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Sample records for change empiric treatment

  1. The Common Factors, Empirically Validated Treatments, and Recovery Models of Therapeutic Change

    ERIC Educational Resources Information Center

    Reisner, Andrew D.

    2005-01-01

    I review the Common Factors Model, the Empirically Validated Therapy Model, and the Recovery Model of therapeutic change and effectiveness. In general, psychotherapy appears to be effective and common factors account for more of the variance than do specific techniques. However, in some areas, particularly in the treatment of anxiety disorders,…

  2. 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.

  3. A recent evaluation of empirical cephalosporin treatment and antibiotic resistance of changing bacterial profiles in spontaneous bacterial peritonitis.

    PubMed

    Yakar, Tolga; Güçlü, Mustafa; Serin, Ender; Alişkan, Hikmet; Husamettin, Erdamar

    2010-04-01

    The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm(3) or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.

  4. Empirical studies on changes in oil governance

    NASA Astrophysics Data System (ADS)

    Kemal, Mohammad

    Regulation of the oil and gas sector is consequential to the economies of oil-producing countries. In the literature, there are two types of regulation: indirect regulation through taxes and tariffs or direct regulation through the creation of a National Oil Company (NOC). In the 1970s, many oil-producing countries nationalized their oil and gas sectors by creating and giving ownership rights of oil and gas resources to NOCs. In light of the success of Norway in regulating its oil and gas resources, over the past two decades several countries have changed their oil governance by changing the rights given to NOC from ownership right to mere access rights like other oil companies. However, empirical literature on these changes in oil governance is quite thin. Thus, this dissertation will explore three research questions to investigate empirically these changes in oil governance. First, I investigate empirically the impact of the changes in oil governance on aggregate domestic income. By employing a difference-in-difference method, I will show that a country which changed its oil governance increases its GDP per-capita by 10%. However, the impact is different for different types of political institution. Second, by observing the changes in oil governance in Indonesia , I explore the impact of the changes on learning-by-doing and learning spillover effect in offshore exploration drilling. By employing an econometric model which includes interaction terms between various experience variables and changes in an oil governance dummy, I will show that the change in oil governance in Indonesia enhances learning-by-doing by the rigs and learning spillover in a basin. Lastly, the impact of the changes in oil governance on expropriation risk and extraction path will be explored. By employing a difference-in-difference method, this essay will show that the changes in oil governance reduce expropriation and the impact of it is different for different sizes of resource stock.

  5. Identifying and developing empirically supported child and adolescent treatments.

    PubMed

    Kazdin, A E; Weisz, J R

    1998-02-01

    Child and adolescent therapy outcome research findings attest to the efficacy of a variety of treatments. This article illustrates promising treatments for selected internalizing (anxiety and depression), externalizing (oppositional, and antisocial behavior), and other (obesity and autism) conditions, and for other aims (preparation for medical and dental procedures). Studies in these areas illustrate worthwhile characteristics that can help inform the search for empirically supported treatments. These characteristics include randomized controlled trials, well-described and replicable treatments, tests with clinical samples, tests of clinical significance, broad-based outcome assessment including measures of real-world functioning, and others. Continued research progress will depend on greater attention to magnitude and maintenance of therapeutic change, long-term follow-up, moderators and mediators of change, and development and testing of treatment in conditions relevant to clinical practice.

  6. Issues and Controversies that Surround Recent Texts on Empirically Supported and Empirically Based Treatments

    ERIC Educational Resources Information Center

    Paul, Howard A.

    2004-01-01

    Since the 1993 APA task force of the Society of Clinical Psychology developed guidelines to apply data-based psychology to the identification of effective psychotherapy, there has been an increasing number of texts focussing on Empirically based Psychotherapy and Empirically Supported Treatments. This manuscript examines recent key texts and…

  7. Treatments for Sleep Changes

    MedlinePlus

    ... Contributing medical factors Non-drug strategies Medications Common sleep changes Many people with Alzheimer’s experience changes in ... at night. Subscribe now Non-drug treatments for sleep changes Non-drug treatments aim to improve sleep ...

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

  9. Empirically Supported Treatment Endeavour: A Successful Future or Inevitable Debacle?

    ERIC Educational Resources Information Center

    Foley, Jessica M.

    2004-01-01

    The Empirically Supported Treatment (EST) endeavour began with and has persisted through prodigious skepticism among practising clinical psychologists. Despite such criticism, however, the advent of managed care guidelines, growing emphasis on biological psychiatry, promotion of scientific interests, and the need for better patient care have…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

  11. An Exploration of Students' Perceptions of Empirically Supported Treatments: The Significance of Gender and Ethnicity

    ERIC Educational Resources Information Center

    Simons, Lori; Giorgio, Tina; Houston, Hank; Jacobucci, Ray

    2007-01-01

    A secondary analysis of a quasi-experimental study was conducted to evaluate differences in students 'perceptions of empirically supported treatments (ESTS) randomized to experimental (n= 10) and attention-control (n= 10) manual-based therapy interventions. The results indicated that attitudinal changes took place for both groups. The results…

  12. Strategies in treatment of suicidality: identification of common and treatment-specific interventions in empirically supported treatment manuals.

    PubMed

    Weinberg, Igor; Ronningstam, Elsa; Goldblatt, Mark J; Schechter, Mark; Wheelis, Joan; Maltsberger, John T

    2010-06-01

    Many reports of treatments for suicidal patients claim effectiveness in reducing suicidal behavior but fail to demonstrate which treatment interventions, or combinations thereof, diminish suicidality. In this study, treatment manuals for empirically supported psychological treatments for suicidal patients were examined to identify which interventions they had in common and which interventions were treatment-specific. Empirically supported treatments for suicidality were identified through a literature search of PsychLit and MEDLINE for the years 1970-2007, employing the following search strategy: [suicide OR parasuicide] AND [therapy OR psychotherapy OR treatment] AND [random OR randomized]. After identifying the reports on randomized controlled studies that tested effectiveness of different treatments, the reference list of each report was searched for further studies. Only reports published in English were included. To ensure that rated manuals actually correspond to the delivered and tested treatments, we included only treatment interventions with explicit adherence rating and scoring and with adequate adherence ratings in the published studies. Five manualized treatments demonstrating efficacy in reducing suicide risk were identified and were independently evaluated by raters using a list of treatment interventions. The common interventions included a clear treatment framework; a defined strategy for managing suicide crises; close attention to affect; an active, participatory therapist style; and use of exploratory and change-oriented interventions. Some treatments encouraged a multimodal approach and identification of suicidality as an explicit target behavior, and some concentrated on the patient-therapist relationship. Emphasis on interpretation and supportive interventions varied. Not all methods encouraged systematic support for therapists. This study identified candidate interventions for possible effectiveness in reducing suicidality. These interventions

  13. 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

    2017-01-01

    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.

  14. 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.

  15. Quantifying uncertainty in climate change science through empirical information theory

    PubMed Central

    Majda, Andrew J.; Gershgorin, Boris

    2010-01-01

    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 CO2. 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. PMID:20696940

  16. Empirically supported psychological treatments: the challenge of evaluating clinical innovations.

    PubMed

    Church, Dawson; Feinstein, David; Palmer-Hoffman, Julie; Stein, Phyllis K; Tranguch, Anthony

    2014-10-01

    Clear and transparent standards are required to establish whether a therapeutic method is "evidence based." Even when research demonstrates a method to be efficacious, it may not become available to patients who could benefit from it, a phenomenon known as the "translational gap." Only 30% of therapies cross the gap, and the lag between empirical validation and clinical implementation averages 17 years. To address these problems, Division 12 of the American Psychological Association published a set of standards for "empirically supported treatments" in the mid-1990s that allows the assessment of clinical modalities. This article reviews these criteria, identifies their strengths, and discusses their impact on the translational gap, using the development of a clinical innovation called Emotional Freedom Techniques (EFT) as a case study. Twelve specific recommendations for updates of the Division 12 criteria are made based on lessons garnered from the adoption of EFT within the clinical community. These recommendations would shorten the cycle from the research setting to clinical practice, increase transparency, incorporate recent scientific advances, and enhance the capacity for succinct comparisons among treatments.

  17. Well-Established and Empirically Supported Behavioral Treatments for Migraine.

    PubMed

    Penzien, Donald B; Irby, Megan B; Smitherman, Todd A; Rains, Jeanetta C; Houle, Timothy T

    2015-07-01

    This paper provides an overview of the well-established and empirically supported behavioral interventions for the treatment of migraine. The considerable evidence base addressing behavioral interventions amassed since 1969 has conclusively established the efficacy of therapies featuring combinations of relaxation, biofeedback, and stress management training, and demonstrated they are capable of yielding benefits on par with pharmacological therapies for migraine. Behavioral interventions also are well suited for delivery across a variety of different contexts (e.g., group vs. individual, standard clinic vs. limited therapist contact, face-to-face vs. technology-assisted). Despite the amply established efficacy and effectiveness of these self-management interventions for the treatment of migraine, the availability and implementation of these approaches remain limited for many headache sufferers. We anticipate the technological advances in delivery platforms will provide better access to behavioral self-management strategies for migraine.

  18. Empirically supported treatments in pediatric psychology: severe feeding problems.

    PubMed

    Kerwin, M E

    1999-06-01

    To identify treatment studies for severe pediatric feeding problems that meet the modified methodological criteria of the Task Force on Promotion and Dissemination of Psychological Procedures (1995). Articles in peer-reviewed medical and psychological journals (1970-1997) reporting psychosocial or behavioral intervention studies targeting an identified oral feeding problem in children were selected. Methodologically rigorous studies were identified and treatments were classified as well established, probably efficacious, or promising interventions according to specified criteria. Effective interventions for children with severe feeding problems are contingency management treatments that include positive reinforcement of appropriate feeding responses and ignoring or guiding inappropriate responses. Promising interventions include positive reinforcement for acceptance and not removing the spoon for refusal and swallow induction training. Because only studies of behavioral interventions met methodological criteria, well-controlled intervention studies are needed across a variety of theoretical perspectives. Empirically supported treatments for feeding problems exist; it is now time to turn to questions about for whom they are appropriate, and when, and why.

  19. 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.

  20. Familiarizing Students with the Empirically Supported Treatment Approaches for Childhood Problems.

    ERIC Educational Resources Information Center

    Wilkins, Victoria; Chambliss, Catherine

    The clinical research literature exploring the efficacy of particular treatment approaches is reviewed with the intent to facilitate the training of counseling students. Empirically supported treatments (ESTs) is defined operationally as evidence-based treatments following the listing of empirically validated psychological treatments reported by…

  1. 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.

  2. Do high rates of empirical treatment undermine the potential effect of new diagnostic tests for tuberculosis in high-burden settings?

    PubMed

    Theron, Grant; Peter, Jonny; Dowdy, David; Langley, Ivor; Squire, S Bertel; Dheda, Keertan

    2014-06-01

    In tuberculosis-endemic settings, patients are often treated empirically, meaning that they are placed on treatment based on clinical symptoms or tests that do not provide a microbiological diagnosis (eg, chest radiography). New tests for tuberculosis, such as the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, USA), are being implemented at substantial cost. To inform policy and rationally drive implementation, data are needed for how these tests affect morbidity, mortality, transmission, and population-level tuberculosis burden. If people diagnosed by use of new diagnostics would have received empirical treatment a few days later anyway, then the incremental benefit might be small. Will new diagnostics substantially improve outcomes and disease burden, or simply displace empirical treatment? Will the extent and accuracy of empirical treatment change with the introduction of a new test? In this Personal View, we review emerging data for how empirical treatment is frequently same-day, and might still be the predominant form of treatment in high-burden settings, even after Xpert implementation; and how Xpert might displace so-called true-positive, rather than false-positive, empirical treatment. We suggest types of studies needed to accurately assess the effect of new tuberculosis tests and the role of empirical treatment in real-world settings. Until such questions can be addressed, and empirical treatment is appropriately characterised, we postulate that the estimated population-level effect of new tests such as Xpert might be substantially overestimated. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Psychodynamic and behavior modification approaches to the treatment of infantile autism empirical similarities.

    PubMed

    Helm, D

    1976-03-01

    In the treatment of infantile autism, behaviorists emphasize directed behavioral change while psychodynamic therapists tend to focus attention on the worker-child relationship. A review of the literature suggests that both of these aspects of intervention are important, and that both play a role in virtually all therapeutic efforts. The similarities in methods of intervention found in the work of investigators of very different theoretical persuasion raise the possibility that most treatment methods owe more to empirical clinical experience than to their presumed derivation from a theoretical model. This thesis is further examined with respect to a 50-year-old case history by Lightmer Witmer, and the work of the present writer with an 11-year-old autistic boy.

  4. 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.

  5. Impact of three empirical anti-tuberculosis treatment strategies for people initiating antiretroviral therapy.

    PubMed

    Van Rie, A; Westreich, D; Sanne, I

    2014-11-01

    Early mortality in people initiating antiretroviral treatment (ART) remains high. Empirical anti-tuberculosis treatment strategies aim to reduce early mortality by initiating anti-tuberculosis treatment in individuals at high risk of death from undiagnosed TB. Using data from 16 913 individuals starting ART under program conditions, we simulated the impact of three empirical treatment strategies (two clinical trials and a pragmatic approach), assuming that 50% of early deaths and 100% of incident TB are averted in those eligible. Compared to starting anti-tuberculosis treatment on clinical or mycobacteriological grounds, 4.4-31.4% more individuals were eligible for anti-tuberculosis treatment, 5.5-25.4% of deaths were averted and 10.9-57.3% of incident TB cases were prevented under empirical anti-tuberculosis treatment strategies. The proportion receiving any anti-tuberculosis treatment during the first 6 months of ART increased from the observed 24.0% to an estimated 27.5%, 40.4% and 51.3%, under the PrOMPT, REMEMBER and pragmatic approach, respectively. The impact of empirical anti-tuberculosis treatment strategies depends greatly on the eligibility criteria chosen. The additional strain placed on anti-tuberculosis treatment facilities and the relatively limited impact of some empirical TB strategies raise the question as to whether the benefits will outweigh the risks at population level.

  6. Empirical methods for modeling landscape change, ecosystem services, and biodiversity

    Treesearch

    David Lewis; Ralph. Alig

    2009-01-01

    The purpose of this paper is to synthesize recent economics research aimed at integrating discrete-choice econometric models of land-use change with spatially-explicit landscape simulations and quantitative ecology. This research explicitly models changes in the spatial pattern of landscapes in two steps: 1) econometric estimation of parcel-scale transition...

  7. 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...

  8. Familiarizing Students with the Empirically Supported Treatment Approaches for Substance Abuse Problems.

    ERIC Educational Resources Information Center

    Wilkins, Victoria; Chambliss, Catherine

    When training counseling students, it is important to familiarize them with the clinical research literature exploring the efficacy of particular treatments. The bulk of the document is comprised of a review of empirically supported treatments (ESTs). ESTs or evidence-based treatments are grounded in studies recommended by the American…

  9. Commentary: Implementing Empirically Supported Treatments in the Schools: What Are We Asking?

    ERIC Educational Resources Information Center

    Evans, Steven W.; Weist, Mark D.

    2004-01-01

    The research reported in this special issue addresses important areas for the continued development of empirically supported school-based treatments. Although advances in the development and evaluation of treatment services have occurred, there is little public demand for the widespread dissemination of these treatments. In this commentary, the…

  10. Drug-induced handwriting changes: an empirical review.

    PubMed

    Gross, L J

    1975-01-01

    Since handwriting is a highly complex, coordinated motor activity, handwrits of pharmacological agents. Its potential has been most evident in research involving therapeutic administrations of anti-psychotic an anti-Parkinsonian drugs, from which consistent and systematic handwriting changes have been observed. This relationship has been found to be particularly significant among the anti-psychotics, since the onset of these graphomotor alterations appear to mark the optmal dose of the drug. Consistent and systematic handwriting changes have not been as evident in inivestigations of drugs used in a nontherapeutic atmosphere. Psychiatric assessments of subjects in ths type of research provided data which indicated that psychological stability may be a factor influencing the susceptibility of one's handwriting to drug induced changes.

  11. Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction.

    PubMed

    Fortis, Spyridon; Corazalla, Edward O; Jacobs, David R; Kim, Hyun J

    2016-09-01

    Health-care providers often diagnose and empirically treat COPD without a confirmative pulmonary function test (PFT) or even despite a PFT that is not diagnostic of obstructive lung disease. We hypothesized that a portion of patients continue to carry a persistent empiric COPD diagnosis and receive treatment with bronchodilators and inhaled steroids after a PFT shows no obstruction. We retrospectively reviewed single PFT sessions with both spirometry and plethysmography in 1,805 subjects. We included subjects who had a normal PFT or a restrictive ventilatory defect. Persistent empiric COPD diagnosis and treatment were defined when subjects with normal PFTs or a restrictive ventilatory defect continued to carry a health-care provider COPD diagnosis or receive treatment with bronchodilators and/or inhaled glucocorticoids, respectively, after a PFT showed no obstruction. One quarter of subjects with FEV1/FVC ≥ lower limit of the normal range had nonspecific PFT abnormalities. We included 473 subjects with normal PFTs and 382 with a restrictive ventilatory defect (n = 855). Persistent empiric COPD diagnosis (60 of 855, 7% prevalence) was associated with current (odds ratio [OR] = 44.7, P < .001) and former smoking (OR = 17.3, P < .001) and older age (OR = 1.03/y, P = .005). Persistent empiric treatment (208 of 855, 24%) was associated with empiric COPD diagnosis (OR = 24.6, P < .001), female sex (OR = 1.75, P = .002), current (OR = 2.04, P = 0.040) and former smoking (OR = 1.53, P = 0.029), interstitial lung disease (OR = 2.09, P = .001), other respiratory diagnosis (OR = 3.17, P < .001), and obstructive sleep apnea (OR = 1.79, P = .006). Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common. Copyright © 2016 by Daedalus Enterprises.

  12. 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.

  13. 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.

  14. Efficacy combined with specified ingredients: a new direction for empirically supported addiction treatment.

    PubMed

    Magill, Molly; Longabaugh, Richard

    2013-05-01

    With the increased need for sanctioning behavioral addiction treatments to guide key stakeholders, focus has shifted to developing and applying criteria for establishing empirically supported treatments (EST). Among the many criteria offered, demonstration of incremental efficacy over a placebo or comparison in at least two independent randomized clinical trials (RCTs) has been the gold standard. While necessary, the present EST criteria are not sufficient. The present work: (i) argues for empirically supported specificity in behavioral addiction treatment, (ii) explores the limitations of empirical support for EST efficacy without evidence of specificity and (iii) discusses implications and recommendations for ultimately raising the bar for status as an EST. The authors review relevant literature on ESTs, evidence-based practice and clinical trial design in the addictions and related disciplines. We clarify that the additional bar of specificity does not denote uniqueness in causal processes and we argue that specificity should not be inferred only via the nature of the experimental contrast. Rather, a treatment has specificity if its active ingredients are identified and validated empirically as predictors of subsequent treatment-related outcomes. Within this new definition, there are implications for clinical research and other key stakeholders. A heightened centrality of empirically supported addiction treatment ingredients moving forward will advance clinical knowledge and evaluation methodology at a far greater pace. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  15. Empirically defining rapid response to intensive treatment to maximize prognostic utility for bulimia nervosa and purging disorder.

    PubMed

    MacDonald, Danielle E; Trottier, Kathryn; McFarlane, Traci; Olmsted, Marion P

    2015-05-01

    Rapid response (RR) to eating disorder treatment has been reliably identified as a predictor of post-treatment and sustained remission, but its definition has varied widely. Although signal detection methods have been used to empirically define RR thresholds in outpatient settings, RR to intensive treatment has not been investigated. This study investigated the optimal definition of RR to day hospital treatment for bulimia nervosa and purging disorder. Participants were 158 patients who completed ≥6 weeks of day hospital treatment. Receiver operating characteristic (ROC) analysis was used to create four definitions of RR that could differentiate between remission and nonremission at the end of treatment. Definitions were based on binge/vomit episode frequency or percent reduction from pre-treatment, during either the first four or first two weeks of treatment. All definitions were associated with higher remission rates in rapid compared to nonrapid responders. Only one definition (i.e., ≤3 episodes in the first four weeks of treatment) predicted sustained remission (versus relapse) at 6- and 12-month follow-up. These findings provide an empirically derived definition of RR to intensive eating disorder treatment, and provide further evidence that early change is an important prognostic indicator.

  16. Treating Asian American women with eating disorders: multicultural competency and empirically supported treatment.

    PubMed

    Smart, Rebekah

    2010-01-01

    Disordered eating and body dissatisfaction are occurring among Asian American women, but the vast majority of treatment literature is based on White Western women. Empirically supported treatments are increasingly encouraged for eating disorders, but therapists find little guidance for implementing them in a culturally sensitive manner. This paper reviews eating problems in Asian American women and explores concepts important to cultural competency in therapy. Examples of how cultural adaptations could be made to an empirically supported treatment are illustrated in a case scenario using aspects of C. G. Fairburn's Enhanced Cognitive Behavioral Therapy for Eating Disorders (2008).

  17. 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…

  18. Identifying Empirically Supported Treatments for Pica in Individuals with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Hagopian, Louis P.; Rooker, Griffin W.; Rolider, Natalie U.

    2011-01-01

    The purpose of the current study was to critically examine the existing literature on the treatment of pica displayed by individuals with intellectual disabilities. Criteria for empirically supported treatments as described by Divisions 12 and 16 of APA, and adapted for studies employing single-case designs were used to review this body of…

  19. Multimodal Treatment of Attention-Deficit Hyperactivity Disorder: An Updated Review of the Empirical Literature.

    ERIC Educational Resources Information Center

    Maier, William J.

    This paper presents an updated review of the empirical literature which examines multimodal forms of treatment for Attention Deficit Hyperactivity Disorder (ADHD). Multimodal treatment typically involves some combination of psychostimulant medication, behavior modification, and cognitive training. Results of studies were grouped into three…

  20. Familiarizing Students with the Empirically Supported Treatment Approaches for Eating Disorders.

    ERIC Educational Resources Information Center

    Wilkins, Victoria; Urban, Greg; Zanotti, Mary; Chambliss, Catherine

    In recent years, bulimia nervosa has plagued young women and become a major issue in mental health care. Strategies for training counseling students so as to acquaint them with clinical research on treatments for bulimia are presented in this report. It reviews empirically supported treatments (ESTs) concerning eating disorders in order to…

  1. Empirical Examination of a Multicomponent Treatment for Pediatric Food Refusal.

    ERIC Educational Resources Information Center

    Hoch, Theodore A.; Babbitt, Roberta L.; Farrar-Schneider, Debra; Berkowitz, Merrill J.; Owens, J. Carl; Knight, Terry L.; Snyder, Angela M.; Rizol, Laura M.; Wise, David T.

    2001-01-01

    This paper reports on assessment and treatment of food refusal for four inpatient boys (ages 2,3,3, and 9) receiving tube feedings. It used a contingency contacting procedure extended by a component analysis. Data suggest that food refusal appeared to be maintained primarily by negative reinforcement contingencies. Caregiver responses indicated a…

  2. 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

  3. Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)

    PubMed Central

    Landry, Eric; Sulz, Linda; Bell, Ali; Rathgeber, Lane; Balogh, Heather

    2014-01-01

    Background Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile–associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu’Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. Objective: To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. Methods: A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. Results: Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51–5.25; p < 0.001). There was also a significant

  4. Assessment and treatment of PTSD after a motor vehicle collision: Empirical findings and clinical observations

    PubMed Central

    Beck, J. Gayle; Coffey, Scott F.

    2007-01-01

    Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with Acute Stress Disorder that are designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed, in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response, as well as augment individual-based treatment formats. PMID:18509507

  5. Efficacy and safety of oral gemifloxacin for the empirical treatment of pneumonia.

    PubMed

    Amitabh, Vindu; Singhal, Anish; Kumar, Sudhir; Patel, Narmada; Rizvi, Yasir S; Mishra, Pankaj

    2012-07-01

    Respiratory tract infections (RTI) are common causes of morbidity and mortality worldwide. Initial antibiotic therapy in upper and lower respiratory tract infections is usually empirical. The increasing evidence of antibacterial resistance in the pathogens commonly associated with pneumonia has raised concerns about the efficacy of currently available therapies and poses a challenge to clinicians. Gemifloxacin is a synthetic fluoroquinolone antimicrobial agent exhibiting potent activity against most Gram negative and Gram positive organisms. Hence, this study was planned to evaluate the efficacy of gemifloxacin as an empirical therapy in pneumonia. This was an open labelled, single-arm study. Patients with clinical features of community acquired pneumonia (CAP) who fulfilled the inclusion criteria received treatment with oral gemifloxacin 320 mg once daily for 5-7 days. Once enrolled in the study, patients were treated as outpatient or as inpatient depending on clinical need. The primary efficacy was to evaluate the clinical response at the end of therapy, i.e., day 9-11 for CAP. Secondary efficacy parameters included radiological and bacteriological response at the end of therapy. Patients were evaluated three times during the entire course of treatment (Visit 1, Day 0; Visit 2, Day 2-4; Visit 3, Day 9-11) for their clinical, radiological and/or bacteriological response, as well as for safety assessment. A total of 105 patients received the study medication (gemifloxacin 320 mg orally). Two patients were "lost to follow-up" and one patient had to discontinue medication due to insufficient therapeutic effects. Clinical response at the end of therapy was successful in 99 (96.1%) while clinical failure was reported in 4 (3.9%) patient. As per the radiological response, 77.1% of the total cases showed improvement, 8.6% had no change, and 2.9% cases had deterioration in radiological findings. Gemifloxacin is an effective drug in the management of CAP. Gemifloxacin with

  6. A Summary of Research on Test Changes: An Empirical Basis for Defining Accommodations.

    ERIC Educational Resources Information Center

    Tindal, Gerald; Fuchs, Lynn

    This document summarizes the research on test changes to provide an empirical basis for defining accommodations for students with disabilities. It begins by providing an historical overview of special education accountability. It describes how separate special education accountability systems have evolved and summarizes information on the…

  7. 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,…

  8. 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,…

  9. High Feasibility of Empiric HIV Treatment for Patients With Suspected Acute HIV in an Emergency Department.

    PubMed

    Jacobson, Kathleen R; Arora, Sanjay; Walsh, Kristin B; Lora, Meredith; Merjavy, Stephen; Livermore, Shanna; Menchine, Michael

    2016-07-01

    Earlier intervention in acute HIV infection limits HIV reservoirs and may decrease HIV transmission. We developed criteria for empiric antiretroviral therapy (ART) in an emergency department (ED) routine HIV screening program. We assessed the feasibility and willingness of patients with suspected acute HIV infection in the ED to begin ART. A suspected acute HIV infection was defined as a positive HIV antigen antibody combination immunoassay with pending HIV-antibody differentiation test results and HIV RNA viral load. During the study period, there were 16 confirmed cases of acute HIV infection: 11 met our criteria for empiric ART and agreed to treatment, 10 were prescribed ART, and 1 left the ED against medical advice without a prescription for ART. Eight patients completed at least one follow-up visit. Empiric HIV treatment in an ED is feasible, well received by patients, and offers a unique entry point into the HIV care continuum.

  10. 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…

  11. 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…

  12. 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…

  13. 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…

  14. 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…

  15. The DSM-5 debate over the bereavement exclusion: psychiatric diagnosis and the future of empirically supported treatment.

    PubMed

    Wakefield, Jerome C

    2013-11-01

    Valid diagnostic criteria support generalizations about treatment effectiveness, allowing progress in developing empirically supported treatments. The DSM-5 revision provides an opportunity to consider whether diagnostic changes are increasing validity. In this paper, I first offer broad suggestions for conceptually advancing diagnostic validity while awaiting greater etiological understanding. These include, for example, improving "conceptual validity" (disorder/nondisorder differentiation); extending diagnosis beyond disorders to include mismatches between normal variation and social demands ("psychological justice"); placing disorder etiology in evolutionary context as harmful failure of biologically designed functioning ("harmful dysfunction"); and taking an integrative theoretical approach to human meaning systems. The paper then examines the DSM-5's controversial decision to eliminate the major depression bereavement exclusion (BE), detailing the evidence and attendant debate. Elimination was defended by citing several hypotheses (e.g., excluded cases are similar to other MDD; exclusions risk missing suicidal cases; medication works with excluded cases), all of which were either empirically falsified or based on faulty arguments. Most dramatically, excluded cases were empirically demonstrated to have no more depression on follow-up than those who never had MDD. I conclude that BE elimination undermined rather than increased conceptual validity and usefulness for treatment research. Finally, I draw some general lessons from the DSM-5 BE debacle.

  16. A simple empirical model for the clarification-thickening process in wastewater treatment plants.

    PubMed

    Zhang, Y K; Wang, H C; Qi, L; Liu, G H; He, Z J; Fan, H T

    2015-01-01

    In wastewater treatment plants (WWTPs), activated sludge is thickened in secondary settling tanks and recycled into the biological reactor to maintain enough biomass for wastewater treatment. Accurately estimating the activated sludge concentration in the lower portion of the secondary clarifiers is of great importance for evaluating and controlling the sludge recycled ratio, ensuring smooth and efficient operation of the WWTP. By dividing the overall activated sludge-thickening curve into a hindered zone and a compression zone, an empirical model describing activated sludge thickening in the compression zone was obtained by empirical regression. This empirical model was developed through experiments conducted using sludge from five WWTPs, and validated by the measured data from a sixth WWTP, which fit the model well (R² = 0.98, p < 0.001). The model requires application of only one parameter, the sludge volume index (SVI), which is readily incorporated into routine analysis. By combining this model with the conservation of mass equation, an empirical model for compression settling was also developed. Finally, the effects of denitrification and addition of a polymer were also analysed because of their effect on sludge thickening, which can be useful for WWTP operation, e.g., improving wastewater treatment or the proper use of the polymer.

  17. 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."

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

    PubMed Central

    Dierssen, Heidi M.

    2010-01-01

    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.” PMID:20861445

  19. Noncontingent reinforcement is an empirically supported treatment for problem behavior exhibited by individuals with developmental disabilities.

    PubMed

    Carr, James E; Severtson, Jamie M; Lepper, Tracy L

    2009-01-01

    Noncontingent reinforcement (NCR) is a function-based treatment for problem behavior that has produced robust effects across a variety of response topographies and reinforcement functions among individuals with developmental disabilities. Several narrative reviews have adequately described this literature. The purpose of the present article was to quantitatively analyze and classify the empirical support for NCR using the criteria developed by The Task Force on the Promotion and Dissemination of Psychological Procedures [Task Force Promoting Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. Clinical Psychology, 48, 3-23]. Of the 59 studies identified for analysis, 24 met the criteria to be included in treatment classification. Fixed-time reinforcer delivery (plus extinction and schedule thinning) was classified as well established, while fixed-time reinforcer delivery (plus extinction) and variable-time reinforcer delivery (plus extinction) were deemed probably efficacious.

  20. Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted Infections in a Pediatric Emergency Department.

    PubMed

    Breslin, Kristen; Tuchman, Lisa; Hayes, Katie L; Badolato, Gia; Goyal, Monika K

    2017-10-01

    To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing testing for a sexually transmitted infection. We conducted a retrospective cross-sectional electronic health record review of all patients aged 13-19 years who had Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) testing sent from an urban, academic pediatric emergency department in 2012. We abstracted data, including patient demographics, chief complaint, sexually transmitted infection test results, and treatment. We calculated test characteristics comparing clinician judgment for presumptive treatment for a sexually transmitted infection with the reference standard of the actual results of testing for a sexually transmitted infection. Of 1223 patient visits meeting inclusion criteria, 284 (23.2%) had a positive GC and/or CT test result. Empiric treatment was provided in 615 encounters (50.3%). Provider judgment for presumptive treatment had an overall sensitivity of 67.6% (95% CI, 61.8-73.0) and a specificity of 55% (95% CI, 51.7-58.2) for accurate GC and/or CT detection. Many adolescents tested for GC and CT receive empiric treatment at the initial emergency department visit. Provider judgment may lack sufficient sensitivity and specificity for identifying infected patients, resulting in the potential for undertreatment of true disease, overtreatment of uninfected patients, or both. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. The effect of empiric antimicrobial treatment duration on detection of bacterial DNA in sterile surgical specimens

    PubMed Central

    Farrell, John Joseph; Wang, Huaping; Sampath, Rangarajan; Lowery, Kristin S.; Bonomo, Robert A.

    2017-01-01

    Initial antimicrobial treatment of patients with deep seated or invasive infections is typically empiric. Usually, cultures of specimens obtained from the suspected source of infection are performed to identify pathogens and guide continued antimicrobial treatment. When patients present with signs and symptoms of infection, but sterile body fluid or tissue specimens cannot be obtained in a timely fashion, growth of bacterial pathogens in culture may be inhibited following initiation of empiric antibiotic treatment. To address this clinical dilemma, we performed a prospective evaluation of conventional culture vs. PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS) on sterile body fluids and tissues submitted to the diagnostic microbiology lab following initiation of empiric antibiotic treatment for patients with suspected infection. In this series of surgical samples, PCR/ESI-MS identified bacterial pathogen(s) in 56% (49/87) of patients with non-diagnostic cultures. Examination of patients stratified by antibiotic treatment duration demonstrated that PCR/ESI-MS sustains high rates of bacterial DNA detection over time by generalized estimating equation models (p<0.0001). PMID:28170436

  2. Training and Consultation to Promote Implementation of an Empirically Supported Treatment: A Randomized Trial

    PubMed Central

    Beidas, Rinad S.; Edmunds, Julie M.; Marcus, Steven C.; Kendall, Philip C.

    2012-01-01

    Objective The study evaluated the efficacy of three training modalities and the impact of ongoing consultation after training. Cognitive-behavioral therapy (CBT) for anxiety among youths, an empirically supported treatment, was used as the exemplar. Participants were randomly assigned to one of three one-day workshops to examine the efficacy of training modality: routine training (training as usual), computer training (computerized version of training as usual), and augmented training (training that emphasized active learning). After training, all participants received three months of ongoing consultation that included case consultation, didactics, and problem solving. Methods Participants were 115 community therapists (mean age of 35.9 years; 90% were women). Outcome measures included the Adherence and Skill Checklist, used to rate a performance-based role-play; a knowledge test; and the Training Satisfaction Rating Scale. Results All three training modalities resulted in limited gains in therapist adherence, skill, and knowledge. There was no significant effect of modality on adherence, skill, or knowledge from pretraining to posttraining. Participants were more satisfied with augmented and routine training than with computer training. Most important, number of consultation hours after training significantly predicted higher therapist adherence and skill at the three-month follow-up. Conclusions The findings suggest that training alone did not result in therapist behavior change. The inclusion of ongoing consultation was critical to influencing therapist adherence and skill. Implications for implementation science and mental health services research are discussed. PMID:22549401

  3. 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.

  4. 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).

  5. Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa.

    PubMed

    Compas, B E; Haaga, D A; Keefe, F J; Leitenberg, H; Williams, D A

    1998-02-01

    Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

  6. 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.

  7. 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

  8. Evaluating Process Quality Based on Change Request Data - An Empirical Study of the Eclipse Project

    NASA Astrophysics Data System (ADS)

    Schackmann, Holger; Schaefer, Henning; Lichter, Horst

    The information routinely collected in change request management systems contains valuable information for monitoring of the process quality. However this data is currently utilized in a very limited way. This paper presents an empirical study of the process quality in the product portfolio of the Eclipse project. It is based on a systematic approach for the evaluation of process quality characteristics using change request data. Results of the study offer insights into the development process of Eclipse. Moreover the study allows assessing applicability and limitations of the proposed approach for the evaluation of process quality.

  9. Increasing Positive Outlook Partially Mediates the Effect of Empirically Supported Treatments on Depression Symptoms Among Adolescents

    PubMed Central

    Jacobs, Rachel H.; Becker, Sara J.; Curry, John F.; Silva, Susan G.; Ginsburg, Golda S.; Henry, David B.; Reinecke, Mark A.

    2014-01-01

    Among adolescents there is evidence that cognitive change partially mediates the effect of cognitive behavioral therapy (CBT) on depression outcome. However, prior studies have been limited by small samples, narrow measures of cognition, and failure to compare cognitive change following CBT to cognitive change following antidepressant medication. This study examined whether change in four cognitive constructs (cognitive distortions, cognitive avoidance, positive outlook, and solution-focused thinking) mediated change in depression severity in a sample of 291 adolescents who participated in the Treatment for Adolescents with Depression Study (TADS). TADS assessed the effects of CBT, fluoxetine, and their combination on depression severity. All three treatments were associated with change in the cognitive constructs and combination treatment produced the greatest change. Furthermore, change in the cognitive constructs partially mediated change in depression severity within all three treatments. Results implicated positive outlook as the construct most associated with change in depression severity over 36 weeks. PMID:24944436

  10. Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe

    PubMed Central

    2013-01-01

    Abstract Objective Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of uUTI. Particularly, it is important to avoid antibiotics associated with a high rate of antimicrobial resistance. This study compares national recommendations from six European countries, investigating recommendations for first-choice antibiotic therapy of uUTI. Setting General practice in six European countries. Method Searches were undertaken on PubMed, the Cochrane Library databases, Google, and Google Scholar. Recommendations from different geographical regions in Europe were investigated: Northern Europe (Denmark, Sweden), Western Europe (Scotland), Central Europe (Germany), Southern Europe (Spain), and Eastern Europe (Croatia). Results The six countries recommended seven different antibiotics. Five countries recommended more than one antibiotic as first-choice treatment. Half of the countries recommended antibiotics associated with a high rate (> 10–20%) of resistant E. coli. All countries recommended at least one antibiotic associated with a low (< 5%) resistance rate. Discussion The differences in first-choice treatment of uUTI could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates exceeding 10–20%, sulphamethizole, trimethoprim. or fluoroquinolones were recommended in half of the countries. Conclusion Within the European countries there are considerable differences in recommendations for empiric first-choice antibiotic treatment of uUTI. In order to reduce the increasing antimicrobial resistance in Europe, it is important to agree on the most appropriate antibiotics for empiric treatment of uUTI. PMID:24102498

  11. Pharmacoeconomic evaluation of caspofungin versus liposomal amphotericin B in empirical treatment of invasive fungal infections in Turkey.

    PubMed

    Turner, S J; Senol, E; Kara, A; Al-Badriyeh, D; Kong, D C M; Dinleyici, E C

    2013-09-01

    Invasive fungal infections (IFIs) are a major concern within healthcare systems. This pharmacoeconomic study evaluated the use of caspofungin (CAS) versus liposomal amphotericin B (L-AmB) in the empirical treatment of IFIs within the Turkish healthcare system. A decision-analytic model was adopted, utilising data from a randomised, non-inferiority clinical trial and a panel of clinical experts in Turkey. A five-point composite outcome measure was used to evaluate both agents. Sensitivity analyses were performed. In the base-case scenario, CAS was preferred over L-AmB by Turkish Lira (TL) 3961 per patient treated, TL 12 904 per successfully treated patient and TL 3972 per death averted. One-way sensitivity analysis did not change the study outcome. Monte Carlo simulation concluded a 71.0% chance of the outcome favouring CAS. The results were most sensitive to changes in length of stay. This is the first economic evaluation of the empirical treatment of IFIs in Turkey and suggests that CAS is more cost effective than L-AmB.

  12. Estimating the Importance of Private Adaptation to Climate Change in Agriculture: A Review of Empirical Methods

    NASA Astrophysics Data System (ADS)

    Moore, F.; Burke, M.

    2015-12-01

    A wide range of studies using a variety of methods strongly suggest that climate change will have a negative impact on agricultural production in many areas. Farmers though should be able to learn about a changing climate and to adjust what they grow and how they grow it in order to reduce these negative impacts. However, it remains unclear how effective these private (autonomous) adaptations will be, or how quickly they will be adopted. Constraining the uncertainty on this adaptation is important for understanding the impacts of climate change on agriculture. Here we review a number of empirical methods that have been proposed for understanding the rate and effectiveness of private adaptation to climate change. We compare these methods using data on agricultural yields in the United States and western Europe.

  13. 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.

  14. ESTIMATION OF TREATMENT EFFECT IN A SUB-POPULATION: AN EMPIRICAL BAYES APPROACH

    PubMed Central

    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 sub-populations. In particular, due to limited sample size for sub-populations and the need for multiple comparisons, standard analysis tends to yield wide confidence intervals of the treatment effect that are often non-informative. We propose an empirical Bayes approach to combine both information embedded in a target sub-population 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. PMID:26010422

  15. 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.

  16. Evaluating the use of empirical error analyses on terrestrial lidar data for geomorphic change detection

    NASA Astrophysics Data System (ADS)

    Corbett, S.; Collins, B. D.

    2011-12-01

    The use of both terrestrial and airborne laser scanning as tools for determining geomorphic change has greatly increased the resolution at which "true" change can be determined. The data, similar to any other survey data, are subject to analytical errors originating from both the data collection and post-processing methodologies. In many cases this analytical error is the summation of three independent errors: (1) the error associated with the georeferenced position of the laser source, (2) the error associated with the projection of the laser beam, and (3) in some cases (terrestrial lidar) the error associated with combining point cloud data from multiple geospatially distinct locations. The difficulty with using the summation (RMSE) of the analytical errors is that the calculated number can be so great that actual changes are masked. Alternatively, by empirically quantifying the relative distance of key stationary objects (e.g. large rocks or other distinct objects visible in the scan data) from one scan period to another, a more robust error analysis can be calculated, where the actual change occurring can be better quantified. To explore these different methods of error analysis we use terrestrial lidar data collected multiple (5) times over a 5-year period from archeological sites in Grand Canyon National Park (GCNP), Arizona. The sites are being monitored as part of a larger effort to understand the natural and anthropogenic effects on archaeological site stability within the Colorado River corridor of the GCNP. The results show that whereas analytical errors can be as high as 5 to 8 cm (as determined by doubling the RMSE for two temporally different datasets), empirical errors indicate that actual change detection thresholds are as low as 2 cm. This improvement of the error assessment gives greater confidence and allows much lower change detection thresholding, which has improved our ability to monitor and understand ongoing geomorphic changes in the Grand

  17. 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.

  18. 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

  19. Cost comparison of microscopy vs. empiric treatment for malaria in Southwestern Nigeria: a prospective study.

    PubMed

    Parikh, Ravi; Amole, Isaac; Tarpley, Margaret; Gbadero, Daniel; Davidson, Mario; Vermund, Sten H

    2010-12-22

    Presumptive treatment for malaria is common in resource-limited settings, yet controversial given the imprecision of clinical diagnosis. The researchers compared costs of diagnosis and drugs for two strategies: (1) empirical treatment of malaria via clinical diagnosis; and (2) empirical diagnosis followed by treatment only with Giemsa smear confirmation. Patients with a diagnosis of clinical malaria were recruited from a mission/university teaching hospital in southwestern Nigeria. The patients underwent free Giemsa thick (diagnosis) and thin (differentiation) smears, but paid for all anti-malarial drugs. Clinical diagnosis was made on clinicians' judgments based on symptoms, including fever, diarrhoea, headache, and body aches. The paediatric regimen was artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg day 1-2 and 5 mg/kg on day three in suspension). Adults were given two treatment options: option one (four and one-half 50 mg artesunate tablets on day one and nine tablets for the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets) and option two (same artesunate regimen plus nine 200 mg tablets of amodiaquine at 10 mg/kg day 1-2 and 5 mg/kg on day three). The researchers calculated the costs of smears/drugs from standard hospital charges. Doctors diagnosed 304 patients (170 adults ages >16 years and 134 pediatric) with clinical malaria, prescribing antimalarial drugs to all. Giemsa thick smears were positive in 115/304 (38%). The typical patient cost for a Giemsa smear was 550 Naira (US$3.74 in 2009). For children, the cost of testing all, but treating only Giemsa positives was N888 ($6.04)/child; the cost of empiric treatment of all who were clinically diagnosed was lower, N660 ($4.49)/child. For adults, the cost of testing all, but treating only Giemsa positives was N711 ($4.84)/adult for treatment option one (artesunate and sulphadoxine/pyrimethamine) and N730 ($4.97)/adult

  20. Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: a prospective study

    PubMed Central

    2010-01-01

    Background Presumptive treatment for malaria is common in resource-limited settings, yet controversial given the imprecision of clinical diagnosis. The researchers compared costs of diagnosis and drugs for two strategies: (1) empirical treatment of malaria via clinical diagnosis; and (2) empirical diagnosis followed by treatment only with Giemsa smear confirmation. Methods Patients with a diagnosis of clinical malaria were recruited from a mission/university teaching hospital in southwestern Nigeria. The patients underwent free Giemsa thick (diagnosis) and thin (differentiation) smears, but paid for all anti-malarial drugs. Clinical diagnosis was made on clinicians' judgments based on symptoms, including fever, diarrhoea, headache, and body aches. The paediatric regimen was artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg day 1-2 and 5 mg/kg on day three in suspension). Adults were given two treatment options: option one (four and one-half 50 mg artesunate tablets on day one and nine tablets for the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets) and option two (same artesunate regimen plus nine 200 mg tablets of amodiaquine at 10 mg/kg day 1-2 and 5 mg/kg on day three). The researchers calculated the costs of smears/drugs from standard hospital charges. Results Doctors diagnosed 304 patients (170 adults ages >16 years and 134 pediatric) with clinical malaria, prescribing antimalarial drugs to all. Giemsa thick smears were positive in 115/304 (38%). The typical patient cost for a Giemsa smear was 550 Naira (US$3.74 in 2009). For children, the cost of testing all, but treating only Giemsa positives was N888 ($6.04)/child; the cost of empiric treatment of all who were clinically diagnosed was lower, N660 ($4.49)/child. For adults, the cost of testing all, but treating only Giemsa positives was N711 ($4.84)/adult for treatment option one (artesunate and sulphadoxine

  1. 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

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

    SciTech Connect

    Cullen, H.M.; Menocal, P.B. de; 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 4,170 {+-} 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. The authors 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. Results document a very abrupt increase in eolian dust and Mesopotamian aridity, accelerator mass spectrometer radiocarbon dates to 4,025 {+-} 125 calendar yr B.P., which persisted for {approximately} 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.

  3. 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

  4. 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.

  5. 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

  6. 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

  7. Testing the robustness of the anthropogenic climate change detection statements using different empirical models

    NASA Astrophysics Data System (ADS)

    Imbers, J.; Lopez, A.; Huntingford, C.; Allen, M. R.

