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Sample records for clinically applied hydroxylapatite

  1. Calcium Hydroxylapatite

    PubMed Central

    Yutskovskaya, Yana Alexandrovna; Philip Werschler, WM.

    2015-01-01

    Background: Calcium hydroxylapatite is one of the most well-studied dermal fillers worldwide and has been extensively used for the correction of moderate-to-severe facial lines and folds and to replenish lost volume. Objectives: To mark the milestone of 10 years of use in the aesthetic field, this review will consider the evolution of calcium hydroxylapatite in aesthetic medicine, provide a detailed injection protocol for a global facial approach, and examine how the unique properties of calcium hydroxylapatite provide it with an important place in today’s market. Methods: This article is an up-to-date review of calcium hydroxylapatite in aesthetic medicine along with procedures for its use, including a detailed injection protocol for a global facial approach by three expert injectors. Conclusion: Calcium hydroxylapatite is a very effective agent for many areas of facial soft tissue augmentation and is associated with a high and well-established safety profile. Calcium hydroxylapatite combines high elasticity and viscosity with an ability to induce long-term collagen formation making it an ideal agent for a global facial approach. PMID:25610523

  2. Presentation of Ligands on Hydroxylapatite

    NASA Technical Reports Server (NTRS)

    Chu, Barbara C. F.; Orgel, Leslie E.

    1997-01-01

    Conjugates of biotin with the decamer of glutamic acid (glu(sub 10)) and the trimer of D,L-2-amino-5-phosphonovaleric acid (I) have been synthesized, and it has been shown that they mediate the binding of avidin to hydroxylapatite. In a similar way a conjugate of methotrexate with glu(sub 10) mediates the binding of dihydrofolate reductase to the mineral. The presentation of ligands on the hydroxylapatite component of bone may find applications in clinical medicine.

  3. Hydroxylapatite Otologic Implants

    SciTech Connect

    McMillan, A.D.; Lauf, R.J.; Beale, B.; Johnson, R.

    2000-01-01

    A Cooperative Research and Development Agreement (CRADA) between Lockheed Martin Energy Research Corporation (LMER) and Smith and Nephew Richards Inc. of Bartlett, TN, was initiated in March 1997. The original completion date for the Agreement was March 25, 1998. The purpose of this work is to develop and commercialize net shape forming methods for directly creating dense hydroxylapatite (HA) ceramic otologic implants. The project includes three tasks: (1) modification of existing gelcasting formulations to accommodate HA slurries; (2) demonstration of gelcasting to fabricate green HA ceramic components of a size and shape appropriate to otologic implants: and (3) sintering and evaluation of the HA components.

  4. Zinc Incorporation Into Hydroxylapatite

    SciTech Connect

    Tang, Y.; Chappell, H; Dove, M; Reeder, R; Lee, Y

    2009-01-01

    By theoretical modeling and X-ray absorption spectroscopy, the local coordination structure of Zn incorporated into hydroxylapatite was examined. Density function theory (DFT) calculations show that Zn favors the Ca2 site over the Ca1 site, and favors tetrahedral coordination. X-ray absorption near edge structure (XANES) spectroscopy results suggest one dominant coordination environment for the incorporated Zn, and no evidence was observed for other Zn-containing phases. Extended X-ray absorption fine structure (EXAFS) fitting of the synthetic samples confirms that Zn occurs in tetrahedral coordination, with two P shells at 2.85-3.07 {angstrom}, and two higher Ca shells at 3.71-4.02 {angstrom}. These fit results are consistent with the most favored DFT model for Zn substitution in the Ca2 site.

  5. Consensus Recommendations for Optimal Augmentation of the Asian Face with Hyaluronic Acid and Calcium Hydroxylapatite Fillers.

    PubMed

    Rho, Nark-Kyoung; Chang, Yao-Yuan; Chao, Yates Yen-Yu; Furuyama, Nobutaka; Huang, Peter Y C; Kerscher, Martina; Kim, Hee-Jin; Park, Je-Young; Peng, Hsien Li Peter; Rummaneethorn, Paisal; Rzany, Berthold; Sundaram, Hema; Wong, Chin Ho; Yang, Yuli; Prasetyo, Adri Dwi

    2015-11-01

    Although the use of filling agents for soft-tissue augmentation has increased worldwide, most consensus statements do not distinguish between ethnic populations. There are, however, significant differences between Caucasian and Asian faces, reflecting not only cultural disparities, but also distinctive treatment goals. Unlike aesthetic patients in the West, who usually seek to improve the signs of aging, Asian patients are younger and request a broader range of indications. Members of the Asia-Pacific Consensus group-comprising specialists from the fields of dermatology, plastic surgery, anatomy, and clinical epidemiology-convened to develop consensus recommendations for Asians based on their own experience using cohesive polydensified matrix, hyaluronic acid, and calcium hydroxylapatite fillers. The Asian face demonstrates differences in facial structure and cosmetic ideals. Improving the forward projection of the "T zone" (i.e., forehead, nose, cheeks, and chin) forms the basis of a safe and effective panfacial approach to the Asian face. Successful augmentation may be achieved with both (1) high- and low-viscosity cohesive polydensified matrix/hyaluronic acid and (2) calcium hydroxylapatite for most indications, although some constraints apply. The Asia-Pacific Consensus recommendations are the first developed specifically for the use of fillers in Asian populations. Therapeutic, V.

  6. Anterior filler displacement following injection of calcium hydroxylapatite gel (Radiesse) for anophthalmic orbital volume augmentation.

    PubMed

    Buchanan, Adam G; Holds, John B; Vagefi, M Reza; Bidar, Maziar; McCann, John D; Anderson, Richard L

    2012-01-01

    To describe the complication of anterior filler displacement following injection of calcium hydroxylapatite gel (Radiesse) for anophthalmic enophthalmos correction. Retrospective case series of patients who experienced anterior filler displacement following orbital injection of calcium hydroxylapatite. Data includes patient demographics, indication for injection, route and volume of injection, description of postinjection complications, and final outcome. Four cases of anterior filler displacement and expansion following injection of calcium hydroxylapatite were identified. The patients' ages ranged from 33 to 64 years old. All 4 patients underwent multiple prior orbital surgeries and suffered from anophthalmic enophthalmos. Injectable calcium hydroxylapatite was delivered transcutaneously, to the deep extraconal orbital space, via 27-gauge, 1.25-inch retrobulbar needles. Each patient received an initial 1.3 ml of filler, with 1 patient receiving an additional 0.8 ml. Within 1 week, all patients experienced prominent, edematous lower eyelids. A CT scan of 1 patient radiographically documented anterior migration of the filler material. Two patients required transconjunctival excision of the filler and infiltrated orbital fat. Histopathologic examination of 1 specimen revealed chronic foreign body granulomatous inflammation. Two patients were treated medically, with resolution of clinical findings over 6 to 9 months. Anterior filler displacement is a potential complication of orbital volume augmentation with injectable calcium hydroxylapatite. Patients should be counseled regarding this possibility when considering options for the treatment of anophthalmic enophthalmos. A history of multiple prior orbital surgeries, with associated tissue disruption and scarring, may be a risk factor for filler displacement.

  7. [Comparative analysis and clinical experience with osteoplastic materials materials based on non-demineralized bone collagen and artificial hydroxylapatite at the close of bone defects in ambulatory surgical dentistry].

    PubMed

    Dunaev, M V; Kitaev, V A; Matavkina, M V; Druzhinin, A E; Bubnov, A S

    2014-01-01

    In the presence of bone defects during surgery is not always performed osteoptastic material replenishment defect that leads to a lengthening of the timing healing, bone regeneration, and treatment outcome. Application of osteoplastic materials allows for faster treatment outcomes, accelerate the regeneration of bone tissue in the area of the defect. To examine the effectiveness of materials based on non-demineralized bone collagen and artificial hydroxylapatite when filling bone defects in outpatient surgical practice dentistry. 22 patients with bone defects of various localization using osteoplastic materials were examined and treated. In our study, two groups were allocated on the etiology of bone loss: radicular cysts and chronic generalized periodontitis. Basic methods of diagnosis and monitoring of treatment in the work presented with the cone-beam computed tomography and digital orthopantomography. Application of the testing osteoplastic materials resulted in faster recovery times with a combination of bone defects using resorbable membranes or gel enriched fibrin. In all 22 patients both tested materials were well tolerated, allergic reactions were not identified. However, five patients with a history of endocrinological history, during which treatment material is applied on the basis non-demineralized bone collagen, the degree of osseointegration has been reduced by 25% compared to the somatic healthy patients. In 3 patients with a history of hematological history, during which the treatment was applied material on the basis of artificial hydroxyapatite, the regeneration of the bone defect was reduced by 20%, which suggests the influence of somatic condition of the patient on the regeneration of bone tissue. Currently, all patients are on dynamic monitoring, recurrence has been detected. Materials based on non-demineralized bone collagen and hydroxyapatite artificial equally successful during the replacement of the bone defect during surgery. However, the

  8. Processing of hydroxylapatite coatings on titanium alloy bone prostheses

    DOEpatents

    Nastasi, Michael A.; Levine, Timothy E.; Mayer, James W.; Pizziconi, Vincent B.

