital stay or mortality, future prospective studies using standardized airway-sampling techniques, treatment modalities, and stratification of disease severity based on objective values, such as arterial blood gas analysis in all dogs with pneumonia, would be needed to determine if a clinical effect of in vitro bacterial resistance to empirically

Dimensional changes of Nb 3Sn Rutherford cables during heat treatment

DOE PAGES

Rochepault, E.; Ferracin, P.; Ambrosio, G.; ...

2016-06-01

In high field magnet applications, Nb 3Sn coils undergo a heat treatment step after winding. During this stage, coils radially expand and longitudinally contract due to the Nb 3Sn phase change. In order to prevent residual strain from altering superconducting performances, the tooling must provide the adequate space for these dimensional changes. The aim of this paper is to understand the behavior of cable dimensions during heat treatment and to provide estimates of the space to be accommodated in the tooling for coil expansion and contraction. In addition, this paper summarizes measurements of dimensional changes on strands, single Rutherford cables,more » cable stacks, and coils performed between 2013 and 2015. These samples and coils have been performed within a collaboration between CERN and the U.S. LHC Accelerator Research Program to develop Nb 3Sn quadrupole magnets for the HiLumi LHC. The results are also compared with other high field magnet projects.« less

Expert opinion vs. empirical evidence

PubMed Central

Herman, Rod A; Raybould, Alan

2014-01-01

Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops. PMID:24637724

Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

PubMed

Kerrigan, Stephanie G; Call, Christine; Schaumberg, Katherine; Forman, Evan; Butryn, Meghan L

2018-03-01

Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology.

PubMed

Galante, Joao R; Rodriguez, Fausto; Grossman, Stuart A; Strowd, Roy E

2017-07-18

Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.

The search for mechanisms of change in behavioral treatments for alcohol use disorders: a commentary.

PubMed

Longabaugh, Richard

2007-10-01

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple. This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested. It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders. Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

NEW INSIGHTS INTO LEAD CORROSION CONTROL AND TREATMENT CHANGE IMPACTS

EPA Science Inventory

This presentation will summarize recent research into the chemistry of lead corrosion control, and focus on five different areas that could impact the prediction of whether or not particular treatment changes are likely to either disturb existing lead corrosion scales, or to actu...

Adapting water treatment design and operations to the impacts of global climate change

NASA Astrophysics Data System (ADS)

Clark, Robert M.; Li, Zhiwei; Buchberger, Steven G.

2011-12-01

It is anticipated that global climate change will adversely impact source water quality in many areas of the United States and will therefore, potentially, impact the design and operation of current and future water treatment systems. The USEPA has initiated an effort called the Water Resources Adaptation Program (WRAP) which is intended to develop tools and techniques that can assess the impact of global climate change on urban drinking water and wastewater infrastructure. A three step approach for assessing climate change impacts on water treatment operation and design is being persude in this effort. The first step is the stochastic characterization of source water quality, the second step is the application of the USEPA Water Treatment Plant model and the third step is the application of cost algorithms to provide a metric that can be used to assess the coat impact of climate change. A model has been validated using data collected from Cincinnati's Richard Miller Water Treatment Plant for the USEPA Information Collection Rule (ICR) database. An analysis of the water treatment processes in response to assumed perturbations in raw water quality identified TOC, pH, and bromide as the three most important parameters affecting performance of the Miller WTP. The Miller Plant was simulated using the EPA WTP model to examine the impact of these parameters on selected regulated water quality parameters. Uncertainty in influent water quality was analyzed to estimate the risk of violating drinking water maximum contaminant levels (MCLs).Water quality changes in the Ohio River were projected for 2050 using Monte Carlo simulation and the WTP model was used to evaluate the effects of water quality changes on design and operation. Results indicate that the existing Miller WTP might not meet Safe Drinking Water Act MCL requirements for certain extreme future conditions. However, it was found that the risk of MCL violations under future conditions could be controlled by

Residential treatment for combat-related posttraumatic stress disorder: identifying trajectories of change and predictors of treatment response.

PubMed

Currier, Joseph M; Holland, Jason M; Drescher, Kent D

2014-01-01

Combat-related posttraumatic stress disorder (PTSD) can be a difficult condition to treat and has been associated with serious medical and economic issues among U.S. military veterans. Distinguishing between treatment responders vs. non-responders in this population has become an important public health priority. This study was conducted to identify pre-treatment characteristics of U.S. veterans with combat-related PTSD that might contribute to favorable and unfavorable responses to high value treatments for this condition. This study focused on 805 patients who completed a VHA PTSD residential program between 2000 and 2007. These patients completed the PTSD Clinical Checklist at pre-treatment, post-treatment, and a four-month follow-up assessment. Latent growth curve analysis (LCGA) was incorporated to determine trajectories of changes in PTSD across these assessments and whether several key clinical concerns for this population were associated with their treatment responses. LCGA indicated three distinct trajectories in PTSD outcomes and identified several clinical factors that were prospectively linked with changes in veterans' posttraumatic symptomatology. When compared to a group with high PTSD symptom severity that decreased over the program but relapsed at follow-up (41%), the near half (48.8%) of the sample with an improving trajectory had less combat exposure and superior physical/mental health. However, when compared to a minority (10.2%) with relatively low symptomatology that also remained somewhat stable, patients in the improving group were younger and also reported greater combat exposure, poorer physical/mental health status, and more problems with substance abuse before the start of treatment. Findings suggest that veterans are most likely to benefit from residential treatment in an intermediate range of symptoms and risk factors, including PTSD symptom severity, history of combat exposure, and comorbid issues with physical/mental health