    2013-04-01

    This paper aims to test the robustness of the detection and attribution of anthropogenic climate change using four different empirical models that were previously developed to explain the observed global mean temperature changes over the last few decades. These studies postulated that the main drivers of these changes included not only the usual natural forcings, such as solar and volcanic, and anthropogenic forcings, such as greenhouse gases and sulfates, but also other known Earth system oscillations such as El Niño Southern Oscillation (ENSO) or the Atlantic Multidecadal Oscillation (AMO). In this paper, we consider these signals, or forced responses, and test whether or not the anthropogenic signal can be robustly detected under different assumptions for the internal variability of the climate system. We assume that the internal variability of the global mean surface temperature can be described by simple stochastic models that explore a wide range of plausible temporal autocorrelations, ranging from short memory processes exemplified by an AR(1) model to long memory processes, represented by a fractional differenced model. In all instances, we conclude that human-induced changes to atmospheric gas composition is affecting global mean surface temperature changes.

  8. 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.)

  9. Clinical Feedback About Empirically Supported Treatments for Obsessive-Compulsive Disorder.

    PubMed

    Jacobson, Nicholas C; Newman, Michelle G; Goldfried, Marvin R

    2016-01-01

    Previous evidence for the treatment of obsessive-compulsive disorder (OCD) has been derived principally from randomized controlled trials. As such, evidence about the treatment of OCD has unilaterally flowed from researchers to clinicians. Despite often having decades of experience treating OCD, clinicians' feedback on their clinical observations in using these treatments has not been solicited. The current study contacted clinicians for their clinical observations on empirically supported treatments for OCD to identify commonly used cognitive-behavioral techniques and their limitations in their practices. One hundred eighty-one psychotherapists completed an online survey. The average participant practiced psychotherapy for 15 years, worked in private practice, held a doctorate, and treated an average of 25 clients with OCD in their lifetime. In regard to the most common techniques, behavioral strategies involving exposure to a feared outcome and prevention of a compulsive ritual were the most frequent group of interventions, followed by techniques that attempted to identify and challenge irrational thoughts. However, the majority of participants also reported incorporating mindfulness or acceptance-based methods. Based on therapists' reports, the most common barriers to the efficacy of cognitive-behavioral interventions included limited premorbid functioning, chaotic lifestyles, controlling and critical families, OCD symptom severity, OCD symptom chronicity, and comorbidities. This study provides insight into common practices and limitations in clinical practice to inform future clinically relevant treatment research. Copyright © 2015. Published by Elsevier Ltd.

  10. Moxifloxacin pharmacokinetic profile and efficacy evaluation in empiric treatment of community-acquired pneumonia.

    PubMed

    Öbrink-Hansen, Kristina; Hardlei, Tore Forsingdal; Brock, Birgitte; Jensen-Fangel, Søren; Kragh Thomsen, Marianne; Petersen, Eskild; Kreilgaard, Mads

    2015-04-01

    When antimicrobials are used empirically, pathogen MICs equal to clinical breakpoints or epidemiological cutoff values must be considered. This is to ensure that the most resistant pathogen subpopulation is appropriately targeted to prevent emergence of resistance. Accordingly, we determined the pharmacokinetic (PK) profile of moxifloxacin at 400 mg/day in 18 patients treated empirically for community-acquired pneumonia. We developed a population pharmacokinetic model to assess the potential efficacy of moxifloxacin and to simulate the maximal MICs for which recommended pharmacokinetic-pharmacodynamic (PK-PD) estimates are obtained. Moxifloxacin plasma concentrations were determined the day after therapy initiation using ultra-high-performance liquid chromatography. Peak drug concentrations (Cmax) and area under the free drug concentration-time curve from 0 to 24 h (fAUC0-24) values predicted for each patient were evaluated against epidemiological cutoff MIC values for Streptococcus pneumoniae, Haemophilus influenzae, and Legionella pneumophila. PK-PD targets adopted were a Cmax/MIC of ≥12.2 for all pathogens, an fAUC0-24/MIC of >34 for S. pneumoniae, and an fAUC0-24/MIC of >75 for H. influenzae and L. pneumophila. Individual predicted estimates for Cmax/MIC and fAUC0-24/MIC as well as simulated maximal MICs resulting in target attainment for oral and intravenous administration of the drug were suitable for S. pneumoniae and H. influenzae but not for L. pneumophila. These results indicate that caution must be taken when moxifloxacin is used as monotherapy to treat community-acquired pneumonia caused by L. pneumophila. In conclusion, this report reveals key information relevant to the empirical treatment of community-acquired pneumonia while highlighting the robust and flexible nature of this population pharmacokinetic model to predict therapeutic success. (Clinical Trials Registration no. NCT01983839.).

  11. Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey

    PubMed Central

    2013-01-01

    Background Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting. Methods Decision analytic modelling was used to create a pathway for patient treatment with a 5-point composite outcome measure. The data was obtained from a major non-inferiority multicentre randomised controlled study, with an expert panel of clinicians in Turkey providing transition probabilities and cost not available in the literature. Sensitivity analyses were performed on the inputs from the clinical trial and the expert panel. Results As per the base case analysis, voriconazole was preferred by Turkish Lira (TL) 2,523 per patient treated and TL2,520 per surviving patient. LAmB was the preferred alternative by TL5,362 per successfully treated patient. Removing fever resolution as part of the composite outcome measure resulted in voriconazole being the preferred alternative per successfully treated patient. Univariate sensitivity analysis highlighted that increasing the duration of voriconazole by >1.2 days or decreasing LAmB by >1.0 days changes the result. Monte Carlo Simulation resulted in 69.4% of simulations favouring voriconazole per patient treated. Conclusion There is a strong likelihood that voriconazole is economically more favourable than LAmB in the empiric treatment of IFI in Turkey. PMID:24279677

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

    PubMed

    Costanza, Jennifer K; 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.

  13. Empirical support for a treatment program for families of young children with externalizing problems.

    PubMed

    Feinfield, Kristin Abbott; Baker, Bruce L

    2004-03-01

    We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children. Families were assigned randomly to an immediate 12-week parent and child treatment condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction with treatment, and increased knowledge of behavior management principles. Relative to the waitlist condition, treatment parents reported statistically and clinically significant reductions in child behavior problems, improved parenting practices (i.e., increased consistency, decreased power assertive techniques), an increased sense of efficacy, and reduced parenting stress. There was a trend toward parents improving their attitudes toward their children. In considering the process of change, we found evidence that improved parenting practices mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress. Five months following treatment, teachers reported significant improvements in child behaviors, whereas parents reported that reductions in child behavior problems and parenting stress were maintained.

  14. Moving empirically supported practices to addiction treatment programs: recruiting supervisors to help in technology transfer.

    PubMed

    Amodeo, Maryann; Storti, Susan A; Larson, Mary Jo

    2010-05-01

    Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, 2001 ; Roman and Johnson, 2002 ; Willenbring et al., 2004 ). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors' perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.

  15. Piperacillin/tazobactam versus cefozopran for the empirical treatment of pediatric cancer patients with febrile neutropenia.

    PubMed

    Ichikawa, Mizuho; Suzuki, Daisuke; Ohshima, Junjiro; Cho, Yuko; Kaneda, Makoto; Iguchi, Akihiro; Ariga, Tadashi

    2011-12-15

    The aim of this study was to evaluate the efficacy and safety of piperacillin/tazobactam (PIP/TAZO) and cefozopran (CZOP) monotherapy in pediatric cancer patients with febrile neutropenia (FN). A total of 119 febrile episodes in 49 neutropenic pediatric cancer patients (20 females and 29 males) with a median age of 6.8 years (range, 0.3-18.4 years) received randomized treatment either with PIP/TAZO 125 mg/kg every 8 hr or CZOP 25 mg/kg every 6 hr. Clinical response was determined at completion of therapy. Durations of fever and neutropenia, the need for modification of the therapy, and mortality rates were compared between the two groups. The frequency of success without modification of treatment was not significantly different between PIP/TAZO (59.6%) and CZOP (53.2%). Durations of fever and antibiotic therapy did not differ between the treatment groups, and no major side effects were observed in either group. PIP/TAZO and CZOP monotherapy were both effective and safe for the initial empirical treatment of pediatric cancer patients with FN. Copyright © 2011 Wiley Periodicals, Inc.

  16. 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

    2017-09-22

    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

  17. 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,…

  18. 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,…

  19. Financial incentives and psychiatric services in Australia: an empirical analysis of three policy changes.

    PubMed

    Doessel, D P; Scheurer, Roman W; Chant, David C; Whiteford, Harvey

    2007-01-01

    Australia has a national, compulsory and universal health insurance scheme, called Medicare. In 1996 the Government changed the Medicare Benefit Schedule Book in such a way as to create different financial incentives for consumers or producers of out-of-hospital private psychiatric services, once an individual consumer had received 50 such services in a 12-month period. The Australian Government introduced a new Item (319) to cover some special cases that were affected by the policy change. At the same time, the Commonwealth introduced a 'fee-freeze' for all medical services. The purpose of this study is two-fold. First, it is necessary to describe the three policy interventions (the constraints on utilization, the operation of the new Item and the general 'fee-freeze'.) The new Item policy was essentially a mechanism to 'dampen' the effect of the 'constraint' policy, and these two policy changes will be consequently analysed as a single intervention. The second objective is to evaluate the policy intervention in terms of the (stated) Australian purpose of reducing utilization of psychiatric services, and thus reducing financial outlays. Thus, it is important to separate out the different effects of the three policies that were introduced at much the same time in November 1996 and January 1997. The econometric results indicate that the composite policy change (constraining services and the new 319 Item) had a statistically significant effect. The analysis of the Medicare Benefit (in constant prices) indicates that the 'fee-freeze' policy also had a statistically significant effect. This enables separate determination of the several policy changes. In fact, the empirical results indicate that the Commonwealth Government underestimated the 'savings' that would arise from the 'constraint' policy.

  20. Modeling longitudinal changes in buprenorphine treatment outcome for opioid dependence.

    PubMed

    Saleh, M I

    2014-11-01

    The present analysis describes the longitudinal change in buprenorphine treatment outcome. It also examines several participant characteristics to predict response to buprenorphine. Participants (n=501, age>15 years) received buprenorphine/naloxone treatment for 4 weeks, and then were randomly assigned to undergo dose tapering over either 7 days or 28 days. An empirical model was developed to describe the longitudinal changes in treatment outcome. Several patient characteristics were also examined as possible factors influencing treatment outcome. We have developed a model that captures the general behavior of the longitudinal change in the probability of having an opioid-negative urine sample following buprenorphine treatment. The model captures both the initial increase (i. e., initial response) and the subsequent decrease (i. e., relapse to opioid) in the likelihood of providing an opioid-negative urine sample. Characteristics associated with successful buprenorphine treatment outcome include: having a negative urine test for drugs, having alcohol problems [assessed using alcohol domain of addiction severity index (ASI-alcohol)] at screening, being older, and receiving low cumulative buprenorphine dose. However, ASI-alcohol values were generally low which make the application of the proposed alcohol effect for patients with more severe alcohol problems questionable. A novel approach for analyzing buprenorphine treatment outcome is presented in this manuscript. This approach describes the longitudinal change in the probability of providing an opioid-free urine sample instead of considering opioid use outcome at a single time point. Additionally, this model successfully describes relapse to opioid. Finally, several patient characteristics are identified as predictors of treatment outcome. © Georg Thieme Verlag KG Stuttgart · New York.

  1. The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa

    PubMed Central

    Caldwell, Judy; Kaplan, Richard; Cobelens, Frank; Wood, Robin

    2017-01-01

    Abstract Objective To investigate the impact of introducing a rapid test as the first-line diagnostic test for drug-sensitive tuberculosis in Cape Town, South Africa. Methods Xpert® MTB/RIF (Xpert®), an automated polymerase-chain-reaction-based assay, was rolled out between 2011 and 2013. Data were available on 102 007 adults treated for pulmonary tuberculosis between 2010 and 2014. Tuberculosis notification rates per 100 000 population were calculated for each calendar year and for each year relative to the test roll-out locally, overall and by bacteriological confirmation. Empirical treatment was defined as treatment given without bacteriological confirmation by Xpert®, sputum smear microscopy or sputum culture. Findings Between 2010 and 2014, the proportion of human immunodeficiency virus (HIV)-negative patients treated empirically for tuberculosis declined from 23% (2445/10 643) to 11% (1149/10 089); in HIV-positive patients, it declined from 42% (4229/9985) to 27% (2364/8823). The overall tuberculosis notification rate decreased by 12% and 19% among HIV-negative and HIV-positive patients, respectively; the rate of bacteriologically confirmed cases increased by 1% and 3%, respectively; and the rate of empirical treatment decreased by 56% and 49%, respectively. These changes occurred gradually following the test’s introduction and stabilized after 3 years. Conclusion Roll-out of the rapid test in a setting with a high prevalence of pulmonary tuberculosis and HIV infection was associated with a halving of empirical treatment that occurred gradually after the test’s introduction, possibly reflecting the time needed for full implementation. More than a quarter of HIV-positive patients with tuberculosis were still treated empirically, highlighting the diagnostic challenge in these patients. PMID:28804167

  2. On the pathophysiology of migraine--links for "empirically based treatment" with neurofeedback.

    PubMed

    Kropp, Peter; Siniatchkin, Michael; Gerber, Wolf-Dieter

    2002-09-01

    Psychophysiological data support the concept that migraine is the result of cortical hypersensitivity, hyperactivity, and a lack of habituation. There is evidence that this is a brain-stem related information processing dysfunction. This cortical activity reflects a periodicity between 2 migraine attacks and it may be due to endogenous or exogenous factors. In the few days preceding the next attack slow cortical potentials are highest and habituation delay experimentally recorded during contingent negative variation is at a maximum. These striking features of slow cortical potentials are predictors of the next attack. The pronounced negativity can be fed back to the patient. The data support the hypothesis that a change in amplitudes of slow cortical potentials is caused by altered habituation during the recording session. This kind of neurofeedback can be characterized as "empirically based" because it improves habituation and it proves to be clinically efficient.

  3. Empirical relationships between health literacy and treatment decision making: a scoping review of the literature.

    PubMed

    Malloy-Weir, Leslie J; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki A

    2015-03-01

    This study asked: What is known from the existing literature about the empirical relationships between health literacy (HL) and the three stages of the treatment decision making (TDM) process: information exchange, deliberation, and deciding on the treatment to implement? A scoping review of the literature was conducted. Four databases were searched and a total of 2772 records were returned. After de-duplication and three levels of relevance screening, 41 primary studies were included. Relationships between HL and information exchange were studied more often than relationships between HL and deliberation and deciding on the treatment to implement. Across the 41 studies, there was little overlap in terms the measure(s) of HL adopted, the aspect of TDM considered, and the characteristics of the study populations--making comparisons of the findings difficult. Multiple knowledge gaps and measurement-related problems were identified; including, the possibility that the process of TDM influences HL. The importance of HL to the three stages of TDM is unclear because of the knowledge gaps and measurement-related problems that exist. There are many uncertainties about how TDM, or the design and use of patient decision aids, should respond to patients with different levels of HL. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Good outcome with early empiric treatment of neural larva migrans due to Baylisascaris procyonis.

    PubMed

    Peters, Jurriaan M; Madhavan, Vandana L; Kazacos, Kevin R; Husson, Robert N; Dangoudoubiyam, Sriveny; Soul, Janet S

    2012-03-01

    We report a remarkably good outcome in a 14-month-old boy with early clinical diagnosis and aggressive empirical treatment of neural larva migrans caused by the raccoon roundworm Baylisascaris procyonis. He presented with fever, meningismus, lethargy, irritability and asymmetric spastic extremity weakness. Early findings of marked blood and cerebrospinal fluid eosinophilia and of diffuse white matter signal abnormality in the brain and spinal cord on MRI suggested a parasitic encephalomyelitis. Rapid presumptive treatment with albendazole and high-dose steroids halted progression of clinical signs. The diagnosis was confirmed by 2 sequential enzyme-linked immunosorbent assay studies positive for B procyonis serum immunoglobulin G and by Western blot. Field examination with soil sampling yielded infective Baylisascaris eggs. Repeat MRI 3 months later showed atrophy and diffuse, chronic white matter abnormalities, discordant with the marked clinical improvement in this interval. At 10 months, residual neurologic deficits included subtle paraparesis and moderate language delay. This case is the first in which spinal involvement in human Baylisascaris infection was clinically suspected and confirmed by neuroimaging. Importantly, early diagnosis and aggressive treatment of Baylisascaris meningo-encephalitis and myelitis with albendazole and high-dose steroids likely contributed to the good outcome in this patient, in contrast with previous reports.

  5. 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

  6. Empirical Model for Predicting Concentrations of Refractory Hydrophobic Organic Compounds in Digested Sludge from Municipal Wastewater Treatment Plants

    PubMed Central

    Deo, Randhir P.; Halden, Rolf U.

    2009-01-01

    An empirical model is presented allowing for the prediction of concentrations of hydrophobic organic compounds (HOCs) prone to accumulate and persist in digested sludge (biosolids) generated during conventional municipal wastewater treatment. The sole input requirements of the model are the concentrations of the individual HOCs entering the wastewater treatment plant in raw sewage, the compound’s respective pH-dependent octanol-water partitioning coefficient (DOW), and an empirically determined fitting parameter (pfit) that reflects persistence of compounds in biosolids after accounting for all potential removal mechanisms during wastewater treatment. The accuracy of the model was successfully confirmed at the 99% confidence level in a paired t test that compared predicted concentrations in biosolids to empirical measurements reported in the literature. After successful validation, the resultant model was applied to predict levels of various HOCs for which occurrence data in biosolids thus far are lacking. PMID:20161626

  7. [Therapy of the neurosurgical postoperative culture negative meningitis by using external lumbar drainage combined with empirical antibiotics treatment].

    PubMed

    Hong, Jian; Wu, Jianjuan; Chen, Budong; Yao, Xin; Yang, Yushan

    2016-05-01

    To evaluate the curative effect of external lumbar drainage combined with empirical antibiotics treatment on the postoperative culture negative meningitis. The clinical data of eighty post-operative meningitis patients with cerebrospinal fluid culture negative were retrospectively analyzed according to inclusive and exclusive criteria from January 2013 to December 2014 in Department of Neurosurgery, Tianjin Huanhu Hospital. All patients were composed of 45 male cases and 35 female cases, aging from 9 to 72 years. All patients were divided into two groups according to receiving the different treatment: one group only receiving a intravenously empirical antibiotics treatment (n=40), another group receiving a combined therapy of external lumbar drainage and intravenously empirical antibiotics treatment (n=40). The volume of drainage of cerebrospinal fluid (CSF) were set up from 200 to 300 ml per day. There was no difference in the dosage and interval of the same antibiotics between two groups. The antibiotics usage and therapeutic effect of two groups of patients were observed and analyzed by t-test, Wilcoxon rank test or χ(2) test. The rate of CSF bacterial culture negative was 62.9% (88/140) in the same period. In group of empirical antibiotics treatment, the time of antibiotics treatment was (12.6±3.1) days, the rate of combined with other antibiotics treatment was 40.0% (16/40), the rate of mortality was 15.0% (6/40). However, in group of external lumbar drainage combined with empirical antibiotics treatment, the 3 data were (5.3±1.2) days, 10.0% (4/40), 7.5% (3/40), respectively. The time of antibiotics of the group of empirical antibiotics was longer (t=3.605, P=0.017), while the rate of combined antibiotics and the rate of mortality were lower (χ(2)=3.971, P=0.035; χ(2)=4.136, P=0.027, respectively). The average drainage time was (5.8±1.5) days, 32 patients gained a complete healing only by their first placement, 5 cases need replacement because of

  8. 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

  9. 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.

  10. Transporting an empirically supported treatment for panic disorder to a service clinic setting: a benchmarking strategy.

    PubMed

    Wade, W A; Treat, T A; Stuart, G L

    1998-04-01

    This work examines the transportability of cognitive-behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting by comparing CMHC treatment outcome data with the results obtained in two controlled efficacy trials. Participants were 110 clients with a primary diagnosis of panic disorder with or without agoraphobia; clients were not excluded on the basis of medication use or changes, severity or frequency of panic attacks, age, or the presence of agoraphobia. Clients completed a 15-session CBT protocol. Despite differences in settings, clients, and treatment providers, the treatment outcomes for clients completing treatment in the CMHC and the efficacy studies were comparable: Of the CMHC clients who completed treatment, 87% were panic-free at the end of treatment, and clients showed significant reductions in anticipatory anxiety, agoraphobic avoidance, generalized anxiety, and symptoms of depression. The present study suggests that panic control treatment can be transported to a CMHC. Challenges facing the transportability of research-based treatment to CMHC clients, settings, and treatment providers are discussed.

  11. Body Composition Changes Associated With Methadone Treatment

    PubMed Central

    Sadek, Gamal E.; Chiu, Simon; Cernovsky, Zack Z.

    2016-01-01

    Background: Methadone is associated with a statistically significant increase in BMI in the first 2 years of treatment. Objectives: To evaluate the changes of body composition (bone mass, % fat, % muscle mass, % water, and basal metabolic rate) related to this increase. Patients and Methods: Changes in body composition were monitored, via bioelectrical impedance, in 29 patients in methadone treatment for opiate dependency (age 18 to 44, mean = 29.3, SD = 7.0, 13 men, 16 women). Results: Within one year from admission to treatment, a statistically significant (t-tests, P < 0.05) increase was noted in their body mass index (BMI), % of body fat, average body mass, and average basal metabolic rate, and relative decrease in their % of muscle mass and % of bone mass. Neither absolute bone mass nor muscle mass changed significantly. Conclusions: Physicians involved in care of methadone patients should recommend dietary and lifestyle changes to improve their overall health. PMID:27162765

  12. 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.

  13. Can empirical hypertonic saline or sodium bicarbonate treatment prevent the development of cardiotoxicity during serious amitriptyline poisoning? Experimental research.

    PubMed

    Paksu, Muhammet Sukru; Zengin, Halit; Ilkaya, Fatih; Paksu, Sule; Guzel, Hasan; Ucar, Durmus; Uzun, Adem; Alacam, Hasan; Duran, Latif; Murat, Naci; Guzel, Ahmet

    2015-01-01

    The aim of this experimental study was to investigate whether hypertonic saline or sodium bicarbonate administration prevented the development of cardiotoxicity in rats that received toxic doses of amitriptyline. Thirty-six Sprague Dawley rats were used in the study. The animals were divided into six groups. Group 1 received toxic doses of i.p. amitriptyline. Groups 2 and 3 toxic doses of i.p. amitriptyline, plus i.v. sodium bicarbonate and i.v. hypertonic saline, respectively. Group 4 received only i.v. sodium bicarbonate, group 5 received only i.v. hypertonic saline, and group 6 was the control. Electrocardiography was recorded in all rats for a maximum of 60 minutes. Blood samples were obtained to measure the serum levels of sodium and ionised calcium. The survival time was shorter in group 1. In this group, the animals' heart rates also decreased over time, and their QRS and QTc intervals were significantly prolonged. Groups 2 and 3 showed less severe changes in their ECGs and the rats survived for a longer period. The effects of sodium bicarbonate or hypertonic saline treatments on reducing the development of cardiotoxicity were similar. The serum sodium levels decreased in all the amitriptyline-applied groups. Reduction of serum sodium level was most pronounced in group 1. Empirical treatment with sodium bicarbonate or hypertonic saline can reduce the development of cardiotoxicity during amitriptyline intoxication. As hypertonic saline has no adverse effects on drug elimination, it should be considered as an alternative to sodium bicarbonate therapy.

  14. 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…

  15. Changing Healthcare Providers’ Behavior during Pediatric Inductions with an Empirically-based Intervention

    PubMed Central

    Martin, Sarah R.; Chorney, Jill MacLaren; Tan, Edwin T.; Fortier, Michelle A.; Blount, Ronald L.; Wald, Samuel H.; Shapiro, Nina L.; Strom, Suzanne L.; Patel, Swati; Kain, Zeev N.

    2011-01-01

    Background Each year over 4 million children experience significant levels of preoperative anxiety, which has been linked to poor recovery outcomes. Healthcare providers (HCP) and parents represent key resources for children to help them manage their preoperative anxiety. The present study reports on the development and preliminary feasibility testing of a new intervention designed to change HCP and parent perioperative behaviors that have been previously reported to be associated with children’s coping and stress behaviors before surgery. Methods An empirically-derived intervention, Provider-Tailored Intervention for Perioperative Stress, was developed to train HCPs to increase behaviors that promote children’s coping and decrease behaviors that may exacerbate children’s distress. Rates of HCP behaviors were coded and compared between pre-intervention and post-intervention. Additionally, rates of parents’ behaviors were compared between those that interacted with HCPs before training to those interacting with HCPs post-intervention. Results Effect sizes indicated that HCPs that underwent training demonstrated increases in rates of desired behaviors (range: 0.22 to 1.49) and decreases in rates of undesired behaviors (range: 0.15 to 2.15). Additionally, parents, who were indirectly trained, also demonstrated changes to their rates of desired (range: 0.30 to 0.60) and undesired behaviors (range: 0.16 to 0.61). Conclusions The intervention successfully modified HCP and parent behaviors. It represents a potentially new clinical way to decrease anxiety in children. A recently National Institute of Child Health and Development funded multi-site randomized control trial will examine the efficacy of this intervention in reducing children’s preoperative anxiety and improving children’s postoperative recovery is about to start. PMID:21606826

  16. 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.

  17. 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…

  18. 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,…

  19. 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…

  20. 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…

  1. 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…

  2. Type of Antifungals: Does it Matter in Empirical Treatment of Otomycosis?

    PubMed

    Navaneethan, Nagendran; YaadhavaKrishnan, Raj Prakash Dharmapuri

    2015-03-01

    To evaluate the efficacy of clotrimazole, miconazole and fluconazole in empirical treatment of otomycosis in our tertiary care hospital and to appraise possible better outcome in otomycosis. Two hundred and ninety five patients who presented with clinical otomycosis at our Melmaruvathur Adiparasakthi Institute of medical sciences were incorporated in this study. Two hundred and fourteen patients who satisfied our criteria were recognized and they were randomly alienated into three groups A, B, C. Group A patients were advised to instill clotrimazole ear drops by themselves. Miconazole cream instillation were done by our trained personal in group B patients. Group C patients were advised to use fluconazole ear drops. Patients were educated to keep ear dry and instructed to come for evaluation in first and second week after initial visit. A randomized double blinded prospective study. In the first week, clotrimazole had a good response than miconazole and fluconazole in our patients and in the second week, our patients showed a drastic response in patients instilling flucanozole ear drops compared to those using micanozole and clotrimazole. This better outcome doesn't show statistical significance since p value is 0.882. Clotrimazole drops, miconazole cream and Fluconazole drops showed almost same therapeutic efficacy in Otomycosis.

  3. 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.

  4. Treatments for Autism: Parental Choices and Perceptions of Change

    ERIC Educational Resources Information Center

    Bowker, Anne; D'Angelo, Nadia M.; Hicks, Robin; Wells, Kerry

    2011-01-01

    Empirically conducted studies of the efficacy of various treatments for autism are limited, which leaves parents with little evidence on which to base their treatment decisions (Kasari, "Journal of Autism and Developmental Disorders," 32: 447-461, 2002). The purpose of this study was to examine the types of treatments in current use by families of…

  5. 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.

  6. Empirically Supported Family-Based Treatments for Conduct Disorder and Delinquency in Adolescents

    PubMed Central

    Henggeler, Scott W.; Sheidow, Ashli J.

    2011-01-01

    Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief strategic family therapy. In addition to summarizing the theoretical and clinical bases of these treatments, their results in efficacy and effectiveness trials are examined with particular emphasis on any demonstrated capacity to achieve favorable outcomes when implemented by real world practitioners in community practice settings. Special attention is also devoted to research on purported mechanisms of change as well as the long-term sustainability of outcomes achieved by these treatment models. Importantly, we note that the developers of each of the models have developed quality assurance systems to support treatment fidelity and youth and family outcomes; and the developers have formed purveyor organizations to facilitate the large scale transport of their respective treatments to community settings nationally and internationally. PMID:22283380

  7. Upscaling Empirically Based Conceptualisations to Model Tropical Dominant Hydrological Processes for Historical Land Use Change

    NASA Astrophysics Data System (ADS)

    Toohey, R.; Boll, J.; Brooks, E.; Jones, J.

    2009-12-01

    Surface runoff and percolation to ground water are two hydrological processes of concern to the Atlantic slope of Costa Rica because of their impacts on flooding and drinking water contamination. As per legislation, the Costa Rican Government funds land use management from the farm to the regional scale to improve or conserve hydrological ecosystem services. In this study, we examined how land use (e.g., forest, coffee, sugar cane, and pasture) affects hydrological response at the point, plot (1 m2), and the field scale (1-6ha) to empirically conceptualize the dominant hydrological processes in each land use. Using our field data, we upscaled these conceptual processes into a physically-based distributed hydrological model at the field, watershed (130 km2), and regional (1500 km2) scales. At the point and plot scales, the presence of macropores and large roots promoted greater vertical percolation and subsurface connectivity in the forest and coffee field sites. The lack of macropores and large roots, plus the addition of management artifacts (e.g., surface compaction and a plough layer), altered the dominant hydrological processes by increasing lateral flow and surface runoff in the pasture and sugar cane field sites. Macropores and topography were major influences on runoff generation at the field scale. Also at the field scale, antecedent moisture conditions suggest a threshold behavior as a temporal control on surface runoff generation. However, in this tropical climate with very intense rainstorms, annual surface runoff was less than 10% of annual precipitation at the field scale. Significant differences in soil and hydrological characteristics observed at the point and plot scales appear to have less significance when upscaled to the field scale. At the point and plot scales, percolation acted as the dominant hydrological process in this tropical environment. However, at the field scale for sugar cane and pasture sites, saturation-excess runoff increased as

  8. 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

  9. Amoxicillin plus temocillin as an alternative empiric therapy for the treatment of severe hospital-acquired pneumonia: results from a retrospective audit.

    PubMed

    Habayeb, H; Sajin, B; Patel, K; Grundy, C; Al-Dujaili, A; Van de Velde, S

    2015-08-01

    A formulary decision was made at a large provider of acute hospital services in Surrey to replace piperacillin/tazobactam with amoxicillin+temocillin for the empiric treatment of severe hospital-acquired pneumonia. This decision was made because the use of broad-spectrum-β-lactam antibiotics is a known risk factor for Clostridium difficile infection (CDI) and for the selection of resistance. After the antibiotic formulary was changed, a retrospective audit was conducted to assess the effect of this change. Data from patients hospitalised between January 2011 and July 2012 for severe hospital-acquired pneumonia and treated empirically with piperacillin/tazobactam or amoxicillin+temocillin were reviewed retrospectively. Clinical characteristics of patients, data related to the episode of pneumonia, clinical success and incidence of significant diarrhoea and CDI were analysed. One hundred ninety-two episodes of severe hospital-acquired pneumonia in 188 patients were identified from hospital records. Ninety-eight patients received piperacillin/tazobactam and 94 amoxicillin+temocillin. At baseline, the two treatment groups were comparable, except that more patients with renal insufficiency were treated with piperacillin/tazobactam. Clinical success was comparable (80 versus 82 %; P = 0.86), but differences were observed between piperacillin/tazobactam and amoxicillin+temocillin for the rates of significant diarrhoea (34 versus 4 %, respectively; P < 0.0001) and for CDI (7 versus 0 %, respectively; P < 0.0028). This preliminary study suggests that the combination amoxicillin+temocillin is a viable alternative to piperacillin/tazobactam for the treatment of severe hospital-acquired pneumonia. This combination appears to be associated with fewer gastrointestinal adverse events. Further studies are needed to evaluate the place of amoxicillin+temocillin as empiric treatment of severe hospital-acquired pneumonia.

  10. 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

  11. 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…

  12. 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…

  13. 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.

  14. 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.

  15. Interpersonal Change Following Intensive Inpatient Treatment

    PubMed Central

    Clapp, Joshua D.; Grubaugh, Anouk L.; Allen, Jon G.; Oldham, John M.; Fowler, J. Christopher; Hardesty, Susan; Frueh, B. Christopher

    2014-01-01

    Objective: Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization. Methods: Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored. Results: Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of patients identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition. Conclusion: Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential

  16. 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

  17. A randomized trial of cefozopran versus cefepime as empirical antibiotic treatment of febrile neutropenia in pediatric cancer patients.

    PubMed

    Sarashina, Takeo; Kobayashi, Ryoji; Yoshida, Makoto; Toriumi, Naohisa; Suzuki, Daisuke; Sano, Hirozumi; Azuma, Hiroshi

    2014-11-01

    Febrile neutropenia (FN) is a common and serious complication of cancer chemotherapy associated with significant morbidity and mortality. Cefozopran (CZOP) is a potential candidate for empirical monotherapy in FN. However, studies on the use of CZOP as empirical treatment for pediatric patients with FN are quite limited. The purpose of this study was to compare the efficacy and safety of CZOP with cefepime (CFPM) empirical monotherapy in pediatric cancer patients with FN. A total of 64 patients with 224 episodes of FN were randomly assigned to receive antibiotic therapy with either CZOP (100 mg/kg/day) or CFPM (100 mg/kg/day). Of these episodes, 223 were considered eligible for the study. Success was defined as resolution of febrile episodes and clinical signs of infection within 120 hr following the start of antibiotic therapy. The success rate was not significantly different between the CZOP (64.0%) and CFPM (56.3%) groups (P = 0.275). Duration of fever, duration of antibiotic therapy, and the success rate in patients with blood stream infection did not differ between the two groups. There was no infection-related mortality in the study period. Both CZOP and CFPM as monotherapy appear to be effective and safe in pediatric patients. This study suggests that CZOP has satisfactory efficacy and is well tolerated as initial empirical therapy for pediatric cancer patients with FN. © 2014 Wiley Periodicals, Inc.

  18. A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy-induced febrile neutropenia in children.

    PubMed

    Caselli, Désirée; Cesaro, Simone; Ziino, Ottavio; Ragusa, Pietro; Pontillo, Alfredo; Pegoraro, Anna; Santoro, Nicola; Zanazzo, Giulio; Poggi, Vincenzo; Giacchino, Mareva; Livadiotti, Susanna; Melchionda, Fraia; Chiodi, Marcello; Aricò, Maurizio

    2012-07-01

    Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data, we performed a prospective, randomized, controlled trial that evaluated 110 neutropenic children with persistent fever. Those at high risk for invasive fungal infections (IFI) received caspofungin (Arm C) or liposomal amphotericinB (Arm B); those with a lower risk were randomized to receive Arm B, C, or no antifungal treatment (Arm A). Complete response to empirical antifungal therapy was achieved in 90/104 patients (86·5%): 48/56 at high risk (85·7%) [88·0% in Arm B; 83·9% in Arm C (P = 0·72)], and 42/48 at low risk (87·5%) [87·5% in control Arm A, 80·0% Arm B, 94·1% Arm C; (P = 0·41)]. None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response. IFI was diagnosed in nine patients (8·2%, 95% confidence interval, 3·8-15·0). This randomized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged <18 years and defined with low risk of IFI. Higher risk patients, including those with relapsed cancer, appear to be the target for empirical antifungal therapy during protracted febrile neutropenia.

  19. 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…

  20. 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...

  1. Treatment Utility of Functional versus Empiric Assessment within Consultation for Reading Problems

    ERIC Educational Resources Information Center

    Beavers, Karen F.; Kratochwill, Thomas R.; Braden, Jeffery P.

    2004-01-01

    In this study, 18 teachers and 32 of their students who had reading difficulties were randomly assigned to one of two assessment conditions. In the functional assessment condition, consultants identified functional relationships among environmental events and targeted reading behaviors to develop an intervention plan. In the empiric condition,…

  2. 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…

  3. Prolonged Initial Empirical Antibiotic Treatment is Associated with Adverse Outcomes in Premature Infants

    PubMed Central

    Kuppala, Venkata S; Meinzen-Derr, Jareen; Morrow, Ardythe L.; Schibler, Kurt R.

    2011-01-01

    Objective To investigate the outcomes following prolonged empirical antibiotic administration to premature infants in the first week of life, concluding subsequent late onset sepsis (LOS), necrotizing enterocolitis (NEC), and death. Study design Study infants were ≤32 weeks gestational age and ≤ 1500 grams birth weight who survived free of sepsis and NEC for 7 days. Multivariable logistic regression was conducted to determine independent relationships between prolonged initial empirical antibiotic therapy (≥ 5 days) and study outcomes controlling for birth weight, gestational age, race, prolonged premature rupture of membranes, days on high frequency ventilation in 7 days, and the amount of breast milk received in the first 14 days of life. Results Of the 365 premature infants surviving 7 days free of sepsis or NEC, 36% received prolonged initial empirical antibiotics, which was independently associated with subsequent outcomes: LOS (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.28–4.67) and the combination of LOS, NEC, or death (OR 2.66, 95% CI 1.12–6.3). Conclusions Prolonged administration of empirical antibiotics to premature infants with sterile cultures in the first week of life is associated with subsequent severe outcomes. Judicious restriction of antibiotic use should be investigated as a strategy to reduce severe outcomes for premature infants. PMID:21784435

  4. 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…

  5. 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.

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

    PubMed Central

    Strymish, Judith; Gupta, Kalpana

    2015-01-01

    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. PMID:26416859

  7. 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.

  8. Antimicrobial resistance in urinary tract infections at a large urban ED: Factors contributing to empiric treatment failure.

    PubMed

    Rosa, Rossana; Abbo, Lilian M; Raney, Kenley; Tookes, Hansel E; Supino, Mark

    2017-03-01

    To calculate the emergency department (ED)-level Escherichia coli percentage of isolates susceptible to commonly used antibiotics and to determine the risk factors associated with inadequate empiric antibiotic therapy among patients treated for urinary tract infections (UTIs) in our ED. Retrospective cohort study conducted at a large tertiary teaching hospital. Participants included patients older than 18years of age who had a urine culture with growth of >100,000 colonies of E. coli. Demographic and therapeutic choices associated with inadequate empiric antibiotic therapy were explored. Antimicrobial susceptibility pattern of E. coli isolates recovered from ED patients were calculated, and stratified by gender and age. A total of 300 unique patients had E. coli bacteriuria during the study period. Among patients who received at least one dose of antibiotic in the ED, variables independently associated with an increased risk of inadequate empiric therapy were age (relative risk [RR] 1.016; 95% confidence interval [CI] 1.001-1.031; P=0.032), male gender (RR 2.507; 95% CI 1.470-4.486; P=0.001), and use of fluoroquinolones (RR 2.128; 95% CI 1.249-3.624 P=0.005). Sub-group analysis of patients discharged from the ED showed that definitive therapy with nitrofurantoin decreased the risk of inadequate empiric antibiotic therapy by 80% (RR 0.202; CI 0.065-0.638; P=0.006). ED-level antibiograms showed differences in antimicrobial susceptibility of E. coli by age and gender. Development of ED-level antimicrobial susceptibility data and consideration of patients' clinical characteristics can help better guide selection of empiric antibiotic therapy for the treatment of UTIs. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. 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

  10. Abnormal epidermal changes after argon laser treatment

    SciTech Connect

    Neumann, R.A.; Knobler, R.M.; Aberer, E.; Klein, W.; Kocsis, F.; Ott, E. )

    1991-02-01

    A 26-year-old woman with a congenital port-wine stain on the forehead was treated three times at 2-month intervals with an argon laser. Six months after the last treatment, moderate blanching and mild scaling confined to the treated area was observed. A biopsy specimen of the treated area revealed a significant decrease in ectatic vessels. However, epidermal changes similar to those of actinic keratosis with disorganized cell layers and marked cytologic abnormalities were seen. Analysis of peripheral blood lymphocytes for a defect in DNA repair was negative. Multiple, argon laser-induced photothermal effects may be responsible for the changes observed in our case and may lead to premalignant epidermal transformation.

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

    PubMed

    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

    2015-08-01

    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 (NDBI)" are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

  12. Recommendations for the Empirical Treatment of Complicated Urinary Tract Infections Using Surveillance Data on Antimicrobial Resistance in the Netherlands

    PubMed Central

    Koningstein, Maike; van der Bij, Akke K.; de Kraker, Marlieke E. A.; Monen, Jos C.; Muilwijk, Jan; de Greeff, Sabine C.; Geerlings, Suzanne E.; van Hall, Maurine A. Leverstein-

    2014-01-01

    Background Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide surveillance data to evaluate antimicrobial coverage of agents for the treatment of c-UTI in the Netherlands. Methods We included the first isolate per patient of urine samples of hospitalised patients collected by the Infectious Disease Surveillance Information System for Antibiotic Resistance (ISIS-AR) in 2012, and determined the probability of inadequate coverage for antimicrobial agents based on species distribution and susceptibility. Analyses were repeated for various patient groups and hospital settings. Results The most prevalent bacteria in 27,922 isolates of 23,357 patients were Escherichia coli (47%), Enterococcus spp. (14%), Proteus mirabilis (8%), and Klebsiella pneumoniae (7%). For all species combined, the probability of inadequate coverage was <5% for amoxicillin or amoxicillin-clavulanic acid combined with gentamicin and the carbapenems. When including gram-negative bacteria only, the probability of inadequate coverage was 4.0%, 2.7%, 2.3% and 1.7%, respectively, for amoxicillin, amoxicillin-clavulanic acid, a second or a third generation cephalosporin in combination with gentamicin, and the carbapenems (0.4%). There were only small variations in results among different patient groups and hospital settings. Conclusions When excluding Enterococcus spp., considered as less virulent, and the carbapenems, considered as last-resort drugs, empirical treatment for c-UTI with the best chance of adequate coverage are one of the studied beta-lactam-gentamicin combinations. This study demonstrates the applicability of routine surveillance data for up-to-date clinical practice guidelines on empirical antimicrobial

  13. 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

  14. Empirically observed learning rates for concentrating solar power and their responses to regime change

    NASA Astrophysics Data System (ADS)

    Lilliestam, Johan; Labordena, Mercè; Patt, Anthony; Pfenninger, Stefan

    2017-07-01

    Concentrating solar power (CSP) capacity has expanded slower than other renewable technologies and its costs are still high. Until now, there have been too few CSP projects to derive robust conclusions about its cost development. Here we present an empirical study of the cost development of all operating CSP stations and those under construction, examining the roles of capacity growth, industry continuity, and policy support design. We identify distinct CSP expansion phases, each characterized by different cost pressure in the policy regime and different industry continuity. In 2008-2011, with low cost pressure and following industry discontinuity, costs increased. In the current phase, with high cost pressure and continuous industry development, costs decreased rapidly, with learning rates exceeding 20%. Data for projects under construction suggest that this trend is continuing and accelerating. If support policies and industrial structure are sustained, we see no near-term factors that would hinder further cost decreases.

  15. An Empirical Study on the Role of Context Factors in Employees' Commitment to Change

    ERIC Educational Resources Information Center

    Soumyaja, Devi; Kamlanabhan, T. J.; Bhattacharyya, Sanghamitra

    2011-01-01

    The study attempts to address the gap of exploring the possible antecedents of employees' commitment to change and its three dimensions. The role of context factors--participation in decision making, quality of communication, trust in management and history of change--are tested on overall commitment to change and also on its three…

  16. An Empirical Study on the Role of Context Factors in Employees' Commitment to Change

    ERIC Educational Resources Information Center

    Soumyaja, Devi; Kamlanabhan, T. J.; Bhattacharyya, Sanghamitra

    2011-01-01

    The study attempts to address the gap of exploring the possible antecedents of employees' commitment to change and its three dimensions. The role of context factors--participation in decision making, quality of communication, trust in management and history of change--are tested on overall commitment to change and also on its three…

  17. An Empirical Typology of Tree Species Assemblages across the U.S. for Assessing Climate Change Threats to Forest Communities

    NASA Astrophysics Data System (ADS)

    Costanza, J. K.; Coulston, J.; Wear, D. N.

    2016-12-01

    An understanding of how the composition of forest tree communities will change in the future is critical for assessing the effects of climate change on forests. Recent research suggests that simply knowing the responses of individual species to changing climate does not adequately capture likely community-level response. In part, this is because some tree species in a community play a larger role than others, and thus, any climate change effects on those species will have greater effects on the associated forest tree community. As the basis of an assessment of climate change impacts to forest communities, we used hierarchical cluster analysis of over 120,000 recent forest inventory plots to empirically define forest tree communities across the U.S. We then used indicator species analysis to define the important tree species in each community. The result was a U.S.-wide typology of 29 clusters representing empirical forest communities. Clusters contained between six and 30,000 inventory plots each, and were associated with between one and twelve indicator species. We show how these clusters can be used to assess forest community-level climate change impacts. For a subset of clusters in the eastern U.S., we overlaid projected habitat suitability maps from USDA Forest Service Climate Change Tree Atlas for the indicator species under two climate change scenarios for the end of the century. Climate change threat results ranged widely for both scenarios, showing an average loss of habitat across all indicator species in some communities, and an average gain for others. For example, the balsam fir-quaking aspen community in the northeastern U.S. was projected to see the most loss of habitat for indicator species, with a change of 47.0% and 73.4% in importance value under the low and high climate change scenarios, respectively. Conversely, the indicator species in the green ash-American elm community were projected to see gains of 32.7% and 117.4% in importance value in

  18. [Amoxicillin and clavulanic acid versus amoxicillin plus gentamicin in the empirical initial treatment of urinary tract infections in hospitalized patients].

    PubMed

    Verzasconi, R; Rodoni, P; Monotti, R; Marone, C; Mombelli, G

    1995-08-19

    We compared the fixed combination amoxicillin plus clavulanic acid with that of amoxicillin plus gentamicin in the empirical initial treatment of severe urinary tract infections. The study included 87 hospitalized patients (51 women and 36 men, mean age 58 +/- 22 years) with acute uncomplicated pyelonephritis (n = 48) or with complicated urinary tract infections (n = 39). 80 patients (92%) had fever and 31 patients (36%) positive blood cultures. 45 patients were randomly assigned to amoxicillin plus clavulanic acid and 42 to amoxicillin plus gentamicin. Overall, 18 patients (21%) were infected with organisms resistant in vitro to amoxicillin plus clavulanic acid, whereas no pathogen was isolated with resistance to amoxicillin plus gentamicin (p < 0.0001). At the end of the empirical treatment (4.2 +/- 1.5 days after the start), significant bacteriuria was present in 6/39 patients (15%) assigned to amoxicillin plus clavulanic acid, compared to 0/34 patients assigned to amoxicillin plus gentamicin (p < 0.05). The clinical response was satisfactory in both groups, and the time from start of therapy to resolution of fever was 2.2 +/- 1.4 days in the amoxicillin plus clavulanic acid group and 2.3 +/- 1.7 days in the amoxicillin plus gentamicin group. Although the in-vitro resistance did not result in a lower clinical efficacy of amoxicillin plus clavulanic acid compared to amoxicillin plus gentamicin in our relatively small sample of patients, the data indicate that the antimicrobial activity of amoxicillin plus clavulanic acid is inadequate to cover the spectrum of causative agents in hospitalized patients with pyelonephritis or complicated urinary tract infections. Amoxicillin plus clavulanic acid should therefore not be used in the initial empirical treatment of these infections.