    1998-01-01

    Processing of hydroxylapatite sol-gel films on titanium alloy bone prostheses. A method utilizing non-line-of-sight ion beam implantation and/or rapid thermal processing to provide improved bonding of layers of hydroxylapatite to titanium alloy substrates while encouraging bone ingrowth into the hydroxylapatite layers located away from the substrate, is described for the fabrication of prostheses. The first layer of hydroxylapatite is mixed into the substrate by the ions or rapidly thermally annealed, while subsequent layers are heat treated or densified using ion implantation to form layers of decreasing density and larger crystallization, with the outermost layers being suitable for bone ingrowth.

  9. Processing of hydroxylapatite coatings on titanium alloy bone prostheses

    DOEpatents

    Nastasi, M.A.; Levine, T.E.; Mayer, J.W.; Pizziconi, V.B.

    1998-10-06

    Processing of hydroxylapatite sol-gel films on titanium alloy bone prostheses. A method utilizing non-line-of-sight ion beam implantation and/or rapid thermal processing to provide improved bonding of layers of hydroxylapatite to titanium alloy substrates while encouraging bone ingrowth into the hydroxylapatite layers located away from the substrate, is described for the fabrication of prostheses. The first layer of hydroxylapatite is mixed into the substrate by the ions or rapidly thermally annealed, while subsequent layers are heat treated or densified using ion implantation to form layers of decreasing density and larger crystallization, with the outermost layers being suitable for bone ingrowth.

  10. [Significance of crown-down root canal preparation technique in endodontic therapy by using the hydroxylapatite sealer].

    PubMed

    Teodorović, Nevenka; Martinović, Zeljko

    2005-06-01

    To evaluate the crown-down preparation technique, and the use of hydroxylapatite based material for the definitive root canal obturation. The investigation included 20 single-canal roots with chronic periapical inflammatory lesion. Biomechanical medicamentous canal preparation was done using the double-flared technique with balanced force, and the obturation was performed with hydroxylapatite sealer (unicone technique). Clinical and radiographic check-up performed 12 months after the treatment, used the following parameters: pain, swelling, percussion and palpation sensitivity, and the presence of fistula. The obtained results showed a successful treatment in 18 cases, while in the 2 cases the treatment failed. These findings suggested that the crown-down preparation technique efficiently cleaned and shaped the root canal, and that the hydroxylapatite-based material created the homogenous and hermetic root canal obturation, so this methodology could be recommended for the endodontic therapy.

  11. Template-directed oligonucleotide ligation on hydroxylapatite

    NASA Technical Reports Server (NTRS)

    Acevedo, O. L.; Orgel, L. E.

    1986-01-01

    It has been suggested that the prebiotic synthesis of the precursors of biopolymers could have occurred on a solid surface such as that provided by clay or some other mineral. One such scheme envisages that growing polymers were localized by adsorption to a mineral surface where an activating agent or activated monomers were supplied continuously or cyclically. Here, it is reported that a sequence of reactions in which initially formed oligo(G)s are reactivated by conversion to phosphorimidazolides in the presence of poly(C) and then allowed to ligate is ideal, in that repeated cycles can be carried out on the surface of hydroxylapatite, whereas in the liquid phase the cycle could be achieved only with considerable difficulty.

  12. Hydroxylapatite nanoparticles: fabrication methods and medical applications

    PubMed Central

    Okada, Masahiro; Furuzono, Tsutomu

    2012-01-01

    Hydroxylapatite (or hydroxyapatite, HAp) exhibits excellent biocompatibility with various kinds of cells and tissues, making it an ideal candidate for tissue engineering, orthopedic and dental applications. Nanosized materials offer improved performances compared with conventional materials due to their large surface-to-volume ratios. This review summarizes existing knowledge and recent progress in fabrication methods of nanosized (or nanostructured) HAp particles, as well as their recent applications in medical and dental fields. In section 1, we provide a brief overview of HAp and nanoparticles. In section 2, fabrication methods of HAp nanoparticles are described based on the particle formation mechanisms. Recent applications of HAp nanoparticles are summarized in section 3. The future perspectives in this active research area are given in section 4. PMID:27877527

  13. Hydroxylapatite nanoparticles: fabrication methods and medical applications

    NASA Astrophysics Data System (ADS)

    Okada, Masahiro; Furuzono, Tsutomu

    2012-12-01

    Hydroxylapatite (or hydroxyapatite, HAp) exhibits excellent biocompatibility with various kinds of cells and tissues, making it an ideal candidate for tissue engineering, orthopedic and dental applications. Nanosized materials offer improved performances compared with conventional materials due to their large surface-to-volume ratios. This review summarizes existing knowledge and recent progress in fabrication methods of nanosized (or nanostructured) HAp particles, as well as their recent applications in medical and dental fields. In section 1, we provide a brief overview of HAp and nanoparticles. In section 2, fabrication methods of HAp nanoparticles are described based on the particle formation mechanisms. Recent applications of HAp nanoparticles are summarized in section 3. The future perspectives in this active research area are given in section 4.

  14. Host response to infection of a subperiosteal hydroxylapatite implant.

    PubMed

    Reznick, J B; Gilmore, W C

    1989-06-01

    Particulate, nonresorbable hydroxylapatite is currently a popular implant material for the augmentation of atrophic alveolar ridges. Most reports have demonstrated favorable biocompatibility with common usage, but how the host bone will respond to the implant in the presence of an infection has not yet been investigated. Hydroxylapatite was implanted subperiosteally on one side of the mandible in four New Zealand White rabbits. After 3 months were allowed to elapse for stabilization of the implant, an infection was induced in both sides of each mandible by inoculation with Bacteroides melaninogenicus. One month later the animals were put to death and both sides of each mandible were examined microscopically. On the nonaugmented side there was total resolution of the infection. The side of each mandible containing the hydroxylapatite implant showed very mild chronic inflammation throughout the medullary space and periosteum. Although the number of animals used was small, the results suggest that the presence of the hydroxylapatite implant may have interfered with the host's ability to resolve the infection in the underlying bone. The possible mechanism of this interference is discussed.

  15. Long-term stability of atrophic ridges reconstructed with hydroxylapatite: a prospective study.

    PubMed

    Mercier, P; Bellavance, F; Cholewa, J; Djokovic, S

    1996-08-01

    This article reports the results of an investigation of the long-term efficacy and stability of reconstructive surgery of atrophic ridges using dense hydroxylapatite (HA). Subperiosteal HA was used as a first stage of reconstruction in 678 ridges, 645 mandibular and 35 maxillary, followed after 4 to 5 weeks by a total lowering of the floor of the mouth, vestibuloplasty, and skin graft in the mandible: a same-stage submucous vestibuloplasty was done in the maxilla. Patients were followed for an average of 5.3 +/- 2.7 years by the same surgical and prosthodontic team. The presence of severe or moderate radiographic change was analyzed in relation to gender, age, severity of atrophy, postoperative complications, clinical changes, patient satisfaction, and type of HA particles used alone or with a binder. Seventy-seven percent of cases had no observable radiographic changes, 13% had moderate changes, and 10% had severe changes, of which fewer than half also had severe clinical changes. Relationships were established between the presence of radiographic change and certain parameters, especially postoperative delay in healing, severe or moderate clinical changes, and type of HA particles used. Hydroxylapatite, when used alone or with binding agents, and in association with basic techniques of reconstructive surgery and soft tissue handling, is a predictable and stable biomaterial for ridge reconstruction.