Final Technical Report for "Collaborative Research: Regional climate-change projections through next-generation empirical and dynamical models"

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

Robertson, A.W.; Ghil, M.; Kravtsov, K.

2011-04-08

This project was a continuation of previous work under DOE CCPP funding in which we developed a twin approach of non-homogeneous hidden Markov models (NHMMs) and coupled ocean-atmosphere (O-A) intermediate-complexity models (ICMs) to identify the potentially predictable modes of climate variability, and to investigate their impacts on the regional-scale. We have developed a family of latent-variable NHMMs to simulate historical records of daily rainfall, and used them to downscale seasonal predictions. We have also developed empirical mode reduction (EMR) models for gaining insight into the underlying dynamics in observational data and general circulation model (GCM) simulations. Using coupled O-A ICMs,more » we have identified a new mechanism of interdecadal climate variability, involving the midlatitude oceans mesoscale eddy field and nonlinear, persistent atmospheric response to the oceanic anomalies. A related decadal mode is also identified, associated with the oceans thermohaline circulation. The goal of the continuation was to build on these ICM results and NHMM/EMR model developments and software to strengthen two key pillars of support for the development and application of climate models for climate change projections on time scales of decades to centuries, namely: (a) dynamical and theoretical understanding of decadal-to-interdecadal oscillations and their predictability; and (b) an interface from climate models to applications, in order to inform societal adaptation strategies to climate change at the regional scale, including model calibration, correction, downscaling and, most importantly, assessment and interpretation of spread and uncertainties in multi-model ensembles. Our main results from the grant consist of extensive further development of the hidden Markov models for rainfall simulation and downscaling specifically within the non-stationary climate change context together with the development of parallelized software; application of NHMMs to

Final Technical Report for "Collaborative Research. Regional climate-change projections through next-generation empirical and dynamical models"

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

Kravtsov, S.; Robertson, Andrew W.; Ghil, Michael

2011-04-08

This project was a continuation of previous work under DOE CCPP funding in which we developed a twin approach of non-homogeneous hidden Markov models (NHMMs) and coupled ocean-atmosphere (O-A) intermediate-complexity models (ICMs) to identify the potentially predictable modes of climate variability, and to investigate their impacts on the regional-scale. We have developed a family of latent-variable NHMMs to simulate historical records of daily rainfall, and used them to downscale seasonal predictions. We have also developed empirical mode reduction (EMR) models for gaining insight into the underlying dynamics in observational data and general circulation model (GCM) simulations. Using coupled O-A ICMs,more » we have identified a new mechanism of interdecadal climate variability, involving the midlatitude oceans mesoscale eddy field and nonlinear, persistent atmospheric response to the oceanic anomalies. A related decadal mode is also identified, associated with the oceans thermohaline circulation. The goal of the continuation was to build on these ICM results and NHMM/EMR model developments and software to strengthen two key pillars of support for the development and application of climate models for climate change projections on time scales of decades to centuries, namely: (a) dynamical and theoretical understanding of decadal-to-interdecadal oscillations and their predictability; and (b) an interface from climate models to applications, in order to inform societal adaptation strategies to climate change at the regional scale, including model calibration, correction, downscaling and, most importantly, assessment and interpretation of spread and uncertainties in multi-model ensembles. Our main results from the grant consist of extensive further development of the hidden Markov models for rainfall simulation and downscaling specifically within the non-stationary climate change context together with the development of parallelized software; application of NHMMs to

Antimicrobial susceptibility survey on bacterial agents of canine and feline urinary tract infections: Weight of the empirical treatment.