  19. Nitrofurantoin Compares Favorably to Recommended Agents as Empirical Treatment of Uncomplicated Urinary Tract Infections in a Decision and Cost Analysis

    PubMed Central

    McKinnell, James A.; Stollenwerk, Nicholas S.; Jung, Chin W.; Miller, Loren G.

    2011-01-01

    OBJECTIVE: To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI). PATIENTS AND METHODS: We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs. RESULTS: Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics. CONCLUSION: From a payer perspective, nitrofurantoin appears to be a reasonable alternative to TMP-SMX and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens. On the basis of efficacy, cost, and low impact on promoting antimicrobial resistance, clinicians should consider nitrofurantoin as a reasonable alternative to TMP-SMX and fluoroquinolones for first-line therapy for uncomplicated UTIs. PMID:21576512

  20. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis.

    PubMed

    McKinnell, James A; Stollenwerk, Nicholas S; Jung, Chin W; Miller, Loren G

    2011-06-01

    To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI). We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs. Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics. From a payer perspective, nitrofurantoin appears to be a reasonable alternative to TMP-SMX and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens. On the basis of efficacy, cost, and low impact on promoting antimicrobial resistance, clinicians should consider nitrofurantoin as a reasonable alternative to TMP-SMX and fluoroquinolones for first-line therapy for uncomplicated UTIs.

  1. 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

  2. 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.

  3. 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.

  4. 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…

  5. 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…

  6. Soil carbon sequestration and land use change associated with biofuel production: Empirical evidence

    SciTech Connect

    Qin, Zhangcai; Dunn, Jennifer B.; Kwon, Hoyoung; Mueller, Steffen; Wander, Michelle M.

    2016-01-01

    Soil organic carbon (SOC) change can be a major impact of land use change (LUC) associated with biofuel feedstock production. By collecting and analyzing data from worldwide field observations with major LUCs from cropland, grassland and forest to lands producing biofuel crops (i.e., corn, switchgrass, Miscanthus, poplar and willow), we were able to estimate SOC response ratios and sequestration rates and evaluate the effects of soil depth and time scale on SOC change. Both the amount and rate of SOC change were highly dependent on the specific land transition. Irrespective of soil depth or time horizon, cropland conversions resulted in an overall SOC gain of 6-14% relative to initial SOC level, while conversion from grassland or forest to corn (without residue removal) or poplar caused significant carbon loss (9-35%). No significant SOC changes were observed in land converted from grasslands or forests to switchgrass, Miscanthus or willow. The SOC response ratios were similar in both 0-30 and 0-100 cm soil depths in most cases, suggesting SOC changes in deep soil and that use of top soil only for SOC accounting in biofuel life cycle analysis (LCA) might underestimate total SOC changes. Soil carbon sequestration rates varied greatly among studies and land transition types. Generally, the rates of SOC change tended to be the greatest during the 10 years following land conversion, and had declined to approach 0 within about 20 years for most LUCs. Observed trends in SOC change were generally consistent with previous reports. Soil depth and duration of study significantly influence SOC change rates and so should be considered in carbon emission accounting in biofuel LCA. High uncertainty remains for many perennial systems, field trials and modeling efforts are needed to determine the site- and system-specific rates and direction of change associated with their production.

  7. An empirical examination of women's empowerment and transformative change in the context of international development.

    PubMed

    Grabe, Shelly

    2012-03-01

    This paper responds to calls from social scientists in the area of globalization and women's empowerment to test a model that investigates both structural and individual components of women's empowerment in the context of globalization. The investigation uses a liberation psychology framework by taking into account the effects of globalization, human rights discourse, and women's activism within social movements to identify how structural inequities may be related to empowerment. Surveys conducted in rural Nicaragua revealed that land ownership and organizational participation among women were related to more progressive gender ideology, and in turn, women's power and control within the marital relationship, individual levels of agency, and subjective well-being. The study demonstrates that psychology can bridge the theoretical arguments surrounding human rights with the practical implementation of development interventions, and provide empirical support that has yet to be demonstrated elsewhere. The findings have important implications for strategies and interventions that can improve conditions for women and contribute to the aims of social justice articulated in the Beijing Platform for Action.

  8. Language Change in the Wake of Empire: Syriac in Its Greco-Roman Context

    ERIC Educational Resources Information Center

    Butts, Aaron Michael

    2013-01-01

    Greek-Aramaic bilingualism was wide-spread throughout Late Antique Syria and Mesopotamia. Among the various Aramaic dialects, Syriac underwent a particularly intense and prolonged period of contact with Greek. This contact led to changes in both languages. The present study provides a new analysis of contact-induced changes in Syriac due to Greek,…

  9. Language Change in the Wake of Empire: Syriac in Its Greco-Roman Context

    ERIC Educational Resources Information Center

    Butts, Aaron Michael

    2013-01-01

    Greek-Aramaic bilingualism was wide-spread throughout Late Antique Syria and Mesopotamia. Among the various Aramaic dialects, Syriac underwent a particularly intense and prolonged period of contact with Greek. This contact led to changes in both languages. The present study provides a new analysis of contact-induced changes in Syriac due to Greek,…

  10. Melting empires? Climate change and politics in Antarctica since the International Geophysical Year.

    PubMed

    Howkins, Adrian

    2011-01-01

    This article examines the relationship between climate change and politics in Antarctica since the International Geophysical Year of 1957-8, paying particular attention to the work of the British Antarctic Survey. Research conducted in Antarctica has played an important role in the understanding of climate change on a global scale. In turn, fears about the consequences of global climate change have radically changed perceptions of Antarctica and profoundly shaped scientific research agendas: a continent that until fifty years ago was perceived largely as an inhospitable wilderness has come to be seen as a dangerously vulnerable environment. This radical shift in perception contrasts with a fundamental continuity in the political power structures of the continent. This article argues that the severity of the threat of climate change has reinforced the privileged political position of the "insider" nations within the Antarctic Treaty System.

  11. Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytical model.

    PubMed

    Vinken, A; Li, Z; Balan, D; Rittenhouse, B; Wilike, R; Nathwani, D

    2001-12-01

    Standard antibiotic treatment of infections has become more difficult and costly due to treatment failure associated with the rise in bacterial resistance. New antibiotics that can overcome such resistant pathogens have the potential for great clinical and economic impact. Linezolid is a new antibiotic that is effective in the treatment of both antibiotic-susceptible and antibiotic-resistant Gram-positive bacterial infections, including those resistant to other available antibiotics. This breadth of activity is unique in existing antibiotics for Gram-positive bacteria and serves as the rationale for exploring the hypothesis that linezolid is an appropriate choice when considering empirical treatment of cellulitis in complicated or compromised patients in the nosocomial setting. A decision-modelling approach was used to compare the predicted first-line treatment efficacy and direct medical costs of linezolid with standard treatment of cellulitis among hospitalized patients. For the purposes of this analysis, standard care is defined along two main pathways: (1) initiating care with intravenous (iv) flucloxacillin, switching to vancomycin if the pathogen is found to be resistant to flucloxacillin, or maintaining flucloxacillin if the pathogen is found susceptible, or when culture and sensitivity analysis is inconclusive; or (2) initiating care with vancomycin, switching to iv flucloxacillin if the pathogen is found susceptible to flucloxacillin, maintaining vancomycin if the infection is found resistant, or when culture and sensitivity are inconclusive. For those patients taking iv flucloxacillin, a switch to oral flucloxacillin was allowed when clinically appropriate. We hypothesized that the cost of care of initiating treatment with linezolid would be less than that for both vancomycin and flucloxacillin in resistance risk ranges typically encountered in UK hospitals. In addition, while the registration trials showed equivalence of linezolid with the comparators in

  12. 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.

  13. Is preemptive antifungal therapy a good alternative to empirical treatment in prolonged febrile neutropenia?

    PubMed

    Koch, Erica; Rada, Gabriel

    2016-06-09

    Patients with prolonged febrile neutropenia are at high risk of invasive fungal infection, so it has been standard practice to initiate empirical antifungal therapy in these cases. However, this strategy is associated with important toxicity, so diagnostic test-guided preemptive antifungal therapy has been proposed as an alternative. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including twelve studies overall. Four randomized controlled trials addressed the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded it is not clear whether preemptive strategy affects mortality because the certainty of the evidence is very low, but it might slightly decrease the use of antifungal agents in patients with prolonged febrile neutropenia.

  14. Empirically Estimating the Potential for Farm-Level Adaptation to Climate Change in Western European Agriculture

    NASA Astrophysics Data System (ADS)

    Moore, F. C.; Lobell, D. B.

    2013-12-01

    Agriculture is one of the economic sectors most exposed to climate change and estimating the sensitivity of food production to these changes is critical for determining the severity of climate change impacts and for informing both adaptation and mitigation policy. While climate change might have adverse effects in many areas, it has long been recognized that farmers have a suite of adaptation options at their disposal including, inter alia, changing planting date, varieties, crops, or the mix and quantity of inputs applied. These adaptations may significantly reduce the adverse impacts of climate change but the potential effectiveness of these options and the speed with which farmers will adopt them remain uncertain. We estimate the sensitivity of crop yields and farm profits in western Europe to climate change with and without the adoption of on-farm adaptations. We use cross-sectional variation across farms to define the long-run response function that includes adaptation and inter-annual variation within farms to define the short-run response function without adaptation. The difference between these can be interpreted as the potential for adaptation. We find that future warming will have a large adverse impact on wheat and barley yields and that adaptation will only be able to mitigate a small fraction of this. Maize, oilseed and sugarbeet yields are more modestly affected and adaptation is more effective for these crops. Farm profits could increase slightly under moderate amounts of warming if adaptations are adopted but will decline in the absence of adaptation. A decomposition of variance gives the relative importance of different sources of uncertainty in projections of climate change impacts. We find that in most cases uncertainty over future adaptation pathways (whether farmers will or will not adopt beneficial adaptations) is the most important source of uncertainty in projecting the effect of temperature changes on crop yields and farm profits. This

  15. Empirically Estimating the Potential for Farm-Level Adaptation to Climate Change in Western European Agriculture

    NASA Astrophysics Data System (ADS)

    Mills, C. M.; Walsh, J. E.; Deser, C.

    2011-12-01

    Agriculture is one of the economic sectors most exposed to climate change and estimating the sensitivity of food production to these changes is critical for determining the severity of climate change impacts and for informing both adaptation and mitigation policy. While climate change might have adverse effects in many areas, it has long been recognized that farmers have a suite of adaptation options at their disposal including, inter alia, changing planting date, varieties, crops, or the mix and quantity of inputs applied. These adaptations may significantly reduce the adverse impacts of climate change but the potential effectiveness of these options and the speed with which farmers will adopt them remain uncertain. We estimate the sensitivity of crop yields and farm profits in western Europe to climate change with and without the adoption of on-farm adaptations. We use cross-sectional variation across farms to define the long-run response function that includes adaptation and inter-annual variation within farms to define the short-run response function without adaptation. The difference between these can be interpreted as the potential for adaptation. We find that future warming will have a large adverse impact on wheat and barley yields and that adaptation will only be able to mitigate a small fraction of this. Maize, oilseed and sugarbeet yields are more modestly affected and adaptation is more effective for these crops. Farm profits could increase slightly under moderate amounts of warming if adaptations are adopted but will decline in the absence of adaptation. A decomposition of variance gives the relative importance of different sources of uncertainty in projections of climate change impacts. We find that in most cases uncertainty over future adaptation pathways (whether farmers will or will not adopt beneficial adaptations) is the most important source of uncertainty in projecting the effect of temperature changes on crop yields and farm profits. This

  16. 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

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

    PubMed Central

    2013-01-01

    Objective 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. Methods 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. Results 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%). Conclusions 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

  18. Cultural change and traditional ecological knowledge. An empirical analysis from the Tsimane' in the Bolivian Amazon.

    PubMed

    Reyes-García, Victoria; Paneque-Gálvez, Jaime; Luz, Ana C; Gueze, Maximilien; Macía, Manuel J; Orta-Martínez, Martí; Pino, Joan

    2014-01-01

    Among the different factors associated to change in traditional ecological knowledge, the study of the relations between cultural change and traditional ecological knowledge has received scan and inadequate scholarly attention. Using data from indigenous peoples of an Amazonian society facing increasing exposure to the mainstream Bolivian society, we analyzed the relation between traditional ecological knowledge, proxied with individual plant use knowledge (n=484), and cultural change, proxied with individual- and village-level (n=47) measures of attachment to traditional beliefs and values. We found that both the individual level of detachment to traditional values and the village level of agreement in detachment to traditional values were associated with individual levels of plant use knowledge, irrespective of other proxy measures for cultural change. Because both the individual- and the village-level variables bear statistically significant associations with plant use knowledge, our results suggest that both the individual- and the supra-individual level processes of cultural change are related to the erosion of plant use knowledge. Results from our work highlight the importance of analyzing processes that happen at intermediary social units -the village in our case study- to explain changes in traditional ecological knowledge.

  19. Cultural change and traditional ecological knowledge. An empirical analysis from the Tsimane’ in the Bolivian Amazon

    PubMed Central

    Reyes-García, Victoria; Paneque-Gálvez, Jaime; Luz, Ana C.; Gueze, Maximilien; Macía, Manuel J.; Orta-Martínez, Martí; Pino, Joan

    2016-01-01

    Among the different factors associated to change in traditional ecological knowledge, the study of the relations between cultural change and traditional ecological knowledge has received scan and inadequate scholarly attention. Using data from indigenous peoples of an Amazonian society facing increasing exposure to the mainstream Bolivian society, we analyzed the relation between traditional ecological knowledge, proxied with individual plant use knowledge (n=484), and cultural change, proxied with individual- and village-level (n=47) measures of attachment to traditional beliefs and values. We found that both the individual level of detachment to traditional values and the village level of agreement in detachment to traditional values were associated with individual levels of plant use knowledge, irrespective of other proxy measures for cultural change. Because both the individual- and the village-level variables bear statistically significant associations with plant use knowledge, our results suggest that both the individual- and the supra-individual level processes of cultural change are related to the erosion of plant use knowledge. Results from our work highlight the importance of analyzing processes that happen at intermediary social units -the village in our case study- to explain changes in traditional ecological knowledge. PMID:27642188

  20. 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

  1. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia.

    PubMed

    Falguera, M; Ruiz-González, A; Schoenenberger, J A; Touzón, C; Gázquez, I; Galindo, C; Porcel, J M

    2010-02-01

    Recommendations for diagnostic testing in hospitalised patients with community-acquired pneumonia remain controversial. The aim of the present study was to evaluate the impact of a therapeutic strategy based on the microbiological results provided by urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila. For a 2-year period, hospitalised patients with community-acquired pneumonia were randomly assigned to receive either empirical treatment, according to international guidelines, or targeted treatment, on the basis of the results from antigen tests. Outcome parameters, monetary costs and antibiotic exposure levels were compared. Out of 194 enrolled patients, 177 were available for randomisation; 89 were assigned to empirical treatment and 88 were assigned to targeted treatment. Targeted treatment was associated with a slightly higher overall cost (euro 1657.00 vs euro 1617.20, p=0.28), reduction in the incidence of adverse events (9% vs 18%, p=0.12) and lower exposure to broad-spectrum antimicrobials (154.4 vs 183.3 defined daily doses per 100 patient days). No statistically significant differences in other outcome parameters were observed. Oral antibiotic treatment was started according to the results of antigen tests in 25 patients assigned to targeted treatment; these patients showed a statistically significant higher risk of clinical relapse as compared with the remaining population (12% vs 3%, p=0.04). The routine implementation of urine antigen detection tests does not carry substantial outcome-related or economic benefits to hospitalised patients with community-acquired pneumonia. Narrowing the antibiotic treatment according to the urine antigen results may in fact be associated with a higher risk of clinical relapse.

  2. Behavior Change Outcomes of Marathon Group Treatment

    ERIC Educational Resources Information Center

    Uhlemann, Max R.; Weigel, Richard G.

    1977-01-01

    This study evaluated behavior change occurring after a marathon group experience, with a focus on individualized rather than shared behavioral change criteria. The individualization of behavior change criteria is based on the assertion that few, if any, single change criteria are appropriate or realistic for assessing change in all individuals.…

  3. Behavior Change Outcomes of Marathon Group Treatment

    ERIC Educational Resources Information Center

    Uhlemann, Max R.; Weigel, Richard G.

    1977-01-01

    This study evaluated behavior change occurring after a marathon group experience, with a focus on individualized rather than shared behavioral change criteria. The individualization of behavior change criteria is based on the assertion that few, if any, single change criteria are appropriate or realistic for assessing change in all individuals.…

  4. Mechanisms of change in psychotherapy for depression: An empirical update and evaluation of research aimed at identifying psychological mediators.

    PubMed

    Lemmens, Lotte H J M; Müller, Viola N L S; Arntz, Arnoud; Huibers, Marcus J H

    2016-12-01

    We present a systematic empirical update and critical evaluation of the current status of research aimed at identifying a variety of psychological mediators in various forms of psychotherapy for depression. We summarize study characteristics and results of 35 relevant studies, and discuss the extent to which these studies meet several important requirements for mechanism research. Our review indicates that in spite of increased attention for the topic, advances in theoretical consensus about necessities for mechanism research, and sophistication of study designs, research in this field is still heterogeneous and unsatisfactory in methodological respect. Probably the biggest challenge in the field is demonstrating the causal relation between change in the mediator and change in depressive symptoms. The field would benefit from a further refinement of research methods to identify processes of therapeutic change. Recommendations for future research are discussed. However, even in the most optimal research designs, explaining psychotherapeutic change remains a challenge. Psychotherapy is a multi-dimensional phenomenon that might work through interplay of multiple mechanisms at several levels. As a result, it might be too complex to be explained in relatively simple causal models of psychological change. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

    ERIC Educational Resources Information Center

    Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

    2008-01-01

    This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

  6. Empirically Supported Family-Based Treatments for Conduct Disorder and Delinquency in Adolescents

    ERIC Educational Resources Information Center

    Henggeler, Scott W.; Sheidow, Ashli J.

    2012-01-01

    Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief…

  7. The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

    ERIC Educational Resources Information Center

    Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

    2008-01-01

    This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

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

    SciTech Connect

    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, 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

  9. Valuing Climate Change Impacts on Human Health: Empirical Evidence from the Literature

    PubMed Central

    Markandya, Anil; Chiabai, Aline

    2009-01-01

    There is a broad consensus that climate change will increase the costs arising from diseases such as malaria and diarrhea and, furthermore, that the largest increases will be in developing countries. One of the problems is the lack of studies measuring these costs systematically and in detail. This paper critically reviews a number of studies about the costs of planned adaptation in the health context, and compares current health expenditures with MDGs which are felt to be inadequate when considering climate change impacts. The analysis serves also as a critical investigation of the methodologies used and aims at identifying research weaknesses and gaps. PMID:19440414

  10. Why Do Firms Train? Empirical Evidence on the Relationship between Training and Technological and Organizational Change

    ERIC Educational Resources Information Center

    Neirotti, Paolo; Paolucci, Emilio

    2013-01-01

    We explore the relationship between training and innovation using key insights from the resource-based approach, organizational learning and labour studies. By using data from 304 large enterprises in Italy, the study highlights a twofold role of training in favouring technological and organizational changes. First, training plays a role in…

  11. Instructional Change in Preschool Classrooms: A Study of Empirically-Based Teacher Support

    ERIC Educational Resources Information Center

    Boat, Mary B.; Carr, Victoria; Barnett, David; Macmann, Gregg; Moomaw, Sally; Pan, Wei; Nichols, Angela

    2009-01-01

    This study examined the effects of staff development and support on Head Start teachers' use of instructional and managerial strategies. Specific research questions were (a) What variables were selected by teachers? and (b) What changes were indicated by the method of support? Observations were conducted for teachers randomly assigned to…

  12. Total factor productivity change in dairy farming: Empirical evidence from southern Chile.

    PubMed

    Moreira, Víctor H; Bravo-Ureta, Boris E

    2016-10-01

    Despite the importance of productivity growth, many studies carried out at the farm level focus primarily on the technical efficiency (TE) component of farm productivity. Therefore, the general purpose of this paper is to measure total factor productivity change and then to decompose this change into several distinct elements. The data were an unbalanced panel for the period from 2005 to 2010 containing 477 farms and 1,426 observations obtained from TODOAGRO, a farm-management center created in 1996 in the southern part of Chile. The region where the data come from accounts for 20% of the total milk processed in the country. Stochastic production frontiers along with the translog functional form were used to analyze total factor productivity change. The econometric evidence indicates that farms exhibit decreasing returns to size implying that costs of production rise as farm size increases, which suggests that the motivation for farm growth stems from the search for income rather than from lowering costs. The main results indicated that productivity gains through TE improvements are limited, with an average TE for the whole sample of 91.0%, and average technical efficiency change of 0.05% per year. By contrast, average technological progress at the sample mean was rather high at 1.90%, which suggests that additional investments in research and subsequent adoption of improved technologies would have a positive effect on productivity growth. The findings also revealed that farm size is not associated with productivity growth for the dairy farms in the sample.

  13. Adaptability: Conceptual and Empirical Perspectives on Responses to Change, Novelty and Uncertainty

    ERIC Educational Resources Information Center

    Martin, Andrew J.; Nejad, Harry; Colmar, Susan; Liem, Gregory Arief D.

    2012-01-01

    Adaptability is proposed as individuals' capacity to constructively regulate psycho-behavioral functions in response to new, changing, and/or uncertain circumstances, conditions and situations. The present investigation explored the internal and external validity of an hypothesised adaptability scale. The sample comprised 2,731 high school…

  14. Adaptability: Conceptual and Empirical Perspectives on Responses to Change, Novelty and Uncertainty

    ERIC Educational Resources Information Center

    Martin, Andrew J.; Nejad, Harry; Colmar, Susan; Liem, Gregory Arief D.

    2012-01-01

    Adaptability is proposed as individuals' capacity to constructively regulate psycho-behavioral functions in response to new, changing, and/or uncertain circumstances, conditions and situations. The present investigation explored the internal and external validity of an hypothesised adaptability scale. The sample comprised 2,731 high school…

  15. Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview

    ERIC Educational Resources Information Center

    Hinyard, Leslie J.; Kreuter, Matthew W.

    2007-01-01

    Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using…

  16. Why Do Firms Train? Empirical Evidence on the Relationship between Training and Technological and Organizational Change

    ERIC Educational Resources Information Center

    Neirotti, Paolo; Paolucci, Emilio

    2013-01-01

    We explore the relationship between training and innovation using key insights from the resource-based approach, organizational learning and labour studies. By using data from 304 large enterprises in Italy, the study highlights a twofold role of training in favouring technological and organizational changes. First, training plays a role in…

  17. Changes in Migration Pattern of Transhumance due to Climate Change: An Empirical Analysis of Gaddi Community of Himachal Himalaya, India

    NASA Astrophysics Data System (ADS)

    Mishra, Himanshu; Wasini Pandey, Bindhy

    2017-04-01

    Transhumance is a complex and traditional livelihood system seeking to maintain equilibrium between pastures, livestock and local people in variable and inhospitable environments. In Western Himalayas in the Indian state of Himachal Pradesh, pastoral groups of Gaddis inhabit almost inaccessible areas, where scarce resources and extreme climatic conditions limit options for alternative land use and livelihood systems. In such a harsh and unforgiving environment, mobility in the form of transhumance has been the traditional ecological response to climatic extremes. However, recently, such additional factors as global as well as regional climate change have brought about changes in the tree line, snow line and pastoral grounds along the historical route of seasonal migration of the Gaddis. The growing unpredictability of the once static route of migration has raised the possibility of Gaddis shifting to alternative land use and land management techniques. In the present research, we explore how transhumant pastoralism has been sustained and stimulated in the context of socioeconomic and climate change in the mountainous region of Himachal Pradesh and the future challenges that it faces. Based on case study research conducted in Chamba district in Himachal Pradesh; we have analysed the status, opportunities, and constraints of transhumant pastoralism in the changing context and modeled the possible alternative land use decisions. Finally we conclude that unless there are affirmative and progressive policy and institutional framework to support transhumant system, the indigenous practice will soon disappear from this part of the world. Keywords: Climate change, Gaddis, Himachal Pradesh, Transhumance, Alternative Land Use

  18. Empirically Supported Interventions.

    PubMed

    Wodarski, John S; Curtis, Sarah V

    2016-01-01

    Within the past four decades the social work profession has responded to the challenge to base practice on empirical evidence to adequately meet client needs. Most social workers would agree that the challenge has resulted in positive changes in the majority of cases-for example, in the execution of relevant research studies; the incorporation of more research findings into practice; the development of a technology of interpersonal helping; an emphasis on the incorporation of new knowledge bases, such as socio-behavioral and systems theory, in the curricula of schools of social work; and the development of services to meet emerging client needs and evidence-based practice. In this article the authors outline different references available pertaining to empirically supported interventions. A literature review revealed several textbooks, reference resources, journals, and handbooks that contain the most current research on therapeutic interventions. Different treatment components were explored in an effort to uncover the most cutting-edge developments in psychosocial treatments. These treatment components include treatment configuration, worker traits, compatibility of worker and client characteristics, professionals versus paraprofessionals, treatment length, and behavior acquisition.

  19. Global climate changes recorded in coastal wetland sediments: Empirical observations linked to theoretical predictions

    NASA Astrophysics Data System (ADS)

    Kolker, Alexander S.; Kirwan, Matthew L.; Goodbred, Steven L.; Cochran, J. Kirk

    2010-07-01

    Whether coastal areas are experiencing, and responding to, an accelerated rate of global sea-level rise (GSLR) is critically important for the ˜2 billion people living near Earth's oceans. Accretion rates from a suite of physiographically diverse coastal wetlands surrounding Long Island, NY accelerated during the 20th century at 2.3 ± 0.2 × 10-2 mm yr-2, which is comparable to reported rates of GSLR acceleration and global temperature changes. Wetlands varied in tidal range, salinity and geomorphic setting, and were located in embayments with limited human impacts in a region with limited and constant rates of subsidence. From geochronologies with temporal resolutions of 2-5 yr, we constructed new composite histories of sediment accretion and mineral deposition. Wetland dynamics are consistent with predictions from sedimentology and a numerical model of ecogeomorphic response, suggesting that these systems, and likely others worldwide, are responding to accelerated GSLR and related climatic changes.

  20. 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.

  1. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections.

    PubMed

    Moen, Marit D; Lyseng-Williamson, Katherine A; Scott, Lesley J

    2009-01-01

    some extent by these adverse events. Both echinocandins were better tolerated than liposomal amphotericin B. The cost of liposomal amphotericin B therapy may also restrict its use, but further pharmacoeconomic studies are required to fully define its cost effectiveness compared with other antifungal agents. Based on comparative data from well controlled trials, extensive clinical experience and its broad spectrum of activity, liposomal amphotericin B remains a first-line option for empirical therapy in patients with febrile neutropenia and in those with disseminated histoplasmosis, and is an option for the treatment of AIDS-associated cryptococcal meningitis, and for invasive Candida spp. or Aspergillus spp. infections. Amphotericin B, a macrocyclic, polyene antifungal agent, is thought to act by binding to ergosterol, the principal sterol in fungal cell membranes and Leishmania cells. This results in a change in membrane permeability, causing metabolic disturbance, leakage of small molecules and, as a consequence, cell death. In vitro and in vivo studies have shown that liposomal amphotericin B remains closely associated with the liposomes in the circulation, thereby reducing the potential for nephrotoxicity and infusion-related toxicity associated with conventional amphotericin B. Amphotericin B shows very good in vitro activity against a broad spectrum of clinically relevant fungal isolates, including most strains of Candida spp. and Aspergillus spp., and other filamentous fungi such as Zygomycetes. Liposomal amphotericin B has proven effective in various animal models of fungal infections, including those for candidiasis, aspergillosis, fusariosis and zygomycosis. Liposomal amphotericin B also shows immunomodulatory effects, although the mechanisms involved are not fully understood, and differ from those of amphotericin B deoxycholate and amphotericin B colloidal dispersion. In adult patients with febrile neutropenia, intravenous liposomal amphotericin B has

  2. An empirical approach to defining loss to follow-up among patients enrolled in antiretroviral treatment programs.

    PubMed

    Chi, Benjamin H; Cantrell, Ronald A; Mwango, Albert; Westfall, Andrew O; Mutale, Wilbroad; Limbada, Mohammed; Mulenga, Lloyd B; Vermund, Sten H; Stringer, Jeffrey S A

    2010-04-15

    In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical "days-late" definition of LTFU among patients on ART. Cohort members were classified as either "in care" or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as "best-performing." Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that > or =60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs.

  3. Economic valuation of environmental benefits from wastewater treatment processes: an empirical approach for Spain.

    PubMed

    Hernández-Sancho, Francesc; Molinos-Senante, María; Sala-Garrido, Ramón

    2010-01-15

    Economic research into the design and implementation of policies for the efficient management of water resources has been emphasized by the European Water Framework Directive (Directive 2000/60/EC). The efficient implementation of policies to prevent the degradation and depletion of water resources requires determining their value in social and economic terms and incorporating this information into the decision-making process. A process of wastewater treatment has many associated environmental benefits. However, these benefits are often not calculated because they are not set by the market, due to inadequate property rights, the presence of externalities, and the lack of perfect information. Nevertheless, the valuation of these benefits is necessary to justify a suitable investment policy and a limited number of studies exist on the subject of the economic valuation of environmental benefits. In this paper, we propose a methodology based on the estimation of shadow prices for the pollutants removed in a treatment process. This value represents the environmental benefit (avoided cost) associated with undischarged pollution. This is a pioneering approach to the economic valuation of wastewater treatment. The comparison of these benefits with the internal costs of the treatment process will provide a useful indicator for the feasibility of wastewater treatment projects.

  4. Three empirical essays on consumer behavior related to climate change and energy

    NASA Astrophysics Data System (ADS)

    Jacobsen, Grant Douglas

    This dissertation consists of three essays. All of the chapters address a topic in the area of household and consumer behavior related to climate change or energy. The first chapter is titled "The Al Gore Effect: An Inconvenient Truth and Voluntary Carbon Offsets". This chapter examines the relationship between climate change awareness and household behavior by testing whether Al Gore's documentary An Inconvenient Truth caused an increase in the purchase of voluntary carbon offsets. The analysis shows that in the two months following the film's release, zip codes within a 10-mile radius of a zip code where the film was shown experienced a 50 percent relative increase in the purchase of voluntary carbon offsets. The second chapter is titled "Are Building Codes Effective at Saving Energy? Evidence from Residential Billing Data in Florida". The analysis shows that Florida's energy-code change that took effect in 2002 is associated with a 4-percent decrease in electricity consumption and a 6-percent decrease in natural-gas consumption in Gainesville, FL. The estimated private payback period for the average residence is 6.4 years and the social payback period ranges between 3.5 and 5.3 years. The third chapter in this dissertation is titled "Do Environmental Offsets Increase Demand for Dirty Goods? Evidence from Residential Electricity Demand". This study evaluates the relationship between green products and existing patterns of consumer behavior by examining the relationship between household enrollment in a green electricity program and consumption of residential electricity. The results suggest there are two different types of green consumers. One type makes a small monthly donation and partially views the donation as a substitute for a previously existing pattern of green behavior, in this case, energy conservation. The other type makes a larger monthly donation and views the donation as a way to make strictly additional improvements in environmental quality.

  5. The Serengeti food web: empirical quantification and analysis of topological changes under increasing human impact.

    PubMed

    de Visser, Sara N; Freymann, Bernd P; Olff, Han

    2011-03-01

    1. To address effects of land use and human overexploitation on wildlife populations, it is essential to better understand how human activities have changed species composition, diversity and functioning. Theoretical studies modelled how network properties change under human-induced, non-random species loss. However, we lack data on realistic species-loss sequences in threatened, real-world food webs to parameterize these models. 2. Here, we present a first size-structured topological food web of one of the most pristine terrestrial ecosystems in the world, the Serengeti ecosystem (Tanzania). The food web consists of 95 grouped nodes and includes both invertebrates and vertebrates ranging from body masses between 10(-7) and 10(4) kg. 3. We study the topological changes in this food web that result from the simulated IUCN-based species-loss sequence representing current species vulnerability to human disturbances in and around this savanna ecosystem. We then compare this realistic extinction scenario with other extinction sequences based on body size and connectance and perform an analysis of robustness of this savanna food web. 4. We demonstrate that real-world species loss in this case starts with the biggest (mega) herbivores and top predators, causing higher predator-prey mass ratios. However, unlike theoretically modelled linear species deletion sequences, this causes poor-connected species to be lost first, while more highly connected species become lost as human impact progresses. This food web shows high robustness to decreasing body size and increasing connectance deletion sequences compared with a high sensitivity to the decreasing connectance deletion scenario. 5. Furthermore, based on the current knowledge of the Serengeti ecosystem, we discuss how the focus on food web topology alone, disregarding nontrophic interactions, may lead to an underestimation of human impacts on wildlife communities, with the number of trophic links affected by a

  6. Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.

    PubMed

    Vrouenraets, Lieke Josephina Jeanne Johanna; Fredriks, A Miranda; Hannema, Sabine E; Cohen-Kettenis, Peggy T; de Vries, Martine C

    2015-10-01

    The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate. Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide. Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits. As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

    ERIC Educational Resources Information Center

    Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

    2006-01-01

    In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

  8. An Investigation of Different Treatment Strategies for Item Category Collapsing in Calibration: An Empirical Study

    ERIC Educational Resources Information Center

    Tay-lim, Brenda Siok-Hoon; Zhang, Jinming

    2015-01-01

    To ensure the statistical result validity, model-data fit must be evaluated for each item. In practice, certain actions or treatments are needed for misfit items. If all misfit items are treated, much item information would be lost during calibration. On the other hand, if only severely misfit items are treated, the inclusion of misfit items may…

  9. Noncontingent Reinforcement Is an Empirically Supported Treatment for Problem Behavior Exhibited by Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Carr, James E.; Severtson, Jamie M.; Lepper, Tracy L.

    2009-01-01

    Noncontingent reinforcement (NCR) is a function-based treatment for problem behavior that has produced robust effects across a variety of response topographies and reinforcement functions among individuals with developmental disabilities. Several narrative reviews have adequately described this literature. The purpose of the present article was to…

  10. Noncontingent Reinforcement Is an Empirically Supported Treatment for Problem Behavior Exhibited by Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Carr, James E.; Severtson, Jamie M.; Lepper, Tracy L.

    2009-01-01

    Noncontingent reinforcement (NCR) is a function-based treatment for problem behavior that has produced robust effects across a variety of response topographies and reinforcement functions among individuals with developmental disabilities. Several narrative reviews have adequately described this literature. The purpose of the present article was to…

  11. Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

    ERIC Educational Resources Information Center

    Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

    2006-01-01

    In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

  12. An Investigation of Different Treatment Strategies for Item Category Collapsing in Calibration: An Empirical Study

    ERIC Educational Resources Information Center

    Tay-lim, Brenda Siok-Hoon; Zhang, Jinming

    2015-01-01

    To ensure the statistical result validity, model-data fit must be evaluated for each item. In practice, certain actions or treatments are needed for misfit items. If all misfit items are treated, much item information would be lost during calibration. On the other hand, if only severely misfit items are treated, the inclusion of misfit items may…

  13. 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

  14. 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.

  15. Empirical study on impact of demographic and economic changes on pension cost

    NASA Astrophysics Data System (ADS)

    Yusof, Shaira; Ibrahim, Rose Irnawaty

    2014-06-01

    A continuation of the same financial standard of living after retirement as before is very importance to retired person. The pension provider has a responsibility to ensure their employees receive the sufficient benefit after retirement and regularly monitor the factors that cause insufficient funds to pay benefit to retirees. Insufficient funds may be due to increased in pension cost. Some of the factors that increase the cost of pensions are changes in mortality rates and interest rates. This study will used these two factors to determine their sensitivity to pension cost. Two methods which are Accrued Benefit Cost Method and Projected Benefit Cost Method will be used to estimate pension cost. Interest rates has a inversely related to pension cost while mortality rates has a directly related to pension cost.

  16. Empirical Records of Environmental Change across the Archean-Proterozoic Transition

    NASA Astrophysics Data System (ADS)

    Kaufman, A. J.

    2011-12-01

    Time-series geochemical analyses of scientific drill cores intersecting the Archean-Proterozoic transition suggest a coupling of environmental and biological change that culminated in the pervasive oxygenation of Earth's atmosphere and oceans. Elemental and multiple isotope measurements of sedimentary archives, including carbonate, shale, and banded iron-formation from Western Australia, South Africa, Brazil, and southern Canada, indicate important changes in the carbon, sulfur, and nitrogen cycles that monitor the redox state of the oceans and the cyanobacterial buildup of atmospheric oxygen and ozone. In response, continental weathering would have increased, resulting in the enhanced delivery of sulfate and nutrients to seawater, further stimulating photoautotrophic fluxes of oxygen to surface environments. The positive feedback may additionally be responsible for the decline of atmospheric methane and surface refrigeration, represented by a series of discrete ice ages beginning around 2.4 billion years ago, due to the loss of greenhouse capacity during a time of lower solar luminosity. While speculative, the linkage of surface oxidation with enhanced nutrient supply and development of stratospheric sunscreen soon after the Archean-Proterozoic boundary suggests that the earliest perturbation in the carbon cycle may be associated with the rapid expansion of single-celled eukaryotes. Both sterol synthesis in eukaryotes and aerobic respiration require significant levels of oxygen in the ambient environment. Hence, Earth's earliest ice age(s) and onset of a modern and far more energetic carbon cycle may have been directly related to the global expansion of cyanobacteria that released oxygen to the environment, and of eukaryotes that respired it.

  17. An empirical model for independent dose verification of the Gamma Knife treatment planning.

    PubMed

    Phaisangittisakul, Nakorn; Ma, Lijun

    2002-09-01

    A formalism for an independent dose verification of the Gamma Knife treatment planning is developed. It is based on the approximation that isodose distribution for a single shot is in the shape of an ellipsoid in three-dimensional space. The dose profiles for a phantom along each of the three major axes are fitted to a function which contains the terms that represent the contributions from a point source, an extrafocal scattering, and a flat background. The fitting parameters are extracted for all four helmet collimators, at various shot locations, and with different skull shapes. The 33 parameters of a patient's skull shape obtained from the Skull Scaling Instrument measurements are modeled for individual patients. The relative doses for a treatment volume in the form of 31 x 31 x 31 matrix of points are extracted from the treatment planning system, the Leksell Gamma-Plan (LGP). Our model evaluates the relative doses using the same input parameters as in the LGP, which are skull measurement data, shot location, weight, gamma-angle of the head frame, and helmet collimator size. For 29 single-shot cases, the discrepancy of dose at the focus point between the calculation and the LGP is found to be within -1% to 2%. For multi-shot cases, the value and the coordinate of the maximum dose point from the calculation agree within +/-7% and +/-3 mm with the LGP results. In general, the calculated doses agree with the LGP calculations within +/-10% for the off-center locations. Results of calculation with this method for the dimension and location of the 50% isodose line are in good agreement with results from Leksell GammaPlan. Therefore, this method can be served as a useful tool for secondary quality assurance of Gamma Knife treatment plans.

  18. 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; Mage=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.

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

    USGS Publications Warehouse

    Robertson, D.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.

  20. Enamel color changes following orthodontic treatment.

    PubMed

    Pandian, Akshaya; Ranganathan, Sukanya; Padmanabhan, Sridevi

    2017-01-01

    To evaluate and compare the effect of various orthodontic bonding systems and clean up procedures on quantitative enamel colour change. A literature search was done to identify the studies that assessed the quantitative enamel colour change associated with the various bonding systems and cleanup procedures. Electronic database (Pub Med, Cochrane and Google Scholar) were searched. First stage screening was performed and the abstracts were selected according to the initial selection criteria. Full text articles were retrieved and analyzed during second stage screening. The bibliographies were reviewed to identify additional relevant studies. Sixteen full text articles were retrieved. Six were rejected because the methodology was different. There was significant enamel colour change following orthodontic bonding, debonding and clean up procedures. Self-etching primers produce less enamel colour change compared to conventional etching. Resin Modified GIC produces least colour change compared to other light cure and chemical cure systems. Polishing following the clean-up procedure reduces the colour change of the enamel.

  1. Empirically supported treatments in rural community mental health centers: a preliminary report on current utilization and attitudes toward adoption.

    PubMed

    Jameson, John Paul; Chambless, Dianne L; Blank, Michael B

    2009-12-01

    Rural community mental health centers (CMHCs) face numerous problems that might be alleviated by the dissemination of empirically supported treatments (ESTs). The current study lays the groundwork for EST dissemination by examining current treatment practices in rural clinics as well as the attitudes of decision makers toward ESTs and perceived barriers to their adoption. Twenty-five rural and 38 non-rural clinical directors responded to a mailed survey. Rural respondents were as likely as non-rural respondents to report EST use in their clinic for most anxiety disorders, and more likely to report use of an EST for major depressive disorder and obsessive-compulsive disorder. However, ESTs represent a relatively small proportion of the treatments reported for depression and anxiety disorders. Attitudes toward manualized ESTs did not differ between groups. Further, rural and nonrural clinics did not see the barriers to the adoption of ESTs as insurmountable. These preliminary results suggest that rural CMHCs are open to the use of ESTs and should be included in widespread dissemination initiatives.

  2. Utilizing disclosure in the treatment of the sequelae of childhood sexual abuse: a theoretical and empirical review.

    PubMed

    Bradley, R G; Follingstad, D R

    2001-02-01

    Although disclosure is a component of many therapeutic approaches to treating the long-term symptoms associated with child sexual abuse (CSA), the ameliorative mechanisms of this approach are still unclear. This review investigates the expected benefits of disclosure in therapy by looking at the theoretical and empirical support for its effectiveness in treating the specific psychopathological sequelae associated with a history of CSA. In order to accomplish this task, a core group of sequelae associated with sexual abuse are presented. The components of disclosure as a therapeutic process are divided into three processes: disclosure-through-description, disclosure-through-rethinking, and disclosure-in-relationship. The review describes the ways in which these elements of disclosure are used within different therapeutic approaches. The treatment outcome literature is then reviewed in terms of the elements of disclosure included in the treatment approaches and the symptoms improved by treatment. In conclusion, implications are presented concerning the appropriate uses of disclosure in psychotherapy directed at alleviating the long-term sequelae associated with a history of CSA.

  3. An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers.

    PubMed

    Brown, M; Oldenhof, E; Allen, J S; Dowling, N A

    2016-12-01

    The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.

  4. Empirical Treatment of Shigella Dysentery with Trimethoprim: Five-Day Course Versus Single Dose

    DTIC Science & Technology

    1987-06-18

    been ade- used because it is 4-5 times more expensive than quately evaluated in the treatment of shigellosis. ampicillin, sulfa drugs , chloramphenicol...tablets of a sulfa drug the preceding day and NMC, NCR, work units 3M464758D849.- 622 OLDFIELD ET AL. BH.062 and 3Ml61102BSIO.AA.421. The views 1974. A...because of increasing resistance to commonly ducted a randomized double-blind placebo con- prescribed drugs . Sulfonamides were the drug of trolled

  5. 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

  6. A propensity score analysis shows that empirical treatment with linezolid does not increase the thirty-day mortality rate in patients with Gram-negative bacteremia.

    PubMed

    Ternavasio-de la Vega, Hugo-Guillermo; Mateos-Díaz, Ana-María; Martinez, Jose-Antonio; Almela, Manel; Cobos-Trigueros, Nazaret; Morata, Laura; De-la-Calle, Cristina; Sala, Marta; Mensa, Josep; Marcos, Miguel; Soriano, Alex

    2014-12-01

    The role of linezolid in empirical therapy of suspected bacteremia remains unclear. The aim of this study was to evaluate the influence of empirical use of linezolid or glycopeptides in addition to other antibiotics on the 30-day mortality rates in patients with Gram-negative bacteremia. For this purpose, 1,126 patients with Gram-negative bacteremia in the Hospital Clinic of Barcelona from 2000 to 2012 were included in this study. In order to compare the mortality rates between patients who received linezolid or glycopeptides, the propensity scores on baseline variables were used to balance the treatment groups, and both propensity score matching and propensity-adjusted logistic regression were used to compare the 30-day mortality rates between the groups. The overall 30-day mortality rate was 16.0% during the study period. Sixty-eight patients received empirical treatment with linezolid, and 1,058 received glycopeptides. The propensity score matching included 64 patients in each treatment group. After matching, the mortality rates were 14.1% (9/64) in patients who received glycopeptides and 21.9% (14/64) in those who received linezolid, and a nonsignificant association between empirical linezolid treatment and mortality rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.69 to 3.82; P = 0.275, McNemar's test) was found. This association remained nonsignificant when variables that remained unbalanced after matching were included in a conditional logistic regression model. Further, the stratified propensity score analysis did not show any significant relationship between empirical linezolid treatment and the mortality rate after adjustment by propensity score quintiles or other variables potentially associated with mortality. In conclusion, the propensity score analysis showed that empirical treatment with linezolid compared with that with glycopeptides was not associated with 30-day mortality rates in patients with Gram-negative bacteremia.

  7. Short- and long-term effectiveness of an empirically supported treatment for agoraphobia.

    PubMed

    Hahlweg, K; Fiegenbaum, W; Frank, M; Schroeder, B; von Witzleben, I

    2001-06-01

    This study examined the effectiveness of individual high-density exposure (2-3 weeks, all day) for panic disorder with agoraphobia (PDAG). Participants were 416 unselected patients with a primary diagnosis of PDAG who were treated by 52 therapists in 3 outpatient clinics of the Christoph-Dornier Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy and at the 1-year follow-up showed highly significant reductions in anxiety symptoms, anxious cognition, agoraphobic avoidance, general symptomatology, and depressive symptoms. Results did not differ significantly between the 3 outpatient clinics and are comparable with the average effect sizes reported by meta-analytic studies of controlled efficacy research, using selected patients and specifically trained therapists. Effectiveness was not dependent on duration of disorder, number of treatment sessions, and therapist experience. The study suggests that high-density exposure can be transported from research settings to the mental health field.

  8. Changing treatment of pediatric splenic trauma

    SciTech Connect

    Kakkasseril, J.S.; Stewart, D.; Cox, J.A.; Gelfand, M.