  16. Equation of State of Carbonated Hydroxylapatite at Ambient Temperature up to 10 GPa: Significance of Carbonate

    SciTech Connect

    X Liu; S Shieh; M Fleet; L Zhang; Q He

    2011-12-31

    The incorporation of the carbonate ion into the crystal structure of hydroxylapatite results in the creation of vacancies, oxygen-loss, and disorder, with consequent changes in physical and chemical properties. High-pressure experimental investigation up to 10 GPa of two synthetic carbonated hydroxylapatite samples with up to 11 wt% CO3, using a diamond-anvil cell and synchrotron powder X-ray diffraction, provides the first rigorous assessment of the mechanical behavior of the carbonated hydroxylapatite. The pressure-volume data suggest that the isothermal bulk modulus of these carbonated hydroxylapatites has been significantly decreased by the presence of the carbonate (up to about 15%), which in turn will affect all the carbonated apatite-related reactions in the geosystem. Since hydroxylapatite is one of the major components of the bones and teeth, the incorporation of the carbonate in the hydroxylapatite weakens teeth and bones not only chemically, but also physically.

  17. Production of nanoparticles from natural hydroxylapatite by laser ablation

    PubMed Central

    2011-01-01

    Laser ablation of solids in liquids technique has been used to obtain colloidal nanoparticles from biological hydroxylapatite using pulsed as well as a continuous wave (CW) laser. Transmission electron microscopy (TEM) measurements revealed the formation of spherical particles with size distribution ranging from few nanometers to hundred nanometers and irregular submicronic particles. High resolution TEM showed that particles obtained by the use of pulsed laser were crystalline, while those obtained by the use of CW laser were amorphous. The shape and size of particles are consistent with the explosive ejection as formation mechanism. PMID:21711800

  18. Ion mixing of pulsed laser deposited hydroxylapatite (HA)

    SciTech Connect

    Alford, T.L.; Russell, S.W.; Pizziconi, V.B.; Mayer, J.W.; Levine, T.E.; Nastasi, M.; Cotell, C.M.; Auyeung, R.C.Y.

    1995-12-31

    Hydroxylapatite (HA) is a calcium-phosphate-bioceramic material which has drawn much attention due to its excellent biocompatibility and tissue bioactivity properties. The use of ion-beam techniques to enhance selected properties of bioactive materials, such as the adhesion of hydroxylapatite (HA) coatings on titanium-based substrates has been investigated. In this study, very thin HA films on titanium substrates were created by pulsed laser deposition techniques. Ion irradiations were carried out using 260-keV argon ions, with fluences of 0.25--50 {times} 10{sup 15} ions/cm{sup 2}, and at room temperature. Rutherford backscattering spectrometry was used to evaluate sample composition before and after irradiation. The amount of mixing was quantified by the mixing rate (the amount of atomic displacement due to an irradiation fluence). This pilot data indicates that mixing was evident after sufficient ion irradiation. The ramification of this preliminary study has provided a quantitative measure of ion mixing as a potential prosthetic biomaterial surface modification technique.

  19. Introduction: Applying Clinical Psychological Science to Practice.

    PubMed

    Cha, Christine B; DiVasto, Katherine A

    2017-02-10

    Mental illness is a prevalent and extraordinarily complex phenomenon. Psychologists have developed distinct approaches toward understanding and treating mental illness, rooted in divergent epistemology. This introduction to the Special Issue on Clinical Psychological Science and Practice provides a brief overview of the scientist-practitioner gap, and explores one step (of many) toward bridging this divide. Seven compelling case illustrations featured in this Special Issue apply empirical findings to case formulation, treatment selection, and assessment across complex and varied clinical presentations. This issue thereby demonstrates the feasibility of integrating research and clinical expertise in mental healthcare.

  20. Comparison of voice outcome after vocal fold augmentation with fat or calcium hydroxylapatite.

    PubMed

    Lodder, Wouter L; Dikkers, Frederik G

    2015-05-01

    To evaluate the short-term voice outcomes of vocal fold augmentation using fat compared to calcium hydroxylapatite product Radiesse Voice (Merz Aesthetics). Retrospective study design. Sixty-six consecutive patients with vocal fold insufficiency were recruited, including the final 33 patients treated with fat and all 33 patients treated with calcium hydroxylapatite product. Before April 2011, fat augmentation was the standard treatment; from April 2011, only calcium hydroxylapatite product was used. For all subjects, videolaryngostroboscopic evaluation, s/z ratios, and voice handicap index (VHI) were analyzed. Treatment outcomes were evaluated 3 months after the augmentation. Two patients augmented with fat (both after 6 months), versus four augmented with calcium hydroxylapatite product (mean after 7 months), needed reintervention. Mean VHI decreased from 18 points in the fat augmentation group compared to 17 points in the calcium hydroxylapatite group. Mean s/z ratio changed -0.33 in the fat augmentation group compared to -0.46 in the calcium hydroxylapatite group. This retrospective cohort demonstrates that there are no short-term differences in VHI outcome or number of reinterventions for augmentation with fat compared to calcium hydroxylapatite product Radiesse Voice (Merz Aesthetics). Level 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Applying sport psychology to improve clinical performance().

    PubMed

    Church, Helen R; Rumbold, James L; Sandars, John

    2017-08-08

    Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

  2. Nurses' intention to apply clinical practice guidelines.

    PubMed

    Kogan, Ella; Tabak, Nili

    2012-12-01

    Using Ajzen and Madden's Theory of Planned Behavior, this study investigates factors which influence nurses' intention to apply clinical practice guidelines in their daily ward work. A convenience sample of 91 nurses in internal medicine wards in three Israeli hospitals answered four questionnaires. Data were processed by Pearson correlation coefficients and multivariate regression. The main findings were that burnout was negatively correlated with the intention to work according to guidelines and that professionalism (in the sense of a tendency to follow taught procedure rather than personal judgment) was positively correlated with it. Furthermore, nurses who perceive their behavioral control and subjective norms to be positive will be the most determined to work according to guidelines, provided they personally command the necessary resources to do so.

  3. Rheological Properties of Calcium Hydroxylapatite With Integral Lidocaine.

    PubMed

    Meland, Melissa; Groppi, Chris; Lorenc, Z Paul

    2016-09-01

    Calcium hydroxylapatite with integral lidocaine, CaHA (+), received FDA approval in 2015 and CE mark approval in 2016. This formulation has been associated with significant pain reduction compared to CaHA. In a previous rheometry study, CaHA without lidocaine demonstrated higher viscosity and elasticity when compared with hyaluronic acid fillers. To compare the rheological properties of CaHA (+) lidocaine to CaHA without lidocaine and to compare the rheological measures of CaHA (+) to 5 cross-linked hyaluronic acid (HA) fillers with integral 0.3% lidocaine.
    The rheological properties of complex viscosity (η*) and elastic modulus (G') were measured for 2 types of CaHA fillers [CaHA without lidocaine and CaHA (+) with integral 0.3% lidocaine] and 5 HA fillers using an oscillation frequency sweep at a sheer stress of 5 pascal tau (Pa) and an interpolation of 0.7 Hz.
    CaHA with and without integral lidocaine demonstrate similar η* and G' measurements. CaHA with and without integral lidocaine demonstrates higher η* and G' compared with HA fillers with integral lidocaine.
    CaHA with integral lidocaine has a similar rheological profile to CaHA without lidocaine: the highest η* and G' compared with available HA fillers with integral lidocaine.

    J Drugs Dermatol. 2016;15(9):1107-1110.

  4. Mixed mode fracture characterization of hydroxylapatite-titanium alloy interface.

    PubMed

    Mann, K A; Edidin, A A; Kinoshita, R K; Manley, M T

    1994-01-01

    Cantilever beam and four-point bend specimen geometries were used to experimentally determine the critical energy release rates for a plasma sprayed hydroxylapatite-titanium alloy (HA-Ti alloy) interface. A locus of energy release rates as a function of crack tip phase angle was determined where a 0 degree phase angle represented tensile opening (mode I) loading and a 90 degree phase angle represented in-plane shear (mode II) loading. Energy release rates were found to increase substantially with an increase in phase angle. An energy release rate of 0.108 N/mm was determined for a phase angle of 0 degrees (mode I). Energy release rates of 0.221, 0.686, and 1.212 N/mm were determined for phase angles of 66 degrees, 69 degrees, and 72 degrees, respectively. The experimental data was matched to a phenomenological model for which crack propagation depended on mode I loading alone indicating that crack propagation at the Ha-Ti alloy interface is dominated by the mode I loading component. Therefore, regions of HA coated implants that experience compressive or shear loading across the HA-Ti alloy interface may be much less likely to debond than regions that experience tensile loading.