PubMed

Rampacci, Elisa; Bottinelli, Marco; Stefanetti, Valentina; Hyatt, Doreene R; Sgariglia, Elisa; Coletti, Mauro; Passamonti, Fabrizio

2018-06-01

This work characterised the antimicrobial susceptibility of uropathogens isolated from empirically treated dogs and cats. Within-household transmission of uropathogens can involve humans and companion animals. Knowledge on the prevalence and susceptibility pattern of isolates from canine and feline urine samples and the impact of prior antimicrobial treatment is important to prevent the dissemination of antimicrobial resistance. A retrospective study was conducted selecting antibiotic-treated companion animals. Urine samples were collected by cystocentesis and were submitted to an Italian diagnostic laboratory over a 2-year period (2013-2015). The antimicrobial susceptibility of the isolates was analysed both using Clinical and Laboratory Standards Institute (CLSI) guidelines and a formula to help select rational antimicrobial therapy. Gram-negative bacteria were clearly prevalent. Gentamicin had the highest impact factors. Amoxicillin/clavulanic acid and doxycycline appeared to be the most effective compounds against Gram-positive infections, whilst marbofloxacin may be a useful option against Gram-negative urinary tract infections (UTIs) as well as doxycycline and trimethoprim/sulfamethoxazole in cats and dogs, respectively. Consulting published studies, a comparable overall trend regarding bacterial species incriminated in canine and feline UTIs and their susceptibilities seems likely, despite different circumstances where the studies were conducted. Companion animals are potential reservoirs of drug-resistant uropathogens. Judicious use of antibiotics is necessary to maintain the efficacy of antimicrobials in human and veterinary medicine. Antimicrobial susceptibility monitoring programmes are therefore essential to facilitate the choice of antimicrobial agent that is most likely to be effective, particularly in cases of prior antimicrobial treatment. Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. All rights reserved.

Comparison of piperacillin tazobactam and cefoperazone sulbactam monotherapy in treatment of febrile neutropenia.

PubMed

Karaman, Serap; Vural, Sema; Yildirmak, Yildiz; Emecen, Merve; Erdem, Ela; Kebudi, Rejin

2012-04-01

Monotherapy has tended to replace the combination therapy in emprical treatment of febrile neutropenia. There is no reported trial which compares the efficacy of cefoperazone-sulbactam (CS) and piperacillin-tazobactam (PIP/TAZO) monotherapies in the treatment of febrile neutropenia. In this prospective randomized study, we aimed to compare the safety and efficacy of CS versus PIP/TAZO as empirical monotherapies in febrile neutropenic children with cancer. The study included febrile, neutropenic children hospitalized at our center for cancer. They were randomly selected to receive CS 100 mg/kg/day or PIP/TAZO 360 mg/kg/day. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. One hundred and two febrile neutropenic episodes were documented in 55 patients with a median age of 4 years. In 50 episodes CS and in 52 episodes PIP/TAZO was used. Duration of fever and neutropenia, neutrophil count, age, sex, and primary disease were not different between two groups. Success rates in the CS and PIP/TAZO groups were respectively 56 and 62% (P > 0.05). Modification rate between two groups showed no significant difference (P > 0.05). No serious adverse effect occurred in either of the groups. CS and PIP/TAZO monotherapy are both safe and effective in the initial treatment of febrile neutropenia in children with cancer. Copyright © 2011 Wiley Periodicals, Inc.

Sensitivity of ab Initio vs Empirical Methods in Computing Structural Effects on NMR Chemical Shifts for the Example of Peptides.

PubMed

Sumowski, Chris Vanessa; Hanni, Matti; Schweizer, Sabine; Ochsenfeld, Christian

2014-01-14

The structural sensitivity of NMR chemical shifts as computed by quantum chemical methods is compared to a variety of empirical approaches for the example of a prototypical peptide, the 38-residue kaliotoxin KTX comprising 573 atoms. Despite the simplicity of empirical chemical shift prediction programs, the agreement with experimental results is rather good, underlining their usefulness. However, we show in our present work that they are highly insensitive to structural changes, which renders their use for validating predicted structures questionable. In contrast, quantum chemical methods show the expected high sensitivity to structural and electronic changes. This appears to be independent of the quantum chemical approach or the inclusion of solvent effects. For the latter, explicit solvent simulations with increasing number of snapshots were performed for two conformers of an eight amino acid sequence. In conclusion, the empirical approaches neither provide the expected magnitude nor the patterns of NMR chemical shifts determined by the clearly more costly ab initio methods upon structural changes. This restricts the use of empirical prediction programs in studies where peptide and protein structures are utilized for the NMR chemical shift evaluation such as in NMR refinement processes, structural model verifications, or calculations of NMR nuclear spin relaxation rates.

Family Involvement and Changes in Child Behavior during Residential Mental Health Treatment

ERIC Educational Resources Information Center

Robst, John; Rohrer, Lodi; Armstrong, Mary; Dollard, Norin; Sharrock, Patty; Batsche, Catherine; Reader, Steven

2013-01-01

Background: Family involvement is viewed as an important component of the treatment process for children in residential treatment centers, but little is known about the impact of contact with family members on changes in youth functioning. Objective: The goal of this study was to use administrative data to examine the association between family…

Improving Empirical Approaches to Estimating Local Greenhouse Gas Emissions

NASA Astrophysics Data System (ADS)

Blackhurst, M.; Azevedo, I. L.; Lattanzi, A.