    1982-06-01

    A review of splenic injuries at Cincinnati Children's Hospital Medical Center from July 1978 to June 1980 revealed this form of injury in 29 patients. Treatment without surgery was successful in 21 patients. Seven patients required operation. One patient died shortly after admission of severe associated injuries. All patients admitted with blunt abdominal trauma were initially treated conservatively. If the clinical state improved, after transfusions if necessary, or remained stable and there were no objective signs of further blood loss, conservative therapy was continued. Liver-spleen scans were obtained on an urgent basis to confirm the diagnosis of splenic injury in patients who did not undergo surgery. No complications of treatment without surgery were recognized. The satisfactory outcome in these patients suggests that there is a place for treatment without surgery in some children with splenic injury.

  9. [Orthodontic treatment as prevention of periodontal changes].

    PubMed

    Dénes, J

    1992-02-01

    Even the general dental practitioners consider the orthodontic therapeutical interventions carried out with removable appliances as a harmful procedure. It is much less known how the lack of adequate orthodontic treatment endangers the peridontium. Clinical data show a cause related correlation between the maxillary incisor protrusion, mandibular frontal jammed dentition, deep vertical overbite, openbite, crossbite early deciduous tooth extractions and the periodontal pathological happenings. So it is very important to start an early orthodontic treatment to avoid the periodontal consequences of malocclusion before it has become irreversible.

  10. Treatment Fidelity: Relation to Treatment Acceptability and Change over Time

    ERIC Educational Resources Information Center

    Tanol, Gizem

    2010-01-01

    The purpose of this study was: (a) to examine the relation between acceptability and fidelity of an intervention package in natural classroom settings, and (b) to examine how fidelity of implementation varies in relation to high vs. low treatment acceptability over the course of an academic school year. Participants were 44 teachers, from 15…

  11. Substance Use in Lesbian, Gay, and Bisexual Populations: An Update on Empirical Research and Implications for Treatment

    PubMed Central

    Green, Kelly E.; Feinstein, Brian A.

    2011-01-01

    Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies, more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV-status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation versus abstinence), targets for intervention, and specific treatment modalities. PMID:22061339

  12. Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants

    PubMed Central

    Cotten, C. Michael; Taylor, Sarah; Stoll, Barbara; Goldberg, Ronald N.; Hansen, Nellie I.; Sánchez, Pablo J.; Ambalavanan, Namasivayam; Benjamin, Daniel K.

    2009-01-01

    OBJECTIVES Our objectives were to identify factors associated with the duration of the first antibiotic course initiated in the first 3 postnatal days and to assess associations between the duration of the initial antibiotic course and subsequent necrotizing enterocolitis or death in extremely low birth weight infants with sterile initial postnatal culture results. METHODS We conducted a retrospective cohort analysis of extremely low birth weight infants admitted to tertiary centers in 1998–2001. We defined initial empirical antibiotic treatment duration as continuous days of antibiotic therapy started in the first 3 postnatal days with sterile culture results. We used descriptive statistics to characterize center practice, bivariate analyses to identify factors associated with prolonged empirical antibiotic therapy (≥5 days), and multivariate analyses to evaluate associations between therapy duration, prolonged empirical therapy, and subsequent necrotizing enterocolitis or death. RESULTS Of 5693 extremely low birth weight infants admitted to 19 centers, 4039 (71%) survived >5 days, received initial empirical antibiotic treatment, and had sterile initial culture results through the first 3 postnatal days. The median therapy duration was 5 days (range: 1–36 days); 2147 infants (53%) received prolonged empirical therapy (center range: 27%–85%). Infants who received prolonged therapy were less mature, had lower Apgar scores, and were more likely to be black. In multivariate analyses adjusted for these factors and center, prolonged therapy was associated with increased odds of necrotizing enterocolitis or death and of death. Each empirical treatment day was associated with increased odds of death, necrotizing enterocolitis, and the composite measure of necrotizing enterocolitis or death. CONCLUSION Prolonged initial empirical antibiotic therapy may be associated with increased risk of necrotizing entero-colitis or death and should be used with caution. PMID

  13. Dream changes following initiation of efavirenz treatment.

    PubMed

    Velasco, María; Pareja, Juan Antonio; Losa, Juan Emilio; Valverde, José Francisco; Espinosa, Alfredo; Gujarro, Carlos

    2011-02-12

    The objective was to evaluate abnormalities in the quality of dreams after the use of efavirenz. Ten HIV patients without neuropsychiatric diseases underwent a polisomnography (PSG) study before and after efavirenz treatment, [after 10.4 (SD 5.4) days]. Patients were awoke after REM phases to record their dreams. All patients had therapeutic efavirenz plasma levels. Dreams were recalled in 84% before efavirenz and 43% after efavirenz (p=0.024). There were no differences in the mean number of words per dream before and after efavirenz treatment (61.9 versus 47.5, p=0.115). The proportion of dreams with no neutral emotional content (either pleasant or unpleasant) was 37.5% in the first night and 66.7% in the second night (p=0.046). There were a higher proportion of dreams with no neutral emotional content after efavirenz treatment in this group of patients. However, no longer dreams and no more dreams with negative emotional content were noted. Dream recall was lower after efavirenz treatment. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  14. Clinical Predictors and Accuracy of Empiric Tuberculosis Treatment among Sputum Smear-Negative HIV-Infected Adult TB Suspects in Uganda

    PubMed Central

    Nakiyingi, Lydia; Bwanika, John Mark; Kirenga, Bruce; Nakanjako, Damalie; Katabira, Catherine; Lubega, Gloria; Sempa, Joseph; Nyesiga, Barnabas; Albert, Heidi; Manabe, Yukari C.

    2013-01-01

    Introduction The existing diagnostic algorithms for sputum smear-negative tuberculosis (TB) are complicated, time-consuming, and often difficult to implement. The decision to initiate TB treatment in resource-limited countries is often largely based on clinical predictors. We sought to determine the clinical predictors and accuracy of empiric TB treatment initiation in HIV-infected sputum smear-negative TB suspects using sputum culture as a reference standard. Setting Out-patient HIV-TB integrated urban clinic in Kampala, Uganda. Methods HIV-infected TB suspects were screened using sputum smear microscopy, and mycobacterial sputum liquid and solid cultures were performed. Smear results were made available to the clinician who made a clinical decision on empiric TB treatment initiation for sputum smear-negative patients. Clinic records were reviewed for patients whose sputum smears were negative to collect data on socio-demographics, TB symptomatology, chest X-ray findings, CD4 cell counts and TB treatment initiation. Results Of 253 smear-negative TB suspects, 56% (142/253) were females, median age 38 IQR (31–44) years, with a median CD4 cell count of 291 IQR (150–482) cells/mm3. Of the 85 (33.6%) smear-negative patients empirically initiated on TB treatment, 35.3% (n = 30) were sputum culture positive compared to only 18 (10.7%) of the 168 untreated patients (p<0.001). Abnormal chest X-ray [aOR 10.18, 95% CI (3.14–33.00), p<0.001] and advanced HIV clinical stage [aOR 3.92, 95% CI (1.20–12.85), p = 0.024] were significantly associated with empiric TB treatment initiation. The sensitivity and specificity of empiric TB treatment initiation in the diagnosis of TB in HIV-infected patients after negative smear microscopy was 62.5% and 73.7% respectively. Conclusion In resource-limited settings, clinically advanced HIV and abnormal chest X-ray significantly predict a clinical decision to empirically initiate TB treatment in smear-negative HIV

  15. An empirical method that separates irreversible stem radial growth from bark water content changes in trees: theory and case studies.

    PubMed

    Mencuccini, Maurizio; Salmon, Yann; Mitchell, Patrick; Hölttä, Teemu; Choat, Brendan; Meir, Patrick; O'Grady, Anthony; Tissue, David; Zweifel, Roman; Sevanto, Sanna; Pfautsch, Sebastian

    2017-02-01

    Substantial uncertainty surrounds our knowledge of tree stem growth, with some of the most basic questions, such as when stem radial growth occurs through the daily cycle, still unanswered. We employed high-resolution point dendrometers, sap flow sensors, and developed theory and statistical approaches, to devise a novel method separating irreversible radial growth from elastic tension-driven and elastic osmotically driven changes in bark water content. We tested this method using data from five case study species. Experimental manipulations, namely a field irrigation experiment on Scots pine and a stem girdling experiment on red forest gum trees, were used to validate the theory. Time courses of stem radial growth following irrigation and stem girdling were consistent with a-priori predictions. Patterns of stem radial growth varied across case studies, with growth occurring during the day and/or night, consistent with the available literature. Importantly, our approach provides a valuable alternative to existing methods, as it can be approximated by a simple empirical interpolation routine that derives irreversible radial growth using standard regression techniques. Our novel method provides an improved understanding of the relative source-sink carbon dynamics of tree stems at a sub-daily time scale.

  16. Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study

    PubMed Central

    2012-01-01

    Background The objective of this study is to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum β-lactamase (ESBL) - producing Escherichia coli and Klebsiella spp. bacteremia. Methods Cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteremia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression. Results We analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.71% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P = 0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients. Conclusion ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited. PMID:23038999

  17. Stages of change: interactions with treatment compliance and involvement.

    PubMed

    DiClemente, C C; Scott, C W

    1997-01-01

    Current perspectives on compliance and involvement in treatment often overlook the fact that treatment occurs in the context of a process of change and not vice versa. Each individual moves at a unique pace through a series of stages of change and in a cyclical fashion over a substantial period of time. Treatment personnel and programs should recognize the diversity of stage status in their clients and address each one in a manner compatible with the client's current stage of change, the tasks needed to move forward in the process of change, and an understanding of the course of change. Such considerations should assist the therapist in developing strategies to increase the engagement of a wide variety of clients, to improve retention of these clients in a realistic course of treatment, and to foster participation in stage-appropriate tasks that promote successful movement through the stages to sustained, long-term change.

  18. Oral fluconazole for empiric treatment of prolonged Fever in neutropenic patients: prospective study in 250 consecutive patients after stem cell transplantation.

    PubMed

    Stemmer, Salomon M; Maor, Yasmin; Hardan, Izhar

    2004-08-01

    Neutropenic patients who continue to be febrile despite adequate broad-spectrum antibacterial treatment require empirical antifungal therapy. The aim of the present study was to evaluate the safety and efficacy of oral fluconazole for empirical antifungal therapy in neutropenic patients with persistent fever. A prospective cohort design was used. The study sample included 250 consecutive patients with high-risk stage II, III, or responding metastatic breast cancer who received high-dose chemotherapy (HDC) with autologous peripheral blood progenitor stem cell transplantation. Those with neutropenic fever lasting more than 72 hours despite broad-spectrum antibacterial coverage were treated with fluconazole. Treatment was continued until fever dropped and/or neutrophil count recovered with blood cultures remaining negative. Antifungal treatment was required in 173 patients (69%). There were no cases of documented deep systemic fungal infection. Two patients (<1%) had positive blood cultures for fungi. None of the patients experienced toxicity related to fluconazole. There was one transplant-related death. Thirty-one patients (18%) were unable to complete the oral fluconazole protocol because of severe mucositis, and they received intravenous fluconazole at the same dose, with similar efficacy. Oral fluconazole is a safe and effective alternative to amphotericin B for empirical early antifungal treatment in persistent neutropenic fever in breast cancer patients undergoing HDC with autologous stem cell support. Further study of oral fluconazole and amphotericin B as empirical agents in other groups of patients with persistent neutropenic fever is warranted.

  19. Comparing Child, Parent, and Family Characteristics in Usual Care and Empirically Supported Treatment Research Samples for Children with Disruptive Behavior Disorders

    ERIC Educational Resources Information Center

    Baker-Ericzen, Mary J.; Hurlburt, Michael S.; Brookman-Frazee, Lauren; Jenkins, Melissa M.; Hough, Richard L.

    2010-01-01

    This study compared data from 34 research trials of five empirically supported treatments (ESTs) with one large usual care (UC) sample on child, parent, and family characteristics for children with Disruptive Behavior Disorders. Large variations were found within and across ESTs on sample characteristics during the past two decades. Most parent…

  20. 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.

  1. The Military’s Role in Enabling Political Transformation: a Catalyst for Change from Republic to Empire

    DTIC Science & Technology

    2008-06-13

    democracy by tyrannical government . For the Romans, it led to the transformation from informal republican empire to formal empire - from a society...standing professional military is not necessarily the cause of the transition from republican to imperial government , it can enable the...characteristics of imperial governance . For Athens and Rome, the rapid expansion and professionalization of the military exerted an influence that transformed

  2. The Effect of Inadequate Initial Empiric Antimicrobial Treatment on Mortality in Critically Ill Patients with Bloodstream Infections: A Multi-Centre Retrospective Cohort Study

    PubMed Central

    Savage, Rachel D.; Fowler, Robert A.; Rishu, Asgar H.; Bagshaw, Sean M.; Cook, Deborah; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, François; Lauzier, François; Marshall, John; Martin, Claudio M.; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steven; Stelfox, Henry T.; Daneman, Nick

    2016-01-01

    Hospital mortality rates are elevated in critically ill patients with bloodstream infections. Given that mortality may be even higher if appropriate treatment is delayed, we sought to determine the effect of inadequate initial empiric treatment on mortality in these patients. A retrospective cohort study was conducted across 13 intensive care units in Canada. We defined inadequate initial empiric treatment as not receiving at least one dose of an antimicrobial to which the causative pathogen(s) was susceptible within one day of initial blood culture. We evaluated the association between inadequate initial treatment and hospital mortality using a random effects multivariable logistic regression model. Among 1,190 patients (1,097 had bacteremia and 93 had candidemia), 476 (40%) died and 266 (22%) received inadequate initial treatment. Candidemic patients more often had inadequate initial empiric therapy (64.5% versus 18.8%), as well as longer delays to final culture results (4 vs 3 days) and appropriate therapy (2 vs 0 days). After adjustment, there was no detectable association between inadequate initial treatment and mortality among bacteremic patients (Odds Ratio (OR): 1.02, 95% Confidence Interval (CI) 0.70–1.48); however, candidemic patients receiving inadequate treatment had nearly three times the odds of death (OR: 2.89, 95% CI: 1.05–7.99). Inadequate initial empiric antimicrobial treatment was not associated with increased mortality in bacteremic patients, but was an important risk factor in the subgroup of candidemic patients. Further research is warranted to improve early diagnostic and risk prediction methods in candidemic patients. PMID:27152615

  3. Should First-Line Empiric Treatment Strategies For Neonates Cover Coagulase-Negative Staphylococcal Infections In Kenya?

    PubMed

    Seale, Anna C; Obiero, Christina W; Jones, Kelsey; Barsosio, Hellen C; Thitiri, Johnstone; Ngari, Moses; Morpeth, Susan; Mohammed, Shebe; Fegan, Greg; Mturi, Neema; Berkley, James A

    2017-07-18

    Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. Whilst coagulase negative staphylococci (CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need for early anti-staphylococcal treatment in empiric antibiotic guidelines, is unknown in sub-Saharan Africa. We examined systematic clinical and microbiologic surveillance data from all neonatal admissions to Kilifi County Hospital (1998-2013) to determine associated case fatality and/or prolonged duration of admission associated with CoNS in neonates treated according to standard WHO guidelines. CoNS was isolated from blood culture in 995/9552 (10%) neonates. Case fatality amongst neonates with CoNS isolated from blood did not differ from other neonatal admissions (p=0.2), and duration of admission was not prolonged (OR=0.9(0.7-1.0), p=0.040). Neonates with CoNS were more likely to have convulsions (OR=1.4(1.0-1.8), p = 0.031), but less likely to have impaired consciousness or severe indrawing (OR 0.8(0.7-0.9), p=0.025; OR=0.9(0.7-1.0), p=0.065). CoNS isolation in blood cultures at admission was not associated with adverse clinical outcomes in neonates treated according to standard WHO guidelines for hospital care in this setting. There is no evidence that first-line antimicrobial treatment guidelines should be altered to increase cover for coagulase- negative staphylococcal infections in neonates in this setting.

  4. Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study.

    PubMed

    Gradel, Kim O; Jensen, Ulrich S; Schønheyder, Henrik C; Østergaard, Christian; Knudsen, Jenny D; Wehberg, Sonja; Søgaard, Mette

    2017-02-06

    Data on the impact of empirical antibiotic treatment (EAT) on patient outcome in a population-based setting are sparse. We assessed the association between EAT and the risk of recurrence within one year, short-term- (2-30 days) and long-term (31-365 days) mortality in a Danish cohort of bacteraemia patients. A cohort study including all patients hospitalized with incident bacteraemia during 2007-2008 in the Copenhagen City and County areas and the North Denmark Region. EAT was defined as the antibiotic treatment given at the 1(st) notification of a positive blood culture. The definition of recurrence took account of pathogen species, site of infection, and time frame and was not restricted to homologous pathogens. The vital status was determined through the civil registration system. Association estimates between EAT and the outcomes were estimated by Cox and logistic regression models. In 6483 eligible patients, 712 (11%) had a recurrent episode. A total of 3778 (58%) patients received appropriate EAT, 1290 (20%) received inappropriate EAT, while EAT status was unrecorded for 1415 (22%) patients. The 2-30 day mortality was 15.1%, 17.4% and 19.2% in patients receiving appropriate EAT, inappropriate EAT, and unknown EAT, respectively. Among patients alive on day 30, the 31-365 day mortality was 22.3% in patients given appropriate EAT compared to 30.7% in those given inappropriate EAT. Inappropriate EAT was independently associated with recurrence (HR 1.25; 95% CI = 1.03-1.52) and long-term mortality (OR 1.35; 95% CI = 1.10-1.60), but not with short-term mortality (OR 0.85; 95% CI = 0.70-1.02) after bacteraemia. Our data indicate that appropriate EAT is associated with reduced incidence of recurrence and lower long-term mortality following bacteraemia.

  5. Final Technical Report for "Collaborative Research. Regional climate-change projections through next-generation empirical and dynamical models"

    SciTech Connect

    Kravtsov, S.; Robertson, Andrew W.; Ghil, Michael; Smyth, Padhraic J.

    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, 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

  6. Final Technical Report for "Collaborative Research: Regional climate-change projections through next-generation empirical and dynamical models"

    SciTech Connect

    Robertson, A.W.; Ghil, M.; Kravtsov, K.; Smyth, P.J.

    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, 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

  7. Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections in İstanbul and Rationale for Empirical Antibiotic Therapy.

    PubMed

    Gökçe, İbrahim; Çiçek, Neslihan; Güven, Serçin; Altuntaş, Ülger; Bıyıklı, Neşe; Yıldız, Nurdan; Alpay, Harika

    2017-04-06

    The causative agent spectrum and resistance patterns of urinary tract infection (UTI) in children are affected by many factors. The aim of this study was to demonstrate the antibiotic resistance in UTI and changing ratio in antibiotic resistance by years. Retrospective cross-sectional study. We analyzed antibiotic resistance patterns of isolated gram (-) bacteria during years 2011-2014 (study period 2) in children with UTI. We compared these findings with data collected in the same centre in 2001-2003 (study period 1). Four hundred sixtyfive uncomplicated community-acquired gram (-) UTIs were analyzed from 2001-2003 and 400 from 2011-2014. Sixty-one percent of patients were female (1.5 girls: 1 boy). Mean age of children included in the study was 3 years and 9 months. Escherichia coli (E.coli) was the predominant isolated bacteria during both periods of the study (60% in study period 1 and 73% in study period 2). The bacteria other than E.coli demonstrated higher level of resistance to all of the antimicrobials except trimethoprim-sulphamethoxazole than E.coli bacteria during years 2011-2014. In our study, we found increasing resistance trends of urinary pathogens for cefixime (from 1% to 15%, p<0.05 ), amikacin (from 0% to 4%, p<0.05) and ciprofloxacin (from 0% to 3%, p<0.05) between the two periods. Urinary pathogens showed decreasing trend for nitrofurantoin (from 17% to 7%, p:0.0001). No significant trends were detected for ampicilline (from 69% to 71%), amoxicillin clavulanate (from 44% to 43%), cefazolin (from 39% to 32%), trimethoprim-sulphamethoxazole (from 32% to 31%), cefuroxime (from 21% to 18%) and ceftriaxone (from 10% to 14%) between the two periods (p>0.05). In childhood UTI, antibiotic resistance should be evaluated periodically and empiric antimicrobial therapy should be decided according to antibiotic sensitivity results.

  8. Empirical change in the prevalence of overweight and obesity in adolescents from 2007 to 2011 in Guangzhou, China.

    PubMed

    Ma, Lu; Mai, Jincheng; Jing, Jin; Liu, Zhaomin; Zhu, Yanna; Jin, Yu; Chen, Yajun

    2014-06-01

    There is a strong evidence of an increasing secular trend in obesity in adolescents in most of the world over the past 10 years. However, no studies have been reported on this trend in Guangzhou, one of the most urbanized areas in China. This study assessed the empirical changes in body mass index (BMI) and the prevalence of overweight and obesity of adolescents in Guangzhou from 2007 to 2011. The data were derived from the surveys on students' constitution and health carried out by government in 2007, 2009, and 2011 in Guangzhou. Randomly, 17,157 students in 2007, 26,381 students in 2009, and 36,328 students in 2011, aged 12 to 18, from schools in the four urban districts were examined. Anthropometric parameters were measured in all students. Adiposity status was estimated using BMI according to the Working Group on Obesity in China criteria. The total prevalence of overweight and obesity increased from 8.1 % and 3.1 % in 2007 to 10.0 % and 4.2 % in 2011, respectively (P < 0.05). However, the total prevalence of obesity decreased significantly from 4.5 % in 2009 to 4.2 % in 2011 (P < 0.05). The prevalence of overweight and obesity in males was significantly higher than that in females in each year among the 4 years (P < 0.05). Although the prevalence of adolescent overweight and obesity in Guangzhou in 2011 is still lower than the average values of Chinese large coastal cities, a significant increase was still found in their prevalence from 2007 to 2011. However, the adolescent obesity, but not the overweight prevalence, starts to decrease from 2009 to 2011.

  9. Changing the public perception of physiotherapeutic treatment.

    PubMed

    Sheppard, L

    1994-01-01

    Market research was undertaken to establish the public perception of physiotherapy. Using this market research strategic recommendations for the future marketing of physiotherapy are made within the professional context. Marketing will be used to contribute to changing the public perception of physiotherapy. The market research involved a qualitative study of five focus groups of the general public and one focus group of physiotherapists. The responses from the focus groups were used to construct an appropriate questionnaire for the qualitative study. A random sample of 510 members of the general public were then surveyed. The market research results yielded the following key features: The best known conditions treated by physiotherapists are musculoskeletal. The least known are women and children. Client-centered care is sought. The importance of location gives potential for physiotherapists to capitalise on tailoring to clients in their area. Doctors are important for referral and communication about physiotherapy. Marketing should be used to inform doctors of what physiotherapy has to offer. A marketing orientation has begun within physiotherapy; however, it must 'fit' the culture initially to be successful. A marketing strategy should be developed on national, state and individual levels based on a strategic intent. At the state level, strategies must be responsive to area or regional needs. Marketing needs to target identified market segments such as workers compensation organisations. Individual physiotherapists must promote themselves within their region, particularly to doctors and clients with the use of relationship marketing. Informal presentations to community groups and school students about physiotherapy will increase their profile.

  10. Does empirical treatment of community-acquired pneumonia with fluoroquinolones delay tuberculosis treatment and result in fluoroquinolone resistance in Mycobacterium tuberculosis? Controversies and solutions.

    PubMed

    Shen, Gwan-Han; Tsao, Thomas Chang-Yao; Kao, Shang-Jyh; Lee, Jen-Jyh; Chen, Yen-Hsu; Hsieh, Wei-Chung; Hsu, Gwo-Jong; Hsu, Yen-Tao; Huang, Ching-Tai; Lau, Yeu-Jun; Tsao, Shih-Ming; Hsueh, Po-Ren

    2012-03-01

    The role of fluoroquinolones (FQs) as empirical therapy for community-acquired pneumonia (CAP) remains controversial in countries with high tuberculosis (TB) endemicity owing to the possibility of delayed TB diagnosis and treatment and the emergence of FQ resistance in Mycobacterium tuberculosis. Although the rates of macrolide-resistant Streptococcus pneumoniae and amoxicillin/clavulanic acid-resistant Haemophilus influenzae have risen to alarming levels, the rates of respiratory FQ (RFQ) resistance amongst these isolates remain relatively low. It is reported that ca. 1-7% of CAP cases are re-diagnosed as pulmonary TB in Asian countries. A longer duration (≥ 7 days) of symptoms, a history of night sweats, lack of fever (> 38 °C), infection involving the upper lobe, presence of cavitary infiltrates, opacity in the lower lung without the presence of air, low total white blood cell count and the presence of lymphopenia are predictive of pulmonary TB. Amongst patients with CAP who reside in TB-endemic countries who are suspected of having TB, imaging studies as well as aggressive microbiological investigations need to be performed early on. Previous exposure to a FQ for >10 days in patients with TB is associated with the emergence of FQ-resistant M. tuberculosis isolates. However, rates of M. tuberculosis isolates with FQ resistance are significantly higher amongst multidrug-resistant M. tuberculosis isolates than amongst susceptible isolates. Consequently, in Taiwan and also in other countries with TB endemicity, a short-course (5-day) regimen of a RFQ is still recommended for empirical therapy for CAP patients if the patient is at low risk for TB. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  11. 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

  12. An empirical analysis of autobiographical memory specificity subtypes in brief emotion-focused and client-centered treatments of depression.

    PubMed

    Boritz, Tali Zweig; Angus, Lynne; Monette, Georges; Hollis-Walker, Laurie

    2008-09-01

    Overgeneral autobiographical memory (ABM) disclosure has been established as a key cognitive marker of clinical depression in experimental research studies. To determine the ecological validity of these findings for psychotherapy treatments of depression, the present study investigated the relationship between change in level of depression and ABM specificity in the context of early, middle, and late therapy session transcripts selected from 34 clients undergoing emotion-focused therapy and client-centered therapy in the York I Depression Study. A hierarchical linear modeling analysis demonstrated that clients disclosed significantly more specific ABMs over the course of therapy. There were no differences in ABM specificity between treatment groups. There was also no evidence that increased specificity differentiated between recovered and unchanged clients at treatment termination.

  13. Assessing changes to South African maize production areas in 2055 using empirical and process-based crop models

    NASA Astrophysics Data System (ADS)

    Estes, L.; Bradley, B.; Oppenheimer, M.; Beukes, H.; Schulze, R. E.; Tadross, M.

    2010-12-01

    Rising temperatures and altered precipitation patterns associated with climate change pose a significant threat to crop production, particularly in developing countries. In South Africa, a semi-arid country with a diverse agricultural sector, anthropogenic climate change is likely to affect staple crops and decrease food security. Here, we focus on maize production, South Africa’s most widely grown crop and one with high socio-economic value. We build on previous coarser-scaled studies by working at a finer spatial resolution and by employing two different modeling approaches: the process-based DSSAT Cropping System Model (CSM, version 4.5), and an empirical distribution model (Maxent). For climate projections, we use an ensemble of 10 general circulation models (GCMs) run under both high and low CO2 emissions scenarios (SRES A2 and B1). The models were down-scaled to historical climate records for 5838 quinary-scale catchments covering South Africa (mean area = 164.8 km2), using a technique based on self-organizing maps (SOMs) that generates precipitation patterns more consistent with observed gradients than those produced by the parent GCMs. Soil hydrological and mechanical properties were derived from textural and compositional data linked to a map of 26422 land forms (mean area = 46 km2), while organic carbon from 3377 soil profiles was mapped using regression kriging with 8 spatial predictors. CSM was run using typical management parameters for the several major dryland maize production regions, and with projected CO2 values. The Maxent distribution model was trained using maize locations identified using annual phenology derived from satellite images coupled with airborne crop sampling observations. Temperature and precipitation projections were based on GCM output, with an additional 10% increase in precipitation to simulate higher water-use efficiency under future CO2 concentrations. The two modeling approaches provide spatially explicit projections of

  14. Empiric treatment of protracted idiopathic purpura fulminans in an infant: a case report and review of the literature

    PubMed Central

    2011-01-01

    etiologies. In the absence of etiology for protracted idiopathic purpura fulminans, management should include tissue biopsy, in which thrombotic findings warrant a trial of empiric anti-coagulation. Some infants, including our patient, may need long-term anti-coagulation, especially when the underlying etiology of coagulation remains unidentified and symptoms recur when treatment is halted. Given that our patient still requires anti-coagulation, he may have a yet to be identified autoimmune-mediated mechanism for his truly idiopathic case of protracted purpura fulminans. PMID:21605440

  15. Proposed Mechanisms for Cancer- and Treatment-Related Cognitive Changes

    PubMed Central

    Merriman, John D.; Von Ah, Diane; Miaskowski, Christine; Aouizerat, Bradley E.

    2013-01-01

    Objectives To review the proposed mechanisms of cognitive changes associated with non-central nervous system cancers and cancer treatment. Data Sources Review and synthesis of data-based publications and review articles. Conclusion Proposed mechanisms include cytokine upregulation, hormonal changes, neurotransmitter dysregulation, attentional fatigue, genetic predisposition, and comorbid symptoms. Implications for Nursing Practice Oncology nurses need to understand the multiple mechanisms that may contribute to the development of cancer- and treatment-related cognitive changes so that they can identify patients at high risk and can help patients understand why these changes occur. PMID:24183157

  16. Changes in water biostability levels in water treatment trials.

    PubMed

    Wolska, Małgorzata

    2015-01-01

    This article presents the results of studies of changes in water biostability levels in water treatment systems. In order to evaluate the potential of microorganism regrowth, both the organic and non-organic nutrient substrate content was taken into account. Pre-treatment in the analyzed water treatment plants ensured high phosphate ion removal effectiveness but a significantly worse effectiveness in removing biodegradable dissolved organic carbon (BDOC). Lowering nutrient substrate content during the main treatment stage was only possible in water treatment systems that incorporated biological processes. Conversely, final water treatment processes only influenced BDOC content in the treated water. Irrespective of the water type and unit treatment process, the limiting factors for microorganism regrowth in the distribution system were the phosphate ion content and BDOC content. However, none of the analyzed treatment systems ensured a reduction in non-organic nitrogen content that would ensure biological stability of the water.

  17. Changes in affect during treatment for depression and anxiety.

    PubMed

    Kring, Ann M; Persons, Jacqueline B; Thomas, Cannon

    2007-08-01

    We tested the hypothesis that the tripartite model [Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and psychometric implications. Journal of Abnormal Psychology, 100, 316-336] can be extended to account for change during treatment for anxiety and depression. Forty-one patients treated naturalistically in private practice with cognitive behavior therapy completed weekly measures of depression, anxiety, negative affect (NA), positive affect (PA), and anxious arousal (AA). Consistent with the model, NA was associated with anxiety and depression during treatment, PA was more strongly related to depression than to anxiety, and AA was more strongly related to anxiety than to depression. As predicted, symptoms of depression and anxiety and NA all decreased during treatment. As predicted, AA also decreased, particularly for patients with panic disorder. PA increased during treatment, but only for patients who showed a significant decline in depression and only over an extended period of treatment. Nearly two-thirds of the variance in anxiety change was accounted for by changes in depression and NA, and just over three-fourths of the variance in depression change was accounted for by changes in anxiety and NA, indicating that much of the change in anxiety and depression across the course of treatment is shared in common.

  18. 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…

  19. Adolescent substance abuse treatment: Organizational change and quality of care

    PubMed Central

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

    2013-01-01

    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 impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives. PMID:23750096

  20. Adolescent substance abuse treatment: Organizational change and quality of care.

    PubMed

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

    2011-04-01

    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 impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.

  1. 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…

  2. The Dimensions of Change in Therapeutic Community Treatment Instrument

    ERIC Educational Resources Information Center

    Orlando, Maria; Wenzel, Suzanne L.; Ebener, Pat; Edwards, Michael C.; Mandell, Wallace; Becker, Kirsten

    2006-01-01

    In this article, the authors describe the refinement and preliminary evaluation of the Dimensions of Change in Therapeutic Community Treatment Instrument (DCI), a measure of treatment process. In Study 1, a 99-item DCI, administered to a cross-sectional sample of substance abuse clients (N = 990), was shortened to 54 items on the basis of results…

  3. The Dimensions of Change in Therapeutic Community Treatment Instrument

    ERIC Educational Resources Information Center

    Orlando, Maria; Wenzel, Suzanne L.; Ebener, Pat; Edwards, Michael C.; Mandell, Wallace; Becker, Kirsten

    2006-01-01

    In this article, the authors describe the refinement and preliminary evaluation of the Dimensions of Change in Therapeutic Community Treatment Instrument (DCI), a measure of treatment process. In Study 1, a 99-item DCI, administered to a cross-sectional sample of substance abuse clients (N = 990), was shortened to 54 items on the basis of results…

  4. Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later

    PubMed Central

    Magill, M.; Kiluk, B.D.; McCrady, B.; Tonigan, J.S.; Longabaugh, R.

    2015-01-01

    Background The current review revisits the article entitled: Active Ingredients of Behavioral Treatments for Alcohol Use Disorders (AUDs) published in Alcoholism: Clinical and Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that. Overview The current review revisits state-of-the-art research on the three treatments examined 10 years ago: Cognitive Behavioral Therapy (CBT), Alcohol Behavior Couples Therapy (ABCT), and Twelve Step Facilitation (TSF). Because of its empirically-validated effectiveness and robust research agenda on the study of process-outcome, Motivational Interviewing (MI) has been selected as the fourth treatment modality to be discussed. For each of these four treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future. Conclusions Noteworthy progress has been made in identifying AITs and MOBCs in these four behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence-based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods. Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation. PMID:26344200

  5. 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.

  6. Changing paradigms in the treatment of malignant pheochromocytoma.

    PubMed

    Grogan, Raymon H; Mitmaker, Elliot J; Duh, Quan-Yang

    2011-04-01

    Pheochromocytomas and paragangliomas are intra- and extra-adrenal neoplasms that are rarely malignant. The treatment of those that are malignant has remained a challenge because little was known about the molecular pathways involved in its malignant transformation. Recently, however, the genetic and molecular changes involved in malignant pheochromocytoma have come to be understood. The authors review the recent literature about the changing treatment options for malignant pheochromocytomas and paragangliomas. Traditional treatments for malignant pheochromocytoma remain unsuccessful. With the advances made in genomics and proteomics, novel pathways in pheochromocytoma carcinogenesis are becoming the targets of new treatment strategies and show promising results. Although several studies and clinical trials show great promise for improving the treatment of pheochromocytomas and paragangliomas, the hope is that future collaborative efforts will allow for prospective clinical trials using an evidenced-based approach.

  7. Shape of the self-concept clarity change during group psychotherapy predicts the outcome: an empirical validation of the theoretical model of the self-concept change

    PubMed Central

    Styła, Rafał

    2015-01-01

    Background: Self-Concept Clarity (SCC) describes the extent to which the schemas of the self are internally integrated, well defined, and temporally stable. This article presents a theoretical model that describes how different shapes of SCC change (especially stable increase and “V” shape) observed in the course of psychotherapy are related to the therapy outcome. Linking the concept of Jean Piaget and the dynamic systems theory, the study postulates that a stable SCC increase is needed for the participants with a rather healthy personality structure, while SCC change characterized by a “V” shape or fluctuations is optimal for more disturbed patients. Method: Correlational study in a naturalistic setting with repeated measurements (M = 5.8) was conducted on the sample of 85 patients diagnosed with neurosis and personality disorders receiving intensive eclectic group psychotherapy under routine inpatient conditions. Participants filled in the Self-Concept Clarity Scale (SCCS), Symptoms' Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy. The SCCS was also administered every 2 weeks during psychotherapy. Results: As hypothesized, among the relatively healthiest group of patients the stable SCC increase was related to positive treatment outcome, while more disturbed patients benefited from the fluctuations and “V” shape of SCC change. Conclusions: The findings support the idea that for different personality dispositions either a monotonic increase or transient destabilization of SCC is a sign of a good treatment prognosis. PMID:26579001

  8. Shape of the self-concept clarity change during group psychotherapy predicts the outcome: an empirical validation of the theoretical model of the self-concept change.

    PubMed

    Styła, Rafał

    2015-01-01

    Self-Concept Clarity (SCC) describes the extent to which the schemas of the self are internally integrated, well defined, and temporally stable. This article presents a theoretical model that describes how different shapes of SCC change (especially stable increase and "V" shape) observed in the course of psychotherapy are related to the therapy outcome. Linking the concept of Jean Piaget and the dynamic systems theory, the study postulates that a stable SCC increase is needed for the participants with a rather healthy personality structure, while SCC change characterized by a "V" shape or fluctuations is optimal for more disturbed patients. Correlational study in a naturalistic setting with repeated measurements (M = 5.8) was conducted on the sample of 85 patients diagnosed with neurosis and personality disorders receiving intensive eclectic group psychotherapy under routine inpatient conditions. Participants filled in the Self-Concept Clarity Scale (SCCS), Symptoms' Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy. The SCCS was also administered every 2 weeks during psychotherapy. As hypothesized, among the relatively healthiest group of patients the stable SCC increase was related to positive treatment outcome, while more disturbed patients benefited from the fluctuations and "V" shape of SCC change. The findings support the idea that for different personality dispositions either a monotonic increase or transient destabilization of SCC is a sign of a good treatment prognosis.

  9. Women's steps of change and entry into drug abuse treatment. A multidimensional stages of change model.

    PubMed

    Brown, V B; Melchior, L A; Panter, A T; Slaughter, R; Huba, G J

    2000-04-01

    The Transtheoretical, or Stages of Change Model, has been applied to the investigation of help-seeking related to a number of addictive behaviors. Overall, the model has shown to be very important in understanding the process of help-seeking. However, substance abuse rarely exists in isolation from other health, mental health, and social problems. The present work extends the original Stages of Change Model by proposing "Steps of Change" as they relate to entry into substance abuse treatment programs for women. Readiness to make life changes in four domains-domestic violence, HIV sexual risk behavior, substance abuse, and mental health-is examined in relation to entry into four substance abuse treatment modalities (12-step, detoxification, outpatient, and residential). The Steps of Change Model hypothesizes that help-seeking behavior of substance-abusing women may reflect a hierarchy of readiness based on the immediacy, or time urgency, of their treatment issues. For example, women in battering relationships may be ready to make changes to reduce their exposure to violence before admitting readiness to seek substance abuse treatment. The Steps of Change Model was examined in a sample of 451 women contacted through a substance abuse treatment-readiness program in Los Angeles, California. A series of logistic regression analyses predict entry into four separate treatment modalities that vary. Results suggest a multidimensional Stages of Change Model that may extend to other populations and to other types of help-seeking behaviors.

  10. "The Worst School I've Ever Been To:" Empirical Evaluations of a Restorative School and Treatment Milieu

    ERIC Educational Resources Information Center

    Mirsky, Laura; Wachtel, Ted

    2007-01-01

    While anecdotal reports have strongly supported restorative practices, there is a need to expand the evidence base through empirical studies of the efficacy of these interventions. This article highlights such emerging findings reported by Paul McCold of the Institute for Restorative Practices in collaboration with researchers from Temple…

  11. High-dose amoxicillin should be included in the empirical treatment of suspected meningitis in patients at risk of HIV infection

    PubMed Central

    Talbot, Ben Edward Michael; Webster, Daniel; Fisher, Martin; Alexander, Eliza

    2011-01-01

    The authors report on a case of Listeria rhomboencepahlitis in a previously undiagnosed HIV positive man. This case is of interest as the incidence of Listeria has increased dramatically in recent years and so may increase in the HIV-infected population. The organism is inherently resistant to cephalosporin antibiotics, empirically employed in the treatment of central nervous system infections and thus highlights the need to include amoxicillin in meningitis treatment regimes in patients at risk of HIV infection as well as the older and those known to be immuno-compromised. PMID:22696737

  12. CHANGES IN OLDER PERSONS' PREFERENCES REGARDING TREATMENT OUTCOMES OVER TIME

    PubMed Central

    Fried, Terri R.; Byers, Amy L.; Gallo, William T.; Ness, Peter H. Van; Towle, Virginia R.; O'Leary, John R.; Dubin, Joel A.

    2007-01-01

    Background: Instructional forms of advance care planning depend upon patients' ability to predict their future treatment preferences. However, preferences may change with changes in patients' health states. Methods: We performed in-home interviews with 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease at least every four months for up to 2 years. Patients were asked to rate whether treatment for their illness would be acceptable if it resulted in one of four health states. Results: The likelihood of rating as acceptable treatment resulting in mild (OR [95% confidence interval]) (1.11 [1.06, 1.16]) and severe (OR 1.06 [1.03, 1.09]) functional disability increased with each month of participation. Patients who had a decline in their ability to perform instrumental activities of daily living were more likely to rate as acceptable treatment resulting in the states of mild (OR 1.23 [1.08, 1.40]) and severe (OR 1.23 [1.11, 1.37]) disability. Although the overall likelihood of rating treatment resulting in a state of pain as acceptable did not change over time (OR 0.98 [0.96, 1.01]), patients who experienced moderate to severe pain were more likely to rate this treatment as acceptable (OR 2.55 [1.56, 4.19]) than those who did not. Conclusions: For some patients, the acceptability of treatment resulting in certain diminished states of health increases over time, and increased acceptability is more likely among patients experiencing a decline in that same domain. These changes pose a challenge to advance care planning, which asks patients to predict their future treatment preferences. PMID:16636215

  13. Manual-guided cognitive-behavioral therapy training: a promising method for disseminating empirically supported substance abuse treatments to the practice community.

    PubMed

    Morgenstern, J; Morgan, T J; McCrady, B S; Keller, D S; Carroll, K M

    2001-06-01

    A gap exists between empirically supported substance abuse treatments and those used in community settings. This study examined the feasibility of training substance abuse counselors to deliver cognitive-behavioral treatment (CBT) using treatment manuals. Participants were 29 counselors. Counselors were randomly assigned to receive CBT training or to a control group. Counselor attitudes were assessed pre- and posttraining. In addition, CBT therapy sessions were videotaped and rated for adherence and skillfulness. CBT counselors reported high levels of satisfaction with the training, intention to use CBT interventions, and confidence in their ability to do so. Ratings indicated that 90% of counselors were judged as having attained at least adequate levels of CBT skillfulness. Findings demonstrate the feasibility of using psychotherapy technology tools as a means of disseminating science-based treatments to the substance abuse practice community.

  14. Behavioral Counseling Content for Optimizing the Use of Buprenorphine for Treatment of Opioid Dependence in Community-Based Settings: A Review of the Empirical Evidence

    PubMed Central

    Copenhaver, Michael M.; Bruce, R. Douglas; Altice, Frederick L.

    2007-01-01

    There is growing empirical evidence of buprenorphine’s effectiveness in treating opioid dependence in community-based settings in the U.S. Decades of research indicates that in order for buprenorphine to have a sizable effect, it must be appropriately supported by behavioral counseling. Studies to date have not established the optimal behavioral counseling content for supporting buprenorphine treatment. The objective of this article is: 1) to review evidence of the key treatment-relevant issues posed by opioid-dependent patients in community-based settings in the U.S.; and 2) to review behavioral counseling content that may optimize the use of buprenorphine for treating opioid dependence in such settings. Evidence points toward the use of behavioral counseling aimed at enhancing patients’ motivation during treatment entry followed by an emphasis on improving coping/relapse prevention skills during the primary phase of treatment. PMID:17891657

  15. Behavioral counseling content for optimizing the use of buprenorphine for treatment of opioid dependence in community-based settings: a review of the empirical evidence.

    PubMed

    Copenhaver, Michael M; Bruce, R Douglas; Altice, Frederick L

    2007-01-01

    There is growing empirical evidence of buprenorphine's effectiveness in treating opioid dependence in community-based settings in the U.S. Decades of research indicates that in order for buprenorphine to have a sizable effect, it must be appropriately supported by behavioral counseling. Studies to date have not established the optimal behavioral counseling content for supporting buprenorphine treatment. The objective of this article is: 1) to review evidence of the key treatment-relevant issues posed by opioid-dependent patients in community-based settings in the U.S.; and 2) to review behavioral counseling content that may optimize the use of buprenorphine for treating opioid dependence in such settings. Evidence points toward the use of behavioral counseling aimed at enhancing patients' motivation during treatment entry followed by an emphasis on improving coping/relapse prevention skills during the primary phase of treatment.

  16. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

    PubMed

    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-04-17

    Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections. We conducted a retrospective cohort study in Premier Perspective database (2009-2013) of 175 US hospitals. We included all adult patients with community-onset culture-positive urinary tract infection (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, treated with antibiotics within 2 days of admission. We employed regression modeling to compute adjusted association of presence of CRE with risk of receiving IET, and of IET on hospital mortality, length of stay (LOS) and costs. Among 40,137 patients presenting to the hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p < 0.001), and more likely to be African-American (19.7% vs. 14.0%, p < 0.001) than those with non-CRE. Both chronic (Charlson score 2.0+/-2.0 vs. 1.9+/-2.1, p = 0.009) and acute (by day 2: ICU 56.3% vs. 30.4%, p < 0.001, and mechanical ventilation 35.8% vs. 11.7%, p < 0.001) illness burdens were higher among CRE than non-CRE subjects, respectively. CRE patients were 3× more likely to receive IET than non-CRE (46.5% vs. 11.8%, p < 0.001). In a regression model CRE was a strong predictor of receiving IET (adjusted relative risk ratio 3.95, 95% confidence interval 3.5 to 4.5, p < 0.001). In turn, IET was associated with an adjusted rise in mortality of 12% (95% confidence interval 3% to 23%), and an excess of 5.2 days (95% confidence interval 4.8, 5.6, p < 0.001) LOS and $10,312 (95% confidence interval $9497, $11,126, p < 0

  17. 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...

  18. Managing pain in children. Changing treatment of headaches.

    PubMed Central

    Kuttner, L.

    1993-01-01

    With growing understanding of the pain system and the variables that contribute to pain-suppressing mechanisms, treatments combining pharmacologic and psychologic methods are becoming the norm for managing pediatric pain. For headaches, however, the trend is away from medication and toward self-management strategies using relaxation, hypnosis, and lifestyle changes. Images Figure 3 PMID:8471904

  19. Stages of Change in Treatment-Seeking Pathological Gamblers

    ERIC Educational Resources Information Center

    Petry, Nancy M.

    2005-01-01

    The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance…

  20. 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...