  5. Clinical practice is not applied scientific method.

    PubMed

    Cox, K

    1995-08-01

    Practice is often described as applied science, but real life is far too complex and interactive to be handled by analytical scientific methods. The limitations of usefulness of scientific method in clinical practice result from many factors. The complexity of the large number of ill-defined variables at many levels of the problem. Scientific method focuses on one variable at a time across a hundred identical animals to extract a single, generalizable 'proof' or piece of 'truth'. Clinical practice deals with a hundred variables at one time within one animal from among a clientele of non-identical animals in order to optimize a mix of outcomes intended to satisfy that particular animal's current needs and desires. Interdependence among the variables. Most factors in the illness, the disease, the patient and the setting are interdependent, and cannot be sufficiently isolated to allow their separate study. Practice as a human transaction involving at least two people is too complex to be analysed one factor at a time when the interaction stimulates unpredictable responses. Ambiguous data. Words have many usages. People not only assign different interpretations to the same words, they assign different 'meanings', especially according to the threat or hope they may imply. The perceptual data gleaned from physical examination may be difficult to specify exactly or to confirm objectively. The accuracy and precision of investigational data and their reporting can be low, and are frequently unknown. Differing goals between science and practice. Science strives for exact points of propositional knowledge, verifiable by logical argument using objective data and repetition of the experiment.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. [Effect of electromagnetic fields on the chemical composition of regenerative bone under defective ceramic hydroxylapatite plastics].

    PubMed

    Luzin, V I; Pokhvalityĭ, A P; Kucherenko, S L; Berezhnyĭ, Ie P

    2003-01-01

    In experiment on white rats with the initial mass 130-150 grams researched influence of volumetric-combinative impulse electromagnetic fields (VCI EMF) with the amplitude of a magnetic field 0.04/0.05 Teslas on composition of a reclaim formative in the field of defect of a tibial bone, filled with ceramic hydroxylapatite (HAP) with a size of particles less than 63 microns. Was researched the exposure by VCI EMF boosts synthesis of organic matters in the field of a forming osteal regenerate in early periods of experiment and accelerates the processes of a mineralization of an organic matrix. was been stated it appears by increase of do the mineral component part in a reclaim. In that case, when the generated osteal defect is filled with ceramic HAP, VCI EMF boosts synthesis of a organic matrix and processes of its mineralization, that leads on to the optimization of chemical composition of a reclaim. In order to use the obtained results in clinical practice, the histological and ultra structural research of a formating reclaim are necessary too. These researches are our proximate task.

  7. [Orthogonal test analysis of compressive strength of porous hydroxylapatite prepared by gel-casting process].

    PubMed

    Han, Yanjun; Li, Musen; Lü, Yupeng; Song, Yunjing; Chen, Y; Low, H

    2004-10-01

    Porous hydroxylapatite (HA) has excellent osseous inductive ability. It has been prepared by gel-casting process, which is feasible and can make complex ceramic material. According to the result of orthogonal test based on the compressive strength, the order and the level of the factors, including monomer HA, initiator MBAM, catalyst APS and water, were dealt with. The effects of drying and sintering technique on the properties of porous hydroxylapatite were also researched. The results showed that the order of every factor in the gel-casting process is as follows, AM-APS, MBAM, H2O. Based on the determined level of each factor, the suitable slurry constituents and drying and sintering technologies were selected, and the porous hydroxylapatite with compressive strength of 6-7 MPa was produced.

  8. Applying pharmacokinetics to veterinary clinical practice.

    PubMed

    Trepanier, Lauren A

    2013-09-01

    This article describes clinical examples in which pharmacokinetic parameters can be used to optimize veterinary patient care. Specific applications include extrapolating drug dosages, optimizing therapy with therapeutic drug monitoring, interpreting pharmacokinetic information provided by drug labels and pharmaceutical companies, and adjusting drug dosages in patients with hepatic or renal failure.

  9. Quality of life outcomes in peri-urethral calcium hydroxylapatite injection.

    PubMed

    Griffin, Meghan A; Janosek-Albright, Kirsten J C; Diaz-Insua, Mireya; Elshatanoufy, Solafa; Atiemo, Humphrey O

    2016-12-01

    Peri-urethral calcium hydroxylapatite injection is an established treatment for patients with stress urinary incontinence. Information is limited regarding calcium hydroxylapatite treatment and quality of life (QOL) outcomes. We hypothesize that patients might improve QOL after peri-urethral calcium hydroxylapatite injection, which was reflected in validated questionnaires. The peri-urethral calcium hydroxylapatite injection billing code was used to identify patients who underwent injection from 2011-2013. Female patients who completed the American Urological Association Symptom Score (AUASS), the AUASS QOL and Michigan Incontinence Symptom Index (M-ISI), and the bother score (M-ISI bother), or pad count at baseline and follow-up were included. Change in questionnaire scores and pads were assessed using the paired t test. Sixty patients underwent 1 (30), 2 (63) or 3 (7 %) peri-urethral calcium hydroxylapatite injections performed by a single surgeon. Thirty-seven patients provided questionnaires and 38 provided pad counts, all with a mean age of 75 years. The overall AUASS, AUASS QOL, and overall M-ISI scores improved in 67.6, 54.8, and 61.3 % respectively (4.5 ± 7.9, 1.3 ± 1.7 and 5.5 ± 8.6 respectively). The M-ISI bother score improved in 44.8 % with a mean improvement of 0.5 ± 2.9, but did not reach significance. There was a 1.7 ± 3.7 decrease in the mean number of pads used daily after the procedure (p = 0.006) and 19 % experienced transient urinary retention. Peri-urethral calcium hydroxylapatite injections can improve urinary QOL scores in patients with initial and recurrent stress urinary incontinence. This short-term retrospective analysis suggests that larger long-term studies focusing on QOL outcomes are needed to evaluate the effect of peri-urethral calcium hydroxylapatite has on incontinence-specific QOL.

  10. Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance

    PubMed Central

    Pereira, Gregório

    2017-01-01

    Background: Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis. Methods: Twenty women (18–55 years old) with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site) and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh). Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm2) followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis. Results: Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale (P < 0.001) with a 4.5-point improvement in mean overall score (P < 0.001) after a single MFU-V/CaHA treatment. At 90 days, histologic analysis showed peak neocollagenesis in samples treated with the 1:1 dilution, whether with CaHA alone or in combination with MFU-V. The highest conversion of collagen type III into collagen type I at month 3 occurred in samples injected with 1:1 and 1:0.6 CaHA dilutions without subsequent MFU-V treatment. Both procedures were well tolerated, and subject satisfaction was high. Conclusions: Combination treatment with MFU-V and diluted CaHA is effective for improving skin laxity and the appearance of cellulite on the buttocks and upper thighs. PMID:28831339

  11. Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance.

    PubMed

    Casabona, Gabriela; Pereira, Gregório

    2017-07-01

    Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis. Twenty women (18-55 years old) with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site) and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh). Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm(2)) followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis. Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale (P < 0.001) with a 4.5-point improvement in mean overall score (P < 0.001) after a single MFU-V/CaHA treatment. At 90 days, histologic analysis showed peak neocollagenesis in samples treated with the 1:1 dilution, whether with CaHA alone or in combination with MFU-V. The highest conversion of collagen type III into collagen type I at month 3 occurred in samples injected with 1:1 and 1:0.6 CaHA dilutions without subsequent MFU-V treatment. Both procedures were well tolerated, and subject satisfaction was high. Combination treatment with MFU-V and diluted CaHA is effective for improving skin laxity and the appearance of cellulite on the buttocks and upper thighs.

  12. Applying proteomic technology to clinical virology.

    PubMed

    Mancone, C; Ciccosanti, F; Montaldo, C; Perdomo, A B; Piacentini, M; Alonzi, T; Fimia, G M; Tripodi, M

    2013-01-01

    Developing antiviral drugs, vaccines and diagnostic markers is still the most ambitious challenge in clinical virology. In the past few decades, data from high-throughput technologies have allowed for the rapid development of new antiviral therapeutic strategies, thus making a profound impact on translational research. Most of the current preclinical studies in virology are aimed at evaluating the dynamic composition and localization of the protein platforms involved in various host-virus interactions. Among the different possible approaches, mass spectrometry-based proteomics is increasingly being used to define the protein composition in subcellular compartments, quantify differential protein expression among samples, characterize protein complexes, and analyse protein post-translational modifications. Here, we review the current knowledge of the most useful proteomic approaches in the study of viral persistence and pathogenicity, with a particular focus on recent advances in hepatitis C research.