2016-12-01

Evidence increasingly indicates our changing climate will have significant global impacts on public health, economies, and ecosystems. As a result, local governments have become increasingly interested in climate change mitigation. In the U.S., cities and counties representing nearly 15% of the domestic population plan to reduce 300 million metric tons of greenhouse gases over the next 40 years (or approximately 1 ton per capita). Local governments estimate greenhouse gas emissions to establish greenhouse gas mitigation goals and select supporting mitigation measures. However, current practices produce greenhouse gas estimates - also known as a "greenhouse gas inventory " - of empirical quality often insufficient for robust mitigation decision making. Namely, current mitigation planning uses sporadic, annual, and deterministic estimates disaggregated by broad end use sector, obscuring sources of emissions uncertainty, variability, and exogeneity that influence mitigation opportunities. As part of AGU's Thriving Earth Exchange, Ari Lattanzi of City of Pittsburgh, PA recently partnered with Dr. Inez Lima Azevedo (Carnegie Mellon University) and Dr. Michael Blackhurst (University of Pittsburgh) to improve the empirical approach to characterizing Pittsburgh's greenhouse gas emissions. The project will produce first-order estimates of the underlying sources of uncertainty, variability, and exogeneity influencing Pittsburgh's greenhouse gases and discuss implications of mitigation decision making. The results of the project will enable local governments to collect more robust greenhouse gas inventories to better support their mitigation goals and improve measurement and verification efforts.

A Review on Assessment and Treatment for Depression in Malaysia

PubMed Central

Mukhtar, Firdaus; Oei, Tian P. S.

2011-01-01

This paper aimed to review the literature on depression that focused on its assessment and treatment in Malaysia. PsycINFO, Medline, local journals were searched, and 18 published articles were included in this paper. Results indicate that research on depression in Malaysia, particularly validation studies and psychotherapy research, was weak and fragmented, with minimal empirical evidence available. Pharmacotherapy still dominated the treatment for depression, and, in terms of psychotherapy, Cognitive Behavioural Therapy (CBT) was recently practiced, but only a few studies have reported on the treatment efficacy of CBT. Major limitations of studies were noted, and, consequently, the problems that are associated with the implementation and future direction of clinical and research on depression in Malaysia were discussed. In short, the contribution of empirical research on the assessment and treatment for depression remained inconsistent and fragmented and urgently in need of further empirical investigation. PMID:21804939

Changes in plasma GABA concentration during vigabatrin treatment of epilepsy: a prospective study.

PubMed

Erdal, J; Gram, L; Alving, J; Löscher, W

1999-04-01

The aim of the present prospective study was to evaluate changes in plasma GABA concentration in relation to clinical response during vigabatrin treatment of epilepsy. We studied 29 patients with uncontrolled partial-onset seizures during open add-on vigabatrin treatment and measured plasma GABA and vigabatrin concentrations by a sensitive HPLC method. Following short-term treatment 17 out of 28 patients had a seizure reduction of > 50% (responders). After long-term treatment 16 out of 22 patients were responders. There was no difference between responders and nonresponders regarding pretreatment seizure frequency, treatment duration, vigabatrin dose, or plasma vigabatrin concentration. Responders had a significant (p < 0.001) increase in mean plasma GABA both after short-term (from 0.380 to 0.530 nmol/ml; mean increase: 48%) and after long-term (from 0.392 to 0.618 nmol/ml; mean increase: 71%) vigabatrin treatment, whilst nonresponders had no significant changes in GABA levels. However, since plasma GABA increased in a subgroup of nonresponders, mean plasma GABA levels did not differ between responders and nonresponders. Although plasma GABA increased significantly in the responder but not in the nonresponder group during vigabatrin treatment of patients with epilepsy, it does not seem to be a reliable marker of individual clinical response to vigabatrin treatment.

Leading change: a concept analysis.

PubMed

Nelson-Brantley, Heather V; Ford, Debra J

2017-04-01

To report an analysis of the concept of leading change. Nurses have been called to lead change to advance the health of individuals, populations, and systems. Conceptual clarity about leading change in the context of nursing and healthcare systems provides an empirical direction for future research and theory development that can advance the science of leadership studies in nursing. Concept analysis. CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, Health Business Elite and Business Source Premier databases were searched using the terms: leading change, transformation, reform, leadership and change. Literature published in English from 2001 - 2015 in the fields of nursing, medicine, organizational studies, business, education, psychology or sociology were included. Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed. Five defining attributes of leading change were identified: (a) individual and collective leadership; (b) operational support; (c) fostering relationships; (d) organizational learning; and (e) balance. Antecedents were external or internal driving forces and organizational readiness. The consequences of leading change included improved organizational performance and outcomes and new organizational culture and values. A theoretical definition and conceptual model of leading change were developed. Future studies that use and test the model may contribute to the refinement of a middle-range theory to advance nursing leadership research and education. From this, empirically derived interventions that prepare and enable nurses to lead change to advance health may be realized. © 2016 John Wiley & Sons Ltd.