  1. An improved empirical dynamic control system model of global mean sea level rise and surface temperature change

    NASA Astrophysics Data System (ADS)

    Wu, Qing; Luu, Quang-Hung; Tkalich, Pavel; Chen, Ge

    2017-03-01

    Having great impacts on human lives, global warming and associated sea level rise are believed to be strongly linked to anthropogenic causes. Statistical approach offers a simple and yet conceptually verifiable combination of remotely connected climate variables and indices, including sea level and surface temperature. We propose an improved statistical reconstruction model based on the empirical dynamic control system by taking into account the climate variability and deriving parameters from Monte Carlo cross-validation random experiments. For the historic data from 1880 to 2001, we yielded higher correlation results compared to those from other dynamic empirical models. The averaged root mean square errors are reduced in both reconstructed fields, namely, the global mean surface temperature (by 24-37%) and the global mean sea level (by 5-25%). Our model is also more robust as it notably diminished the unstable problem associated with varying initial values. Such results suggest that the model not only enhances significantly the global mean reconstructions of temperature and sea level but also may have a potential to improve future projections.

  2. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 35.

    ERIC Educational Resources Information Center

    CDM Group, Inc.

    This TIP on the guidelines for treatment of substance use disorders is based on a fundamental rethinking of the concept of motivation. It suggests that the cognitive-behavioral approach to treatment requires a different perspective on the problem and on the prerequisites for change, while placing greater responsibility on the counselor whose job…

  3. Onychomycosis: epidemiology, diagnosis, and treatment in a changing landscape.

    PubMed

    Rosen, Theodore; Friedlander, Sheila Fallon; Kircik, Leon; Zirwas, Matthew J; Stein Gold, Linda; Bhatia, Neal; Gupta, Aditya K

    2015-03-01

    Onychomycosis is an often overlooked and/or undertreated disease. This may be in part due to an under appreciation among both physicians and patients of its impact on quality of life and the potential for significant complications, from tinea corporis and cruris, to bacterial superinfection. Some health care providers are unaware of the effective low-risk treatments currently available. Changing demographic characteristics such as the relative aging of the population; the increasing prevalence of diabetes and peripheral vascular disease, and widespread iatrogenic immunosuppression; and changes in lifestyle practices such as earlier and greater participation in sports, are likely to lead to an increased prevalence of onychomycosis in both adults and children. Two topical onychomycosis treatments, efinaconazole 10% solution, and tavaborole 5% solution were recently approved by the FDA. This article reviews the state of knowledge and describes, briefly, these new treatment options.

  4. Changes in antibody profile after treatment of human onchocerciasis.

    PubMed

    Lee, S J; Francis, H L; Awadzi, K; Ottesen, E A; Nutman, T B

    1990-08-01

    To define the changes in antibody response to Onchocerca volvulus antigens after treatment of patients with onchocerciasis, IgG and IgE antibodies were examined quantitatively and qualitatively in 21 patients and 3 control individuals before and sequentially for 14 days after treatment with diethylcarbamazine. The quantitative levels of IgE and IgG responses (both polyclonal and O. volvulus-specific) remained essentially unchanged for all patients, but 9 of the 21 patients showed intensified responses to one or more parasite-specific antigens, and 8 of 21 developed antibodies to previously undetected antigens. There was a significant correlation between the intensities of infection and the development of newly recognized anti-O. volvulus antibodies. These studies demonstrate that O. volvulus-specific IgE and IgG antibody responses are, at least transiently, enhanced by treatment with diethylcarbamazine and that after treatment, parasites possibly release antigens previously hidden from the host's immune response.

  5. Second modernity as a research agenda: theoretical and empirical explorations in the 'meta-change' of modern society.

    PubMed

    Beck, Ulrich; Lau, Christoph

    2005-12-01

    In this article we are reformulating the theory of reflexive modernization as an empirical research programme and summarize some of the most recent findings which have been produced by a research consortium in Munich (integrating four universities, funded by the German Research Society (DFG)). On this basis we reject the idea that Western societies at the beginning of the twenty-first century move from the modern to the post-modern. We argue that there has been no clear break with the basic principles of modernity but rather a transformation of basic institutions of modernity such as the nation-state and the nuclear family. We would suggest, therefore, that what we are witnessing is a second modernity. Finally, we reform the theory of reflexive modernization in reaction to three uttered objections.

  6. Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial.

    PubMed

    Timsit, Jean-Francois; Azoulay, Elie; Schwebel, Carole; Charles, Pierre Emmanuel; Cornet, Muriel; Souweine, Bertrand; Klouche, Kada; Jaber, Samir; Trouillet, Jean-Louis; Bruneel, Fabrice; Argaud, Laurent; Cousson, Joel; Meziani, Ferhat; Gruson, Didier; Paris, Adeline; Darmon, Michael; Garrouste-Orgeas, Maité; Navellou, Jean-Christophe; Foucrier, Arnaud; Allaouchiche, Bernard; Das, Vincent; Gangneux, Jean-Pierre; Ruckly, Stéphane; Maubon, Daniele; Jullien, Vincent; Wolff, Michel

    2016-10-18

    Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome. To determine whether empirical micafungin reduces invasive fungal infection (IFI)-free survival at day 28. Multicenter double-blind placebo-controlled study of 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, exposed to broad-spectrum antibacterial agents, and enrolled between July 2012 and February 2015 in 19 French ICUs. Empirical treatment with micafungin (100 mg, once daily, for 14 days) (n = 131) vs placebo (n = 129). The primary end point was survival without proven IFI 28 days after randomization. Key secondary end points included new proven fungal infections, survival at day 28 and day 90, organ failure, serum (1-3)-β-D-glucan level evolution, and incidence of ventilator-associated bacterial pneumonia. Among 260 patients (mean age 63 years; 91 [35%] women), 251 (128, micafungin group; 123, placebo group) were included in the modified intent-to-treat analysis. Median values were 8 for Sequential Organ Failure Assessment (SOFA) score, 3 for number of Candida-colonized sites, and 99 pg/mL for level of (1-3)-β-D-glucan. On day 28, there were 82 (68%) patients in the micafungin group vs 79 (60.2%) in the placebo group who were alive and IFI free (hazard ratio [HR], 1.35 [95% CI, 0.87-2.08]). Results were similar among patients with a (1-3)-β-D-glucan level of greater than 80 pg/mL (n = 175; HR, 1.41 [95% CI, 0.85-2.33]). Day-28 IFI-free survival in patients with a high SOFA score (>8) was not significantly different when compared between the micafungin vs placebo groups (HR, 1.69 [95% CI, 0.96-2.94]). Use of empirical micafungin decreased the rate of new invasive fungal infection in 4 of 128 patients (3%) in the micafungin group vs placebo (15/123 patients [12

  7. Piperacillin/tazobactam versus cefepime for the empirical treatment of pediatric cancer patients with neutropenia and fever: a randomized and open-label study.

    PubMed

    Uygun, Vedat; Karasu, Gulsun Tezcan; Ogunc, Dilara; Yesilipek, Akif; Hazar, Volkan

    2009-10-01

    This is a prospective, randomized, and open-label clinical trial that examines the efficiency and safety of PIP/TAZO monotherapy in comparison to cefepime (CEF), for the empirical treatment of pediatric cancer patients with neutropenia and fever. One hundred thirty-one consecutive febrile episodes in 70 neutropenic pediatric cancer patients received randomized treatment either with piperacillin/tazobactam (PIP/TAZO) 80 mg/kg piperacillin/10 mg/kg tazobactam every 6 hr or CEF 50 mg/kg every 8 hr. Clinical response was determined at completion of therapy. Duration of fever, neutropenia, hospitalization, the need for modification of the therapy, and mortality rates were compared between the two groups. One hundred twenty-seven episodes in 69 patients (35 females, 34 males) with a median age of 4.2 years were assessed for efficiency (65 PIP/TAZO, 62 CEF). The frequency of success without modification of treatment was nearly identical for both PIP/TAZO (60.0%) and CEF (61.3%) (P > 0.05). The overall response rate, with or without modification of assigned treatment, was 96.9% for PIP/TAZO and 98.4% for CEP (P > 0.05). Infection-related mortality at the end of the febrile episode was 2.4%. Duration of fever and hospitalization were not different between the treatment groups. No major side effects were observed in neither of the groups. PIP/TAZO treatment was as effective and safe as CEF monotherapy as an initial empirical regimen in pediatric cancer patients with fever and neutropenia.

  8. Antipsychotic induced metabolic changes & treatment response: a prospective study.

    PubMed

    Sharma, Eesha; Venkatasubramanian, Ganesan; Varambally, Shivarama; Sivakumar, Palanimuthu T; Subbakrishna, Doddaballapur K; Gangadhar, Bangalore N

    2014-10-01

    Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment of psychosis. Multiple studies suggest that metabolic side effects correlate with response to antipsychotic treatment. However, few studies have systematically looked at this. We conducted an exploratory, naturalistic, prospective, trans-diagnostic study to examine this association. 100 patients with psychosis, initiated on antipsychotic treatment alone, were assessed on Brief Psychiatric Rating Scale (BPRS), visual analog scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and fasting serum lipid and glucose profiles at baseline, 2-4 weeks (n=71) and 8-12 weeks (n=39). Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4 weeks) increase in appetite and triglyceride levels (R(2)=0.257; p=0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R(2)=0.169; p=0.009). Early appetite and triglyceride changes predicted antipsychotic treatment response. Involvement of dopaminergic, serotonergic and histaminergic neural pathways could explain the association between appetite and treatment response. Insulin signaling pathways have been implicated in lipid changes with antipsychotics. Study findings suggest metabolic side effects may be early predictors of antipsychotic response. These findings warrant further examination to elucidate the interaction between metabolic pathways and psychotic illnesses, and possibly mechanism of action of antipsychotics beyond dopamine blockade. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. 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.

  10. Changes in pharmaceutical treatment of diabetes and family financial burdens.

    PubMed

    Sarpong, Eric M; Bernard, Didem M; Miller, G Edward

    2012-08-01

    Recent changes in diabetes treatment guidelines and the introduction of new, more expensive pharmaceuticals appear to increase the financial challenges for nonelderly adults with diabetes. The authors used Medical Expenditure Panel Survey data to examine changes in the prevalence of diabetes and comorbidities, diabetes treatment, financial burdens, and the relationship between high financial burdens and patient characteristics. From 1997-1998 to 2006-2007, the total number of nonelderly adults treated for diabetes nearly doubled, from 5.4 to 10.7 million, and the proportion of diabetes patients using multiple drugs to treat their condition increased significantly. About a fifth of diabetes patients spent 10% or more of their family income on health care, and about one in nine spent 20% or more of their family income on health care. In 2006-2007, diabetes patients who were older, female, in poor health, or lacked insurance were more likely than others to have high burdens.

  11. Knowledge-driven institutional change: an empirical study on combating desertification in northern China from 1949 to 2004.

    PubMed

    Yang, Lihua; Wu, Jianguo

    2012-11-15

    Understanding institutional changes is crucial for environmental management. Here we investigated how institutional changes influenced the process and result of desertification control in northern China between 1949 and 2004. Our analysis was based on a case study of 21 field sites and a meta-analysis of additional 29 sites reported in the literature. Our results show that imposed knowledge-driven institutional change was often perceived as a more progressive, scientific, and rational type of institutional change by entrepreneurs, scholars, experts, and technicians, while voluntary, knowledge-driven institutional change based on indigenous knowledge and experiences of local populations was discouraged. Our findings also demonstrate that eight working rules of imposed knowledge-driven institutional change can be applied to control desertification effectively. These rules address the issues of perception of potential gains, entrepreneurs' appeals and support, coordination of multiple goals, collaboration among multiple organizations, interest distribution and conflict resolution, incremental institutional change, external intervention, and coordination among the myriad institutions involved. Imposed knowledge-driven institutional change tended to be more successful when these rules were thoroughly implemented. These findings provide an outline for implementing future institutional changes and policy making to combat desertification and other types of ecological and environmental management.

  12. Enamel structural changes induced by hydrochloric and phosphoric acid treatment.

    PubMed

    Bertacci, Angelica; Lucchese, Alessandra; Taddei, Paola; Gherlone, Enrico F; Chersoni, Stefano

    2014-12-30

    The aim of this study was to evaluate enamel acid-induced structural changes after 2 different treatments, by means of Raman and infrared (IR) spectroscopy analyses, and to correlate these findings with permeability measured as fluid discharge from outer enamel. Two different treatments were investigated: 10 enamel slices were etched with 15% hydrochloric acid (HCl) for 120 seconds and 10 slices with 37% phosphoric acid gel (H3PO4) for 30 seconds, rinsed for 30 seconds and then air-dried for 20 seconds. Powders of enamel treated as previously described were produced. Replicas of enamel subjected to the same treatments were obtained to evaluate the presence of fluid droplets on enamel surface. Raman and IR spectroscopy showed that the treatment with both hydrochloric and phosphoric acids induced a decrease in the carbonate content of the enamel apatite. At the same time, both acids induced the formation of HPO42- ions. After H3PO4 treatment, the bands due to the organic component of enamel decreased in intensity, while they increased after HCl treatment. Replicas of H3PO4 treated enamel showed a strongly reduced permeability. Replicas of HCl 15% treated samples showed a maintained permeability. A decrease of the enamel organic component, as resulted after H3PO4 treatment, involves a decrease in enamel permeability, while the increase of the organic matter (achieved by HCl treatment) still maintains enamel permeability.The results suggested a correlation between organic matter and enamel permeability. Permeability was affected by etching technique and could be involved in marginal seal, gap and discoloration at the enamel interface, still causes of restoration failure.

  13. Mandibular arch perimeter changes with lip bumper treatment.

    PubMed

    Osborn, W S; Nanda, R S; Currier, G F

    1991-06-01

    The effects of lip bumper treatment on the mandibular arch were observed in 32 patients with late transitional and early permanent dentitions. Dental cast measurements were made for arch perimeter, arch length, and arch width. Cephalometric radiographs were used to determine labial tipping of the incisors and distal movement of the molars. Arch circumference increased in all patients, ranging from 0.7 mm to 8.8 mm, with an average of 4.1 mm. The mean increase in arch length was 1.2 mm and was largely attributed to anterior tipping of the mandibular incisors. Change in arch length was the most predictive variable for the increase in arch circumference. Passive changes in arch width were recorded, with a mean increase of 2.0 mm in the intercanine distance and 2.5 mm in the first premolar distance. Arch width increments contributed to the increase in arch circumference, but the increases in arch width were not found to be predictive of the change in arch circumference. Changes in either arch circumference or arch length were not related to the duration of treatment, age and sex of the patient, or the eruption status of the permanent second molars.

  14. Subtypes of Batterers in Treatment: Empirical Support for a Distinction between Type I, Type II and Type III

    PubMed Central

    Graña, José Luis; Redondo, Natalia; Muñoz-Rivas, Marina J.; Cantos, Arthur L.

    2014-01-01

    This study explores the existence of different types of batterers in a sample of 266 men who had been court referred for intimate partner violence. The data collected in the assessment that have been used to perform a hierarchical and a two-step cluster analysis fall into three areas: aggression towards the partner, general aggression and presence of psychopathology and personality traits, more specifically, alcohol use, borderline and antisocial personality traits, psychopathy traits, state anger and trait anger, anger expression and control, anger, hostility, and, finally, impulsivity. The results show a typology consisting of 3 types of batterers on the basis of violence level and psychopathology: low (65%), moderate (27.8%) and high (7.1%). This study provides empirical support for the development of batterer typologies. These typologies will help achieve early detection of different types of batterers, allowing us to tailor interventions on the basis of the needs of each of the types. PMID:25329828

  15. Malaria treatment policy change and implementation: the case of Uganda.

    PubMed

    Nanyunja, Miriam; Nabyonga Orem, Juliet; Kato, Frederick; Kaggwa, Mugagga; Katureebe, Charles; Saweka, Joaquim

    2011-01-01

    Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.

  16. 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.

  17. Impact of ivermectin on onchocerciasis transmission: assessing the empirical evidence that repeated ivermectin mass treatments may lead to elimination/eradication in West-Africa

    PubMed Central

    Borsboom, Gerard JJM; Boatin, Boakye A; Nagelkerke, Nico JD; Agoua, Hyacinthe; Akpoboua, Komlan LB; Alley, E William Soumbey; Bissan, Yeriba; Renz, Alfons; Yameogo, Laurent; Remme, Jan HF; Habbema, J Dik F

    2003-01-01

    Background The Onchocerciasis Control Program (OCP) in West Africa has been closed down at the end of 2002. All subsequent control will be transferred to the participating countries and will almost entirely be based on periodic mass treatment with ivermectin. This makes the question whether elimination of infection or eradication of onchocerciasis can be achieved using this strategy of critical importance. This study was undertaken to explore this issue. Methods An empirical approach was adopted in which a comprehensive analysis was undertaken of available data on the impact of more than a decade of ivermectin treatment on onchocerciasis infection and transmission. Relevant entomological and epidemiological data from 14 river basins in the OCP and one basin in Cameroon were reviewed. Areas were distinguished by frequency of treatment (6-monthly or annually), endemicity level and additional control measures such as vector control. Assessment of results were in terms of epidemiological and entomological parameters, and as a measure of inputs, therapeutic and geographical coverage rates were used. Results In all of the river basins studied, ivermectin treatment sharply reduced prevalence and intensity of infection. Significant transmission, however, is still ongoing in some basins after 10–12 years of ivermectin treatment. In other basins, transmission may have been interrupted, but this needs to be confirmed by in-depth evaluations. In one mesoendemic basin, where 20 rounds of four-monthly treatment reduced prevalence of infection to levels as low as 2–3%, there was significant recrudescence of infection within a few years after interruption of treatment. Conclusions Ivermectin treatment has been very successful in eliminating onchocerciasis as a public health problem. However, the results presented in this paper make it almost certain that repeated ivermectin mass treatment will not lead to the elimination of transmission of onchocerciasis from West Africa. Data

  18. "Roadblocks" revisited: neural change, stuttering treatment, and recovery from stuttering.

    PubMed

    Ingham, Roger J; Finn, Patrick; Bothe, Anne K

    2005-01-01

    In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990). Research directions in stuttering: Consensus and conflict. In Cooper, J. A. (Ed.), Research needs in stuttering: Roadblocks and future directions (pp. 98-100). Rockville, MD: American Speech-Language-Hearing Association.] that adults who have recovered from stuttering might inform our understanding of the nature and treatment of persistent stuttering. It is suggested that those who have recovered could constitute a behavioral, cognitive, and neurophysiologic benchmark for evaluating stuttering treatment for adolescents and adults, while helping to identify the limits of recovery from a persistent disorder. This possibility seems especially promising because of findings from recent studies investigating untreated recovery during childhood and adulthood, the emerging evidence concerning neural plasticity and reorganization, and reports of neural system changes during stuttering treatment. Potential obstacles to applying findings from unassisted recovery to treatment do exist, but the benefits of attempts to fully understand stuttering certainly outweigh the difficulties. After completing this activity, the learner will be able to: (1) describe two complexities involved in determining whether recovery from stuttering was assisted or unassisted; (2) discuss the implications for stuttering research of two neural plasticity research findings from areas other than stuttering; and (3) evaluate the possible implications for stuttering treatment of a coordinated research program that addresses behavioral, cognitive, and neurological characteristics of assisted and unassisted recovery from stuttering.

  19. Change from inverse to normal magnetic fabrics through thermal treatment

    NASA Astrophysics Data System (ADS)

    Kim, H.; Cho, H.; Jeong, J. O.; Son, M.; Sohn, Y. K.

    2014-12-01

    The Gusandong Tuff is an extensive rhyolitic ignimbrite that has been used as an excellent key bed in the Cretaceous Gyeongsang Basin, SE Korea. Magnetic fabric analysis in the tuff, using AMS (Anisotropy of Magnetic Susceptibility) technique, shows an anomalous fabric which has horizontal k3 and vertical k1 axes in several sites. The fabric is interpreted to be an inverse one attributed to single-domain magnetites. We attempted a stepwise thermal treatment to investigate the changes of AMS axes and parameters (T, PJ) in four sites (KT11B, KT11M, KT18B, KT18M). All these sites dominantly include the specimens showing the anomalous fabric. Rock magnetism shows that magnetites are the main carrier of the AMS fabric. The changing patterns of magnetic fabric during heating are classified into 4 types: (1) Type-0 is characterized by unchanged three principal axes (k1, k2, k3) over all heating steps. (2) Type-I shows the exchange of k1 and k2 axes each other. (3) Type-II is characterized by the exchange of k2 and k3 axes each other. (4) Type-III shows that three principal axes switch their positions with one another. Except for Type-0, most of the magnetic fabrics are transformed gradually. The directional changes of the axes begin between 450-580°C and then terminate near 670°C. After the thermal treatment, all the fabrics become geologically normal as vertical k3 and horizontal k1 axes. It is also notable that the beginning temperatures are nearly equal to those of inflection points in the T-PJ plots. In the sites KT18B and KT18M which showed girdle-distributed and vertical k1 axes, respectively, before the treatment, all the k1 axes become horizontally and co-directionally clustered after the treatment. This result indicates that the thermal treatment can be a strongly useful tool for eliminating the inverse AMS magnetic fabric of natural rocks. The changes of axis orientation and magnitude observed in this study can be reasonably explained with the theoretical

  20. Epigenetic changes in the rat livers induced by pyrazinamide treatment

    SciTech Connect

    Kovalenko, V.M.; Bagnyukova, T.V.; Sergienko, O.V.; Bondarenko, L.B.; Shayakhmetova, G.M.; Matvienko, A.V.; Pogribny, I.P.

    2007-12-15

    Drug-induced liver injury, including drug-induced hepatotoxicity during the treatment of tuberculosis infection, is a major health problem with increasingly significant challenges to modern hepatology. Therefore, the assessment and monitoring of the hepatotoxicity of antituberculosis drugs for prevention of liver injury are great concerns during disease treatment. The recently emerged data showing the ability of toxicants, including pharmaceutical agents, to alter cellular epigenetic status, open a unique opportunity for early detection of drug hepatotoxicity. Here we report that treatment of male Wistar rats with antituberculosis drug pyrazinamide at doses of 250, 500 or 1000 mg/kg/day body weight for 45 days leads to an early and sustained decrease in cytosine DNA methylation, progressive hypomethylation of long interspersed nucleotide elements (LINE-1), and aberrant promoter hypermethylation of placental form glutathione-S-transferase (GSTP) and p16{sup INK4A} genes in livers of pyrazinamide-treated rats, while serum levels of bilirubin and activity of aminotransferases changed modestly. The early occurrence of these epigenetic alterations and their association with progression of liver injury specific pathological changes indicate that alterations in DNA methylation may be useful predictive markers for the assessment of drug hepatotoxicity.

  1. Structural changes of synthetic opal by heat treatment

    NASA Astrophysics Data System (ADS)

    Arasuna, Akane; Okuno, Masayuki; Okudera, Hiroki; Mizukami, Tomoyuki; Arai, Shoji; Katayama, Shin'ichi; Koyano, Mikio; Ito, Nobuaki

    2013-10-01

    The structural changes of synthetic opal by heat treatment up to 1,400 °C were investigated using scanning electron microscopy, X-ray diffraction, and Fourier transform infrared and Raman spectroscopies. The results indicate that the dehydration and condensation of silanol in opal are very important factors in the structural evolution of heat-treated synthetic opal. Synthetic opal releases water molecules and silanols by heat treatment up to 400 °C, where the dehydration of silanol may lead to the condensation of a new Si-O-Si network comprising a four-membered ring structure of SiO4 tetrahedra, even at 400 °C. Above 600 °C, water molecules are lost and the opal surface and internal silanol molecules are completely dehydrated by heat effect, and the medium-temperature range structure of opal may begin to thermally reconstruct to six-membered rings of SiO4 tetrahedra. Above 1,000 °C, the opal structure almost approaches that of silica glass with an average structure of six-membered rings. Above 1,200 °C, the opal changes to low-cristobalite; however, minor evidence of low-tridymite stacking was evident after heat treatment at 1,400 °C.

  2. Impact of farm level adaptation to climate change on agricultural productivity and farmers' wellbeing: Empirical evidence from Pakistan

    NASA Astrophysics Data System (ADS)

    Abid, Muhammad; Scheffran, Jürgen

    2016-04-01

    Climate change is projected to adversely affect the agricultural sector and attached rural livelihoods, particularly in the developing countries. Hence adaptation to climate change is crucial to support agricultural productivity and rural livelihoods. The current study is based on comprehensive cross sectional data collected through 450 face-to-face interviews with farmers from three agro-ecological zones of Punjab province, Pakistan. This paper aims to examine the factors that influence the farmers' adaptation decisions and to assess the impact of farm level adaptation on crop productivity and farmers' wellbeing. The paper uses correlation analysis, binary logistic regression and propensity score matching techniques in order to explore the study objectives. The results of the study indicate that education, age, land holdings, farmer-to-farmer interaction, access to weather forecasting information and location in agro-ecological zone does have significant impact on farmers' decision to adapt to climate change. Major adaptation measures adopted by farmers were changing planting dates, changing cropping varieties, planting shaded trees and changing input-mix. Moreover the study found a positive and significant impact of adaptation on productivity of all major crops (wheat, sugarcane, maize and rice) and on farmers' wellbeing in term of farm income. Furthermore, the study also found that the extent of adaptation benefits increases with the number of adaptation measures. The findings of the study suggest to focus on farmers' education and easy access to climate-specific information for better adaptation at farm level and improved farm wellbeing. Key words: Climate change; Farm level adaptation; crop productivity; farmers' wellbeing; Pakistan

  3. 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.

  4. 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

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

    PubMed

    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.

  6. Changes over Time and Disparities in Schizophrenia Treatment Quality

    PubMed Central

    Lehman, Anthony F.; Goldman, Howard; Frank, Richard G.

    2008-01-01

    Background Schizophrenia medication and psychosocial treatment options have expanded since the Schizophrenia PORT was conducted. However, there also have been considerable changes in the delivery of mental health care in the public sector, as well as increasing state concerns about Medicaid cost containment. Objectives To examine trends and patient characteristics associated with differences in schizophrenia medication and visit treatment quality in a Medicaid population. Research Design Observational study of claims data from July 1, 1996 to June 30, 2001. Subjects Florida Medicaid enrollees diagnosed with schizophrenia (N=23,619). Measures We examined the likelihood of meeting any one and all four of the following quality standards: 1) receiving antipsychotic medication, 2) antipsychotic continuity and 3) dosing consistent with PORT recommendations and, 4) mental health visit continuity. Separate models were fit for acute and maintenance phases of treatment. Results Approximately 18% of acute and 7% of maintenance phases met all four quality standards. Antipsychotic quality improved (largely driven by an increasingly likelihood of receiving any antipsychotic), while visit continuity declined. The greatest disparities were seen for persons with co-occurring substance use disorders and of Black race. Quality differences were often phase specific and at times in opposite directions across treatment phases. Conclusions The improvement in antipsychotic treatment quality is encouraging. However, visit continuity declined. This study highlights the importance of quality measurement that includes focus on different treatment modalities and phases of care, as well as for potentially vulnerable populations (such as persons with co-occurring substance use disorders and minority race/ethnicity). PMID:19169121

  7. Clostridium difficile: Changing Epidemiology, Treatment and Infection Prevention Measures.

    PubMed

    Cecil, Jane A

    2012-12-01

    Clostridium difficile was first reported as a cause of antibiotic-associated colitis in 1978. In more recent years we have witnessed disturbing trends associated with C. difficile infection (CDI). CDI has become more common, affecting populations previously considered at low risk, more severe with an associated increase in mortality, and more difficult to treat with some patients experiencing multiple relapses and a reduced responsiveness to previously effective antibiotics. These trends have been coincident with the emergence of a new hypervirulent strain responsible for several outbreaks in the last decade. Fortunately, we have also seen promising developments, particularly with regard to testing and treatment. This review discusses recent changes in the epidemiology of CDI and recent developments in the testing, treatment and prevention of CDI.

  8. CO2 laser microsurgeries in treatment of larynx pathological changes

    NASA Astrophysics Data System (ADS)

    Kus, Jan; Osmolski, Antoni; Kubiczek-Jagielska, Marzena; Frenkiel, Zofia; Milczarek, Katarzyna

    1996-03-01

    The results of the laser microsurgical treatment of the 273 patients with different pathological changes in the larynx are presented in the paper. In this number are included cases with tumors (80), precancers (40), papillomatosis (17), and stenosis of the larynx (71). Patients were treated with carbon-dioxide surgical laser with the laser beam power ranging from 12 to 28 watts depending on the pathology and its advance. Positive results of the treatment were observed in 73% to 100% of cases in different groups of patients. The authors suggest that in some cases the carbon-dioxide laser is only an alternative tool but in many cases, e.g., in papillomatosis, it is much better than traditional equipment. There are also cases such as hemangioma where the laser is an unreplaceable surgical technique.

  9. Changing Bilingual Self-Perceptions from Early Adolescence to Early Adulthood: Empirical Evidence from a Mixed-Methods Case Study

    ERIC Educational Resources Information Center

    Caldas, Stephen J.

    2008-01-01

    In the emerging tradition of language socialization research, this study examines the changing bilingual self-perceptions of three children, identical twin girls and their older brother, from early adolescence through early adulthood. The children were reared in a predominantly French-speaking home in south Louisiana by French/English bilingual…

  10. Changing Bilingual Self-Perceptions from Early Adolescence to Early Adulthood: Empirical Evidence from a Mixed-Methods Case Study

    ERIC Educational Resources Information Center

    Caldas, Stephen J.

    2008-01-01

    In the emerging tradition of language socialization research, this study examines the changing bilingual self-perceptions of three children, identical twin girls and their older brother, from early adolescence through early adulthood. The children were reared in a predominantly French-speaking home in south Louisiana by French/English bilingual…

  11. 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

  12. 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

  13. Structural changes in microcrystalline cellulose in subcritical water treatment.

    PubMed

    Tolonen, Lasse K; Zuckerstätter, Gerhard; Penttilä, Paavo A; Milacher, Walter; Habicht, Wilhelm; Serimaa, Ritva; Kruse, Andrea; Sixta, Herbert

    2011-07-11

    Subcritical water is a high potential green chemical for the hydrolysis of cellulose. In this study microcrystalline cellulose was treated in subcritical water to study structural changes of the cellulose residues. The alterations in particle size and appearance were studied by scanning electron microscopy (SEM) and those in the degree of polymerization (DP) and molar mass distributions by gel permeation chromatography (GPC). Further, changes in crystallinity and crystallite dimensions were quantified by wide-angle X-ray scattering and (13)C solid-state NMR. The results showed that the crystallinity remained practically unchanged throughout the treatment, whereas the size of the remaining cellulose crystallites increased. Microcrystalline cellulose underwent significant depolymerization in subcritical water. However, depolymerization leveled off at a relatively high degree of polymerization. The molar mass distributions of the residues showed a bimodal form. We infer that cellulose gets dissolved in subcritical water only after extensive depolymerization.

  14. Capacity to consent to treatment: empirical comparison of three instruments in older adults with and without dementia.

    PubMed

    Moye, Jennifer; Karel, Michele J; Azar, Armin R; Gurrera, Ronald J

    2004-04-01

    The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments. Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as assessed with three capacity instruments. Mean performance of adults with dementia on a legal standard of understanding treatment information was impaired relative to controls on all instruments, and it was also impaired for an appreciation standard on one instrument and a reasoning standard on two instruments. However, in categorical ratings, most adults with dementia were within the normal range on all decisional capacities. Legal standards were operationalized differently across the three instruments for the capacities of appreciation and reasoning. Most adults with mild dementia can participate in medical decision making as defined by legal standards, although memory impairments may limit demonstration of understanding of diagnostic and treatment information. In dementia, assessments of reasoning about treatment options should focus on whether a person can describe salient reasons for a specific choice, whereas assessments of appreciation of the meaning of diagnostic and treatment information should focus on whether a person can describe the implications of various choices for future states. More research is needed to establish the reliability and validity of assessment tools and of capacity constructs.

  15. Benchmarks for detecting 'breakthroughs' in clinical trials: empirical assessment of the probability of large treatment effects using kernel density estimation.

    PubMed

    Miladinovic, Branko; Kumar, Ambuj; Mhaskar, Rahul; Djulbegovic, Benjamin

    2014-10-21

    To understand how often 'breakthroughs,' that is, treatments that significantly improve health outcomes, can be developed. We applied weighted adaptive kernel density estimation to construct the probability density function for observed treatment effects from five publicly funded cohorts and one privately funded group. 820 trials involving 1064 comparisons and enrolling 331,004 patients were conducted by five publicly funded cooperative groups. 40 cancer trials involving 50 comparisons and enrolling a total of 19,889 patients were conducted by GlaxoSmithKline. We calculated that the probability of detecting treatment with large effects is 10% (5-25%), and that the probability of detecting treatment with very large treatment effects is 2% (0.3-10%). Researchers themselves judged that they discovered a new, breakthrough intervention in 16% of trials. We propose these figures as the benchmarks against which future development of 'breakthrough' treatments should be measured. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Acceptance and commitment therapy: empirical considerations.

    PubMed

    Rector, Neil A

    2013-06-01

    Cognitive-behavioral therapy (CBT), including behavior therapy, cognitive therapy, and their integration, has evolved over the past four decades to become the most empirically supported psychological treatment for a range of psychiatric conditions, spanning the preponderance of Axis I disorders, selected Axis II disorders, and a range of associated clinical-health problems. The evolution of cognitive-behavioral theory and treatment has followed a coherent scientific framework, first introduced in the cognitive-behavioral modeling and treatment of depression, to include: (a) systematic clinical observations, (b) definition and psychometric operationalization of key disorder-specific cognitive, emotional and behavioral constructs, (c) laboratory investigation of operationalized disorder-specific processes, (d) development of comprehensive CBT treatment interventions to target the processes of empirically tested disorder-specific models, (e) progression from early noncontrolled clinical outcome studies to the development of sophisticated, large-scale randomized controlled trials testing disorder-specific CBT interventions, (f) examination of disorder-specific moderators and mediators of change in CBT treatment, and (g) openness to refinements and elaborations based on empirical updates from experimental and clinical investigations. Copyright © 2011. Published by Elsevier Ltd.

  17. Potential utility of empirical tuberculosis treatment for HIV-infected patients with advanced immunodeficiency in high TB-HIV burden settings.

    PubMed

    Lawn, S D; Ayles, H; Egwaga, S; Williams, B; Mukadi, Y D; Santos Filho, E D; Godfrey-Faussett, P; Granich, R M; Harries, A D

    2011-03-01

    The human immunodeficiency virus (HIV) and HIV-associated tuberculosis (TB-HIV) epidemics remain uncontrolled in many resource-limited regions, especially in sub-Saharan Africa. The scale of these epidemics requires the consideration of innovative bold interventions and 'out-of-the-box' thinking. To this end, a symposium entitled 'Controversies in HIV' was held at the 40th Union World Conference on Lung Health in Cancun, Mexico, in December 2009. The first topic debated, entitled 'Annual HIV testing and immediate start of antiretroviral therapy for all HIV-infected persons', received much attention at international conferences and in the literature in 2009. The second topic forms the subject of this article. The rationale for the use of empirical TB treatment is premised on the hypothesis that in settings worst affected by the TB-HIV epidemic, a subset of HIV-infected patients have such a high risk of undiagnosed TB and of associated mortality that their prognosis may be improved by immediate initiation of empirical TB treatment used in conjunction with antiretroviral therapy. In addition to morbidity and mortality reduction, additional benefits may include prevention of nosocomial TB transmission and TB preventive effect. Potential adverse consequences, however, may include failure to consider other non-TB diagnoses, drug co-toxicity, compromised treatment adherence, and logistical and resource challenges. There may also be general reluctance among national TB programmes to endorse such a strategy. Following fruitful debate, the conclusion that this strategy should be carefully evaluated in randomised controlled trials was strongly supported. This paper provides an in-depth consideration of this proposed intervention.

  18. Multidisciplinary approach to the treatment of invasive fungal infections in adult patients. Prophylaxis, empirical, preemptive or targeted therapy, which is the best in the different hosts?

    PubMed Central

    Zaragoza, Rafael; Pemán, Javier; Salavert, Miguel; Viudes, Ángel; Solé, Amparo; Jarque, Isidro; Monte, Emilio; Romá, Eva; Cantón, Emilia

    2008-01-01

    The high morbidity, mortality, and health care costs associated with invasive fungal infections, especially in the critical care setting and immunocompromised host, have made it an excellent target for prophylactic, empiric, and preemptive therapy interventions principally based on early identification of risk factors. Early diagnosis and treatment are associated with a better prognosis. In the last years there have been important developments in antifungal pharmacotherapy. An approach to the new diagnosis tools in the clinical mycology laboratory and an analysis of the use new antifungal agents and its application in different clinical situations has been made. Furthermore, an attempt of developing a state of the art in each clinical scenario (critically ill, hematological, and solid organ transplant patients) has been performed, trying to choose the best strategy for each clinical situation (prophylaxis, pre-emptive, empirical, or targeted therapy). The high mortality rates in these settings make mandatory the application of early de-escalation therapy in critically ill patients with fungal infection. In addition, the possibility of antifungal combination therapy might be considered in solid organ transplant and hematological patients. PMID:19337433

  19. Comparative Case Study of Diffusion of Eye Movement Desensitization and Reprocessing in Two Clinical Settings: Empirically Supported Treatment Status Is Not Enough.

    PubMed

    Cook, Joan M; Biyanova, Tatyana; Coyne, James C

    2009-01-01

    An in-depth comparative case study was conducted of two attempts at diffusion of an empirically supported, but controversial, psychotherapy: eye movement desensitization and reprocessing (EMDR). One Department of Veterans Affairs (VA) treatment setting in which there was substantial uptake was compared with a second VA setting in which it was not adopted. Qualitative interviews were conducted with 10 mental health clinicians at the first site, and 19 at the second. Critical selling points for EMDR were a highly regarded champion, the observability of effects with patients, and personally experiencing its effects during a role training session. Compatibility with existing psychotherapist practices and values further allowed the therapy to become embedded in the organizational culture. At the second site, a sense that EMDR was not theoretically coherent or compelling overwhelmed other considerations, including its empirical status. Comparative studies contrasting settings in which innovative therapies are implemented versus those in which they were rejected may aid in refining theories of and strategies for dissemination.

  20. [Changes in the treatment strategy of primary gastric lymphoma].

    PubMed

    Tóth, Imre; Nagy, Zsolt; Barna, Tibor; Szucs, Géza

    2007-04-01

    Nowadays the management strategy for primary gastric lymphoma is undergoing change due to the effectiveness of chemotherapy and immunotherapy. While earlier surgical resection was the primary treatment and chemotherapy was only a follow-on procedure, at the present time this arrangement seems to have been reversed. Early stage low-grade MALT lymphoma can be treated with Helicobacter pylori eradication. Total or subtotal gastrectomy with D2 lymphadenectomy and with adjuvant chemotherapy in R1 situation is proposed up to stage II.1. The strategy is similar in the case of high-grade gastric lymphoma, but resection is useful only in those cases when one can be assured the result will be an R0 situation. With the exception of these cases, the only indication for resection is chemo-resistance. There is no reason for operating in advanced stages of the disease. The only purpose can be to manage complications. Unfortunately, the exact diagnosis is difficult. The diagnosis of lymphoma can often only be made after the operation. In the 6-year period between 1st January 2000 and 31st December 2005 we treated 38 patients for primary gastric lymphoma. Altogether 9 patients were operated on. Resection was performed in 6 cases. The diagnosis of lymphoma was known preoperatively only in one case. Nowadays surgery seems to be only secondary to chemotherapy and immuno-chemotherapy in the treatment of primary gastric MALT lymphoma. Our own cases also mirror this change.

  1. Fluctuating Arctic Sea ice thickness changes estimated by an in situ learned and empirically forced neural network model

    USGS Publications Warehouse

    Belchansky, G.I.; Douglas, D.C.; Platonov, N.G.

    2008-01-01

    Sea ice thickness (SIT) is a key parameter of scientific interest because understanding the natural spatiotemporal variability of ice thickness is critical for improving global climate models. In this paper, changes in Arctic SIT during 1982-2003 are examined using a neural network (NN) algorithm trained with in situ submarine ice draft and surface drilling data. For each month of the study period, the NN individually estimated SIT of each ice-covered pixel (25-km resolution) based on seven geophysical parameters (four shortwave and longwave radiative fluxes, surface air temperature, ice drift velocity, and ice divergence/convergence) that were cumulatively summed at each monthly position along the pixel's previous 3-yr drift track (or less if the ice was <3 yr old). Average January SIT increased during 1982-88 in most regions of the Arctic (+7.6 ?? 0.9 cm yr-1), decreased through 1996 Arctic-wide (-6.1 ?? 1.2 cm yr-1), then modestly increased through 2003 mostly in the central Arctic (+2.1 ?? 0.6 cm yr-1). Net ice volume change in the Arctic Ocean from 1982 to 2003 was negligible, indicating that cumulative ice growth had largely replaced the estimated 45 000 km3 of ice lost by cumulative export. Above 65??N, total annual ice volume and interannual volume changes were correlated with the Arctic Oscillation (AO) at decadal and annual time scales, respectively. Late-summer ice thickness and total volume varied proportionally until the mid-1990s, but volume did not increase commensurate with the thickening during 1996-2002. The authors speculate that decoupling of the ice thickness-volume relationship resulted from two opposing mechanisms with different latitudinal expressions: a recent quasi-decadal shift in atmospheric circulation patterns associated with the AO's neutral state facilitated ice thickening at high latitudes while anomalously warm thermal forcing thinned and melted the ice cap at its periphery. ?? 2008 American Meteorological Society.

  2. Unintentional force changes in cyclical tasks performed by an abundant system: Empirical observations and a dynamical model.

    PubMed

    Reschechtko, Sasha; Hasanbarani, Fariba; Akulin, Vladimir M; Latash, Mark L

    2017-05-14

    The study explored unintentional force changes elicited by removing visual feedback during cyclical, two-finger isometric force production tasks. Subjects performed two types of tasks at 1Hz, paced by an auditory metronome. One - Force task - required cyclical changes in total force while maintaining the sharing, defined as relative contribution of a finger to total force. The other task - Share task - required cyclical changes in sharing while keeping total force unchanged. Each trial started under full visual feedback on both force and sharing; subsequently, feedback on the variable that was instructed to stay constant was frozen, and finally feedback on the other variable was also removed. In both tasks, turning off visual feedback on total force elicited a drop in the mid-point of the force cycle and an increase in the peak-to-peak force amplitude. Turning off visual feedback on sharing led to a drift of mean share toward 50:50 across both tasks. Without visual feedback there was consistent deviation of the two force time series from the in-phase pattern (typical of the Force task) and from the out-of-phase pattern (typical of the Share task). This finding is in contrast to most earlier studies that demonstrated only two stable patterns, in-phase and out-of-phase. We interpret the results as consequences of drifts of parameters in a dynamical system leading in particular to drifts in the referent finger coordinates toward their actual coordinates. The relative phase desynchronization is caused by the right-left differences in the hypothesized drift processes, consistent with the dynamic dominance hypothesis. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

  3. Volume changes of human endothelial cells induced by photodynamic treatment

    NASA Astrophysics Data System (ADS)

    Leunig, Andreas; Staub, Frank; Plesnila, Nick; Peters, Jurgen; Feyh, Jens; Gutmann, Ralph; Goetz, Alwin E.

    1996-01-01

    Photodynamic therapy (PDT) has shown promising results in treatment of malignant tumors. However, the mechanisms leading to tumor destruction during PDT are still not completely understood. In addition to effects on the microcirculation, damage to cellular structures has been observed following exposure of cells to PDT. A phenomenon preceding these events might possibly be cell swelling. We therefore studied the influence of treatment with Photofrin (PF) and laser light on volume changes and cell viability of endothelial cells. Endothelial cells were obtained from human umbilical cord veins (HUVEC) by an adaption of the method of Maruyama (1963). After subcultivation the cells were harvested and transferred as a cell suspension into a specially designed incubation chamber. Cells received either PF in concentrations of 1.5 or 3.0 (mu) g/ml and laser illumination (630 nm; 40 mW/cm2, 4 Joule), PF alone, or laser treatment only. Following start of PF incubation and after phototreatment cell samples were taken for volume measurements using flow cytometry and for studies of cellular morphology using scanning electron microscopy. Simultaneously, cell viability was monitored by the trypan blue exclusion test and colorimetric MTT assay. (abstract truncated)

  4. Changes in optical behaviour of iron pyritohedron upon microwave treatment

    NASA Astrophysics Data System (ADS)

    Arvind, Hemant K.; Choudhary, B. L.; Dolia, S. N.; Dalela, S.; Jakhar, S. R.; Kumar, Sudhish

    2016-05-01

    We have utilized the volumetric heating of materials by microwave energy absorption for investigating the changes in the optical behavior of a well characterized natural crystal of iron pyritohedron (FeS2). For microwave treatment virgin central core pieces of the FeS2 crystal were ground to fine powder and then heated in a microwave oven for half an hour. Powder XRD measurements confirmed that the microwave treatment on FeS2 does not affect the face centered cubic structure of FeS2. The UV-Visible optical spectrum of the microwave treated FeS2 display a narrow optical absorption peak at ˜315 nm, on the other hand in the UV-Vis spectrum of pure FeS2 a broad absorption band with a maximum centered ˜310-330 nm was observed. The band gap energies for pure and microwave treated FeS2 are estimated to be 1.09 eV and 1.35 eV respectively. This study clearly indicates that microwave treatment results in a blue shift in the absorption edge and enhancement in the band gap energy.

  5. Translating Empirically Supported Strategies into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder

    ERIC Educational Resources Information Center

    Smits, Jasper A. J.; Powers, Mark B.; Berry, Angela C.; Otto, Michael W.

    2007-01-01

    Many patients suffering from panic disorder do not receive adequate care. Advances in the conceptualization and treatment of panic disorder encourage innovative strategies for targeting core fears (fears of anxiety sensations) that underlie this disorder. In this article, we discuss the use of exercise as a potential strategy for therapeutic…

  6. A survey of the infrastructure for children's mental health services: implications for the implementation of empirically supported treatments (ESTs).