  13. Applying HIV testing guidelines in clinical practice.

    PubMed

    Mahoney, Megan R; Fogler, Jess; Weber, Shannon; Goldschmidt, Ronald H

    2009-12-15

    An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission.

  14. The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency.

    PubMed

    Caffier, Philipp P; I Nasr, Ahmed; Weikert, Sebastian; Rummich, Julius; Gross, Manfred; Nawka, Tadeus

    2017-05-01

    To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency. Prospective clinical pilot study. After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre-/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic-aerodynamic analysis). In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre- and postoperative findings were not significant. The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case. 4 Laryngoscope, 127:1125-1130, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Applying Research on Family Violence to Clinical Practice.

    ERIC Educational Resources Information Center

    Gelles, Richard J.

    1982-01-01

    Considers whether research on family violence can be applied to clinical practice. Suggests limitations of the knowledge base constrain the application of research on family violence to clinical work, and certain aspects of the research paradigm also limit the transfer of research knowledge to clinical practice. (Author)

  16. Successful Treatment of Calcium Hydroxylapatite Nodules With Intralesional 5-Fluorouracil, Dexamethasone, and Triamcinolone.

    PubMed

    Aguilera, Shino Bay; Aristizabal, Miguel; Reed, Ann

    2016-09-01

    Although infrequent, non-inflammatory nodules are potential complications associated with dermal filler injections. There is a lack of consensus in the literature regarding potential treatments to help resolve nodules associated with calcium hydroxylapatite (CaHA) filler injections. This case report describes the successful treatment of a non-inflammatory nodule related to CaHA injection using a combination of 5-fluorouracil, dexamethasone, and triamcinolone.

    J Drugs Dermatol. 2016;15(9):1142-1143.

  17. Synthesis and characterization of phosphocitric acid, a potent inhibitor of hydroxylapatite crystal growth.

    PubMed

    Tew, W P; Mahle, C; Benavides, J; Howard, J E; Lehninger, A L

    1980-04-29

    Human urine and extracts of rat liver mitochondria contain apparently identical agents capable of inhibiting the precipitation or crystallization of calcium phosphate. Its general properties, as well as 1H NMR and mass spectra, have suggested that the agent is phosphocitric acid. This paper reports the synthesis of phosphocitric acid via the phosphorylation of triethyl citrate with o-phenylene phosphochloridate, hydrogenolysis of the product to yield triethyl phosphocitrate, hydrolytic removal of the blocking ethyl groups and also chromatographic purification. An enzymatic assay of phosphocitrate is described. Synthetic phosphocitrate was found to be an exceedingly potent inhibitor of the growth of hydroxylapatite seed crystals in a medium supersaturated with respect to Ca2+ and phosphate. Comparative assays showed phosphocitrate to be much more potent than the most active precipitation-crystallization inhibitors previously reported, which include pyrophosphate and ATP. 14C-Labeled phosphocitrate was bound very tightly to hydroxylapatite crystals. Such binding appeared to be essential for its inhibitory activity on crystal growth. Citrate added before but not after, phosphocitrate greatly enhanced the inhibitory potency of the latter. This enhancement effect was not given by other tricarboxylic acids. The monoethyl ester of phosphocitrate had no inhibitory effect on hydroxylapatite crystal growth.

  18. Solubilization of the chromatin-bound estrogen receptor from chicken liver and fractionation on hydroxylapatite.

    PubMed

    Gschwendt, M

    1976-08-16

    1. High-affinity estrogen-binding sites can be solubilized from the liver chromatin of estrogenized chickens by treatment of the chromatin with 2 M KCL/5 M urea and fractionation on hydroxylapatite. Two estrogen-binding proteins are eluted from hydroxylapatite columns by 20mM phosphate (binding protein I) and 200mMphosphate (binding protein II), respectively. 2. The binding protein I is part of a non-histone protein fraction containing acid-soluble and insoluble proteins, whereas the binding protein II elutes together with high molecular weight nonhistone proteins containing acid insoluble proteins only. Both binding proteins exhibit the smae affinity for estradiol (Kd approximately 10(-9) M). 3. From chromatin of untreated chickens very small amounts of binding protein I (0.1 pmol/mg protein compared to 1.9 pmol/mg protein from estrogenized chickens) with the smae affinity for estradiol as that from estrogenized animals can be solubilized. Binding protein II is not detectable. 4. The "soluble nuclear estrogen receptor" extracted from crude liver nucleir of estrogenized chickens by 0.5 M KCL behaves on hydroxylapatite very similarly to salt/urea-dissociated chromatin with respect to the binding protein I. No binding protein II, however, can be demonstrated. 5. Chromatography of various preparations on Bio-Gel A-1.5 m indicates that the binding protein II is a residual chromatin fragment containing an unseparated binding protein-DNA complex, whereas the binding protein I represents the solubilized nucleic-acid-free chromosomal estrogen receptor. The "soluble nuclear receptor" and the binding protein I, however, are not identical with respect to their chromatographic behaviour on Bio-Gel A-1.5m, even though their estrogen binding entity remaining after trypsin treatment seems to be very similar.

  19. Investigation of xFe2O4 (x = Mn, Co) doped hydroxylapatite ferromagnetic biomaterials for the treatment of damaged bone and magnetically targeted drug delivery systems

    NASA Astrophysics Data System (ADS)

    Anand, Vikas; Singh, K. J.; Kaur, Kulwinder; Bhatia, Gaurav

    2016-05-01

    Magnetically attracted MnFe2O4 and CoFe2O4 doped hydroxylapatite samples have been prepared by using co-precipitation method in the laboratory. Bioactive nature of samples has been confirmed from XRD spectra. Ferromagnetic behavior of samples has been studied by using vibration sample magnetometer. Human osteoblast cell line MG63 has been used to explore the cell viability of samples. Drug carrier ability of samples has been checked with gentamycin as an antibiotic and results show that samples can be used as excellent drug carriers. Drug loaded samples can be easily targeted to specific area due to their attractive nature towards external magnetic field. Our results indicate that prepared samples possess good bioactive as well as ferromagnetic behavior with drug carrier ability and hence, our samples can be potential candidates for the clinical applications.

  20. Effects of heat treatment of wood on hydroxylapatite type mineral precipitation and biomechanical properties in vitro.

    PubMed

    Rekola, J; Lassila, L V J; Hirvonen, J; Lahdenperä, M; Grenman, R; Aho, A J; Vallittu, P K

    2010-08-01

    Wood is a natural fiber reinforced composite. It structurally resembles bone tissue to some extent. Specially heat-treated birch wood has been used as a model material for further development of synthetic fiber reinforced composites (FRC) for medical and dental use. In previous studies it has been shown, that heat treatment has a positive effect on the osteoconductivity of an implanted wood. In this study the effects of two different heat treatment temperatures (140 and 200 degrees C) on wood were studied in vitro. Untreated wood was used as a control material. Heat treatment induced biomechanical changes were studied with flexural and compressive tests on dry birch wood as well as on wood after 63 days of simulated body fluid (SBF) immersion. Dimensional changes, SBF sorption and hydroxylapatite type mineral formation were also assessed. The results showed that SBF immersion decreases the biomechanical performance of wood and that the heat treatment diminishes the effect of SBF immersion on biomechanical properties. With scanning electron microscopy and energy dispersive X-ray analysis it was shown that hydroxylapatite type mineral precipitation formed on the 200 degrees C heat-treated wood. An increased weight gain of the same material during SBF immersion supported this finding. The results of this study give more detailed insight of the biologically relevant changes that heat treatment induces in wood material. Furthermore the findings in this study are in line with previous in vivo studies.

  1. Applying developmental programming to clinical obstetrics: my ward round.

    PubMed

    Painter, R C

    2015-10-01

    The theory of developmental programming is supported by accumulating evidence, both observational and experimental. The direct application of the principles of developmental programming by clinicians to benefit pregnant women remains an area of limited attention. Examining a selection of inpatients at an obstetric referral center, I searched for situations in which clinical decision making could be driven by the principles of developmental programming. I also looked for situations in which the clinical research agenda could be dictated by these concepts. In the decision to undertake preventive measures to avoid preeclampsia, the offspring's perspective may support more liberal application of calcium and aspirin. Consideration of the long-term health perspective of the offspring could drive choices in the management of obesity and diabetes in pregnancy. The administration of corticosteroids in women delivering by elective cesarean at term may have modest short-term benefits, but additional trials are necessary to investigate long-term offspring health. The offspring of women suffering hyperemesis gravidarum may benefit from nutritional therapy. The long-term health of the offspring could affect couples' choice for IVF or expectant management. Applying the principles of developmental programming to the management of pregnant women could drive clinical decision making and is driving the clinical research agenda. Increasingly, developmental programming concepts are becoming an integral part of clinical practice, as well as determining the choice of outcomes in trials in obstetrics and fertility medicine. The presented cases underscore the need for more research to guide clinical practice.