The urban health transition hypothesis: empirical evidence of an avian influenza Kuznets curve in Vietnam?

PubMed

Spencer, James Herbert

2013-04-01

The literature on development has focused on the concept of transition in understanding the emergent challenges facing poor but rapidly developing countries. Scholars have focused extensively on the health and urban transitions associated with this change and, in particular, its use for understanding emerging infectious diseases. However, few have developed explicit empirical measures to quantify the extent to which a transitions focus is useful for theory, policy, and practice. Using open source data on avian influenza in 2004 and 2005 and the Vietnam Census of Population and Housing, this paper introduces the Kuznets curve as a tool for empirically estimating transition and disease. Findings suggest that the Kuznets curve is a viable tool for empirically assessing the role of transitional dynamics in the emergence of new infectious diseases.

[Research on the hospital construction and structure in Daehan empire and colonial modern period].

PubMed

Han, Dong Gwan; Ryu, Chang Ug; Ko, Sang Kyun; Jung, Jae Kook; Moon, Jong Youn; Park, Yoon Hyung

2011-12-31

It was the late Chosun Dynasty and Daehan Empire era that Western Medicine has firstly been introduced to Korea, previously operating on a basis of Korean traditional medicine. Western Medicine has been introduced by American missionary and Japanese Imperialism. An introduction of Western Medicine made it feasible to proceed new type medical care including operation, leading to require a new form of medical facilities. In the beginning, new facilities were constructed by Japanese Imperialism. Other hand many of facilities including Severance Hospital were established by missionaries. First of all, Daehan Empire established and managed a modern type of medical facility named "Jejoongwon" in 1885 as a government institution hospital. The Red Cross Hospital built in 1889. Afterwards, Jejoongwon and the Red Cross Hospital were taken over to missionary hospital and Japanese Imperialism, respectively. Japanese Imperialists firstly have protected their nationals residing in Chosun but have proceeded care a few Chosun people to exploit medical treatment as a mean to advertise superiority of the Empire of Japan. The facility that has firstly been established and managed was Jeseang Hospital in Busan in 1877, leading to establish in Wonju, Wonsan, and Mokpo. Afterwards, Japan has organized "Donginhoi" as a civil invasion organization, leading for "Donginhoi" to established "Dongin Hospital" in Pyeongyang, Daegu, and Seoul. Since 1909, governmental leading medical facility named Jahye Hospital was established according to an imperial order, leading to establish 32 hospitals all over the nation. American missionaries have established and managed 28 hospitals started from Severance Hospital built in 1904. However, Chosun doctors started to having educated and opening up their own hospital since 1920, leading for many of medical facilities to be established, but most of them have taken different roles followed by 6.25 War and economic development period. However, some of them

Orthodontic treatment effects on inflammatory marker profiles in saliva before and after 2 archwire changes

NASA Astrophysics Data System (ADS)

Yamamoto, Zulham; Jaafar, Ikmal Mohamad; Rohaya, M. A. W.; Abidin, Intan Zarina Zainol; Senafi, Sahidan; Ariffin, Zaidah Zainal; Ariffin, Shahrul Hisham Zainal

2013-11-01

Periodontal tissue changes exerted by external forces in orthodontic treatment allow tooth movement. The changes in periodontal tissues i.e. inflammation can be monitored using gingival crevicular fluid (GCF). GCF is a component of saliva. Saliva could be used to monitor periodontal disease progression. The use of saliva to monitor periodontal tissues changes during orthodontic treatment is still unknown. Therefore, we observed the profiles of inflammatory markers namely creatine kinase ('CK), nitric oxide (NO), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) in saliva of orthodontic patients to evaluate their importance in orthodontic treatment. A total of 21 subjects (13 female and 8 male) participated in this study. Samples were collected from gingival crevicular fluid at three period of archwire changes: baseline (M0), 2 weeks after 0.014" NiTi archwire (M1), and 2 weeks after 0.018" NiTi archwire (M2). All enzyme activities i.e. CK, LDH and AST were measured spectrophotometrically at 340 nm. Griess assay was used to measure nitric oxide level. CK activity, NO level, LDH activity and AST activity in saliva samples did not show significant differences among period of archwire changes. The use of inflammatory marker profiles in saliva may not represent the changes in periodontal tissues during orthodontic treatment.

Artifact interactions retard technological improvement: An empirical study

PubMed Central

Magee, Christopher L.