    PubMed

    Schoenwald, Sonja K; Chapman, Jason E; Kelleher, Kelly; Hoagwood, Kimberly Eaton; Landsverk, John; Stevens, Jack; Glisson, Charles; Rolls-Reutz, Jennifer

    2008-03-01

    A structured interview survey of directors of a large national sample (n = 200) of mental health service organizations treating children examined the governance, financing, staffing, services, and implementation practices of these organizations; and, director ratings of factors important to implementation of new treatments and services. Descriptive analyses showed private organizations financing services with public (particularly Medicaid) funds are prevalent and that employment of professional staff, clinical supervision and training, productivity requirements, and outcomes monitoring are common. Results of random effects regression models (RRMs) evaluating associations between governance, financing, and organizational characteristics and the use of new treatments and services showed for-profit organizations more likely to implement such treatments, and organizations with more licensed clinical staff and weekly clinical supervision in place less likely to do so. Results of RRMs evaluating relations between director ratings of the importance to new treatment and service implementation of three factors-fit with existing implementation practices, infrastructure support, and organizational mission and support-suggest greater importance to public than private organizations of these factors. Implications for EST implementation and future research are described.

  7. Translating Empirically Supported Strategies into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder

    ERIC Educational Resources Information Center

    Smits, Jasper A. J.; Powers, Mark B.; Berry, Angela C.; Otto, Michael W.

    2007-01-01

    Many patients suffering from panic disorder do not receive adequate care. Advances in the conceptualization and treatment of panic disorder encourage innovative strategies for targeting core fears (fears of anxiety sensations) that underlie this disorder. In this article, we discuss the use of exercise as a potential strategy for therapeutic…

  8. Interstitial capillary changes in lithium nephropathy: effects of antihypertensive treatment.

    PubMed

    Skyum, Helle; Marcussen, Niels; Nielsen, Steen Horne; Christensen, Sten

    2004-10-01

    Histopathological changes were investigated in the tubulointerstitium and in the capillaries of male Wistar rats with lithium-induced nephropathy using stereological methods. Two antihypertensive drugs with opposite effects on the renin-angiotensin system, an ACE inhibitor (angiotensin converting enzyme inhibitor) and a thiazide diuretic, modified the nephropathy. Generally, there was a significant positive correlation between the reduction in GFR (glomerular filtration rate) and the reduction in the volume of intact tubular structures and interstitial capillaries. A significant negative correlation was seen between the reduction in GFR and the increase in tubulocapillary distance and the absolute volume of interstitial connective tissue, respectively. Treatment with perindopril, and to some extent hydrochlorothiazide, reversed the rise in systolic blood pressure associated with lithium-induced nephropathy but did not affect the progression to terminal uraemia, the structural renal changes or the mortality. In conclusion, severe tubular and capillary changes are seen in this model of chronic renal failure. Tubular atrophy is associated with a decrease in interstitial capillaries and with an increase in the tubulocapillary distance. Systemic hypertension or activation of the renin-angiotensin system may not be important factors for the progression to terminal renal failure.

  9. Energetics and structure in solvent: A dielectric continuum model of solvation combined with molecular mechanics, Ab Initio, and Semi-empirical molecular orbital treatments of the solute

    SciTech Connect

    Tawa, G.J.; Pratt, L.R.; Martin, R.L.

    1996-12-31

    We present a method for computing the electrostatic component of the solvation free energy, {Delta}G{sup el}, of a solute molecule in the presence of solvent modeled as a dielectric continuum. The method is based on an integral form of Poisson`s equation which is solved to obtain a distribution of induced polarization charge at the solute-solvent dielectric interface. The solution of Poisson`s equation is obtained by application of a boundary element procedure. The method is tested by comparing its predictions of {Delta}G{sup el} to exact values for several model problems. The method is then used in a variety of contexts to assess its qualitative prediction ability. It is first combined with a molecular mechanics treatment of the solute to evaluate the effects of aqueous solvent on the conformational equilibria of several small molecules of interest-these are N-methyl acetamide and alanine dipeptide. For both molecules dielectric continuum solvation predicts torsional free energies of solvation that are in accord with other more complete treatments of solvation. The method is then combined with ab initio and semi-empirical molecular orbital theory for the solute. Self consistent reaction field calculations (SCRF) are performed to evaluate the correlation is in general very good. Relative agreement with experiment is best for ions where electrostatics predominate and worst for non-polar neutral molecules were electrostatics are minor. Semi-empirical configuration interaction SCRF calculations are also performed in the presence of solvent in order to determine ground-to-excited state absorption energy shifts for formaldehyde and indole mine ground-to-excited state absorption energy shifts for formaldehyde and indole when placed in water. We find a rough correlation between transition energy shifts and the dipole moments of the initial and final states involved in the transition.

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

    PubMed Central

    Cwinn, Matthew; Rahman, Sheikh Hasibur

    2017-01-01

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

  11. Reconstructing Holocene sea-level change from coastal freshwater peat: A combined empirical and model-based approach

    NASA Astrophysics Data System (ADS)

    Anderson, William; Gehrels, Roland

    2014-05-01

    Freshwater environments have long been considered to be unsuitable for the reconstruction of Holocene sea-level changes as they provide limiting, rather than precise, sea-level index points. We recorded the stratigraphy of a small beach and backbarrier coastal Phragmites marsh at Hallsands, south Devon, southwest England, using hand-drilled cores and ground penetrating radar, and collected five new sea-level index points from the base of a Holocene peat sequence to refine the regional Holocene relative sea-level curve. We demonstrate that the samples, despite their freshwater origin, represent accurate sea-level index points due to the quantifiable relationship between tide levels and groundwater. By means of water-table monitoring and groundwater modelling we show that the primary controls on the water table in the marsh are: (1) stratigraphy; (2) peat permeability; and (3) recharge rates in the backbarrier marsh. The five index points document relative sea-level positions between 7200 and 2400 cal yr BP. Three points are in good agreement with previously collected regional data from intertidal deposits and two points usefully fill gaps in the existing reconstruction. We present an amended Holocene relative sea-level curve for south Devon, based on 30 data points. We conclude that the base of Holocene freshwater peat sequences in small backbarrier systems provide reliable index points for the reconstruction of relative Holocene sea-level changes provided that: (1) the backbarrier stratigraphy show uninterrupted peat sequences demonstrating that the barrier has remain closed; (2) the water table in the backbarrier marsh is controlled by the tidally-oscillating sea level; (3) values of recharge and peat permeability are such that ponding and drying of the backbarrier marsh is limited; and (4) the beach is relatively thin and its permeability is not the primary control of water-table elevations in the backbarrier marsh. The combined approach of data collection and

  12. Evaluation of treatment and posttreatment changes of protraction facemask treatment using the PAR index.

    PubMed

    Ngan, P; Yiu, C

    2000-10-01

    The purpose of this study was to use the Peer Assesment Rating (PAR) index score to evaluate the treatment and posttreatment changes of Class III patients treated by protraction facemask. The sample consisted of 20 Chinese children, 6 to 11 years old, with Class III skeletal malocclusion who had been treated with maxillary expansion and a protraction facemask. The average treatment time was 8.2 months, followed by 1 year of retention with a Class III functional appliance. Study casts were taken pretreatment (T1), posttreatment (T2), 1 year follow-up (T3), and 2 years follow-up (T4). After treatment, PAR scores were calculated for each time period. Differences among the 4 time periods were analyzed with the Wilcoxin matched-pairs test. Significant reductions in PAR scores were found at T2 (56%), T3 (70%), and T4 (63%) compared with T1. Immediately posttreatment (T2), 17 (85%) of 20 patients had improved PAR scores by a reduction of at least 30%. Reductions were caused primarily by correction of the anterior crossbite. One year after treatment (T3), further reductions in PAR score were noted (P <.01) as a result of better alignment of the anterior segment, improvement of the buccal occlusion, and overbite and midline corrections. Two years after treatment (T4), PAR scores were higher than at the previous time period. The increases were due to relapses in overjet (4 of 20 patients), overbite, and centerline corrections. These results indicate that significant reductions in the severity of Class III malocclusion can be achieved with early orthopedic facemask treatment. In most cases, further improvement in the PAR score can be expected 1 and 2 years after treatment. In a few patients, the benefits of early treatment are negated by relapses in overjet, overbite, and centerline corrections during the follow-up period.

  13. The Changing Landscape of Lung Cancer Research and Treatment

    Cancer.gov

    Along with the Lung Cancer Social Media (#LCSM) community, the National Cancer Institute will be co-hosting a lively and interactive Google Hangout on Air about the changing landscape of lung cancer research and treatment. During the chat, viewers will have the opportunity to pose questions to a panel of lung cancer experts including NCI's Dr. Shakun Malik, the head of thoracic oncology therapeutics, Roy S. Herbst, MD, PhD, Chief of Medical Oncology, Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven and David Tom Cooke MD FACS, Head, Section of General Thoracic Surgery University of California, Davis. You can also learn more and follow along on the #LCSM Chat page. The chat will be moderated by lung cancer advocate and #LCSM co-founder, Janet Freeman-Daily. To ask questions of our experts, simply use the #LCSM hashtag during the chat.

  14. Clarithromycin vs. Gemifloxacin in Quadruple Therapy Regimens for Empiric Primary Treatment of Helicobacter pylori Infection: A Randomized Clinical Trial.

    PubMed

    Masoodi, Mohsen; Talebi-Taher, Mahshid; Tabatabaie, Khadijeh; Khaleghi, Siamak; Faghihi, Amir-Hossein; Agah, Shahram; Asadi, Reyhaneh

    2015-04-01

    BACKGROUND Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection. METHODS In this randomized double blind clinical trial (RCT 2012102011054N2), a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e- Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole (20 mg) twice daily, bismuth subcitrate (240 mg) twice daily, amoxicillin (1 gr) twice daily, and gemifloxacin (320 mg) once daily, and those in the OBAC group received omeprazole (20 mg) twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin (1 gr) twice daily, and clarithromycin (500 mg) twice daily for 10 days. RESULTS Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H.pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively (p=0.568). CONCLUSION The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin.

  15. Blood Pressure and Heart Rate Changes During Clozapine Treatment.

    PubMed

    Norman, Sarah M; Sullivan, Kelli M; Liu, Fang; DiPaula, Bethany A; Jose, Pedro A; Kitchen, Christopher A; Feldman, Stephanie M; Kelly, Deanna L

    2017-09-01

    People with schizophrenia are 3-4 times more likely to die from cardiovascular disease than the general population. Clozapine (CLZ) is the gold standard of treatment for refractory schizophrenia. It has been associated with tachycardia and recent evidence shows individuals prescribed CLZ may develop blood pressure (BP) elevation and hypertension. The purpose of this study was to examine the effects of CLZ on BP and heart rate (HR). This was a retrospective chart review of patients 18-75 years old with a DSM IV diagnosis of Schizophrenia or Schizoaffective disorder. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR measured 12 weeks before and 24 weeks during CLZ treatment. Eighteen patient records were included in this study. The mean stabilized CLZ dose was 441.7 ± 171.8 mg/day. DBP (t = 1.02, df = 79.5, = 2.00, 0.049) and HR (t = 1.32, df = 355  = -4.61, < 0.0001) were significantly higher after CLZ initiation. A trend was noted for increase in SBP (p = 0.071). 22 % of patients met criteria for hypertension before CLZ and 67 % during CLZ treatment (Chi Square = 6.25, df = 1, p = 0.0124). No significant changes in weight or renal function occured during CLZ treatment. No patients had evidence of cardiomyopathy. The data suggest CLZ may be associated with a rise in BP and HR. The results of this study support previous literature that found an increase in SBP/DBP regardless of CLZ dose, occurring early in treatment. Due to high risk of cardiovascular morbidity and mortality, more work is needed to determine risk factors and understand the mechanism of action that may cause this side effect.

  16. Identifying significant covariates for anti-HIV treatment response: mechanism-based differential equation models and empirical semiparametric regression models.

    PubMed

    Huang, Yangxin; Liang, Hua; Wu, Hulin

    2008-10-15

    In this paper, the mechanism-based ordinary differential equation (ODE) model and the flexible semiparametric regression model are employed to identify the significant covariates for antiretroviral response in AIDS clinical trials. We consider the treatment effect as a function of three factors (or covariates) including pharmacokinetics, drug adherence and susceptibility. Both clinical and simulated data examples are given to illustrate these two different kinds of modeling approaches. We found that the ODE model is more powerful to model the mechanism-based nonlinear relationship between treatment effects and virological response biomarkers. The ODE model is also better in identifying the significant factors for virological response, although it is slightly liberal and there is a trend to include more factors (or covariates) in the model. The semiparametric mixed-effects regression model is very flexible to fit the virological response data, but it is too liberal to identify correct factors for the virological response; sometimes it may miss the correct factors. The ODE model is also biologically justifiable and good for predictions and simulations for various biological scenarios. The limitations of the ODE models include the high cost of computation and the requirement of biological assumptions that sometimes may not be easy to validate. The methodologies reviewed in this paper are also generally applicable to studies of other viruses such as hepatitis B virus or hepatitis C virus.

  17. Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain.

    PubMed

    Saturno, Pedro J; Medina, Francesc; Valera, Fermin; Montilla, Joaquina; Escolar, Pilar; Gascón, Juan J

    2003-12-01

    To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain. We identified existing guidelines through a nationwide census and listed their recommendations, grouped according to the main steps of the process flow-chart. To assess reliability we analysed the variability of statements. To analyse validity we assessed the type of scientific evidence supporting the recommendations, and we compared them with a list of evidence-based recommendations that was elaborated for this study. Primary health care centres (n = 24) with guidelines for neck-pain treatment and follow-up. We quantified the number of recommendations, the proportion of valid statements, the frequencies of non-evidence-based recommendations, and the absence of the evidence-based recommendations we had identified. The 34 identified guidelines contained 325 recommendations, with great variation between guidelines with respect to the number, type (for up to 26 different clinical decisions), and content of the recommendations they provided. Direct assessment of the scientific evidence was not possible because no specific reference was given to support any recommendation. When compared with our list, only 20.9% of the recommendations could be considered evidence-based. No guideline contained all the eight evidence-based recommendations we identified. The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.

  18. Changes in rhizosphere bacterial gene expression following glyphosate treatment.

    PubMed

    Newman, Molli M; Lorenz, Nicola; Hoilett, Nigel; Lee, Nathan R; Dick, Richard P; Liles, Mark R; Ramsier, Cliff; Kloepper, Joseph W

    2016-05-15

    In commercial agriculture, populations and interactions of rhizosphere microflora are potentially affected by the use of specific agrichemicals, possibly by affecting gene expression in these organisms. To investigate this, we examined changes in bacterial gene expression within the rhizosphere of glyphosate-tolerant corn (Zea mays) and soybean (Glycine max) in response to long-term glyphosate (PowerMAX™, Monsanto Company, MO, USA) treatment. A long-term glyphosate application study was carried out using rhizoboxes under greenhouse conditions with soil previously having no history of glyphosate exposure. Rhizosphere soil was collected from the rhizoboxes after four growing periods. Soil microbial community composition was analyzed using microbial phospholipid fatty acid (PLFA) analysis. Total RNA was extracted from rhizosphere soil, and samples were analyzed using RNA-Seq analysis. A total of 20-28 million bacterial sequences were obtained for each sample. Transcript abundance was compared between control and glyphosate-treated samples using edgeR. Overall rhizosphere bacterial metatranscriptomes were dominated by transcripts related to RNA and carbohydrate metabolism. We identified 67 differentially expressed bacterial transcripts from the rhizosphere. Transcripts downregulated following glyphosate treatment involved carbohydrate and amino acid metabolism, and upregulated transcripts involved protein metabolism and respiration. Additionally, bacterial transcripts involving nutrients, including iron, nitrogen, phosphorus, and potassium, were also affected by long-term glyphosate application. Overall, most bacterial and all fungal PLFA biomarkers decreased after glyphosate treatment compared to the control. These results demonstrate that long-term glyphosate use can affect rhizosphere bacterial activities and potentially shift bacterial community composition favoring more glyphosate-tolerant bacteria.

  19. Changes in manifest dream affect during psychoanalytic treatment.

    PubMed

    Kramer, Milton; Glucksman, Myron L

    2006-01-01

    Affect is central to our understanding of many processes, including dreams. The question has been raised as to whether it is the affective or narrative aspect of dreaming that is central to its development. The purpose of the study is to assess the frequency and valence of affect in the manifest content of dream reports of patients in analytic therapy and if affect is absent to assess the frequency and valence of affect in the associations to the dream reports without affect [MK1]. The presence and valence of affect was evaluated in the first and last manifest dream report of 24 patients who had completed psychoanalytic treatment. If no affect was found, the dream associations were examined for affect and valence. Affect was found in 58.3% of dream reports. The valence of affect in dream reports became more positive during the course of treatment from 19.2% in the first manifest dream report to 53.3% in the last. The associations to the dream reports without affect had affect 94.1% of the time. Affect was present in either the dream report or the associations to it 97.9% of the time. The positive change in affect is most likely the result of psychotherapeutic treatment, although the psychotropic medication 46% of the patients were on at the time of the last dream report and the passage of time may also be factors. The centrality of affect in dream formation and interpretation is supported if the view of the dream experience includes the associations to the dream report.

  20. Balancing the health workforce: breaking down overall technical change into factor technical change for labour-an empirical application to the Dutch hospital industry.

    PubMed

    Blank, Jos L T; van Hulst, Bart L

    2017-02-17

    Well-trained, well-distributed and productive health workers are crucial for access to high-quality, cost-effective healthcare. Because neither a shortage nor a surplus of health workers is wanted, policymakers use workforce planning models to get information on future labour markets and adjust policies accordingly. A neglected topic of workforce planning models is productivity growth, which has an effect on future demand for labour. However, calculating productivity growth for specific types of input is not as straightforward as it seems. This study shows how to calculate factor technical change (FTC) for specific types of input. The paper first theoretically derives FTCs from technical change in a consistent manner. FTC differs from a ratio of output and input, in that it deals with the multi-input, multi-output character of the production process in the health sector. Furthermore, it takes into account substitution effects between different inputs. An application of the calculation of FTCs is given for the Dutch hospital industry for the period 2003-2011. A translog cost function is estimated and used to calculate technical change and FTC for individual inputs, especially specific labour inputs. The results show that technical change increased by 2.8% per year in Dutch hospitals during 2003-2011. FTC differs amongst the various inputs. The FTC of nursing personnel increased by 3.2% per year, implying that fewer nurses were needed to let demand meet supply on the labour market. Sensitivity analyses show consistent results for the FTC of nurses. Productivity growth, especially of individual outputs, is a neglected topic in workforce planning models. FTC is a productivity measure that is consistent with technical change and accounts for substitution effects. An application to the Dutch hospital industry shows that the FTC of nursing personnel outpaced technical change during 2003-2011. The optimal input mix changed, resulting in fewer nurses being needed to let

  1. Typology of Couples Entering Alcohol Behavioral Couple Therapy: An Empirical Approach and Test of Predictive Validity on Treatment Response

    PubMed Central

    Ladd, Benjamin O.; McCrady, Barbara S.

    2016-01-01

    The current study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking Alcohol Behavioral Couple Therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in-session behavior were established reliably, labeled Avoider, Validator, Hostile, and Ambivalent-Detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types. PMID:25808432

  2. [Treatment of depressive patients in private practice--empirical results, health political and social conditions and recommendations].

    PubMed

    Goesmann, Cornelia; Bühren, Astrid; Neuy-Bartmann, Astrid

    2007-09-01

    Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.

  3. Brain electrical activity changes in treatment refractory schizophrenics after olanzapine treatment.

    PubMed

    Cerdán, Luis F; Guevara, Miguel A; Sanz, Araceli; Amezcua, Claudia; Ramos-Loyo, Julieta

    2005-06-01

    The aim of the present study was to identify brain electrical activity changes generated by olanzapine (OLZ) in treatment refractory schizophrenics (TRS). 14 paranoid TRS (31.5+/-8.39 years old) were evaluated before and after 8 weeks of OLZ treatment. Psychopathology was evaluated by means of total BPRS and PANSS scores. Resting EEG was recorded in the pre (under typical neuroleptics) and post (under OLZ) sessions. A good response to OLZ was observed in 57% of TRS. A significant reduction in positive and negative symptoms scales of PANSS was found. Absolute power of theta1, theta2, alpha1 bands increased after treatment, while beta2 power showed a decrease. Intrahemispheric correlation increased between different zones of the frontal areas and between frontal and posterior areas, while interhemispheric correlation decreased in theta2. EEG changes were more evident in those patients who had a better response to OLZ. OLZ showed to be effective in TRS, improving psychiatric symptoms and increasing activity synchronization between different areas within each hemisphere that may indicate a functional reorganization, particularly in good responders.

  4. Empiric antibiotic protocols for cancer patients with neutropenia: a single center study of treatment efficacy and mortality in patients with bacteremia.

    PubMed

    Kleinhendler, Eyal; Cohen, Matan J; Moses, Allon E; Paltiel, Ora; Strahilevitz, Jacob; Cahan, Amos

    2017-07-10

    A number of empiric antibiotic treatment options for febrile neutropenia exist, yet there is no universally-accepted initial protocol. We aimed to assess the performance of a protocol (piperacillin, gentamicin and cefazolin) introduced over 40 years ago and compare its coverage against bacteria isolated from blood of neutropenic patients to that of various commonly used antibiotic treatment protocols. Adults with neutropenia admitted between 2003 and 2012 to the hemato-oncologic departments, in whom blood cultures were taken on admission were included. Appropriateness of several common antibiotic protocols was assessed based on the susceptibility of the blood isolates. Crude mortality rates were computed by the susceptibility of bacteria isolated from patients' blood to the actual treatment given. In total, 180 admissions of neutropenic patients (in which fever above 38°C was documented in 95) with positive blood cultures were analyzed. The actual antibiotic regimen prescribed was deemed appropriate in 82% of bacteremia episodes. The recommended institutional protocol was used in 62% of bacteremia episodes in neutropenic patients. This protocol would have been appropriate in 85% of all neutropenic bacteremia episodes and 89% of episodes in febrile neutropenia patients, compared to piperacillin/tazobactam (79%, p=0.13 and 76%, p=0.002, respectively) and to imipenem (93%, p=0.004 and 92%, p=0.74, respectively). Isolation of bacteria resistant to the actual antibiotic treatment given was associated with higher mortality at one week and 30 days. Common current antibiotic regimens provide similar coverage among febrile neutropenic patients whereas broad spectrum antibiotic combinations maximize coverage among neutropenic patients. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  5. Ticarcillin-clavulanic acid plus amikacin versus ceftazidime plus amikacin in the empirical treatment of fever in acute leukemia: a prospective randomized trial.

    PubMed

    Fanci, R; Paci, C; Leoni, F; Casini, C; Longo, G

    2003-06-01

    We evaluated the efficacy of ticarcillin-clavulanic acid plus amikacin (TCA) with ceftazidime plus amikacin (CFA) as empiric therapy of fever in acute leukemia in a total of 127 episodes. The overall success rate of the therapy (survival) was 93% in TCA group and 92% in CFA group. Success without therapy modifications (afebrile at 72 hours) was 39% for TCA, 31% for CFA; success with modifications was 55% and 61% respectively. Failure (death due to documented or presumed infection) was 6% for TCA and 8% for CFA. Differences were not statistically significant. The success without modifications was higher in the group of patients with fever of unknown origin (FUO) than in documented infections (DI), mainly with CFA. No differences were documented in the resistance rate and in clinical outcome during severe neutropenia (ANC <100 microl). In our experience TCA is as effective as CFA as first-line treatment in severe neutropenic patients with acute leukemia, although in both regimens patients with DI are likely to require modifications in treatment.

  6. Advanced Wastewater Treatment Engineering—Investigating Membrane Fouling in both Rotational and Static Membrane Bioreactor Systems Using Empirical Modelling

    PubMed Central

    Paul, Parneet; Jones, Franck Anderson

    2016-01-01

    Advanced wastewater treatment using membranes are popular environmental system processes since they allow reuse and recycling. However, fouling is a key limiting factor and so proprietary systems such as Avanti’s RPU-185 Flexidisks membrane bioreactor (MBR) use novel rotating membranes to assist in ameliorating it. In earlier research, this rotating process was studied by creating a simulation model based on first principles and traditional fouling mechanisms. In order to directly compare the potential benefits of this rotational system, this follow-up study was carried out using Avanti’s newly developed static (non-rotating) Flexidisks MBR system. The results from operating the static pilot unit were simulated and modelled using the rotational fouling model developed earlier however with rotational switching functions turned off and rotational parameters set to a static mode. The study concluded that a rotating MBR system could increase flux throughput when compared against a similar static system. It is thought that although the slowly rotating spindle induces a weak crossflow shear, it is still able to even out cake build up across the membrane surface, thus reducing the likelihood of localised critical flux being exceeded at the micro level and lessening the potential of rapid trans-membrane pressure increases at the macro level. PMID:26742053

  7. Advanced Wastewater Treatment Engineering-Investigating Membrane Fouling in both Rotational and Static Membrane Bioreactor Systems Using Empirical Modelling.

    PubMed

    Paul, Parneet; Jones, Franck Anderson

    2016-01-05

    Advanced wastewater treatment using membranes are popular environmental system processes since they allow reuse and recycling. However, fouling is a key limiting factor and so proprietary systems such as Avanti's RPU-185 Flexidisks membrane bioreactor (MBR) use novel rotating membranes to assist in ameliorating it. In earlier research, this rotating process was studied by creating a simulation model based on first principles and traditional fouling mechanisms. In order to directly compare the potential benefits of this rotational system, this follow-up study was carried out using Avanti's newly developed static (non-rotating) Flexidisks MBR system. The results from operating the static pilot unit were simulated and modelled using the rotational fouling model developed earlier however with rotational switching functions turned off and rotational parameters set to a static mode. The study concluded that a rotating MBR system could increase flux throughput when compared against a similar static system. It is thought that although the slowly rotating spindle induces a weak crossflow shear, it is still able to even out cake build up across the membrane surface, thus reducing the likelihood of localised critical flux being exceeded at the micro level and lessening the potential of rapid trans-membrane pressure increases at the macro level.

  8. Changes in Trypanosoma cruzi-specific immune responses following treatment: surrogate markers of treatment efficacy

    PubMed Central

    Laucella, Susana A.; Mazliah, Damián Pérez; Bertocchi, Graciela; Alvarez, María G.; Cooley, Gretchen; Viotti, Rodolfo; Albareda, María C.; Lococo, Bruno; Postan, Miriam; Armenti, Alejandro; Tarleton, Rick L.

    2009-01-01

    Background As many as 20 million people are living with Trypanosoma cruzi infection in Latin American, yet few receive any treatment. The major limitation in developing and evaluating potential new drugs for their efficacy is the lack of reliable tests to assess parasite burden and elimination. Methods Adults volunteers with chronic T. cruzi infection were evaluated clinically and stratified according to the Kuschnir classification. Individuals in group 0 and group 1 clinical status were treated with 5 mg benznidazole/kg/day for 30 days. The changes in T. cruzi-specific T cell and antibody responses, as well as in clinical status, were measured periodically over the 3-5 year follow-up period and compared to pre-treatment conditions and to an untreated control group. Results The frequency of peripheral IFN- g-producing T cells specific for T. cruzi declined as early as 12 months after BZ treatment and subsequently became undetectable in a substantial proportion of treated subjects. Addtionally decreases in antibody responses to a pool of recombinant T. cruzi proteins also declined in many of these same subjects. The shift to negative IFN- g T cell responses was highly associated with an early increase in IFN- g-producing T cells with phenotypic features of effector/effector memory cells in a subset of subjects. Benznidazole treatment also resulted in an increase in naïve and early differentiated memory-like CD8+ T cells in a majority of subjects. Conclusions BZ treatment during chronic Chagas disease has a substantial impact on parasite-specific immune response that is likely to be indicative of treatment efficacy and cure. PMID:19877967

  9. Fleet Fatality Risk and its Sensitivity to Vehicle Mass Change in Frontal Vehicle-to-Vehicle Crashes, Using a Combined Empirical and Theoretical Model.

    PubMed

    Shi, Yibing; Nusholtz, Guy S

    2015-11-01

    The objective of this study is to analytically model the fatality risk in frontal vehicle-to-vehicle crashes of the current vehicle fleet, and its sensitivity to vehicle mass change. A model is built upon an empirical risk ratio-mass ratio relationship from field data and a theoretical mass ratio-velocity change ratio relationship dictated by conservation of momentum. The fatality risk of each vehicle is averaged over the closing velocity distribution to arrive at the mean fatality risks. The risks of the two vehicles are summed and averaged over all possible crash partners to find the societal mean fatality risk associated with a subject vehicle of a given mass from a fleet specified by a mass distribution function. Based on risk exponent and mass distribution from a recent fleet, the subject vehicle mean fatality risk is shown to increase, while at the same time that for the partner vehicles decreases, as the mass of the subject vehicle decreases. The societal mean fatality risk, the sum of these, incurs a penalty with respect to a fleet with complete mass equality. This penalty reaches its minimum (~8% for the example fleet) for crashes with a subject vehicle whose mass is close to the fleet mean mass. The sensitivity, i.e., the rate of change of the societal mean fatality risk with respect to the mass of the subject vehicle is assessed. Results from two sets of fully regression-based analyses, Kahane (2012) and Van Auken and Zellner (2013), are approximately compared with the current result. The general magnitudes of the results are comparable, but differences exist at a more detailed level. The subject vehicle-oriented societal mean fatality risk is averaged over all possible subject vehicle masses of a given fleet to obtain the overall mean fatality risk of the fleet. It is found to increase approximately linearly at a rate of about 0.8% for each 100 lb decrease in mass of all vehicles in the fleet.

  10. Global Transcriptional Changes Following Statin Treatment in Breast Cancer.

    PubMed

    Bjarnadottir, Olöf; Kimbung, Siker; Johansson, Ida; Veerla, Srinivas; Jönsson, Mats; Bendahl, Pär-Ola; Grabau, Dorthe; Hedenfalk, Ingrid; Borgquist, Signe

    2015-08-01

    Statins purportedly exert antitumoral effects, but the underlying mechanisms are currently not fully elucidated. The aim of this study was to explore potential statin-induced effects on global gene expression profiles in primary breast cancer. This window-of-opportunity phase II trial enrolled 50 newly diagnosed breast cancer patients prescribed atorvastatin (80 mg/day) for 2 weeks presurgically. Pre- and posttreatment tumor samples were analyzed using Significance Analysis of Microarrays (SAM) to identify differentially expressed genes. Similarly, SAM and gene ontology analyses were applied to gene expression data derived from atorvastatin-treated breast cancer cell lines (MCF7, BT474, SKBR3, and MDAMB231) comparing treated and untreated cells. The Systematic Motif Analysis Retrieval Tool (SMART) was used to identify enriched transcription factor-binding sites. Literature Vector Analysis (LitVAn) identified gene module functionality, and pathway analysis was performed using GeneGo Pathways Software (MetaCore; https://portal.genego.com/). Comparative analysis of gene expression profiles in paired clinical samples revealed 407 significantly differentially expressed genes (FDR = 0); 32 upregulated and 375 downregulated genes. Restricted filtration (fold change ≥1.49) resulted in 21 upregulated and 46 downregulated genes. Significantly upregulated genes included DUSP1, RHOB1, GADD45B, and RGS1. Pooled results from gene ontology, LitVAn and SMART analyses identified statin-induced effects on the apoptotic and MAPK pathways among others. Comparative analyses of gene expression profiles in breast cancer cell lines showed significant upregulation of the mevalonate and proapoptotic pathways following atorvastatin treatment. We report potential statin-induced changes in global tumor gene expression profiles, indicating MAPK pathway inhibition and proapoptotic events. ©2015 American Association for Cancer Research.

  11. Evidence for Adverse Phonatory Change Following an Inhaled Combination Treatment

    ERIC Educational Resources Information Center

    Erickson, Elizabeth; Sivasankar, Mahalakshmi

    2010-01-01

    Purpose: Voice problems are reported as a frequent side effect of inhaled combination (IC) treatments. The purpose of this experimental study was to investigate whether IC treatments are detrimental to phonation. We hypothesized that IC treatment would significantly increase phonation threshold pressure (PTP) and perceived phonatory effort (PPE),…

  12. Evidence for Adverse Phonatory Change Following an Inhaled Combination Treatment

    ERIC Educational Resources Information Center

    Erickson, Elizabeth; Sivasankar, Mahalakshmi

    2010-01-01

    Purpose: Voice problems are reported as a frequent side effect of inhaled combination (IC) treatments. The purpose of this experimental study was to investigate whether IC treatments are detrimental to phonation. We hypothesized that IC treatment would significantly increase phonation threshold pressure (PTP) and perceived phonatory effort (PPE),…

  13. Very large treatment effects in randomised trials as an empirical marker to indicate whether subsequent trials are necessary: meta-epidemiological assessment

    PubMed Central

    Nagendran, Myura; Pereira, Tiago V; Kiew, Grace; Altman, Douglas G; Maruthappu, Mahiben; Ioannidis, John P A

    2016-01-01

    Objective To examine whether a very large effect (VLE; defined as a relative risk of ≤0.2 or ≥5) in a randomised trial could be an empirical marker that subsequent trials are unnecessary. Design Meta-epidemiological assessment of existing published data on randomised trials. Data sources Cochrane Database of Systematic Reviews (2010, issue 7) with data on subsequent large trials updated to 2015, issue 12. Eligibility criteria All binary outcome forest plots were selected, which contained an index randomised trial with a VLE that was nominally statistically significant (P<0.05), included a subsequent large randomised trial (≥200 events and ≥200 non-events) for validation of the effect, assessed a primary outcome of the review, and was not a subgroup or sensitivity analysis. Results Of 3082 reviews yielding 85 002 forest plots, only 44 (0.05%) satisfied the inclusion criteria. Index trials were generally small, with a median sample of 99 (median 14 events). Few index trials were rated at low risk of bias (9 of 44; 20%). The relative risk was closer to the null in the subsequent large trials in 43 of 44 cases. Subsequent large trial data failed to find a statistically significant (P<0.05) effect in the same direction in 19 cases (43%, 95% confidence interval 29% to 58%). Even when the subsequent large trials did find a significant effect in the same direction, the additional primary outcomes in most of these trials would have to be considered before deciding in favour of using the intervention. Subsequent large trial data found a statistically significant effect in the same direction in 19 of 21 cases when the index trial also had a value of P<0.001. Conclusions The frequency of VLEs followed by a large trial is vanishingly small, and where they occur they do not appear to be a reliable marker for a benefit that is reproducible and directly actionable. An empirical rule using a VLE in a randomised controlled trial as a marker that further trials are

  14. The impact of pathological narcissism on psychotherapy utilization, initial symptom severity, and early-treatment symptom change: a naturalistic investigation.

    PubMed

    Ellison, William D; Levy, Kenneth N; Cain, Nicole M; Ansell, Emily B; Pincus, Aaron L

    2013-01-01

    The impact of pathological narcissism on psychotherapy has seldom been investigated empirically, despite extensive clinical theory proposing that highly narcissistic individuals should be reluctant to engage in treatment and derive smaller benefits from therapy. In this study, we investigate the relationship between scores on the Pathological Narcissism Inventory (PNI; Pincus et al., 2009), which assesses both narcissistic grandiosity and narcissistic vulnerability, and clinical variables in a sample of outpatients (N=60) at a community mental health center. Results indicated that grandiosity, but not vulnerability, was negatively related to the use of adjunctive services and positively predicted client-initiated termination of psychotherapy. In addition, grandiosity and vulnerability were related to initial levels of different symptoms in multilevel models using a subsample (n=41) but not generally related to the linear rate of symptom change in early psychotherapy. The results highlight the clinical utility of assessing pathological narcissism in a real-world psychotherapeutic context.

  15. Multimodality treatment strategies have changed prognosis of peritoneal metastases

    PubMed Central

    Lungoci, Corneliu; Mironiuc, Aurel Ion; Muntean, Valentin; Oniu, Traian; Leebmann, Hubert; Mayr, Max; Piso, Pompiliu

    2016-01-01

    For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with “terminal status/despair”. The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists’ perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. PMID:26798438

  16. The Essence of Residential Treatment: III. Change and Adaptation

    ERIC Educational Resources Information Center

    Leichtman, Martin

    2008-01-01

    This paper examines four challenges facing residential treatment programs: Providing short-term treatment, increasing family involvement, preparing children for life in the community, and offering a "hospital level of care." It shows that past problems in these areas have arisen from the social conditions and historical circumstances in which…

  17. Sequential Changes in Cortical Excitation during Orthodontic Treatment.

    PubMed

    Horinuki, E; Yamamoto, K; Shimizu, N; Koshikawa, N; Kobayashi, M

    2016-07-01

    Cortical excitation responding to periodontal ligament (PDL) stimulation is observed in the rat primary somatosensory (S1), secondary somatosensory, and insular oral region of the cortex (S2/IOR), which are considered to process somatosensation, including nociception. Our previous studies have demonstrated that excitatory propagation induced by PDL stimulation is facilitated in S1 and S2/IOR 1 d after experimental tooth movement (ETM), and tetanic stimulation of IOR induces long-term potentiation of cortical excitatory propagation consistently. These findings raise the possibility that ETM induces neuroplastic changes, and as a result, facilitation of cortical excitation would be sustained for weeks. However, no information is available about the temporal profiles of the facilitated cortical responses. We estimated PDL stimulation-induced cortical excitatory propagation in S1 and S2/IOR of rats by optical imaging 1 to 7 d after ETM of the maxillary first molar. ETM models showed facilitated cortical excitatory propagation in comparison with controls and sham groups 1 d after ETM, but the facilitation gradually recovered to the control level 3 to 7 d after ETM. Sham groups that received wire fixation without orthodontic force tended to enhance cortical responses, although the differences between controls and sham groups were almost insignificant. We also examined the relationship between cortical responses and expression of inflammatory cytokines, interleukin (IL)-1β and tumor necrosis factor (TNF)-α, in PDL of the first molar. The peak amplitude of optical signals responding to PDL stimulation tended to be increased in parallel to the number of IL-1β and TNF-α immunopositive cells, suggesting that, at least in part, the enhancement of cortical responses is induced by PDL inflammation. These findings suggest that ETM-induced facilitation of cortical excitatory propagation responding to PDL stimulation 1 d after ETM recovers to the control level within a week

  18. Single-daily ceftriaxone plus amikacin versus thrice-daily ceftazidime plus amikacin as empirical treatment of febrile neutropenia in children with cancer.

    PubMed

    Ariffin, H; Arasu, A; Mahfuzah, M; Ariffin, W A; Chan, L L; Lin, H P

    2001-02-01

    Empirical antibiotic treatment for febrile neutropenic patients has been the mainstay of treatment for many years. Beta-lactam antibiotics and aminoglycosides have been the most frequently used drug combination. The purpose of this study was to evaluate the efficacy, safety, tolerance and costs of single-daily ceftriaxone plus amikacin versus thrice-daily dose of ceftazidime plus amikacin. One hundred and ninety-one episodes of fever and neutropenia in 128 patients from October 1997 to December 1998 were included in a prospective, open-label, single-centre study. Patients were randomly assigned to either treatment group and evaluated as successes or failures according to defined criteria. Daily assessments were made on all patients and all adverse events recorded. Univariate and multivariate analysis of outcomes and a cost analysis were carried out. There were 176 evaluable patient-episodes with 51.1% in the single-daily ceftriaxone-amikacin group and 48.9% in the ceftazidime-amikacin group. There were 50 positive blood cultures: 12 Gram-positive bacteria, 33 Gram-negative bacteria and five fungi. Pseudomonas aeruginosa (P. aeruginosa) accounted for 14% of total isolates. The overall success rate was 55.5% in the ceftriaxone group compared to 51.2% in the ceftazidime group (P = 0.56). Mean time to defervescence was 4.2 days in the single-daily group and 4.3 days in the thrice-daily group. There were nine infection-related deaths; five in the single-daily ceftriaxone group. The daily cost of the once-daily regime was 42 Malaysian Ringgit less than the thrice-daily regime. There was a low incidence of adverse effects in both groups, although ototoxicity was not evaluable. The once-daily regime of ceftriaxone plus amikacin was as effective as the 'standard' combination of thrice-daily ceftazidime and amikacin with no significant adverse effects in either group. The convenience and substantial cost benefit of the once-daily regime will be particularly useful in

  19. Simple physical-empirical model of the precipitation distribution based on a tropical sea surface temperature threshold and the effects of climate change

    NASA Astrophysics Data System (ADS)

    Jauregui, Yakelyn R.; Takahashi, Ken

    2017-06-01

    The observed nonlinear relationship between tropical sea surface temperature (T_s ) and precipitation (P) on climate timescales, by which a threshold (T_c ) must be exceeded by T_s in order for deep convection to occur, is the basis of a physical-empirical model (PEM) that we fitted to observational data and CMIP5 climate model output and used to show that, with essentially only two constant parameters (T_c and the sensitivity a_1 of P to T_s>T_c ), it provides a useful first-order description of the climatological and interannual variability of the large-scale distribution of tropical P given T_s , as well as of the biases of the Global Climate Models (GCMs). A substantial limitation is its underestimation of the peak P in the convergence zones, as the necessary processes associated with the atmospheric circulation are not considered. The pattern of the intermodel correlation between the mean T_s-T_c for each GCM and the average P distribution is in agreement with the double ITCZ bias, featuring roughly zonally-symmetric off-equatorial maxima, rather than being regionally or hemispherically restricted. The inter-comparison of GCMs indicates a relationship between T_c with the near-equatorial low-level (850 hPa) tropospheric temperature, consistent with the interpretation that it is a measure of the convective inhibition (CIN). The underestimation of T_c is linked to the cold free tropospheric bias in the GCMs. However, the discrepancy among the observational datasets is a limitation for assessing the GCM biases from the PEM framework quantitatively. Under the RCP4.5 climate change scenario, T_c increases slightly more than the mean tropical T_s , implying a stabilizing trend consistent with the amplified free tropospheric warming relative to the surface. However, since a_1 increases by 10-50%/° C with the surface warming, its effect dominates and results in generally positive precipitation change (Δ P ) in the equatorial regions. In the equatorial eastern

  20. Gender representation of cancer patients in medical treatment and psychosocial survivorship research: changes over three decades.

    PubMed

    Hoyt, Michael A; Rubin, Lisa R

    2012-10-01

    Prior studies raise concern about gender bias in cancer research, including insufficient inclusion of women or men, or studying women and men differently. The 1993 National Institutes of Health Revitalization Act aimed to eliminate gender bias in medicine. To examine changes in medical and psychological literature, this study reviews gender representation in biomedical treatment studies and psychosocial survivorship studies published in a single year. Research published in Cancer in 2007, and all empirical psychological studies about cancer published that year, provided a 15-year update to findings reported by Meyerowitz and Hart. The gender distribution and context of included articles were coded and compared with findings from 1983 and 1992. Across biomedical studies, 34.3% of subjects were women (vs 47% of new cancers and 48% of cancer deaths). Among men, 41.3% had sex-specific cancers (vs 12.5% [1983] and 12.3% [1992]). Among women, 46.1% had sex-specific cancers (vs 69.1% [1983] and 64.6% [1992]). Fewer women (36.8%) were represented in sex-nonspecific cancer studies (vs 41.4% [1983] and 42.5% [1992]); however, fewer studies had a significant (>20%) gender disparity. Across psychosocial studies, representation of men increased to 47.9% (vs 30.4% [1983] and 29.9% [1992]). The proportion of men in studies of feelings/relationships increased to 47% (vs 22.9% [1992]); the proportion of women in studies assessing physical/functional ability increased to 58.3% (vs 45.4%). Women remain under-represented in sex-nonspecific biomedical research, whereas men's representation in sex-specific research increased substantially. Psychosocial research trends suggest movement from research questions supporting traditional stereotypes that women feel and men act. Copyright © 2012 American Cancer Society.

  1. Changes in treatment plan for carpal tunnel syndrome based on electrodiagnostic test results.

    PubMed

    Becker, S J E; Makanji, H S; Ring, D

    2014-02-01

    This study evaluated how often the treatment plan for carpal tunnel syndrome (CTS) changed based on electrodiagnostic test results. Secondly, we assessed factors associated with a change in the treatment plan for CTS. One-hundred-and-thirty English-speaking adult patients underwent electrodiagnostic testing in a prospective cohort study. Treatment plan was recorded before and after testing. Treatment plan changed in 25 patients (19%) based on electrodiagnostic test results. The plan for operative treatment before testing decreased significantly after testing (83% versus 72%). The best logistic regression model for no change in treatment plan included a prolonged or non-recordable median distal sensory latency (normal, prolonged, or non-recordable), and explained 24% of the variation. For surgeons that manage CTS on the basis of objective pathophysiology rather than symptoms, electrodiagnostic test results often lead to changes in recommended treatment.

  2. 76 FR 17617 - Changes to Treatments for Citrus Fruit From Australia

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    ...; ] DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service Changes to Treatments for Citrus Fruit... phytosanitary treatments. SUMMARY: We are advising the public that we are adding new approved phytosanitary treatment schedules to the Plant Protection and Quarantine Treatment Manual for certain species of...

  3. [Personality changes of neurotic patients as outcome of the treatment].

    PubMed

    Jodzio, K

    1993-01-01

    The present article attempted to assess the importance of outcomes which appeared during the treatment of 30 neurotic patients. This study specially concentrates on measures of emotional empathy, self-confidence and introspection. There were two surveys in the clinical group: before and after the treatment was completed. Data were compared with a control group, also consisting of 30 persons (15 male and 15 female) matched for age and education. All patients attending group psychotherapy were also treated by pharmacotherapy. As it appeared from the analysis before treatment high empathy in patients was found, but this declined after therapy, however it was still significantly higher than in the control group. The first survey revealed also that patients demonstrated lower levels of self-confidence and introspection. After treatment there were no important differences between the groups. Relationships between the studied qualities were not statistically significant.

  4. Assessing the Impacts of Climate Change on Drinking Water Treatment

    EPA Science Inventory

    Climate change may affect both surface water and ground water quality. Increases (or decreases) in precipitation and related changes in flow can result in problematic turbidity levels, increased levels of organic matter, high levels of bacteria, virus and parasites and increased...

  5. Assessing the Impacts of Climate Change on Drinking Water Treatment

    EPA Science Inventory

    Climate change may affect both surface water and ground water quality. Increases (or decreases) in precipitation and related changes in flow can result in problematic turbidity levels, increased levels of organic matter, high levels of bacteria, virus and parasites and increased...

  6. Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment

    PubMed Central

    Chen, Ronald C.; Dusetzina, Stacie B.; Wheeler, Stephanie B.; Jackson, George L.; Nielsen, Matthew E.; Carpenter, William R.; Weinberger, Morris

    2016-01-01

    Purpose: The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment. Methods: We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics. Results: Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00). Conclusion: Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care. PMID:26957641

  7. One-year treatment patterns and change trajectories for adolescents participating in outpatient treatment for the first time.