  2. Surgical treatment using porous hydroxylapatite blocks for severe habitual dislocation of the bilateral temporomandibular joint in a patient with epilepsy.

    PubMed

    Watatani, K; Shirasuna, K; Morioka, S; Saka, M; Aikawa, T; Matsuya, T

    1992-12-01

    A patient with severe habitual dislocation of the bilateral temporomandibular joint involving epilepsy was operated using porous hydroxylapatite blocks as intervention material. The patient was followed up for 4 years. He has been well without recurrence of dislocation or any complication. In this paper, we report the procedure and the relevant literature is discussed.

  3. Clinical response of two brush-applied peroxide whitening systems.

    PubMed

    Barlow, Ashley; Gerlach, Robert W; Date, Robert F; Brennan, Kieran; Struzycka, Izabela; Kwiatkowska, Anna; Wierzbicka, Maria

    2003-01-01

    A randomized, examiner-blind parallel design study was conducted to evaluate the clinical efficacy and tolerability of two brush-applied, peroxide-based tooth whiteners. A total of 38 subjects were randomized to Colgate Simply White, an 18% carbamide peroxide paint-on liquid in an applicator bottle, or Crest Night Effects, a 19% sodium percarbonate system in unit dose sachets that dries to form an adherent film. Treatment was for 14 days. The 18% carbamide peroxide gel was applied twice daily, while the 19% sodium percarbonate film was applied for overnight use. Subjects were evaluated at baseline, and again after 7 and 14 days of treatment using digital images to assess tooth color, and oral examinations to establish safety. Whitening efficacy was determined by evaluating the reduction in tooth yellowness (delta b*), increase in tooth brightness (delta L*), reduction in tooth redness (delta a*) and overall tooth color change relative to pure white (delta W*). After 14 days, the mean change in yellowness (delta b*) was -1.43 +/- 0.20 for the 19% sodium percarbonate film, and -0.44 +/- 0.06 for the 18% carbamide peroxide gel. Mean change in brightness (delta L*) was 1.13 +/- 0.13 and 0.55 +/- 0.13 in the film and gel groups, respectively. Between-group comparisons showed highly significant (p < or = 0.003) whitening for the 19% sodium percarbonate film compared to the 18% carbamide peroxide gel for all 14-day color measurements (delta b*, delta L*, delta a* or delta W). Both products were well-tolerated, with no subjects discontinuing treatment early due to a causal adverse event. In a direct clinical comparison of two brush-applied products over 14 days, Crest Night Effects provided significant and meaningful improvement in tooth color, representing more than double the whitening measured for the Colgate Simply White.

  4. Energetics of Sn2+ isomorphic substitution into hydroxylapatite: First-principles predictions

    DOE PAGES

    Weck, Philippe F.; Kim, Eunja

    2016-11-04

    In this study, the energetics of Sn2+ substitution into the Ca2+ sublattice of hydroxylapatite (HA), Ca10(PO4)6(OH)2, has been investigated within the framework of density functional theory. Calculations reveal that Sn2+ incorporation via coupled substitutions at Ca(II) sites is energetically favourable up to a composition of Sn6Ca4(PO4)6(OH)2, and further substitutions at Ca(I) sites proceed once full occupancy of Ca(II) sites by Sn2+ is achieved. Compositions of SnxCa10–x(PO4)6(OH)2 (x = 4–9) are predominant, with an optimal stoichiometry of Sn8Ca2(PO4)6(OH)2, and Sn-substituted HA follows approximately Vegard's law across the entire composition range.

  5. Microscopic and ultrastructural evidences in human skin following calcium hydroxylapatite filler treatment.

    PubMed

    Zerbinati, Nicola; D'Este, Edoardo; Parodi, Pier Camillo; Calligaro, Alberto

    2017-07-01

    This study uses light and electron microscopes to gain a better knowledge of the interactions of calcium hydroxylapatite filler with the connective tissue of the skin and the modifications of the human deep dermis, after 2 months of treatment. Some morphological evidences of this observational study of filler treated tissue support-specific mechanism involved in the structural modifications of both filler microspherules and cells of the connective tissue. They demonstrate the absence of any immunological reaction and show that the used filler is modified very slowly over time by the action of cells of the connective tissue closely related to the filler without any activity of phagocytosis. Furthermore, associated with the modifications of the filler, evidences of stimulatory effects on dermal fibroblasts are reported.

  6. Tissue integration of the collagen-hydroxylapatite implant: histological examination in canine bone and surrounding tissues.

    PubMed

    Remacle, M; Marbaix, E; Mustin, V

    1991-01-01

    Using the dog as an animal model, we have tested an implant material composed of purified fibrillar collagen (PFC) and particulate hydroxylapatite (HA) in the mandible and in surrounding tissues. Bone and tissue samples were taken at 2, 4 and 6 months for histological study. After 2 months, the PFC was replaced by fibro-connective host tissues. After 4 months, some small areas of ossification were observed around the HA particles. After 6 months, the fibro-connective tissue was replaced by neo-formed bone in the mandible. PFC was found to increase the interfaces between the HA particles and the host tissues, permitting HA integration into the bone. The PFC/HA implant was also molded when moistened by blood or saline solution and then became mis-sharpen by local pressures exerted. These findings show that the implant should preferably be reserved for the restoration of bones not subjected to significant forces or local stresses.

  7. In vitro bioactive behavior of hydroxylapatite-coated porous Al(2)O(3).

    PubMed

    Shi, D; Jiang, G; Wen, X

    2000-09-01

    To produce bioactive materials for bone substitutes, two major deposition methods, suspension method and thermal deposition method, were employed to develop bioactive, mechanically strong, and porous ceramics. Hydroxylapatite (HA) has been uniformly coated onto inner pore surfaces of reticulated alumina substrates. It has been found that the in vitro bioactivity of HA coatings was affected by both structural crystallinity and specific surface area. Well-crystallized HA heat-treated at high temperatures has resulted in reduced bioactivity. The bio-reaction rate was found to increase with the surface area of HA. We have found that the stability of the well-crystallized HA is associated with the high driving force required for the formation of hydroxy-carbonate apatite (HCA) phase.

  8. Structural water in carbonated hydroxylapatite and fluorapatite: confirmation by solid state (2)H NMR.

    PubMed

    Yoder, Claude H; Pasteris, Jill D; Worcester, Kimberly N; Schermerhorn, Demetra V

    2012-01-01

    Water is well recognized as an important component in bone, typically regarded as a constituent of collagen, a pore-filling fluid in bone, and an adsorbed species on the surface of bone crystallites. The possible siting and role of water within the structure of the apatite crystallites have not been fully explored. In our experiments, carbonated hydroxyl- and fluorapatites were prepared in D(2)O and characterized by elemental analysis, thermal gravimetric analysis, powder X-ray diffraction, and infrared and Raman spectroscopy. Two hydroxylapatites and two fluorapatites, with widely different amounts of carbonate were analyzed by solid state (2)H NMR spectroscopy using the quadrupole echo pulse sequence, and each spectrum showed one single line as well as a low-intensity powder pattern. The relaxation time of 7.1 ms for 5.9 wt% carbonated hydroxylapatite indicates that the single line is likely due to rapid, high-symmetry jumps in translationally rigid D(2)O molecules, indicative of structural incorporation within the lattice. Discrimination between structurally incorporated and adsorbed water is enhanced by the rapid exchange of surface D(2)O with atmospheric H(2)O. Moreover, a (2)H resonance was observed for samples dried under a variety of conditions, including in vacuo heating to 150°C. In contrast, a sample heated to 500°C produced no deuterium resonance, indicating that structural water had been released by that temperature. We propose that water is located in the c-axis channels. Because structural water is observed even for apatites with very low carbonate content, some of the water molecules must lie between the monovalent ions.