2017-01-01

Empirical research has shown performance improvement of many different technological domains occurs exponentially but with widely varying improvement rates. What causes some technologies to improve faster than others do? Previous quantitative modeling research has identified artifact interactions, where a design change in one component influences others, as an important determinant of improvement rates. The models predict that improvement rate for a domain is proportional to the inverse of the domain’s interaction parameter. However, no empirical research has previously studied and tested the dependence of improvement rates on artifact interactions. A challenge to testing the dependence is that any method for measuring interactions has to be applicable to a wide variety of technologies. Here we propose a novel patent-based method that is both technology domain-agnostic and less costly than alternative methods. We use textual content from patent sets in 27 domains to find the influence of interactions on improvement rates. Qualitative analysis identified six specific keywords that signal artifact interactions. Patent sets from each domain were then examined to determine the total count of these 6 keywords in each domain, giving an estimate of artifact interactions in each domain. It is found that improvement rates are positively correlated with the inverse of the total count of keywords with Pearson correlation coefficient of +0.56 with a p-value of 0.002. The results agree with model predictions, and provide, for the first time, empirical evidence that artifact interactions have a retarding effect on improvement rates of technological domains. PMID:28777798

Integrated empirical ethics: loss of normativity?

PubMed

van der Scheer, Lieke; Widdershoven, Guy

2004-01-01

An important discussion in contemporary ethics concerns the relevance of empirical research for ethics. Specifically, two crucial questions pertain, respectively, to the possibility of inferring normative statements from descriptive statements, and to the danger of a loss of normativity if normative statements should be based on empirical research. Here we take part in the debate and defend integrated empirical ethical research: research in which normative guidelines are established on the basis of empirical research and in which the guidelines are empirically evaluated by focusing on observable consequences. We argue that in our concrete example normative statements are not derived from descriptive statements, but are developed within a process of reflection and dialogue that goes on within a specific praxis. Moreover, we show that the distinction in experience between the desirable and the undesirable precludes relativism. The normative guidelines so developed are both critical and normative: they help in choosing the right action and in evaluating that action. Finally, following Aristotle, we plead for a return to the view that morality and ethics are inherently related to one another, and for an acknowledgment of the fact that moral judgments have their origin in experience which is always related to historical and cultural circumstances.

Cultural Accommodation of Substance Abuse Treatment for Latino Adolescents

PubMed Central

Burrow-Sanchez, Jason; Martinez, Charles; Hops, Hyman; Wrona, Megan

2011-01-01

Collaborating with community stakeholders is an often suggested step when integrating cultural variables into psychological treatments for members of ethnic minority groups. However, there is a dearth of literature describing how to accomplish this process within the context of substance abuse treatment studies. This paper describes a qualitative study conducted through a series of focus groups with stakeholders in the Latino community. Data from focus groups were used by researchers to guide the integration of cultural variables into an empirically-supported substance abuse treatment for Latino adolescents currently being evaluated for efficacy. A model for culturally accommodating empirically-supported treatments for ethnic minority participants is also described. PMID:21888499

Motivational stage of change in young patients undergoing day treatment for eating disorders.

PubMed

Bustin, Lisa A; Lane-Loney, Susan E; Hollenbeak, Christopher S; Ornstein, Rollyn M

2013-01-01

The objective was to determine whether motivation to change is significantly altered over the course of partial hospitalization in children and adolescents with eating disorders (EDs). This study was a retrospective chart review of 30 sets of adolescents and their parents who completed the Motivational Stage of Change for Adolescents Recovering from an Eating Disorder (MSCARED) at both intake and discharge from partial hospitalization. The main outcome variables included change in stage of change (SOC) for patients and their parents. Secondary outcomes included correlations between SOC and other baseline variables, as well as changes in SOC and psychological test scores. The SOC was significantly higher at discharge than at intake in both the patients and parents, but the two groups were not in agreement at discharge. The change in the SOC was correlated with change in Children's Eating Attitudes Test scores. Assessment of decisional balance showed correlations with SOC. Age, change in weight, and psychiatric diagnoses did not correlate with initial SOC. The MSCARED may be a useful tool for monitoring young ED patients' psychological improvements with day treatment. Initial SOC is not predictive of treatment outcomes.

Forecasting land cover change impacts on drinking water treatment costs in Minneapolis, Minnesota

EPA Science Inventory

Source protection is a critical aspect of drinking water treatment. The benefits of protecting source water quality in reducing drinking water treatment costs are clear. However, forecasting the impacts of environmental change on source water quality and its potential to influenc...

Trust and Decision Making: An Empirical Platform

DTIC Science & Technology

2008-06-01

13th ICCRTS “C2 for Complex Endeavors” Trust and Decision Making : An Empirical Platform Topic(s): Cognitive and Social Issues...and Decision Making : An Empirical Platform 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Trust and Decision Making : An Empirical Platform Dr. Joseph B

Change in surface properties of zirconia and initial attachment of osteoblastlike cells with hydrophilic treatment.