    PubMed

    Godley, Susan H; Passetti, Lora L; Funk, Rodney R; Garner, Bryan R; Godley, Mark D

    2008-03-01

    The American Society on Addiction Medicine's Patient Placement criteria are commonly used in adolescent treatment. However, the use of these criteria and how they affect the course of treatment and interact with adolescent change has not been examined. Twelve-month treatment patterns were examined for 176 adolescents who entered their first ever episode in a treatment system using these criteria. Forty-one percent of the adolescents received additional treatment after their initial outpatient episode with over 30 unique treatment sequences (i.e., various combinations of outpatient, intensive outpatient, and residential treatment). Significant differences in treatment patterns were found between the change trajectory groups. For example, adolescents who participated in only one outpatient treatment episode were more likely to be in the low alcohol and drug use (AOD) group and less likely to have high rates of time in a controlled environment or to report moderate AOD use. Over one-third of the adolescents participated in additional treatment and almost one-quarter of those who only participated in outpatient treatment had problematic use. These findings suggest the need for clinical monitoring protocols that can be used to identify adolescents needing additional treatment or recovery services.

  8. Towards empirical identification of a clinically meaningful indicator of treatment outcome: Features of candidate indicators and evaluation of sensitivity to treatment effects and relationship to one year follow up cocaine use outcomes

    PubMed Central

    Carroll, Kathleen M.; Kiluk, Brian D.; Nich, Charla; DeVito, Elise E.; Decker, Suzanne; LaPaglia, Donna; Duffey, Dianne; Babuscio, Theresa A.; Ball, Samuel A.

    2014-01-01

    Background Selection of an appropriate indictor of treatment response in clinical trials is complex, particularly for the various illicit drugs of abuse. Most widely-used indicators have been selected based on expert group recommendation or convention rather than systematic empirical evaluation. Absence of an evidence-based, clinically meaningful index of treatment outcome hinders cross-study evaluations necessary for progress in addiction treatment science. Method Fifteen candidate indicators used in multiple clinical trials as well as some proposed recently are identified and discussed in terms of relative strengths and weaknesses (practicality, cost, verifiability, sensitivity to missing data). Using pooled data from five randomized controlled trials of cocaine dependence (N = 434), the indicators were compared in terms of sensitivity to the effects of treatment and relationship to cocaine use and general functioning during follow-up. Results Commonly used outcome measures (percent negative urine screens; percent days of abstinence) performed relatively well in that they were sensitive to the effects of the therapies evaluated. Others, including complete abstinence and reduction in frequency of use, were less sensitive to effects of specific therapies and were very weakly related to cocaine use or functioning during follow-up. Indicators more strongly related to cocaine use during follow-up were those that reflected achievement of sustained periods of abstinence, particularly at the end of treatment. Conclusions These analyses did not demonstrate overwhelming superiority of any single indicator, but did identify several that performed particularly poorly. Candidates for elimination included retention, complete abstinence, and indicators of reduced frequency of cocaine use. PMID:24556275

  9. A scoping study to identify opportunities to advance the ethical implementation and scale-up of HIV treatment as prevention: priorities for empirical research

    PubMed Central

    2014-01-01

    Background Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and “scaling up” of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. Methods We drew on the Arksey and O’Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Results Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader

  10. Using dreams to assess clinical change during treatment.

    PubMed

    Glucksman, Myron L; Kramer, Milton

    2004-01-01

    This article describes several studies that examine the relationship between the manifest content of selected dreams reported by patients and their clinical progress during psychoanalytic and psychodynamically oriented treatment. There are a number of elements that dreaming and psychotherapy have in common: affect regulation; conflict resolution; problem-solving; self-awareness; mastery and adaptation. Four different studies examined the relationship between the manifest content of selected dreams and clinical progress during treatment. In each study, the ratings of manifest content and clinical progress by independent observers were rank-ordered and compared. In three of the four studies there was a significant correlation between the rankings of manifest content and the rankings of clinical progress. This finding suggests that the manifest content of dreams can be used as an independent variable to assess clinical progress during psychoanalytic and psychodynamically oriented treatment.

  11. Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.

    PubMed

    Ng, Tat Ming; Khong, Wendy X; Harris, Patrick N A; De, Partha P; Chow, Angela; Tambyah, Paul A; Lye, David C

    2016-01-01

    Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), P<0.01). After adjusting for confounders, use of empiric piperacillin-tazobactam was not associated with increased 30-day mortality (OR 1.00, 95% CI; 0.45-2.17). Empiric piperacillin-tazobactam was not associated with increased 30-day mortality and may result in fewer multi-drug resistant and fungal infections when compared with a carbapenem.

  12. Ultrasonic verification of microstructural changes due to heat treatment

    NASA Technical Reports Server (NTRS)

    Generazio, E. R.

    1986-01-01

    Ultrasonic attenuation was measured for polycrystalline samples of nickel and copper with various grain-size distributions produced by heat treatment. Attenuation as a function of frequency was determined for a sample having a known mean grain diameter. Once this function was determined, it could be scaled to determine the mean grain size of other samples of the same material with different mean grain diameters. These results were obtained by using broadband pulse-echo ultrasound in the 25 to 100 MHz frequency range. The results suggest an ultrasonic, nondestructive approach for verifying heat treatment of metals.

  13. [CHANGES OF A TREATMENT PROGRAM FOR AN ACUTE PANCREATITIS].

    PubMed

    Kostyrnoy, O V; Kosenko, A V; Bayomi, Imad Mokhamed Abdel S K

    2015-11-01

    Pathogenetically substantiated program of complex diagnosis, prophylaxis and treatment of purulent-necrotic complications (PNC) was elaborated for improvement of results of the necrotic pancreatitis treatment. With the objective to study the PNC pathogenesis and a probation of new preparations for local treatment the experimantal simulation of the disease was accomplished. There was proved, that during the disease course the integrity of pancreatic ductal system is disordered . A 42-year experience of treatment of an acute pancreatitis was analyzed. In I period (1970 - 1980) the operative interventions were conducted; in 11 period (1981 - 1991)--a scientifically substantiated conservative therapy; in III period (1992 - 2000)--the diagnostic procedures possibilities were extended, and operative intervention were performed in accordance to severe indications. There was established, that the main cause of PNC is a secondary microbal contamination occurrence on the third-fifth postoperative days, the immediate manipulations on pancreatic gland are forbidden; a one-time surgical processing of the necrosis foci is insufficient; the staged necrsequestrectomy constitutes the optimal operation.

  14. Comparative assessment of organic and conventional production of row crops under climate change: Empirical and simulated yield variation in the Chippewa River Watershed, MN

    USDA-ARS?s Scientific Manuscript database

    The long-term provision of ecosystem services, including stable temporal crop yields, provided by the traditional corn-soybean cropping system in the Chippewa River Watershed (CRW) in west-central Minnesota are being threatened by several anthropogenic and climatic factors. We conducted an empirical...

  15. 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.

  16. Physiological Changes in Older Adults and Their Effect on Diabetes Treatment

    PubMed Central

    Gates, Brian J.; Walker, Kevin M.

    2014-01-01

    In Brief Physiological changes associated with aging have the potential to affect the treatment of diabetes. However, evidence regarding treatment of diabetes in geriatric patients has been limited, especially for “oldest-old” patients. Recent research has provided greater insight into the risks and benefits of treatment, and new guidelines provide more specific information regarding treatment goals in older people with diabetes and encourage greater individualization of treatment. PMID:26246752

  17. 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...

  18. Body mass index change in autism spectrum disorders: comparison of treatment with risperidone and aripiprazole.

    PubMed

    Wink, Logan K; Early, Maureen; Schaefer, Tori; Pottenger, Amy; Horn, Paul; McDougle, Christopher J; Erickson, Craig A

    2014-03-01

    The purpose of this study was to assess change in body mass index (BMI) and age- and gender-adjusted BMI Z-score in subjects ages 2-20 years with autism spectrum disorders (ASD), who were treated longitudinally with risperidone or aripiprazole at a tertiary care ASD clinic. As part of a larger project involving longitudinal drug treatment data in ASD, detailed demographic and treatment data were collected for 142 subjects ages 2-20 years who had been started on risperidone or aripiprazole for treatment of irritability. Mean age at start of treatment, treatment duration, final Clinical Global Impressions-Improvement Scale score, BMI change per year of treatment, and BMI Z-score change per year of treatment (primary outcome measure) were calculated for each drug treatment group. Group means were compared using t tests and Wilcoxon rank sum tests. There was a statistically significant BMI and BMI Z-score increase in the risperidone and aripiprazole treatment groups individually. No statistically significant difference between the two treatment groups was noted in mean BMI change per year of treatment or BMI Z-score change per year of treatment. In our review of long-term naturalistic treatment of irritability using risperidone versus aripiprazole in persons with ASD, a significant increase in both BMI and age- and gender-adjusted BMI Z-score was noted for each treatment group. No significant difference in BMI or BMI Z-score change was noted when the two treatment groups were compared. We conclude that in our patient population at a tertiary care ASD clinic, the effects of risperidone and aripiprazole on body weight gain in naturalistic long-term treatment are no different.

  19. Changing Needle Practices in Community Outreach and Methadone Treatment.

    ERIC Educational Resources Information Center

    Wechsberg, Wendee M.; And Others

    1994-01-01

    This pretest/posttest study used two samples of injecting drug users (184 from street outreach and 103 from a methadone program) to assess drug use and human immunodeficiency virus risk practices. The improvement in risk behaviors at posttest suggests that intervention programs were agents of change. (SLD)

  20. Changes in vitamin D metabolites during teriparatide treatment

    USDA-ARS?s Scientific Manuscript database

    The objective was to assess changes in serum 1,25(OH)2D and 25(OH)D concentrations during teriparatide 20 g/day (teriparatide) therapy in the double-blind Fracture Prevention Trial of postmenopausal women with osteoporosis and male study of men with osteoporosis. Patients were randomized to teripara...

  1. Treatment Ideology and Correctional Bureaucracy: A Study of Organizational Change.

    ERIC Educational Resources Information Center

    Martinson, Robert Magnus

    A study was made of organizational change induced by a staff training project in six correctional institutions for youth in the California system, which is currently engaged in introducing "therapeutic community" into correctional facilities. Part I described and evaluated a federally financed training project. The "resource…

  2. 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.

  3. Identifying Patients Who Need a Change in Depression Treatment and Implementing That Change.

    PubMed

    Papakostas, George I

    2016-08-01

    For patients whose depression is difficult to treat or treatment-resistant, physicians must make an educated choice to switch, augment, or combine therapies to help patients adequately respond after initial treatment selections fail. Uncover some of the complexities of this challenging diagnosis by following the case of Robert, a 55-year-old accountant whose inadequate response to treatment by his primary care doctor has prompted a referral to a specialist.

  4. Common misconceptions about cognitive mediation of treatment change: a commentary to Longmore and Worrell (2007).

    PubMed

    Hofmann, Stefan G

    2008-01-01

    The article by Richard J. Longmore and Michael Worrell [Clinical Psychology Review, Volume 27, 2007, pp. 173-187] reviews a selection of studies showing no significant difference between treatment conditions that include formal cognitive restructuring techniques and other behavioral treatment modalities that do not include techniques to directly challenge cognitions. Based on this literature, Longmore and Worrell question the validity of the cognitive behavioral treatment model and argue that changes in symptoms are not mediated by changes in cognitions. Longmore and Worrell's arguments are based on common misconceptions about mediation models of treatment change. This commentary discusses and clarifies these misconceptions.

  5. Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial.

    PubMed

    Brunkhorst, Frank M; Oppert, Michael; Marx, Gernot; Bloos, Frank; Ludewig, Katrin; Putensen, Christian; Nierhaus, Axel; Jaschinski, Ulrich; Meier-Hellmann, Andreas; Weyland, Andreas; Gründling, Matthias; Moerer, Onnen; Riessen, Reimer; Seibel, Armin; Ragaller, Maximilian; Büchler, Markus W; John, Stefan; Bach, Friedhelm; Spies, Claudia; Reill, Lorenz; Fritz, Harald; Kiehntopf, Michael; Kuhnt, Evelyn; Bogatsch, Holger; Engel, Christoph; Loeffler, Markus; Kollef, Marin H; Reinhart, Konrad; Welte, Tobias

    2012-06-13

    Early appropriate antimicrobial therapy leads to lower mortality rates associated with severe sepsis. The role of empirical combination therapy comprising at least 2 antibiotics of different mechanisms remains controversial. To compare the effect of moxifloxacin and meropenem with the effect of meropenem alone on sepsis-related organ dysfunction. A randomized, open-label, parallel-group trial of 600 patients who fulfilled criteria for severe sepsis or septic shock (n = 298 for monotherapy and n = 302 for combination therapy). The trial was performed at 44 intensive care units in Germany from October 16, 2007, to March 23, 2010. The number of evaluable patients was 273 in the monotherapy group and 278 in the combination therapy group. Intravenous meropenem (1 g every 8 hours) and moxifloxacin (400 mg every 24 hours) or meropenem alone. The intervention was recommended for 7 days and up to a maximum of 14 days after randomization or until discharge from the intensive care unit or death, whichever occurred first. Degree of organ failure (mean of daily total Sequential Organ Failure Assessment [SOFA] scores over 14 days; score range: 0-24 points with higher scores indicating worse organ failure); secondary outcome: 28-day and 90-day all-cause mortality. Survivors were followed up for 90 days. Among 551 evaluable patients, there was no statistically significant difference in mean SOFA score between the meropenem and moxifloxacin group (8.3 points; 95% CI, 7.8-8.8 points) and the meropenem alone group (7.9 points; 95% CI, 7.5-8.4 points) (P = .36). The rates for 28-day and 90-day mortality also were not statistically significantly different. By day 28, there were 66 deaths (23.9%; 95% CI, 19.0%-29.4%) in the combination therapy group compared with 59 deaths (21.9%; 95% CI, 17.1%-27.4%) in the monotherapy group (P = .58). By day 90, there were 96 deaths (35.3%; 95% CI, 29.6%-41.3%) in the combination therapy group compared with 84 deaths (32.1%; 95% CI, 26.5%-38.1%) in

  6. Treatment of requests for sex-change surgery with psychotherapy.

    PubMed

    Kirkpatrick, M; Freidmann, C T

    1976-10-01

    The authors describe two patients whose requests for sex-change surgery represented crises in sexual identity and anxiety-masking symptoms. Brief psychotherapy enabled these patients to relinquish their belief in a surgical "cure". In evaluating such request, the psychiatrist should consider the patient's total personality rather than focusing on the genuineness of the perceived gender disorder. Whatever the final decision, the opportunity for continued psychotherapy should be provided.

  7. [The change of valence of chromium by acid treatment].

    PubMed

    Hara, N

    1982-11-01

    There are many kinds of chromium compounds in nature, and most of them exist as Cr6+- and Cr3+-compounds. Generally, these two kinds of compounds are stable in normal circumstances. When the chromium in biomaterial or in atmospheric substances is analyzed, the samples are usually ashed with strong acids at high temperatures to destroy the organic components, and chromium compounds are changed to water soluble salts in this ashing process. And then chromium is determined in various methods. The relation between the used acids and the behavior of chromium were investigated, and the following facts have been cleared. Though the total amount of chromium in the samples remains constant, the valence of chromium is apt to change easily in the ashing process (Cr6+ in equilibrium Cr3+). As Cr3+ is more stable than Cr6+ in acid solution, the reductive reaction proceeds mainly as (Cr6+ leads to Cr3+). But each acid has the peculiar reductive action on Cr6+. Even if the same acid is used, its reductive power changes very sensitively as the used conditions are altered. The reductive action of mixed acid differs from that of original acid remarkably. Certain acid has the oxidizing action on Cr3+. Thus, the mechanisms and reactions between strong acids and chromium are very complicated. So, for the determination of the amounts of individual Cr6+ and Cr3+, the oxidizing or reductive action of the used acid must be considered cautiously.

  8. Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment

    PubMed Central

    2013-01-01

    Introduction: The relevance of tobacco use in opioid addiction (OA) has generated a demand for available and more effective interventions. Thus, further analysis of less explored nicotine–opioid clinical interactions is warranted. Methods: A post-hoc analysis of OA participants in a double-blind, randomized very low dose naltrexone (VLNTX) inpatient detoxification trial evaluated measures of opioid withdrawal and tobacco use. Intreatment smokers were compared with nonsmokers, or smokers who were not allowed to smoke. Results: A total of 141 (81%) of 174 OA participants were smokers, all nicotine-dependent. Inpatient smoking was a predictor of opioid withdrawal discomfort. Intreatment smokers (n = 96) showed significantly higher opioid craving (F = 3.7, p < .001) and lower detoxification completion rate (χ2 = 7.9, p < .02) compared with smokers who were not allowed to smoke (n = 45) or nonsmokers (n = 33). Smoking during treatment was associated with more elevated cigarette craving during detoxification (F = 4.1, p < .001) and a higher number of cigarettes smoked at follow-up (F = 3.6, p < .02). Among intreatment smokers, VLNTX addition to methadone taper was effective in easing opioid withdrawal and craving more than other treatments, whereas the combination VLNTX–clonidine was associated with significantly reduced cigarette craving and smoking during detoxification. Conclusions: Failure to address tobacco use may negatively affect pharmacologically managed opioid discontinuation. Opioid detoxification may offer a window of opportunity to expand smoking cessation treatment, hence improving OA outcomes. The observed effects support testing of VLNTX–clonidine in smoking cessation trials among individuals with or without substance abuse. PMID:23572466

  9. Changes in Cancer Treatment: Mabs, Mibs, Mids, Nabs, and Nibs.

    PubMed

    Tariman, Joseph D

    2017-03-01

    Cancer therapeutics has been growing in an unprecedented fashion and has evolved rapidly in the past two decades. Specific gene mutation, protein dysfunction and dysregulation, intracellular signaling pathways, and immune modulation have been targeted. These therapeutic advances came largely because of improved understanding of the pathobiology of cancer at the genetic and molecular levels. This article addresses the need of novice nurses for cancer treatment-related information and evidence-based nursing care of patients diagnosed with cancer while undergoing novel and breakthrough therapeutics. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The Interpersonal-Psychological Theory of Suicide in Adolescents: A Preliminary Report of Changes Following Treatment.

    PubMed

    King, Jessica D; Horton, Sarah E; Hughes, Jennifer L; Eaddy, Michael; Kennard, Betsy D; Emslie, Graham J; Stewart, Sunita M

    2017-03-31

    This study investigated change in suicide risk in the framework of the interpersonal theory of suicide. Fifty-four adolescents completed measures of interpersonal needs, acquired capability, depressive symptoms, and suicide risk at entry and exit from treatment. There was a significant drop following treatment in unmet interpersonal needs but not in acquired capability, consistent with the theory. Both change in the interaction between interpersonal needs and in depressive symptoms contributed unique prediction to change in suicide risk. These findings extend the research in understanding changes in suicide risk and inform treatment by suggesting cognitive targets for intervention.

  11. Evaluating Marginal Policy Changes and the Average Effect of Treatment for Individuals at the Margin.

    PubMed

    Carneiro, Pedro; Heckman, James J; Vytlacil, Edward

    2010-01-01

    This paper develops methods for evaluating marginal policy changes. We characterize how the effects of marginal policy changes depend on the direction of the policy change, and show that marginal policy effects are fundamentally easier to identify and to estimate than conventional treatment parameters. We develop the connection between marginal policy effects and the average effect of treatment for persons on the margin of indifference between participation in treatment and nonparticipation, and use this connection to analyze both parameters. We apply our analysis to estimate the effect of marginal changes in tuition on the return to going to college.

  12. Respiratory and Cognitive Mediators of Treatment Change in Panic Disorder: Evidence for Intervention Specificity

    ERIC Educational Resources Information Center

    Meuret, Alicia E.; Rosenfield, David; Seidel, Anke; Bhaskara, Lavanya; Hofmann, Stefan G.

    2010-01-01

    Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this…

  13. Respiratory and Cognitive Mediators of Treatment Change in Panic Disorder: Evidence for Intervention Specificity

    ERIC Educational Resources Information Center

    Meuret, Alicia E.; Rosenfield, David; Seidel, Anke; Bhaskara, Lavanya; Hofmann, Stefan G.

    2010-01-01

    Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this…

  14. 75 FR 46901 - Changes to Treatments for Sweet Cherries from Australia and Irradiation Dose for Mediterranean...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-04

    ... Animal and Plant Health Inspection Service Changes to Treatments for Sweet Cherries from Australia and... sweet cherries imported from Australia into the United States. We are also adding to the treatment...-0140) a proposal\\2\\ to amend the regulations by adding new treatment schedules for sweet cherries and...

  15. Endovascular treatment of chronic arterial mesenteric ischemia: a changing perspective?

    PubMed

    Gibbons, C P; Roberts, D E

    2010-03-01

    Endovascular treatment for chronic mesenteric ischemia is growing in popularity because of its lower periprocedural morbidity and mortality than open surgery. It is especially suitable for the high-risk surgical candidate and for those who have a poor nutritional state, although endovascular surgery may not be possible in patients with ostial occlusions or heavily calcified vessels. A positive response to angioplasty is helpful to secure a diagnosis in patients with slightly atypical symptoms. There are little data at present to suggest that primary stenting is better than angioplasty alone, but insertion of a stent may be valuable as a rescue procedure following dissection, vascular recoil, or thrombosis during angioplasty. The superior mesenteric artery is probably the most important vessel to treat but, where this is impossible, celiac or inferior mesenteric artery dilatation may have therapeutic benefit. However, there is some evidence at present favoring multiple, as opposed to single-vessel, angioplasty or stenting. Long-term patency is better after mesenteric bypass, which may be preferred in the younger and fitter patient. Treatment of the celiac artery compression syndrome is primarily surgical, but stent insertion may have a role as a secondary procedure where there is a residual stenosis after median arcuate ligament division.

  16. Changing the Paradigm of Cancer Screening, Prevention, and Treatment

    PubMed Central

    2016-01-01

    The war on cancer has been fought during the past several decades primarily based on the somatic mutation model of cancer. This has resulted in the emphasis on cancer screening and elimination of any detected cancerous/precancerous cells as the primary method of cancer prevention. This approach has reduced mortality from some cancers, but age-adjusted cancer mortality rates continue to be high. The lack of significant progress in reducing cancer mortality rates may be indicative of a fundamental flaw in the cancer model used. An alternative model of cancer is the immune suppression model of cancer based on the tremendous increase in cancers when the immune system is suppressed. According to this model, the key carcinogenic event is the suppression of the immune system which enables the already existing covert cancers to grow uncontrollably, causing cancer. Hence, cancer screening would consist of identifying those with weak immune system response. The primary mode of cancer prevention and treatment would be boosting of the immune system, for example, through exercise, infection, and low-dose radiation, as they are all known to enhance immune system response and reduce cancers. There is sufficient evidence to justify clinical trials of this approach for cancer screening, prevention, and treatment. PMID:27928220

  17. Measurements of Nb3Sn conductor dimension changes during heat treatment

    NASA Astrophysics Data System (ADS)

    Bocian, D.; Ambrosio, G.; Whitson, G. M.

    2012-06-01

    During the heat treatment of Nb3Sn coils the conductor material properties change significantly. These effects together with the changes of the conductor dimensions during heat treatment may introduce large strains in the coils for accelerator magnets. The US LHC Accelerator Research Program (LARP) has initiated a study aiming at understanding the thermal expansion and contraction of Nb3Sn strands, cables and coils during heat treatment. Several measurements on OST RRP 54/61 and OST RRP 108/127 strands were performed, and a few more are in progress, in order to have sufficient inputs for finite element simulation of the dimensional changes during heat treatment. Three strand quantities were measured: diameter change, length change and twist change. The measured types of strands (OST RRP 54/61 and OST RRP 108/127) demonstrated diameter change by +2.15% and +1.88%, and length change by +0.035% and -0.045% respectively. The measured twist change after reaction was about 4%. In this paper an impact of twist change on strand length change was studied, as well. The results of measurements show a significant contribution of twist change to the strand length change.

  18. Constructing Unit-Specific Empiric Treatment Guidelines for Catheter-Related and Primary Bacteremia by Determining the Likelihood of Inadequate Therapy

    PubMed Central

    Davis, Megan E.; Anderson, Deverick J.; Sharpe, Michelle; Chen, Luke F.; Drew, Richard H.

    2013-01-01

    This study aimed to determine the feasibility of using likelihood of inadequate therapy (LIT), a parameter calculated by using pathogen frequency and in vitro susceptibility for determination of appropriate empiric antibiotic therapy for primary bloodstream infections. Our study demonstrates that LIT may reveal differences in traditional antibiograms. PMID:22418641

  19. [Change of attitude in the surgical treatment of lung metastases].

    PubMed

    Czeyda-Pommersheim, Ferenc; Kovács, Tibor; Sulyok, Zoltán; Farkas, Emil; Besznyák, István; Köves, István

    2004-12-01

    There has been no major change in surgical technique of lung metastasectomy till the last decades. In the latest years the variety of diagnostic tools and methods grew significantly. There are more chemotherapy possibilities and more palliative surgical techniques (VATS, ITP, RFTA) to treat certain types of lung metastases. Based on data of the International Registry of Lung Metastases the most important prognostic factor for metastasectomy is how radical the procedure was (clear resection margin). The more aggressive approach (even pneumonectomy for R0 resection) is becoming more popular.

  20. Changes in pain-related coping strategies and their importance for treatment outcome following multimodal inpatient treatment: does sex matter?

    PubMed

    Hechler, Tanja; Kosfelder, Joachim; Vocks, Silja; Mönninger, Theresa; Blankenburg, Markus; Dobe, Michael; Gerlach, Alexander L; Denecke, Heide; Zernikow, Boris

    2010-05-01

    While sex differences in pain-related coping have been widely reported, little is known on sex differences in changes in coping following multimodal pain treatment and how these changes relate to treatment outcome. The present prospective study therefore aimed to investigate sex differences in coping strategies between boys and girls with chronic pain prior to multimodal inpatient treatment and at 3-month follow-up. Sixty-four boys and 103 girls with various pain disorders were evaluated. Core outcomes (pain intensity and pain-related disability) and coping were assessed via validated questionnaires. At admission, boys and girls used similar coping strategies. Three months following treatment, boys and girls decreased passive pain coping and seeking social support while they maintained the degree of positive self-instruction. Girls displayed higher seeking social support than boys and of importance, only for girls, a reduction in seeking social support was related to decreases in pain intensity. In both groups, the changes in coping were related to positive treatment outcome. Results suggest that both groups may benefit from reductions in passive pain coping and seeking social support. The causal quality of this relationship remains to be determined in future studies. Gender-role expectations and family interactions may account for the sex differences demonstrated for seeking social support. Boys and girls with chronic pain show profound similarities in pain-related coping strategies prior and after multimodal pain treatment. The changes in coping are related to positive treatment outcomes. Sex-specific treatment strategies for changing seeking social support may need to be developed and tested for their differential efficacy in boys and girls. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

  1. Managing golf injuries: technique and equipment changes that aid treatment.

    PubMed

    Metz, J P

    1999-07-01

    Proper golf technique and equipment and preventive measures can minimize golf-related injuries of the back, shoulders, elbows, and hands and wrists. Rotating the shoulder and hip a similar amount during the backswing and keeping the spine vertical during the follow-through can reduce lumbar spine strain. A rigid back support may lower the risk of vertebral compression fracture in osteoporotic patients. Shortening the backswing can decrease pressure on a degenerative acromioclavicular joint. Therapy for 'golfer's elbow' includes medial counterforce bracing, larger club grips, and graphite shafts. Treatments for wrist and hand disorders include proper swing and grip technique and larger, softer grips. Diagnosis of the easy-to-miss fracture of the hook of the hamate may require tomogram, CT, or MRI.

  2. 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…

  3. 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.

  4. [Evaluation of the change process during treatment of adolescent psychotics].

    PubMed

    Chabert, C; Behar-Azoulay, C; Chrétien, M; Guedeney, N; Jeammet, P; Aubin, J P; Birot, E; Brechon, G

    1990-01-01

    This study rests on work comparing the processes of change in the mental functioning of eleven psychotic teenagers through two perspectives: a psychological perspective centered on the comparison of two psychological examinations carried out at intervals of one and a half and three years; a psychiatric perspective taking into account elements supplied by the doctor and the nursing staff in the facility and concerning the evolution of each patient between the first and second psychological examination. The evolution was judged according to three factors liable to explain the therapeutic effects: the ability of psychic movement through the appearance or the reappearance of a function in the primal process; setting up limits and defenses of a narcissistic order; the improvement in the ability to make bonds. In spite of the difficulties in regrouping the subjects, the comparative results between the tests and the clinical setting generally confirmed our initial hypotheses.

  5. Changing low income smokers' beliefs about tobacco dependence treatment.

    PubMed

    Christiansen, Bruce; Reeder, Kevin; Fiore, Michael C; Baker, Timothy B

    2014-06-01

    This field study tested an intervention that challenged beliefs about the effectiveness of various quit methods held by Salvation Army client smokers from two urban locations (N = 245). Data (surveys administered immediately after and one month post-intervention) were collected 2009-2010 and analyzed using primarily χ(2) and t-tests. The intervention changed client perceptions about the effectiveness of quitting methods. Compared to no-intervention controls, intervention participants reported significantly greater smoking reduction and greater likelihood of contacting the Wisconsin Tobacco Quit Line. Study implications/limitations are discussed and future research directions noted. This research was supported by grant UL1TR000427 from the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences, NIH.

  6. Measuring changes in client-level treatment process in the therapeutic community (TC) with the Dimensions of Change Instrument (DCI).

    PubMed

    Paddock, Susan M; Edelen, Maria O; Wenzel, Suzanne L; Ebener, Patricia; Mandell, Wallace; Dahl, James

    2007-01-01

    The Dimensions of Change Instrument (DCI) measures treatment process in residential therapeutic community (TC) settings. It summarizes eight factors of treatment process from a client perspective. We present evidence of the reliability of the DCI for assessing both adult (N = 519) and adolescent (N = 474) client perceptions of treatment process. The DCI factors significantly increase over time, with increases consistently seen across all DCI factors for adults. We highlight areas for future DCI modifications to broaden its applicability to adolescents. Our findings show that clinicians can use the DCI to evaluate adult client progress and target areas for improving quality of care.

  7. Psychoanalysis and empirical research.

    PubMed

    Giannoni, Massimo

    2003-11-01

    At the beginning of the nineteenth century, the idea of reason began to lose its universal and absolute value, undermining the view of science as a form of objective knowledge that reveals a fundamental reality. These changes have also had an impact on psychoanalysis, leading to a proliferation of theories and the end of a positivistic approach, epitomized by a 'neutral' analyst who knows the contents of the patient's mind. Hermeneutic philosophy provides a tool with which to explore both theoretical multiplicity and the contribution of the analyst's subjectivity to the analytic process. Furthermore, a hermeneutic approach does not have to be hostile to empirical science, but can be integrated with it in a 'scientific-hermeneutic model' in which historical and biological principles are given equal value.

  8. Changes in some physical properties induced by vacuum heat treatment

    NASA Technical Reports Server (NTRS)

    Hultquist, A. E.

    1972-01-01

    A method is proposed for reducing or eliminating outgassing of materials by heat treating them in vacuum prior to use. This may be performed on the raw material prior to manufacturing and installation or after fabrication of parts. Processing of a fabricated part can be performed only on relatively small parts and on assemblies containing no components which are affected by the required temperatures and pressures. Processing conditions of temperature and time are dependent on the particular application and the materials involved. Silicone-coated fiber glass cloth was vacuum-heat treated for 100 hrs at 400 + or - 25 F at pressures of 0.001 torr or less. The materials were tested in terms of tensile strength and tear properties in both the smooth and several creased configurations. Data obtained on one side silicone coated fiber glass showed large reductions in these properties as a result of the vacuum-heat treatment. The problem was alleviated by coating both sides of the fiber glass.

  9. [Relationship between cocaine dependence treatment and personal values of openness to change and conservation].

    PubMed

    Galdós, Jesús Saiz; Sánchez, Isabel Martínez

    2010-01-01

    To analyze the relationship between participation in a drug addiction treatment program and Schwartz's values of Openness to change (Self-direction, Stimulation and Hedonism) and Conservation (Tradition, Conformity and Security) in cocaine users. The present quasi-experimental study was carried out on a sample of 411 adult cocaine users, grouped according to whether they had begun treatment more than three months earlier or less than three months earlier or they were not receiving any treatment. Using Schwartz's Personal Values Questionnaire (PVQ), we measured the priority given by each of these groups to the values of Conservation and Openness to change. Participants who had initiated the treatment more than three months earlier tended to score lower in the values of Openness to change than those who were not in treatment, though there were no significant differences in these values between those who were not in treatment and those who had been in treatment for less than three months. On the other hand, it was observed that participants in treatment, regardless of the time spent in treatment, scored higher in values of Conservation than the cocaine users who were not in treatment. These results reveal the relationship between attendance on a cocaine-dependence treatment program and personal values, together with their potential importance in treatment and rehabilitation programs for cocaine users.

  10. 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.

  11. Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning

    PubMed Central

    Jensen, Mark P.; Turner, Judith A.; Romano, Joan M.

    2007-01-01

    Little is known about how patient functioning changes after completion of multidisciplinary pain programs, and what factors are associated with such changes when they occur; for example, whether improvement or deterioration in functioning corresponds to changes in patient beliefs and coping during this period. The objective of this study was to examine the extent to which changes in patient pain and functioning were associated with changes in beliefs and coping after multidisciplinary pain treatment. Patients with chronic pain (N = 141) completed outcome (pain, functioning) and process (beliefs, catastrophizing, coping) measures at the end of multidisciplinary pain treatment and 12 months posttreatment. On average, patients reported similar levels of pain at both times, but showed a small worsening in disability and depression outcomes between posttreatment and follow-up, which were associated significantly with concurrent changes in the process measures. In particular, increased belief in oneself as disabled by pain, catastrophizing, and increased use of resting, guarding and asking for assistance in response to pain were linked with increased disability and depression. Decreased perceived control over pain was also consistently associated with worsening of these outcomes. The results highlight the potential importance of specific pain-related beliefs and coping responses in long-term patient pain and adjustment. Research is needed to determine whether booster interventions after the end of intensive multidisciplinary treatment that target these beliefs and coping responses improve long-term outcomes. PMID:17250963

  12. Does change in readiness influence retention among African American women and men in substance abuse treatment?

    PubMed

    Montgomery, LaTrice; Burlew, A Kathleen; Korte, Jeffrey E

    2017-04-03

    African Americans are less likely than other racial groups to engage in and complete outpatient substance abuse treatment. The current study, conducted as a secondary analysis of a multisite randomized clinical trial, examined whether readiness to change (RTC) over time influences retention and whether gender moderates the relationship between changes in RTC and retention among 194 African American women and men. Participants completed the University of Rhode Island Change Assessment at baseline and at the end of the 16-week study. Findings revealed a significant relationship between RTC over time and retention. Specifically, the more RTC increased throughout the 16-week study, the longer participants remained in treatment. In addition, gender moderated the relationship between changes in RTC and retention, with a stronger association between changes in RTC and retention among men relative to women. One approach to improving substance abuse treatment retention rates is to focus on increasing RTC during treatment, especially among African American men.

  13. Sensitivity changes after morphine treatment in the mouse uterus.

    PubMed

    Contreras, E; Tamayo, L; Juica, S

    1982-01-01

    The addition of morphine to a bath containing the vas deferens from chronically morphinized mice induces a facilitatory effect on noradrenaline contractile responses. This facilitatory effect of morphine has been thought to be a dependence-like effect. In the present work the possibility that a pretreatment with morphine might induce a similar effect on the contractile responses of the mouse uterus to acetylcholine and serotonin was examined. The acute effect of morphine on the uteri of untreated mice consisted in an attenuation of the responses to both substances, whereas a long term pretreatment with morphine induced a supersensitivity state. Tolerance to the depressant action of morphine on the contractile responses induced by the stimulating compounds was also observed. Acute morphine in the uteri from morphinized mice did not induce a facilitatory effect on acetylcholine or serotonin responses. Naloxone did not modify the effects of morphine in the naive or chronically treated mice. The supersensitivity state and the intensity of tolerance were unaffected by changes in the concentration of calcium in the bath medium. Caffeine or theophylline decreased the tolerance observed in the uterus from chronically morphinized mice. The attenuation of tolerance suggests that methylxanthines induce effects opposed to those of chronic morphine in the calcium distribution within the cell.

  14. Treatment with antipsychotics in pregnancy: Changes in drug disposition.

    PubMed

    Westin, Andreas Austgulen; Brekke, Malin; Molden, Espen; Skogvoll, Eirik; Castberg, Ingrid; Spigset, Olav

    2017-06-23

    Although pregnancy is known to cause changes in drug pharmacokinetics, little is known about its impact on serum levels of antipsychotics. In this study, we retrospectively assessed 201 routine serum antipsychotic therapeutic drug monitoring concentration measurements obtained from a total of 110 pregnancies in 103 women, and 512 measurements from the same women before and after pregnancy. Serum concentrations in the third trimester were significantly lower than baseline for quetiapine (-76%; CI, -83%, -66%; p<0.001) and aripiprazole (-52%; CI, -62%, -39%; p<0.001), but not for olanzapine (-9%; CI, -28%, +14%; p=0.40). For the remaining antipsychotics (perphenazine, haloperidol, ziprasidone, risperidone and clozapine) our data set was limited, but it indicates that concentrations may decline at least for perphenazine and possibly also for haloperidol. Even though the clinical consequence of the serum concentrations decline remains to be elucidated, our results warrant close clinical monitoring throughout pregnancy, preferentially supported by therapeutic drug monitoring. This article is protected by copyright. All rights reserved. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  15. Upper-tract changes after treatment of posterior urethral valves.

    PubMed

    Lal, R; Bhatnagar, V; Mitra, D K

    1998-07-01

    This paper discusses the long-term sequelae in the upper urinary tract with respect to hydroureteronephrosis (HUN), vesicoureteral reflux (VUR), renal parenchymal disease, and their correlation with renal function in 84 boys with posterior urethral valves followed for 1 to 21 years. Thirty-one boys (39.3%) were adolescents or older at the time of review. The incidence of high-grade VUR (grade III or more) was 47.6% at presentation, and resolution following decompression of the lower urinary tract occurred in 38.7% of refluxing units. VUR was associated with a high incidence of chronic renal failure (CRF) (30%) on long-term follow up; however, 16% of non-refluxing patients also progressed to CRF. The incidences of renal parenchymal disease and persistent upper-tract dilatation in the non-refluxing group were 25% and 50% of renal units respectively. Gross HUN persisted in 12.3% of patients despite decompression and reconstructive surgery, with vesicoureteral junction (VUJ) obstruction being documented in 1 patient only. Moderate and mild upper-tract dilatation persisted in 31.6% and 43.9% of patients, respectively. Persistent gross HUN was associated with a very high incidence of CRF (92.3%), while 88.4% of those with persistent mild/moderate dilatation maintained normal renal function over a follow-up period ranging from 1 to 21 years. This study emphasizes the need for systematic evaluation to exclude VUJ obstruction and abnormal urodynamics as a cause of persistent HUN so that effective therapy can be instituted early to relieve back-pressure and to provide a low-pressure reservoir with effective emptying. In the absence of either of these causes, persistent ureterectasis after treatment is presumably due to secondary peristaltic failure as a consequence of ureteral fibrosis, ureteral tortuosity, or developmental dysplasia.

  16. 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.

  17. Stages of change, self-stigma, and treatment compliance among Chinese adults with severe mental illness.

    PubMed

    Tsang, H W H

    2013-12-01

    1. Individuals with higher global functioning, better readiness for action, and lower self-esteem decrement tend to have better psychosocial treatment participation. 2. Individuals with lesser psychiatric symptoms are more likely to have better treatment attendance. 3. Self-stigmatisation undermines treatment compliance. Its indirect effects can be mediated via stages of change and insight. 4. The self-stigma reduction programme may reduce self-esteem decrement, promote readiness for changing own problematic behaviours, and enhance psychosocial treatment compliance. However, its therapeutic effects were not maintained during the 6-month follow-up.

  18. Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options.

    PubMed

    Golan, Yoav

    2015-08-05

    Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam. This systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa. Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded. Practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

  19. Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters.

    PubMed

    Cheng, Wan-Ling; Hsueh, Po-Ren; Lee, Ching-Chi; Li, Chia-Wen; Li, Ming-Ji; Chang, Chia-Ming; Lee, Nan-Yao; Ko, Wen-Chien

    2016-04-01

    Clinical information about bacteremic pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing organism is limited. A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2010, clinical information and outcome of adults with bacteremic pneumonia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae were analyzed. The primary outcome is the 30-day mortality. A total of 111 patients with bacteremic pneumonia caused by E. coli (37 patients, 33.3%) and K. pneumoniae (74, 66.7%) were identified. Their mean age was 69.2 years and 51.4% were male patients. Fifty-seven (51.3%) episodes were classified as hospital-acquired infections, 19 (17.1%) as health-care-associated infections, and four (3.6%) as community-acquired infections. Fifty-one (45.9%) patients received appropriate empiric antimicrobial therapy. The 30-day mortality rate was 40.5% (45 patients). In the multivariate analysis, several independent risk factors, including rapidly fatal underlying disease [odds ratio (OR), 5.75; 95% confidence interval (CI), 1.54-21.48; p = 0.009], severe sepsis (OR, 4.84; 95% CI, 1.55-15.14; p = 0.007), critical illness (OR, 4.28; 95% CI, 1.35-13.57; p = 0.013), and receipt of appropriate empirical therapy (OR, 0.19; 95% CI, 0.07-0.55; p = 0.002), were associated with 30-day mortality. The survival analysis consistently found that individuals with appropriate empiric therapy had a higher survival rate (log-rank test, p < 0.001). ESBL-producing bacteremic pneumonia, especially health-care-associated infections, often occurred in adults with comorbidities. Appropriate empirical therapy was associated with a favorable outcome. Copyright © 2014. Published by Elsevier B.V.

  20. 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.

  1. 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

  2. Are changes in consumption of "healthy" foods related to changes in consumption of "unhealthy" foods during pediatric obesity treatment?

    PubMed

    Looney, Shannon M; Raynor, Hollie A

    2012-04-01

    Increasing fruits and vegetables (FVs), a dietary recommendation for pediatric weight management, is theorized to reduce energy intake by reducing intake of more energy-dense foods, such as snack foods (SFs). This study examined the relationship between changes in FV, SF, and energy intake in children enrolled in a 6-month, family-based behavioral pediatric weight management trial. Secondary data analyses examined dietary intake in 80 overweight (≥ 85th to <95th percentile for body mass index [BMI]) and obese (≥ 95th percentile for BMI) children (7.2 ± 1.7 years) with complete dietary records at 0 and 6 months. Participants were randomized to one of three treatment conditions: (1) increased growth monitoring with feedback; (2) decrease SFs and sugar sweetened beverages; or (3) increase FVs and low-fat dairy. With treatment condition controlled in all analyses, FV intake significantly increased, while SF and energy intake decreased, but not significantly, from 0 to 6 months. Change in FV intake was not significantly associated with change in SF consumption. Additionally, change in FV intake was not significantly related to change in energy intake. However, reduction in SF intake was significantly related to reduction in energy intake. Changing only FVs, as compared to changing other dietary behaviors, during a pediatric obesity intervention may not assist with reducing energy intake.

  3. On the report of the first successful surgical treatment of brain abscess in the Ottoman Empire by Dr. Cemil Topuzlu in 1891.

    PubMed

    Mut, Melike; Dinç, Gülten; Naderi, Sait

    2007-10-01

    IN 1891, Dr. Cemil Topuzlu operated on a brain abscess that originated as a complication of a depression fracture of the cranial inner table. The patient presented with Jacksonian seizures on his left side after a sharp trauma resulting in a 15 cm-long scalp laceration and underlying linear cranial fracture in the right parietal bone. Dr. Topuzlu attributed Jacksonian epilepsy to the fracture irritating the motor area in the right hemisphere and attempted a craniotomy based on his measurements to localize the Rolandic fissure. The operation was complicated by a brain abscess, and Dr. Topuzlu reoperated to drain the abscess. He successfully treated the brain abscess and Jacksonian seizures and then presented this case in the Royal Society of Medicine of the Ottoman Empire and in the International Surgery Congress in Lyon in 1894. The case report was published in his surgery book in 1905. The case was not only the first case of brain abscess to be treated successfully with surgical intervention in the Ottoman Empire, it was also one of the first cases of neurological surgery performed using contemporary anesthesiological and surgical techniques, which reveals the importance of neurological examination and cerebral localization techniques in the era before x-rays. Dr. Topuzlu was the founder of modern surgery in the Ottoman Empire and deserves to be credited for his novel applications in the 19th century.

  4. Monitoring changes in anti-tuberculosis treatment: associated factors determined at the time of diagnosis.

    PubMed

    Altet, M N; Vidal, R; Milá, C; Rodrigo, T; Casals, M; Mir, I; Ruiz-Manzano, J; Jiménez-Fuentes, M A; Sánchez, F; Maldonado, J; Blanquer, R; de Souza-Galväo, M L; Solsona, J; Azlor, E; Díaz, D; Calpe, J L; Caylá, J A

    2013-11-01

    To determine predictive factors for changes in standard anti-tuberculosis chemotherapy at the time of diagnosis. A prospective study was performed among tuberculosis (TB) patients treated at specialised centres during 2008-2009. Treatment outcome was monitored per standard guidelines. Treatment was considered successful if the patient was cured or completed treatment. Factors associated with treatment modification were analysed at the bivariate and multivariate levels using logistic regression. A total of 427 patients were included in the study. The initial standard treatment regimen was retained for 249 patients (58.3%), extended to 9 months for 36 (8.4%) and changed for 142 (33.3%). Factors associated with a change of regimen at the multivariate level were female sex, age ≥ 50 years, human immunodeficiency virus infection, comorbidities, alcoholism, hospitalisation and culture-positive sputum. Drug resistance and toxicity were analysed independently. Treatment outcome was successful in 97.2% of cases without a regimen change and in 87.3% of those with a changed regimen (P < 0.001). Factors associated with changes in the initial anti-tuberculosis regimen should be considered for rigorous follow-up. Results obtained through individualised treatment provided by specialists were good despite the complexity of the cases treated.