  9. Applying Organ Clearance Concepts in a Clinical Setting

    PubMed Central

    2008-01-01

    Objective To teach doctor of pharmacy (PharmD) students how to apply organ clearance concepts in a clinical setting in order to optimize dose management, select the right drug product, and promote better patient-centered care practices. Design A student-focused 5-hour topic entitled "Organ Clearance Concepts: Modeling and Clinical Applications" was developed and delivered to second-year PharmD students. Active-learning techniques, such as reading assignments and thought-provoking questions, and collaborative learning techniques, such as small groups, were used. Student learning was assessed using application cards and a minute paper. Assessment Overall student responses to topic presentation were overwhelmingly positive. The teaching strategies here discussed allowed students to play an active role in their own learning process and provided the necessary connection to keep them motivated, as mentioned in the application cards and minute paper assessments. Students scored an average of 88% on the examination given at the end of the course. Conclusion By incorporating active-learning and collaborative-learning techniques in presenting material on organ clearance concept, students gained a more thorough knowledge of dose management and drug-drug interactions than if the concepts had been presented using a traditional lecture format. This knowledge will help students in solving critical patient situations in a real-world context. PMID:19214275

  10. A case report of ophthalmic artery emboli secondary to Calcium Hydroxylapatite filler injection for nose augmentation- long-term outcome.

    PubMed

    Cohen, Eyal; Yatziv, Yossi; Leibovitch, Igal; Kesler, Anat; Cnaan, Ran Ben; Klein, Ainat; Goldenberg, Dafna; Habot-Wilner, Zohar

    2016-07-08

    Filler injection for face augmentation is a common cosmetic procedure in the last decades, in our case report we describe long-term outcomes of a devastating complication of ophthalmic artery emboli following Calcium Hydroxylapatite filler injection to the nose bridge. A healthy 24-year-old women received a Calcium Hydroxylapatite filler injection to her nose bridge for the correction of nose asymmetry 8 years post rhinoplasty. She developed sudden right eye ocular pain and visual disturbances. Visual acuity was 20/20 in both eyes and visual field in the right eye showed inferior arch with fixation sparing and supero-temporal central scotoma. Examination revealed marked periorbital edema and hematoma, ptosis, ocular movements limitation, an infero-temporal branch retinal artery occlusion and multiple choroidal emboli. Eighteen months post initial presentation ptosis and eye movements returned normal and choroidal emboli absorbed almost completely. However, visual acuity declined to 20/60, visual field showed severe progressive deterioration with a central and supero-nasal field remnant and the optic disc became pallor. Cosmetic injection of calcium hydroxylapatite to the nose bridge can result in arterial emboli to the ophthalmic system with optic nerve, retinal and choroidal involvement causing long term severe visual acuity and visual field impairment.

  11. Synthesis and solubility of Pb-Ca and P-As hydroxylapatite solid solutions

    NASA Astrophysics Data System (ADS)

    Puzio, Bartosz; Młynarska, Maria; Motyka, Joanna; Oknińska, Joanna; Mandelt, Agnieszka; Chlebowska, Patrycja; Kwaśniak-Kominek, Monika; Manecki, Maciej

    2016-04-01

    The objective of the study are three solid solution series: - HPY hydroxylpyromorphite Pb5(PO4)3OH - HAP hydroxylapatite Ca5(PO4)3OH - HAP hydroxylapatite Ca5(PO4)3OH - JBM johnbaumite Ca5(AsO4)3OH - JBM johnbaumite Ca5(AsO4)3OH - HMI hydroxylmimetite Pb5(AsO4)3OH The phases were synthesized from aqueous solutions at high pH (over 8) at ambient temperature by dropwise mixing of chemical reagents: Pb(NO3)2, Ca(NO3)2.4H2O, (NH4)H2PO4, and Na2AsHO4.7H2O. The products of all syntheses are crystalline, monomineral fine powders (crystal size less than 1 μm). Their chemical composition is close to theoretical. Systematic shift of XRD peaks and FTIR or Raman bands is observed within the solid solution series. Dissolution experiments were run at 5oC, 25oC, 45oC, and 65oC. An aliquot of 0.5g of each phase was dissolved in 250 mL of 0.05M NH4NO3 (pH between 3 and 5) for about 3 months. In all cases dissolution resulted in increase of pH by about 1. The systems were considered in equilibrium when three consecutive samplings (ca. two weeks apart) resulted in similar concentrations (within 3 standard deviations). The dissolution of all phases in question is incongruent. The amount of precipitating secondary phases was too small for identification. The results of HPY - HAP dissolution experiments are inconclusive due to strongly incongruent dissolution. This is partially in contrary to recent report by Zhu et al. (2015). Systematic increase of solubility is observed in HAP - JBM series. Also, the solubility of these phases increases with the increase of temperature. This is more pronounced for HAP than for JBM. Systematic increase of solubility is also observed in HMI - JBM series. This work is partially funded by AGH research grant no 11.11.140.319 and partially by Polish NCN grant No 2014/01/M/ST10/00355. Zhu,Y., Zhu, Z., Zhao, X., Liang, Y., Huang, Y., 2015. Characterization, dissolution, and solubility of lead hydroxypyromorphite Pb5(PO4)3OH at 25-45oC. Journal of Chemistry

  12. Antheraea pernyi silk sericin mediating biomimetic nucleation and growth of hydroxylapatite crystals promoting bone matrix formation.

    PubMed

    Jiayao, Zhuang; Guanshan, Zhou; Jinchi, Zhang; Yuyin, Chen; Yongqiang, Zhu

    2017-03-01

    Bone biomineralization is well-regulated processes mediated by extracellular matrix proteins. The materials that can direct nucleation of hydroxylapatite (HAp) crystals and assembly of well-structured material-minerals complex are the key to mimicking the natural mineralization. This study used sericin from Antheraea pernyi (A.pernyi), non-mulberry silkworm cocoon as template to mediate nucleation of HAp crystals. Here we find out that AS (Antheraea pernyi sericin) can nucleate the formation HAp crystals in simulated body fluid verified by XRD and FTIR observations. The HAp crystals are organized into nano-rods oriented with c-axis preferentially parallel to the long axis of AS due to hydrogen bonds and electrostatic interaction and finally aggregated into HAp globule. The cell culture of human bone marrow-derived mesenchymal stem cells (BMSCs) showed that the HAp crystals mediated by AS not only stimulate cell adhesion and proliferation but also promote 0f osteogenic differentiation, suggesting that the resultant mineralized AS biomaterial has potential in promoting bone formation. Thus our work will provide significant implication on biomineralization of A. pernyi silk sericin as a potential scaffold for tissue engineering. © 2016 Wiley Periodicals, Inc.

  13. Plasma-Sprayed Hydroxylapatite-Based Coatings: Chemical, Mechanical, Microstructural, and Biomedical Properties

    NASA Astrophysics Data System (ADS)

    Heimann, Robert B.

    2016-06-01

    This contribution discusses salient properties and functions of hydroxylapatite (HA)-based plasma-sprayed coatings, including the effect on biomedical efficacy of coating thickness, phase composition and distribution, amorphicity and crystallinity, porosity and surface roughness, cohesion and adhesion, micro- and nano-structured surface morphology, and residual coating stresses. In addition, it will provide details of the thermal alteration that HA particles undergo in the extremely hot plasma jet that leads to dehydroxylated phases such as oxyhydroxylapatite (OHA) and oxyapatite (OA) as well as thermal decomposition products such as tri-(TCP) and tetracalcium phosphates (TTCP), and quenched phases such as amorphous calcium phosphate (ACP). The contribution will further explain the role of ACP during the in vitro interaction of the as-deposited coatings with simulated body fluid resembling the composition of extracellular fluid (ECF) as well as the in vivo responses of coatings to the ECF and the host tissue, respectively. Finally, it will briefly describe performance profiles required to fulfill biological functions of osteoconductive bioceramic coatings designed to improve osseointegration of hip endoprostheses and dental root implants. In large parts, the content of this contribution is a targeted review of work done by the author and his students and coworkers over the last two decades. In addition, it is considered a stepping stone toward a standard operation procedure aimed at depositing plasma-sprayed bioceramic implant coatings with optimum properties.

  14. Energetics of Sn2+ isomorphic substitution into hydroxylapatite: First-principles predictions

    SciTech Connect

    Weck, Philippe F.; Kim, Eunja

    2016-11-04

    In this study, the energetics of Sn2+ substitution into the Ca2+ sublattice of hydroxylapatite (HA), Ca10(PO4)6(OH)2, has been investigated within the framework of density functional theory. Calculations reveal that Sn2+ incorporation via coupled substitutions at Ca(II) sites is energetically favourable up to a composition of Sn6Ca4(PO4)6(OH)2, and further substitutions at Ca(I) sites proceed once full occupancy of Ca(II) sites by Sn2+ is achieved. Compositions of SnxCa10–x(PO4)6(OH)2 (x = 4–9) are predominant, with an optimal stoichiometry of Sn8Ca2(PO4)6(OH)2, and Sn-substituted HA follows approximately Vegard's law across the entire composition range.