PubMed

Watanabe, Hiroaki; Saito, Kensuke; Kokubun, Katsutoshi; Sasaki, Hodaka; Yoshinari, Masao

2012-01-01

The objectives of this study were to characterize change in surface properties of tetragonal zirconia polycrystals (TZP) after hydrophilic treatment, and to determine the effect of such changes on initial attachment of osteoblast-like cells. Roughened surfaces were produced by alumina-blasting and acid-etching. Hydrophilic treatment comprised application of immediately after blasting and acid-etching (Blast/Etch), oxygen plasma (O2-Plasma), ultraviolet light (UV). Specimens stored in air were used as a control. The water contact angle was determined and surface analysis was performed using an X-ray photoelectron spectroscopy. Blast/Etch, O2-Plasma and UV specimens showed superhydrophilicity, and these hydrophilic treatments to TZP elicited a marked decrease in carbon content and an increase in hydroxyl groups. Hydrophilic treatments enhanced initial attachment of osteoblast-like cells and a change in cell morphologies. These results indicate that Blast/Etch, O2-Plasma, or UV treatment has potential in the creation and maintenance of superhydrophilic surfaces and enhancing initial attachment of osteoblast-like cells.

Changing Donor Funding and the Challenges of Integrated HIV Treatment.

PubMed

Nattrass, Nicoli; Hodes, Rebecca; Cluver, Lucie

2016-07-01

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Change in Sense of Community: An Empirical Finding

ERIC Educational Resources Information Center

Loomis, Colleen; Dockett, Kathleen H.; Brodsky, Anne E.

2004-01-01

This study investigated changes in students' psychological sense of community (SOC) under two conditions of external threat against their urban, historically Black, public nonresidential university in a U.S. mid-Atlantic city. Two independent stratified random samples (N = 801 and N = 241) consisting of undergraduate and graduate women (61%) and…

How fast is fisheries-induced evolution? Quantitative analysis of modelling and empirical studies

PubMed Central

Audzijonyte, Asta; Kuparinen, Anna; Fulton, Elizabeth A

2013-01-01

A number of theoretical models, experimental studies and time-series studies of wild fish have explored the presence and magnitude of fisheries-induced evolution (FIE). While most studies agree that FIE is likely to be happening in many fished stocks, there are disagreements about its rates and implications for stock viability. To address these disagreements in a quantitative manner, we conducted a meta-analysis of FIE rates reported in theoretical and empirical studies. We discovered that rates of phenotypic change observed in wild fish are about four times higher than the evolutionary rates reported in modelling studies, but correlation between the rate of change and instantaneous fishing mortality (F) was very similar in the two types of studies. Mixed-model analyses showed that in the modelling studies traits associated with reproductive investment and growth evolved slower than rates related to maturation. In empirical observations age-at-maturation was changing faster than other life-history traits. We also found that, despite different assumption and modelling approaches, rates of evolution for a given F value reported in 10 of 13 modelling studies were not significantly different. PMID:23789026

Changes in brain connectivity related to the treatment of depression measured through fMRI: a systematic review

PubMed Central

Gudayol-Ferré, Esteve; Peró-Cebollero, Maribel; González-Garrido, Andrés A.; Guàrdia-Olmos, Joan

2015-01-01

Depression is a mental illness that presents alterations in brain connectivity in the Default Mode Network (DMN), the Affective Network (AN) and other cortical-limbic networks, and the Cognitive Control Network (CCN), among others. In recent years the interest in the possible effect of the different antidepressant treatments on functional connectivity has increased substantially. The goal of this paper is to conduct a systematic review of the studies on the relationship between the treatment of depression and brain connectivity. Nineteen studies were found in a systematic review on this topic. In all of them, there was improvement of the clinical symptoms after antidepressant treatment. In 18 out of the 19 studies, clinical improvement was associated to changes in brain connectivity. It seems that both DMN and the connectivity between cortical and limbic structures consistently changes after antidepressant treatment. However, the current evidence does not allow us to assure that the treatment of depression leads to changes in the CCN. In this regard, some papers report a positive correlation between changes in brain connectivity and improvement of depressive symptomatology, particularly when they measure cortical-limbic connectivity, whereas the changes in DMN do not significantly correlate with clinical improvement. Finally, some papers suggest that changes in connectivity after antidepressant treatment might be partly related to the mechanisms of action of the treatment administered. This effect has been observed in two studies with stimulation treatment (one with rTMS and one with ECT), and in two papers that administered three different pharmacological treatments. Our review allows us to make a series of recommendations that might guide future researchers exploring the effect of anti-depression treatments on brain connectivity. PMID:26578927

Mediation of the relationship of behavioural treatment type and changes in psychological predictors of healthy eating by body satisfaction changes in women with obesity.