  5. Neural changes after phonological treatment for anomia: An fMRI study

    PubMed Central

    Rochon, Elizabeth; Leonard, Carol; Burianova, Hana; Laird, Laura; Soros, Peter; Graham, Simon; Grady, Cheryl

    2016-01-01

    Functional magnetic resonance imaging (fMRI) was used to investigate the neural processing characteristics associated with word retrieval abilities after a phonologically-based treatment for anomia in two stroke patients with aphasia. Neural activity associated with a phonological and a semantic task was compared before and after treatment with fMRI. In addition to the two patients who received treatment, two patients with aphasia who did not receive treatment and 10 healthy controls were also scanned twice. In the two patients who received treatment, both of whose naming improved after treatment, results showed that activation patterns changed after treatment on the semantic task in areas that would have been expected (e.g., left hemisphere frontal and temporal areas). For one control patient, there were no significant changes in brain activation at the second scan; a second control patient showed changes in brain activation at the second scan, on the semantic task, however, these changes were not accompanied with improved performance in naming. In addition, there appeared to be bilateral, or even more right than left hemisphere brain areas activated in this patient than in the treated patients. The healthy control group showed no changes in activation at the second scan. These findings are discussed with reference to the literature on the neural underpinnings of recovery after treatment for anomia in aphasia. PMID:20547416

  6. The role of readiness to change in response to treatment of adolescent depression.

    PubMed

    Lewis, Cara C; Simons, Anne D; Silva, Susan G; Rohde, Paul; Small, David M; Murakami, Jessica L; High, Robin R; March, John S

    2009-06-01

    The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of fluoxetine (an antidepressant medication), cognitive-behavioral therapy, their combination, and a pill placebo. An abbreviated Stages of Change Questionnaire was used to obtain 4 readiness to change scores: precontemplation, contemplation, action, and maintenance. The association between each readiness score and depression severity across 12 weeks of acute treatment for depression, as measured by the Children's Depression Rating Scale--Revised, was examined. Although treatment response was not moderated by any of the readiness scores, baseline action scores predicted outcome: Higher action scores were associated with better outcome regardless of treatment modality. Furthermore, treatment effects were mediated by change in action scores during the first 6 weeks of treatment, with increases in action scores related to greater improvement in depression. Assessing readiness to change may have implications for tailoring treatments for depressed adolescents.

  7. 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.

  8. 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.

  9. The impact of treatment for head and neck cancer on positive psychological change within a year of completing treatment.

    PubMed

    Harding, S; Moss, T P

    2017-08-23

    Head and neck cancer carries a high level of morbidity and mortality. So why could anyone find having such a disease a positive event? The adversity hypothesis of "what doesn't kill you makes you stronger" suggests that people can use adversity to develop as human beings. This positive psychological change has received little attention in relation to head and neck cancer. Responses to the Silver Lining Questionnaire, University of Washington Quality of Life Questionnaire, and Short-Form 12 were collected from a postal survey, 3 to 12 months after the completion of treatment for head and neck cancer. Fifty-two (63%) people returned the survey and were included in the analysis. Time since completion of therapy did not show any relationship with positive psychological change. Tumour stage and treatment regimen both had a relationship with positive change. Participants with lower stage tumours had higher levels of positive change than those with tumours of higher stages. Participants who had surgery alone reported more positive change than those who had surgery with radiotherapy. A social factor related to greater change was being married or living with a partner when compared to living alone. Further research would aid the identification of bio-psychosocial factors that influence the development of positive psychological change and inform the development of rehabilitation interventions. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Assessing Change Readiness and Treatment Eagerness among Psychoactive Substance Users in Northern Nigeria.

    PubMed

    Abiola, Tajudeen; Udofia, Owoidoho; Sheikh, Taiwo L; Sanni, Kamaldeen

    2015-11-01

    Studies on psychoactive substance use in Nigeria had focused on prevalence and rarely on treatment implication(s) of large rates reported. Further challenge was to find suitable instruments to monitor change readiness as well as predict treatment outcomes along motivation continuum and according to resilience characteristics. Such ability will not only help to match treatment strategy with stage of change but also come with a more satisfactory outcome. This study therefore provided psychometric properties of one of such measuring scales: Stage of Change Readiness and Treatment Eagerness Scale version 8 (SOCRATES-8) and the accompanying change in resilience among Nigerians using psychoactive substances. Participants were 111 psychoactive substance dependent users in three treatment centers in Northern Nigeria. All respondents filled sociodemographic questionnaire, SOCRATES-8 and 14-item Resilience Scale. The study found overall motivation for change among participants to be medium on the three subscales of SOCRATES-8: ambivalence (median=14.00; range=7-20); recognition (median=31.00; range=7-35); and taking steps (median=35.00; range=12-40). More than half (61.3%) scored moderately on resilience. The Internal reliability of SOCRATES-8's subscales fell into acceptable range (ambivalence=0.54; recognition=0.87; taking steps=0.84). Pearson correlation coefficients of subscales with resilience are positive and in moderate range except for ambivalence with very low coefficient. Hierarchical cluster analysis based on participants' resilience characteristics yields five distinct profiles corresponding to five stages of motivational change. ANOVA of these five profiles based on SOCRATES' 3 subscales was significant. The study demonstrates utility of SOCRATES-8 to assess change readiness and treatment eagerness of psychoactive substance abusers according to stages of change and their resilience characteristics. This will aid treatment planning and can also measure treatment

  11. 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

  12. Does group cognitive behavioral therapy module type moderate depression symptom changes in substance abuse treatment clients?

    PubMed Central

    Paddock, Susan M.; Hunter, Sarah B.; Leininger, Thomas J.

    2014-01-01

    Little is known about the effect of group therapy treatment modules on symptom change during treatment and on outcomes post-treatment. Secondary analyses of depressive symptoms collected from two group therapy studies conducted in substance use treatment settings were examined (n = 132 and n = 44). Change in PHQ-9 scores was modeled using longitudinal growth modeling combined with random effects modeling of session effects, with time-in-treatment interacted with module theme to test moderation. In both studies, depressive symptoms significantly decreased during the active treatment phase. Symptom reductions were not significantly moderated by module theme in the larger study. However, the smaller pilot study’s results suggest future examination of module effects is warranted, given the data are compatible with differential reductions in reported symptoms being associated with attending People-themed module sessions versus Thoughts-themed sessions. PMID:24657006

  13. 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.

  14. Recovery of Online Sentence Processing in Aphasia: Eye Movement Changes Resulting from Treatment of Underlying Forms

    ERIC Educational Resources Information Center

    Mack, Jennifer E.; Thompson, Cynthia K.

    2017-01-01

    Purpose: The present study tested whether (and how) language treatment changed online sentence processing in individuals with aphasia. Method: Participants with aphasia (n = 10) received a 12-week program of Treatment of Underlying Forms (Thompson & Shapiro, 2005) focused on production and comprehension of passive sentences. Before and after…

  15. 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…

  16. The Role of Readiness to Change in Response to Treatment of Adolescent Depression

    ERIC Educational Resources Information Center

    Lewis, Cara C.; Simons, Anne D.; Silva, Susan G.; Rohde, Paul; Small, David M.; Murakami, Jessica L.; High, Robin R.; March, John S.

    2009-01-01

    The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of…

  17. Motivating Treatment Seeking and Behavior Change by Untreated Military Personnel Abusing Alcohol or Drugs

    DTIC Science & Technology

    2010-09-01

    intervention , motivational enhancement therapy 16. SECURITY CLASSIFICATION OF: U 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF...military personnel who are not currently in substance abuse treatment . The intervention is designed to prompt: (a) a willingness to participate voluntarily...Motivating Treatment Seeking and Behavior Change by Untreated Military Personnel Abusing Alcohol or Drugs PRINCIPAL INVESTIGATOR: Denise

  18. Changes in canopy fuels and fire behavior after ponderosa pine restoration treatments: A landscape perspective

    Treesearch

    J. P. Roccaforte; P. Z. Fule

    2008-01-01

    (Please note, this is an abstract only) We modeled crown fire behavior and assessed changes in canopy fuels before and after the implementation of restoration treatments in a ponderosa pine landscape at Mt. Trumbull, Arizona. We measured 117 permanent plots before (1996/1997) and after (2003) thinning and burning treatments. The plots are evenly distributed across the...

  19. Change in Depressive Symptoms among Treatment-Seeking College Students Who Are Sexual Minorities

    ERIC Educational Resources Information Center

    Effrig, Jessica C.; Maloch, Janelle K.; McAleavey, Andrew; Locke, Benjamin D.; Bieschke, Kathleen J.

    2014-01-01

    Changes in students' depressive symptoms during the course of treatment at college counseling centers were examined by sexual orientation. In Study 1, results showed that depressive symptoms decreased similarly across sexual orientation groups during the course of treatment. In Study 2, family support did not moderate the relationship between…

  20. Fuel accumulation and forest structure change following hazardous fuel reduction treatments throughout California

    Treesearch

    Nicole M. Vaillant; Erin K. Noonan-Wright; Alicia L. Reiner; Carol M. Ewell; Benjamin M. Rau; Josephine A. Fites-Kaufman; Scott N. Dailey

    2015-01-01

    Altered fuel conditions coupled with changing climate have disrupted fire regimes of forests historically characterised by high-frequency and low-to-moderate-severity fire. Managers use fuel treatments to abate undesirable fire behaviour and effects. Short-term effectiveness of fuel treatments to alter fire behaviour and effects is well documented; however, long-term...

  1. 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…

  2. Change in Depressive Symptoms among Treatment-Seeking College Students Who Are Sexual Minorities

    ERIC Educational Resources Information Center

    Effrig, Jessica C.; Maloch, Janelle K.; McAleavey, Andrew; Locke, Benjamin D.; Bieschke, Kathleen J.

    2014-01-01

    Changes in students' depressive symptoms during the course of treatment at college counseling centers were examined by sexual orientation. In Study 1, results showed that depressive symptoms decreased similarly across sexual orientation groups during the course of treatment. In Study 2, family support did not moderate the relationship between…

  3. The Role of Readiness to Change in Response to Treatment of Adolescent Depression

    ERIC Educational Resources Information Center

    Lewis, Cara C.; Simons, Anne D.; Silva, Susan G.; Rohde, Paul; Small, David M.; Murakami, Jessica L.; High, Robin R.; March, John S.

    2009-01-01

    The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of…

  4. Weight Changes In Patients With Hodgkin Lymphoma Following Treatment: Experience From A Cancer Hospital.

    PubMed

    Ali, Jamshed; Siddiqui, Neelam; Hameed, Abdul

    2016-01-01

    Some recent studies have suggested that patients with Hodgkin lymphoma who undergo remission following treatment are likely to experience significant weight gain and may become overweight or obese. The association between treatment for Hodgkin lymphoma and subsequent weight gain has not been explored in Pakistan. We undertook a review of weight changes in adult Hodgkin lymphoma patients who received treatment at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. In this longitudinal study, we collected and analysed secondary data including adult patients who received treatment for Hodgkin lymphoma at our institute from January 2010 till December 2013. We retrospectively noted baseline demographic, clinical characteristics, details about treatment received and change in weight from baseline at start of treatment to 6, 12, and 18 months after start of treatment. A total of 470 patients registered for Hodgkin lymphoma at our centre. Data were available for 402 patients who were included in this study. Progressive increase in weight was observed in patients after treatment. The mean weight gain from the start of treatment to 6, 12, and 18 months was 3.1 kg, 7.1 kg, and 9.5 kg, respectively. Weight gain was not significantly associated with age or sex of patients. Weight gain was significantly associated with higher stages of cancer, response to treatment and B symptoms. The evaluation of Hodgkin lymphoma patients after treatment demonstrated considerable tendency for weight gain. Further work is warranted to explore this association and its impact on HL survivors.

  5. The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey.

    PubMed

    Merli, Manuela; Lucidi, Cristina; Di Gregorio, Vincenza; Falcone, Marco; Giannelli, Valerio; Lattanzi, Barbara; Giusto, Michela; Ceccarelli, Giancarlo; Farcomeni, Alessio; Riggio, Oliviero; Venditti, Mario

    2015-01-01

    The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.

  6. Soil erosion risk assessment using interviews, empirical soil erosion modeling (RUSLE) and fallout radionuclides in a volcanic crater lake watershed subjected to land use change, western Uganda

    NASA Astrophysics Data System (ADS)

    De Crop, Wannes; Ryken, Nick; Tomma Okuonzia, Judith; Van Ranst, Eric; Baert, Geert; Boeckx, Pascal; Verschuren, Dirk; Verdoodt, Ann

    2017-04-01

    Population pressure results in conversion of natural vegetation to cropland within the western Ugandan crater lake watersheds. These watersheds however are particularly prone to soil degradation and erosion because of the high rainfall intensity and steep topography. Increased soil erosion losses expose the aquatic ecosystems to excessive nutrient loading. In this study, the Katinda crater lake watershed, which is already heavily impacted by agricultural land use, was selected for an explorative study on its (top)soil characteristics - given the general lack of data on soils within these watersheds - as well as an assessment of soil erosion risks. Using group discussions and structured interviews, the local land users' perceptions on land use, soil quality, soil erosion and lake ecology were compiled. Datasets on rainfall, topsoil characteristics, slope gradient and length, and land use were collected. Subsequently a RUSLE erosion model was run. Results from this empirical erosion modeling approach were validated against soil erosion estimates based on 137Cs measurements.

  7. Risk reduction treatment of high-risk psychopathic offenders: the relationship of psychopathy and treatment change to violent recidivism.

    PubMed

    Olver, Mark E; Lewis, Kathy; Wong, Stephen C P

    2013-04-01

    The relationships of psychopathy, therapeutic change, and violent recidivism were examined in a sample of 152 high-risk violent offenders treated in a high-intensity violence reduction program at the Regional Psychiatric Centre (RPC) in Saskatoon, SK. The Violence Risk Scale (VRS; Wong & Gordon, 1999-2003) and Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003) were rated on the sample. As an extension on a prior psychometric study of the VRS (Lewis, Olver, & Wong, 2012), the associations of therapeutic change scores, obtained from pre- and posttreatment ratings of VRS dynamic items, and violent recidivism were examined among high-risk psychopathic offenders (mean PCL-R >25) over approximately 5 years' follow-up. Positive therapeutic change correlated negatively with the PCL-R, particularly Factor 1 and the Affective facet, and was significantly associated with reductions in violent recidivism after controlling for psychopathy. The association of change to violent outcome decreased, however, when controlling for the Affective facet. Taken together, the present results suggest that risk-related treatment changes demonstrated by high-risk psychopathic offenders can be predictive of reductions in violent recidivism, and that reliable measurements of therapeutic change may be informative about treatment outcome in a high-risk violent offender group.

  8. Automatic Associations and Panic Disorder: Trajectories of Change over the Course of Treatment

    ERIC Educational Resources Information Center

    Teachman, Bethany A.; Marker, Craig D.; Smith-Janik, Shannan B.

    2008-01-01

    Cognitive models of anxiety and panic suggest that symptom reduction during treatment should be preceded by changes in cognitive processing, including modifying the anxious schema. The current study tested these hypotheses by using a repeated measures design to evaluate whether the trajectory of change in automatic panic associations over a…

  9. Motivating Treatment Seeking and Behavior Change by Untreated Military Personnel Abusing Alcohol or Drugs

    DTIC Science & Technology

    2012-09-01

    Untreated Military Personnel Abusing Alcohol or Drugs PRINCIPAL INVESTIGATOR: Denise Walker, Ph.D. CONTRACTING ORGANIZATION...Behavior Change by Untreated Military Personnel 5a. CONTRACT NUMBER Abusing Alcohol or Drugs ...change or enrollment in a treatment or self-help program, and (c) cessation of abuse of alcohol or other drugs . Following focus groups with 30

  10. Stability of pharyngeal airway dimensions: tongue and hyoid changes after treatment with a functional appliance.

    PubMed

    Yassaei, Soghra; Tabatabaei, Zohre; Ghafurifard, Rova

    2012-01-01

    Because stability is known as the fundamental key of the successful outcome of orthodontics treatment, this study investigated the stability of tongue, hyoid bone and airway dimensions at least two years after active treatment with Faramand functional appliance in patients with class II div 1 malocclusion. The present findings indicate that treatment with functional appliance has the potential to increase pharyngeal airway dimensions and changes in tongue and hyoid position. Importantly, these achieved changes seemed to be maintained in long-term, up to 4 years on average.

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

    PubMed

    Lee, Yong-Keun

    2016-11-01

    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.

  12. 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

  13. Suicide in the Byzantine Empire.

    PubMed

    Tsoukalas, G; Laios, K; Kontaxaki, M-I; Karamanou, M; Androutsos, G

    2013-01-01

    Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient's bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey.

  14. Directionality of change in youth anxiety treatment involving parents: an initial examination.

    PubMed

    Silverman, Wendy K; Kurtines, William M; Jaccard, James; Pina, Armando A

    2009-06-01

    This randomized clinical trial compared cognitive behavioral therapy (CBT) with minimal parent involvement to CBT with active parent involvement in a sample of 119 youths (7-16 years old; 33.6% Caucasian, 61.3% Latino) with anxiety disorders. The dynamics of change between youth anxiety and parent variables (positive-negative behaviors toward the child, conflict in the parent-youth relationship, and parental anxiety) in both treatment conditions over pretreatment, posttreatment, and 12-month follow-up were also examined. Results indicated that youth anxiety was significantly reduced with both treatments and that the dynamics of change may not solely flow from parent to youth but also from youth to parent. Findings highlight the need for research on directionality and mechanisms of change to move from evidence-based treatments toward evidence-based explanations of treatment outcome. Copyright 2009 APA

  15. Social desirability and change following substance abuse treatment in male offenders.

    PubMed

    Davis, Christopher G; Doherty, Sherri; Moser, Andrea E

    2014-09-01

    The efficacy of cognitive-behavioral treatment for substance abuse is contingent on changing clients' attitudes, beliefs, and expectancies. Assessing such change with self-report instruments may be problematic in offenders to the extent that they perceive that treatment success may secure privileges. This study assesses the extent to which increases in social desirability predict improvement in self-efficacy, perceptions of control, and perceived ability to cope and resist use of drugs. Male offenders in a moderate-intensity (N = 1,431) and a high-intensity (N = 316) substance abuse program were assessed before and after treatment on a range of beliefs and attitudes targeted in treatment, along with a measure of social desirability. Regression analyses indicate that those reporting the greatest increase in social desirability also reported the greatest improvement in attitudes and beliefs about drug and alcohol use, thereby suggesting that such self-report measures of change should be regarded with a degree of skepticism.

  16. SU-E-J-267: Change in Mean CT Intensity of Lung Tumors During Radiation Treatment

    SciTech Connect

    Mahon, R; Tennyson, N; Weiss, E; Hugo, G

    2015-06-15

    Purpose: To evaluate CT intensity change of lung tumors during radiation therapy. Methods: Repeated 4D CT images were acquired on a CT simulator during the course of therapy for 27 lung cancer patients on IRB approved protocols. All subjects received definitive radiation treatment ± chemotherapy. CT scans were completed prior to treatment, and 2–7 times during the treatment course. Primary tumor was delineated by an experienced Radiation Oncologist. Contours were thresholded between −100 HU and 200 HU to remove airways and bone. Correlations between the change in the mean tumor intensity and initial tumor intensity, SUVmax, and tumor volume change rate were investigated. Reproducibility was assessed by evaluating the variation in mean intensity over all phases in 4DCT, for a subgroup of 19 subjects. Results: Reproducibility of tumor intensity between phases as characterized by the root mean square of standard deviation across 19 subjects was 1.8 HU. Subjects had a mean initial tumor intensity of 16.5 ± 11.6 HU and an overall reduction in HU by 10.3 ± 8.5 HU. Evaluation of the changes in tumor intensity during treatment showed a decrease of 0.3 ± 0.3 HU/day for all subjects, except three. No significant correlation was found between change in HU/day and initial HU intensity (p=0.53), initial PET SUVmax (p=0.69), or initial tumor volume (p=0.70). The rate of tumor volume change was weakly correlated (R{sup 2}=0.05) with HU change (p=0.01). Conclusion: Most lung cancer subjects showed a marked trend of decreasing mean tumor CT intensity throughout radiotherapy, including early in the treatment course. Change in HU/day is not correlated with other potential early predictors for response, such as SUV and tumor volume change. This Result supports future studies to evaluate change in tumor intensity on CT as an early predictor of response.

  17. Perception of multimodal cognitive treatment for people with chronic widespread pain--changing one's life plan.

    PubMed

    Bremander, Ann; Bergman, Stefan; Arvidsson, Barbro

    2009-01-01

    The aim of this study was to gain a deeper understanding of chronic widespread pain patients' perception of a multimodal treatment with a cognitive approach. A reformulated grounded theory study based on interviews with 16 participants in the programme was conducted at the end of a 6-month treatment period. The result describes a conceptual model of the informants' perception of the treatment. The core category 'changing one's life plan' comprised of three categories: 'changing one's perception of life', 'depending on support' and 'managing one's life'. Changing one's perception of life could be deep and overwhelming 'overall life changes' or more superficial 'life adjustments'. Support by health professionals and the patient group were of importance. At the end of the rehabilitation program managing one's life was perceived as either 'reorientation' or 'stagnation'. The informants who experienced overall life changes achieved reorientation with support by others, while those who experienced life adjustments did not change their way of managing one's life to any great extent. The core category changing one's life plan included the categories; changing one's perception of life, depending on support and managing one's life. Informants experiencing overall life changes were more likely to achieve reorientation than those who experienced life adjustments.

  18. A prospective study of iridial pigmentation and eyelash changes due to ophthalmic treatment with latanoprost.

    PubMed

    Chiba, Tatsuya; Kashiwagi, Kenji; Ishijima, Kiyotaka; Furuichi, Mieko; Kogure, Satoshi; Abe, Keitetsu; Chiba, Nami; Tsukahara, Shigeo

    2004-01-01

    To conduct a 12-month prospective study on the occurrence of latanoprost-induced iridial pigmentation and eyelash change in Japanese patients with glaucoma Seventy-five patients (75 eyes) were enrolled in the study. Photographs of the iris and eyelashes were taken under identical conditions before and after treatment. Three glaucoma specialists assessed the iridial pigmentation/eyelash change independently with no knowledge of patient data. The effects of age, sex, concomitant medication, and type of glaucoma on iridial pigmentation/eyelash change were investigated, and intraocular pressure (IOP) reduction and iridocorneal angle pigmentation before and after latanoprost treatment were compared between patients with iridial pigmentation/eyelash change and patients without these changes. The incidence of iridial pigmentation was 6.3% at 1 month, 15.7% at 3 months, 37.8% at 6 months, and 56.5% at 12 months. The incidence of eyelash change was 0% at 1 month, 33.8% at 3 months, 44.4% at 6 months, and 46.2% at 12 months. Latanoprost did not affect IOP reduction or iridocorneal angle pigmentation. No significant relationship between iridial pigmentation and eyelash change was observed. None of the investigated parameters except age affected the iridial pigmentation/eyelash change. Iridial pigmentation and eyelash change occurred at a high frequency in long-term treatment with latanoprost in Japanese glaucoma patients.

  19. Application of empirically supported treatments to clinical settings. In: Jelalian, E., Steele, R.G., editors. Handbook of Childhood and Adolescent Obesity

    USDA-ARS?s Scientific Manuscript database

    This book chapter identifies treatments for pediatric obesity that have been shown to be effective in research settings and discusses how these treatments can be implemented in an applied clinical setting. Behavior-based treatments have demonstrated the best outcomes. Commonly used behavioral strate...

  20. 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.

  1. Changes of the Mandible after Orthodontic Treatment with and without Extraction of Four Premolars

    PubMed Central

    Hosseinzadeh-Nik, Tahereh; Eftekhari, Armin; Shahroudi, Atefe Saffar; Kharrazifard, Mahammad Javad

    2016-01-01

    Objectives: This study was designed to assess the changes of the mandible of patients who underwent orthodontic treatment with or without extraction of four premolars. Materials and Methods: Eighteen Class I bimaxillary protrusion patients treated with extraction of four first premolars and retraction of anterior teeth and 18 Class I non-extraction patients with a mean age of 16.38±0.4 years were selected. Cephalometric analysis was performed before and after treatment. Twenty-four variables for analyzing the hard and soft tissues of the mandible were compared between the two groups. Repeated measures ANOVA was used for the comparison of the two groups fallowed by paired t-test. The relationship between the soft and hard tissue variables was studied using the Pearson’s correlation coefficient. Results: In both groups, the mean value of angular measurements related to B point and Pogonion (Pog) decreased with treatment (P<0.05). Similarly, the symphysis depth of soft tissue decreased (P=0.008). The mean angular value of Y-axis increased in both groups after treatment (P=0.007). The mean changes in hard tissue symphysis depth after treatment were different in the two groups (P=0.021). Vertical, horizontal and rotational changes in soft tissue B point (B’) and Pogonion (pog’) followed their underlying hard tissue changes (P<0.05). Conclusions: Points B and Pog showed backward movement after orthodontic treatments in both extraction and non-extraction patients. Changes in B’ and Pog’ were directly influenced by the changes in the corresponding points of the underlying hard tissue. Orthodontic treatments with and without extraction of premolars produced insignificant changes in vertical facial dimension. PMID:28392817

  2. Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index.

    PubMed

    Fiebelkorn, Amy Parker; Person, Bobbie; Quick, Robert E; Vindigni, Stephen M; Jhung, Michael; Bowen, Anna; Riley, Patricia L

    2012-08-01

    Point-of-use water treatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use water treatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index. We used 22 key words to search peer-reviewed literature from 1950 to 2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use water treatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the water treatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation. In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions. Seven (27%) papers reported high sustained use of point-of-use water treatment with rates >50% at the last recorded follow-up. Despite documented health benefits of point-of-use water treatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation

  3. The Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ): change with treatment and prediction of outcome.

    PubMed

    Pinto, Angela Marinilli; Heinberg, Leslie J; Coughlin, Janelle W; Fava, Joseph L; Guarda, Angela S

    2008-04-01

    The purpose of this study was to examine the predictive validity of the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), an empirically-derived self-report instrument that assesses confidence to eat without engaging in eating disordered behavior or experiencing undue emotional distress (Normative Eating Self-Efficacy) and confidence to maintain a realistic body image that is not dominated by pursuit of thinness (Body Image Self-Efficacy). Participants were 104 female inpatients with anorexia nervosa (AN), subthreshold AN, or underweight bulimia nervosa who were treated at a specialized eating disorder clinic and completed the EDRSQ and Eating Disorder Inventory-2 (EDI-2) Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales upon admission. A subset of patients completed the EDRSQ (n=81) and EDI-2 subscales (n=70) following inpatient treatment. Self-efficacy increased significantly during treatment. EDRSQ scores at admission were inversely related to length of hospital stay and posttreatment DT and BD subscales and positively related to partial hospital weight gain rate. The EDRSQ significantly predicted length of hospital stay and posttreatment BD above and beyond clinical indicators and eating disorder psychopathology at inpatient admission. Findings support the validity of the EDRSQ and suggest it is a useful predictor of short-term hospital treatment outcome in underweight eating disorder patients.

  4. 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.

  5. Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

    PubMed Central

    Menning, Sanne; de Ruiter, Michiel B.; Veltman, Dick J.; Boogerd, Willem; Oldenburg, Hester S. A.; Reneman, Liesbeth

    2017-01-01

    Background Cognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain. Methods Participants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n = 28), or no systemic treatment (n = 24) and no-cancer controls (n = 31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design. Results Task performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups. Conclusions Parietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural

  6. Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type.

    PubMed

    Menning, Sanne; de Ruiter, Michiel B; Veltman, Dick J; Boogerd, Willem; Oldenburg, Hester S A; Reneman, Liesbeth; Schagen, Sanne B

    2017-01-01

    Cognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain. Participants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n = 28), or no systemic treatment (n = 24) and no-cancer controls (n = 31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design. Task performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups. Parietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural integrity after systemic treatment. Overall

  7. The heart of change: Acceptance and intimacy mediate treatment response in a brief couples intervention.

    PubMed

    Hawrilenko, Matt; Gray, Tatiana D; Córdova, James V

    2016-02-01

    In this study, we examined mediators of a brief couples intervention. Intimate safety, acceptance, and activation were examined in 2 roles: their contribution to marital satisfaction gains in the first 2 weeks after treatment (contemporaneous effects), and how early changes in the mediators influenced longer term changes in marital satisfaction over 2 years of follow-up (lagged effects). Married couples (N = 215) were randomized to either an intervention group or a wait-list control group and followed for 2 years. Latent change-score models were used to examine contemporaneous and time-lagged mediation. A booster intervention in the 2nd year was used for a replication study. Changes in intimate safety and acceptance were uniquely associated with contemporaneous treatment effects on relationship satisfaction in Year 1, but only acceptance was uniquely associated with contemporaneous effects in Year 2. With respect to lagged effects, early changes in acceptance partially mediated later changes in marital satisfaction in Year 1, whereas the same effect for intimate safety was marginally significant. These lagged paths were moderate in size and indirect effects were small. No lagged effects were significant in Year 2. Change in activation was not significant as either a contemporaneous or a lagged predictor of change in relationship satisfaction. We found moderate support for acceptance and more limited support for intimate safety as mediators of short- and long-term treatment response, suggesting that these processes play an important role in sustaining marital health.

  8. The Heart of Change: Acceptance and Intimacy Mediate Treatment Response in a Brief Couples Intervention

    PubMed Central

    Hawrilenko, Matt; Gray, Tatiana D.; Cordova, James V.

    2015-01-01

    This study examined mediators of a brief couples intervention. Intimate safety, acceptance, and activation were examined in two roles: their contribution to marital satisfaction gains in the first two weeks after treatment (contemporaneous effects), and how early changes in the mediators influenced longer-term changes in marital satisfaction over two years of follow-up (lagged effects). Married couples (N = 215) were randomized to intervention or wait-list control and followed for two years. Latent change score models were used to examine contemporaneous and time-lagged mediation. A booster intervention in the second year was used for a replication study. Changes in intimate safety and acceptance were uniquely associated with contemporaneous treatment effects on relationship satisfaction in year one, but only acceptance was uniquely associated with contemporaneous effects in year two. With respect to lagged effects, early changes in acceptance partially mediated later changes in marital satisfaction in year one, whereas the same effect for intimate safety was marginally significant. These lagged paths were moderate in size and indirect effects were small. No lagged effects were significant in year two. Changes in activation were not significant as either a contemporaneous or lagged predictor of changes in relationship satisfaction. This study found moderate support for acceptance and more limited support for intimate safety as mediators of short and long-term treatment response, suggesting that these processes play an important role in sustaining marital health. PMID:26524618

  9. 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.

  10. 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

  11. Secondary structure and conformational change of mushroom polyphenol oxidase during thermosonication treatment by using FTIR spectroscopy.

    PubMed

    Baltacıoğlu, Hande; Bayındırlı, Alev; Severcan, Feride

    2017-01-01

    To understand the conformational changes of mushroom PPO, the secondary structural change of the enzyme during thermosonication treatment at different power (60, 80 and 100%), temperature (20-60°C) and time (0-30min) combinations was investigated by using FTIR spectroscopy and compared with the change in enzyme activity. The enzyme inactivation higher than 99% was obtained at 100% amplitude at 60°C for 10min. FTIR studies showed that marked spectral changes were noted after ultrasound treatment at 20°C. The α-helix and β-sheet contents decreased, while aggregated β-sheet, turns and random coil contents increased as temperature increased up to 60°C during thermosonication treatment for 10min indicating protein denaturation. Aggregated bands located at 1683 and 1616cm(-1) became evident after ultrasound treatment at 40°C. When temperature was lowered back to 25°C, from ultrasound treatment at 60°C, these bands were still observed, indicating the irreversible change in the structure.

  12. 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.

  13. 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.

  14. Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders.

    PubMed

    Tomba, Elena; Tecuta, Lucia; Schumann, Romana; Ballardini, Donatella

    2017-04-01

    Psychological well-being changes following cognitive-behavioral therapy-based treatment were investigated in outpatients with eating disorders (ED). While it is known that CBT reduces symptomatology in EDs, less is known about how changes in positive functioning may ensue. One-hundred and eighty five ED outpatients were analyzed for pre-treatment and post-treatment changes in psychological well-being (PWB) by last observation carried forward - Wilcoxon signed rank tests. Significant gains in all PWB dimensions were found, with moderate effect size correlations in environmental mastery (r=-.418), personal growth (r=-.351) and self-acceptance (r=-.341). A subsample of patients in remission (n=51) was selected and compared to healthy controls in PWB post-treatment scores through Mann-Whitney U tests. Remitted patients showed significantly lower psychological well-being in two dimensions compared to controls: PWB-positive relations (r=-.360) and PWB-self-acceptance (r=-.288). However, more than 50% of ED outpatients in remission had PWB scores that fell below the 50th percentile of healthy controls in all psychological well-being dimensions, despite significant treatment response. Several mechanisms of psychological well-being change following CBT-based treatment are discussed. The assessment of treatment outcome in EDs may benefit from considering changes in positive functioning such as psychological well-being, in addition to the standard measurement of BMI, symptomatology and behavioral parameters. CBT-based treatment outcomes may be strengthened by promoting the development of optimal domains particularly in the interpersonal realm, such as building of quality and warm relationships and focusing on enhancing self-acceptance.

  15. 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

  16. Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).

    PubMed

    Heinz, W J; Buchheidt, D; Christopeit, M; von Lilienfeld-Toal, M; Cornely, O A; Einsele, H; Karthaus, M; Link, H; Mahlberg, R; Neumann, S; Ostermann, H; Penack, O; Ruhnke, M; Sandherr, M; Schiel, X; Vehreschild, J J; Weissinger, F; Maschmeyer, G

    2017-08-30

    Fever may be the only clinical symptom at the onset of infection in neutropenic cancer patients undergoing myelosuppressive chemotherapy. A prompt and evidence-based diagnostic and therapeutic approach is mandatory. A systematic search of current literature was conducted, including only full papers and excluding allogeneic hematopoietic stem cell transplant recipients. Recommendations for diagnosis and therapy were developed by an expert panel and approved after plenary discussion by the AGIHO. Randomized clinical trials were mainly available for therapeutic decisions, and new diagnostic procedures have been introduced into clinical practice in the past decade. Stratification into a high-risk versus low-risk patient population is recommended. In high-risk patients, initial empirical antimicrobial therapy should be active against pathogens most commonly involved in microbiologically documented and most threatening infections, including Pseudomonas aeruginosa, but excluding coagulase-negative staphylococci. In patients whose expected duration of neutropenia is more than 7 days and who do not respond to first-line antibacterial treatment, specifically in the absence of mold-active antifungal prophylaxis, further therapy should be directed also against fungi, in particular Aspergillus species. With regard to antimicrobial stewardship, treatment duration after defervescence in persistently neutropenic patients must be critically reconsidered and the choice of anti-infective agents adjusted to local epidemiology. This guideline updates recommendations for diagnosis and empirical therapy of fever of unknown origin in adult neutropenic cancer patients in light of the challenges of antimicrobial stewardship.

  17. Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

    PubMed Central

    López-Campos, Jose Luis; Abad Arranz, María; Calero Acuña, Carmen; Romero Valero, Fernando; Ayerbe García, Ruth; Hidalgo Molina, Antonio; Aguilar Perez-Grovas, Ricardo I; García Gil, Francisco; Casas Maldonado, Francisco; Caballero Ballesteros, Laura; Sánchez Palop, María; Pérez-Tejero, Dolores; Segado, Alejandro; Calvo Bonachera, Jose; Hernández Sierra, Bárbara; Doménech, Adolfo; Arroyo Varela, Macarena; González Vargas, Francisco; Cruz Rueda, Juan J

    2016-01-01

    Introduction This study is an analysis of a pilot COPD clinical audit that evaluated adherence to guidelines for patients with COPD in a stable disease phase during a routine visit in specialized secondary care outpatient clinics in order to identify the variables associated with the decision to step-up or step-down pharmacological treatment. Methods This study was a pilot clinical audit performed at hospital outpatient respiratory clinics in the region of Andalusia, Spain (eight provinces with over eight million inhabitants), in which 20% of centers in the area (catchment population 3,143,086 inhabitants) were invited to participate. Treatment changes were evaluated in terms of the number of prescribed medications and were classified as step-up, step-down, or no change. Three backward stepwise binominal multivariate logistic regression analyses were conducted to evaluate variables associated with stepping up, stepping down, and inhaled corticosteroids discontinuation. Results The present analysis evaluated 565 clinical records (91%) of the complete audit. Of those records, 366 (64.8%) cases saw no change in pharmacological treatment, while 99 patients (17.5%) had an increase in the number of drugs, 55 (9.7%) had a decrease in the number of drugs, and 45 (8.0%) noted a change to other medication for a similar therapeutic scheme. Exacerbations were the main factor in stepping up treatment, as were the symptoms themselves. In contrast, rather than symptoms, doctors used forced expiratory volume in 1 second and previous treatment with long-term antibiotics or inhaled corticosteroids as the key determinants to stepping down treatment. Conclusion The majority of doctors did not change the prescription. When changes were made, a number of related factors were noted. Future trials must evaluate whether these therapeutic changes impact clinically relevant outcomes at follow-up. PMID:27330285

  18. 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.

  19. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease.

    PubMed

    Ramig, L O; Dromey, C

    1996-08-01

    The purpose of this study was to document changes in aerodynamic and glottographic aspects of vocal function in patients with Parkinson disease who received two forms of high effort treatment. Previous reports (Ramig, Countryman, Thompson, & Horii, 1995) have documented increased sound pressure level (SPL) following treatment that trained phonation and respiration (Lee Silverman Voice Treatment: LSVT), but not for treatment that trained respiration only (R). In order to examine the mechanisms underlying these differences, measures of maximum flow declination rate (MFDR) and estimated subglottal pressure (Psub) were made before and after treatment. A measure of relative vocal fold adduction (EGGW) was made from the electroglottographic signal during sustained vowel phonation. Sound pressure level data from syllable repetition, sustained vowel phonation, reading, and monologue tasks were also analyzed to allow a more detailed understanding of treatment-related change in several contexts. Consistent with increases in SPL, significant increases in MFDR, estimated Psub, and EGGW were measured posttreatment in patients who received the LSVT. Similar changes were not observed following R treatment. These findings suggest that the combination of increased vocal fold adduction and subglottal pressure is a key in generating posttreatment increases in vocal intensity in idiopathic Parkinson disease (IPD).

  20. Benchmarks for detecting ‘breakthroughs’ in clinical trials: empirical assessment of the probability of large treatment effects using kernel density estimation

    PubMed Central

    Miladinovic, Branko; Kumar, Ambuj; Mhaskar, Rahul; Djulbegovic, Benjamin

    2014-01-01

    Objective To understand how often ‘breakthroughs,’ that is, treatments that significantly improve health outcomes, can be developed. Design We applied weighted adaptive kernel density estimation to construct the probability density function for observed treatment effects from five publicly funded cohorts and one privately funded group. Data Sources 820 trials involving 1064 comparisons and enrolling 331 004 patients were conducted by five publicly funded cooperative groups. 40 cancer trials involving 50 comparisons and enrolling a total of 19 889 patients were conducted by GlaxoSmithKline. Results We calculated that the probability of detecting treatment with large effects is 10% (5–25%), and that the probability of detecting treatment with very large treatment effects is 2% (0.3–10%). Researchers themselves judged that they discovered a new, breakthrough intervention in 16% of trials. Conclusions We propose these figures as the benchmarks against which future development of ‘breakthrough’ treatments should be measured. PMID:25335959

  1. Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior.

    PubMed

    Kazdin, Alan E; Whitley, Moira K

    2003-06-01

    This study evaluated a parent problem-solving (PPS) intervention designed to augment the effects of evidence-based therapy for children referred to treatment for aggressive and antisocial behavior. All children (N = 127, ages 6-14 years) and their families received problem-solving skills training (PSST), and parents received parent management training (PMT). Families were randomly assigned to receive or not to receive an additional component (PPS) that addressed parental stress over the course of treatment. Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment. The implications of the findings for improving evidence-based treatment as well as the limitations of adding components to treatment are detailed.

  2. 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.

  3. Treatment of severe thyroid function disorders and changes in body composition.

    PubMed

    Stangierski, Adam; Ruchała, Marek; Krauze, Tomasz; Moczko, Jerzy; Guzik, Przemysław

    2016-01-01

    Hyper- and hypothyroidism are accompanied by altered metabolic rate, thermogenesis, and body weight. The aim of this study was to estimate the relation between treatment-induced changes in thyroid function, and the accompanying body composition in patients with either severe hypo- or hyperthyroidism. Body composition analysis and hormonal assessment were measured at the initial diagnosis of thyroid disorder, after three-month treatment, and finally after complete recovery from hyperthyroidism (n = 18) or hypothyroidism (n = 27). Nonparametric Spearman correlation was used to analyse the relation between thyroid hormones and body composition as well as their respective changes. In hypothyroid patients applied treatment significantly reduced (p < 0.05) total body weight, mainly due to a decrease in fat mass, whereas in hyperthyroid patients it caused a weight gain, with a simultaneous increase in muscle, water and fat mass. Total body weight and fat mass were significantly correlated with thyroid hormones' concentrations in all patients. Changes of fat, water, or muscle mass were strongly correlated with the changes in the patients' hormonal status. Body composition is related to the concentration of thyroid hormones in thyroid dysfunction. Treatment-induced changes in thyroid hormones concentrations are correlated with the magnitude of the change of body weight, including muscle, water, and fat amount. (Endokrynol Pol 2016; 67 (4): 359-366).

  4. Predicting Treatment Seekers Readiness to Change their Drinking Behavior in the COMBINE Study

    PubMed Central

    DiClemente, Carlo C.; Doyle, Suzanne R.; Donovan, Dennis

    2010-01-01

    Background Initial motivation and readiness to change are complex constructs and have been important but inconsistent predictors of treatment attendance and drinking outcomes in studies of alcoholism treatment. Motivation can be described in multiple ways as simply the accumulation of consequences that push change, a shift in intentions, or engagement in various tasks that are part of a larger process of change. Method Using baseline data from participants in the COMBINE Study, this study re-evaluated the psychometric properties of a 24-item, measure of motivation derived from the URICA that yielded four subscales representing attitudes and experiences related to tasks of stages of Precontemplation, Contemplation, Action, and Maintenance Striving as well as a second order factor score representing a multidimensional view of readiness to change drinking. A variety of hypothesized predictors of readiness and the stage subscales were examined using multiple regression analyses in order to better understand the nature of this measure of motivation. Results Findings supported the basic subscale structure and the overall motivational readiness score derived from this measure. Readiness to change drinking behavior was predicted by baseline measures of perceived stress, drinking severity, psychiatric co-morbidity, self-efficacy, craving, and with positive treatment outcome expectancies. However, absolute values were small indicating that readiness for change is not explained simply by demographic, drinking severity, treatment, change process, or contextual variables. Conclusion This measure demonstrated good psychometric properties and results supported the independence as well as convergent and divergent validity of the measured constructs. Predictors of overall readiness and subscale scores indicate that a variety of personal and contextual factors contribute to treatment seekers motivation to change in an understandable but complex manner. PMID:19320633

  5. Asthma treatment in a population-based cohort: putting step-up and step-down treatment changes in context.

    PubMed

    Yawn, Barbara P; Wollan, Peter C; Bertram, Susan L; Lowe, David; Butterfield, Joseph H; Bonde, Denise; Li, James T C

    2007-04-01

    To assess the frequency and types of visits related to modifications in the intensity of asthma medications. We retrospectively reviewed the medical records of adults (aged 18-40 years) and children (aged 6-17 years) living in Olmsted County, Minnesota, to evaluate changes in asthma medications by dose and drug class and site and type of visit (routine vs unscheduled) at the time of changes. All records from all visits were reviewed for each patient to identify asthma-related visits at all sites of care from January 1, 2002, through December 31, 2003. The study consisted of 397 adults and children. In 255 patients, 597 asthma medication changes occurred. Step-up changes usually occurred because of an exacerbation or loss of control of asthma and adhered to the medication hierarchy in the national asthma guidelines. Twenty step-up changes involved skipping inhaled corticosteroid (ICS) monotherapy and moving directly to combined ICSs plus a long-acting beta-agonist (LABA). Lack of documentation of asthma symptom frequency or interference with activities made it impossible to determine whether these 'skips' were appropriate. Only 78 physician-directed step-down changes were documented, usually to a lower dose of combined ICSs and LABAs or a move from combined ICSs and LABAs to anti-inflammatory monotherapy. Patients initiated additional step-down changes between encounters. Step-down changes occurred at routine or follow-up asthma visits, but the limited number of such visits provided few opportunities for step-down care. The continuing episodic-style treatment of asthma aimed at exacerbation management facilitates step-up changes in asthma therapy. The dearth of asthma evaluation visits limited opportunities to step down use of asthma medications and to provide long-term asthma management.

  6. Risk-Taking Propensity Changes Throughout the Course of Residential Substance Abuse Treatment

    PubMed Central

    Aklin, Will M.; Tull, Matthew T.; Kahler, Christopher W.; Lejuez, C.W.

    2009-01-01

    High rates of relapse following treatment have compelled researchers to elucidate the individual difference factors that change among those who receive substance abuse treatment. Previous research has suggested that trait-disinhibition variables may be of particular relevance. Given that these variables are primarily considered to be trait-level factors, the extent to which they are malleable by treatment is an important consideration. Thus, the purpose of this study was to examine the effect of a residential substance abuse treatment program on specific trait-disinhibition variables (e.g., risk-taking, impulsivity). A sample of 81 inner-city substance users were assessed on self-report and behavioral indicators of trait-disinhibition over a 30-day course of treatment. Risk-taking propensity was found to significantly decrease from pre- to post-treatment. Results are discussed with respect to implications for better understanding the factors that may operate as mechanisms of change during treatment, thereby having the potential to inform substance abuse prevention and treatment programs. PMID:20161264

  7. Changes in Diarrheal Disease and Treatment Among Brazilian Children from 1986 to 1996

    PubMed Central

    Sastry, Narayan; Burgard, Sarah

    2010-01-01

    We examined changes in diarrhea prevalence and treatment in Brazil between 1986 and 1996. Over this 10-year period there was a small decline in diarrhea prevalence but treatment with oral rehydration therapy (ORT) increased greatly. Deaths due to dehydration were thus averted, although the costly burden of morbidity remained high. The decline in diarrhea prevalence was largely due to changes in the effects of several key covariates, such as breastfeeding, with only a modest role played by socioeconomic change, infrastructure improvements, and other behavioral factors. ORT treatment of diarrhea was essentially unrelated to child and family characteristics, suggesting that the large increase was due to the success of public health efforts to promote its use widely. Our results suggest that the most effective policies for reducing diarrhea prevalence are likely to be further increases in education and the promotion of breastfeeding. Persistent disparities in diarrhea prevalence mean that policies to prevent the disease should be targeted at disadvantaged socioeconomic groups. PMID:21359099

  8. Changing global essential medicines norms to improve access to AIDS treatment: lessons from Brazil.

    PubMed

    Nun