PubMed

Annesi, James J

Psychological correlates of both short- and long-term weight loss are poorly understood. Changes in satisfaction with one's body might serve to motivate healthier eating by mediating treatments' effect on psychological factors previously suggested to be associated with weight loss. Women with obesity (age 48.6±7.1 years; BMI 35.4±3.3kg/m 2 ) were randomly assigned to social cognitive theory-based weight-management treatments that were either group sessions emphasizing physical activity-derived self-regulation (experimental; n=53) or review of a written manual and phone support (comparison; n=54). Changes in weight, physical activity, body satisfaction, negative mood, and self-efficacy and self-regulation for controlled eating were assessed over 3, 6, 12, and 24 months. The experimental treatment was associated with significantly more favourable changes across variables. Over 6, 12, and 24 months, body satisfaction change mediated relationships between treatment type and changes in each of the psychological predictors of healthier eating (mood, self-efficacy, self-regulation). Reciprocal, mutually reinforcing, relationships between changes in body satisfaction and those psychological predictors were also found. Increased physical activity was associated with improved body satisfaction, even after controlling for weight changes. Findings increased understandings of the role of body satisfaction in improving psychological predictors of healthier eating over both the short- and longer-term. Results also suggested that body satisfaction could be improved through increased physical activity, irrespective of change in weight. Although results were limited to women with class 1 and 2 obesity, findings on interactions of psychological factors associated with eating changes have implications for the architecture of improved behavioural treatments. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Space evolution model and empirical analysis of an urban public transport network

NASA Astrophysics Data System (ADS)

Sui, Yi; Shao, Feng-jing; Sun, Ren-cheng; Li, Shu-jing

2012-07-01

This study explores the space evolution of an urban public transport network, using empirical evidence and a simulation model validated on that data. Public transport patterns primarily depend on traffic spatial-distribution, demands of passengers and expected utility of investors. Evolution is an iterative process of satisfying the needs of passengers and investors based on a given traffic spatial-distribution. The temporal change of urban public transport network is evaluated both using topological measures and spatial ones. The simulation model is validated using empirical data from nine big cities in China. Statistical analyses on topological and spatial attributes suggest that an evolution network with traffic demands characterized by power-law numerical values which distribute in a mode of concentric circles tallies well with these nine cities.

Patients' impression of change following treatment for chronic pain: global, specific, a single dimension, or many?

PubMed

Scott, Whitney; McCracken, Lance M

2015-06-01

The Patient Global Impression of Change (PGIC) measure has frequently been used as an indicator of meaningful change in treatments for chronic pain. However, limited research has examined the validity of PGIC items despite their wide adoption in clinical trials for pain. Additionally, research has not yet examined predictors of PGIC ratings following psychologically based treatment for pain. The purpose of the present study was to examine the validity, factor structure, and predictors of PGIC ratings following an interdisciplinary psychologically based treatment for chronic pain. Patients with chronic pain (N = 476) completed standard assessments of pain, daily functioning, and depression before and after a 4-week treatment program based on the principles of acceptance and commitment therapy. Following the program, patients rated 1 item assessing their impression of change overall and several items assessing their impression of more specific changes: physical and social functioning, work-related activities, mood, and pain. Results indicated that the global and specific impression of change items represent a single component. In the context of the acceptance and commitment therapy-based treatment studied here, overall PGIC ratings appeared to be influenced to a greater degree by patients' experienced improvements in physical activities and mood than by improvements in pain. The findings suggest that in addition to a single overall PGIC rating, domain-specific items may be relevant for some treatment trials. This article reports on the validity and predictors of patients' impression of change ratings following interdisciplinary psychologically based treatment for pain. In addition to a single overall PGIC rating, domain-specific items may be important for clinicians and researchers to consider depending on the focus of treatment. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Empirical complexities in the genetic foundations of lethal mutagenesis.

PubMed

Bull, James J; Joyce, Paul; Gladstone, Eric; Molineux, Ian J

2013-10-01

From population genetics theory, elevating the mutation rate of a large population should progressively reduce average fitness. If the fitness decline is large enough, the population will go extinct in a process known as lethal mutagenesis. Lethal mutagenesis has been endorsed in the virology literature as a promising approach to viral treatment, and several in vitro studies have forced viral extinction with high doses of mutagenic drugs. Yet only one empirical study has tested the genetic models underlying lethal mutagenesis, and the theory failed on even a qualitative level. Here we provide a new level of analysis of lethal mutagenesis by developing and evaluating models specifically tailored to empirical systems that may be used to test the theory. We first quantify a bias in the estimation of a critical parameter and consider whether that bias underlies the previously observed lack of concordance between theory and experiment. We then consider a seemingly ideal protocol that avoids this bias-mutagenesis of virions-but find that it is hampered by other problems. Finally, results that reveal difficulties in the mere interpretation of mutations assayed from double-strand genomes are derived. Our analyses expose unanticipated complexities in testing the theory. Nevertheless, the previous failure of the theory to predict experimental outcomes appears to reside in evolutionary mechanisms neglected by the theory (e.g., beneficial mutations) rather than from a mismatch between the empirical setup and model assumptions. This interpretation raises the specter that naive attempts at lethal mutagenesis may augment adaptation rather than retard it.

Beyond Autism Treatment: The Application of Applied Behavior Analysis in the Treatment of Emotional and Psychological Disorders