  15. Biological stability and osteoconductivity in rabbit tibia of pulsed laser deposited hydroxylapatite coatings.

    PubMed

    Peraire, C; Arias, J L; Bernal, D; Pou, J; León, B; Arañó, A; Roth, W

    2006-05-01

    A comparative study of the biological stability and the osteoconductivity of hydroxylapatite (HA) coatings produced by pulsed laser deposition (PLD) and plasma spraying (PS) was conducted. Three different implant groups were used: grit-blasted titanium rods coated with HA-PLD (2-microm-thick), grit-blasted titanium rods coated with HA-PS (50-microm-thick), and uncoated. Implantation took place into the proximal tibia of 12 mature New Zealand White rabbits for 24 weeks. Samples were evaluated using descriptive histology and histomorphometry. While HA-PS implants showed considerable instability and reduction in thickness after 24 weeks, but no statistical difference to the titanium group, the HA-PLD group showed a significant higher amount of bone apposition (Scheffé test, p<0.05) than the other two groups, without signs of degradation or dissolution. Remarkably, after 6 months, the almost intact thin pulsed laser deposited coating could be observed by electron microscopy in extended areas. Copyright (c) 2006 Wiley Periodicals, Inc.

  16. Formation of Biphasic Hydroxylapatite-Beta Magnesium Tricalcium Phosphate in Heat Treated Salmonid Vertebrae.

    PubMed

    Butler, Don H; Shahack-Gross, Ruth

    2017-06-15

    Ichthyoarchaeological evidence is uncommon at ancient hunter-gatherer sites from various regions and timeframes. This research contributes to the development of microarchaeological techniques useful for identifying fishing economies in situations where classifiable bones are unavailable. Specifically, traces of heat altered bone mineral in domestic hearths are expected to provide markers for discarded fish remains. We used a series of laboratory incineration experiments to characterize the mineralogy of burned salmonid vertebrae. Fourier transform infrared spectroscopy and x-ray diffraction distinguished the formation of beta magnesium tricalcium phosphate (βMgTCP) at temperatures as low as 600 °C. Bones from a sample of game mammals and birds did not form this phase at temperatures below 1,000 °C. We propose that this neoformed mineral can serve as a proxy for hunter-gatherer salmonid fishing when typical ichthyoarchaeological evidence is absent. Using Fourier transform infrared spectroscopy, it will be possible to rapidly and inexpensively determine the presence of βMgTCP in fragmentary burned bone remains associated with combustion features. The occurrence of βMgTCP in archaeological hearth features will offer a new means of further evaluating the temporal, geographic, and cultural scope of salmonid harvesting. We also acknowledge the value of biphasic hydroxylapatite-βMgTCP recovered from Atlantic salmon vertebrae as a bioceramic.

  17. 42 CFR 55a.102 - Who is eligible to apply for a Black Lung clinics grant?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Who is eligible to apply for a Black Lung clinics... SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.102 Who is eligible to apply for a Black Lung clinics grant? Any State or public or private entity may apply for a grant under this...

  18. 42 CFR 55a.102 - Who is eligible to apply for a Black Lung clinics grant?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Who is eligible to apply for a Black Lung clinics... SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.102 Who is eligible to apply for a Black Lung clinics grant? Any State or public or private entity may apply for a grant under...

  19. 42 CFR 55a.102 - Who is eligible to apply for a Black Lung clinics grant?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Who is eligible to apply for a Black Lung clinics... SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.102 Who is eligible to apply for a Black Lung clinics grant? Any State or public or private entity may apply for a grant under...

  20. 42 CFR 55a.102 - Who is eligible to apply for a Black Lung clinics grant?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Who is eligible to apply for a Black Lung clinics... SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.102 Who is eligible to apply for a Black Lung clinics grant? Any State or public or private entity may apply for a grant under...

  1. 42 CFR 55a.102 - Who is eligible to apply for a Black Lung clinics grant?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Who is eligible to apply for a Black Lung clinics... SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.102 Who is eligible to apply for a Black Lung clinics grant? Any State or public or private entity may apply for a grant under...

  2. Applying ‘science’ in chiropractic clinical practice

    PubMed Central

    Jamison, Jennifer R

    1990-01-01

    The chiropractic profession is increasingly expressing the sentiment that chiropractic clinical intervention should rest upon a scientific foundation. Before ‘scientific research’ can become meaningful in chiropractic clinical practice, it is necessary that field practitioners be conversant with research terminology. If chiropractic clinical practice is to achieve credibility as a scientific mode of health care and if the benefits of a ‘scientific’ practice model are to enhance patient care, then future chiropractic practitioners must be familiar with a currently accredited scientific frame of reference. A survey of final year chiropractic students at Phillip Institute of Technology found that respondents appreciation of the strength of diverse clinical research methodologies and their ranking of criteria for ascertaining a cause-effect association bears some similarity (RHO = 0.97 and 0.98 respectively, p < 0.05) to that of the ‘scientific’ clinical community.

  3. Spectroscopic analyses on sonocatalytic damage to bovine serum albumin (BSA) induced by ZnO/hydroxylapatite (ZnO/HA) composite under ultrasonic irradiation.

    PubMed

    Wang, Zhiqiu; Li, Ying; Wang, Jun; Zou, Mingming; Gao, Jingqun; Kong, Yumei; Li, Kai; Han, Guangxi

    2012-08-01

    ZnO/hydroxylapatite (ZnO/HA) composite with HA molar content of 6.0% was prepared by the method of precipitation and heat-treated at 500°C for 40min and was characterized by powder X-ray diffraction (XRD). The sonocatalytic activities of ZnO/HA composite was carried out through the damage of bovine serum albumin (BSA) in aqueous solution. Furthermore, the effects of several factors on the damage of BSA molecules were evaluated by means of UV-vis and fluorescence spectra. Experimental results indicated that the damage degree of BSA aggravated with the increase of ultrasonic irradiation time, irradiation power and ZnO/HA addition amount, but weakened with the increase of solution acidity and ionic strength. In addition, the damage site to BSA was also studied by synchronous fluorescence technology and the damage site was mainly at tryptophan (Trp) residue. This paper provides a valuable reference for driving sonocatalytic method to treat tumor in clinic application.

  4. [Prevention of postenucleation syndrome: the hydroxylapatite silicone implant. Preliminary experimental studies and initial clinical experiences].

    PubMed

    Guthoff, R; Vick, H P; Schaudig, U

    1995-04-01

    An orbital implant after enucleation compensates for volume deficiency and increases prosthesis motility. In the literature, however, an extrusion rate of orbital implant between 10 and 25% is reported. Since the introduction of hydroxylapatic ceramics (HAC), these numbers have been reduced considerably. The HAC, which is derived from corals, has a rough surface and requires a scleral covering for implantation. The HAC, which is made in the laboratory, can be produced with smoother surfaces, so that a homoplastic covering is no longer mandatory. A composite implant was developed to improve prosthesis motility further. This consists of artificial HAC at its anterior surface to guarantee safe tissue integration; the posterior part of the implant is manufactured from silicon rubber to create a jointlike structure in Tenon's capsule. Integration of the porous HAC in the orbital soft tissues has been tested and confirmed by animal experiments. After 30 full HAC implants and 25 composite implants, only one extrusion occurred. In all other cases, compatibility proved to be excellent; transmission of the motility to the prosthesis was moderate to good. Examinations comparing prosthesis motility and computer tomographically evaluated implant motility enabled the analysis of deficits in motility transmission of the implant for the artificial eye.

  5. Adsorption of arsenic with struvite and hydroxylapatite in phosphate-bearing solutions.

    PubMed

    Rouff, Ashaki A; Ma, Ning; Kustka, Adam B

    2016-03-01

    Arsenic sorption at above neutral pH is relevant when considering contaminant mobility in alkaline, phosphorus-bearing wastewaters, and may be viable in the presence phosphate minerals. Arsenic adsorption on struvite (MgNH4PO4 · 6H2O, MAP) and hydroxylapatite (Ca5(PO4)3OH, HAP) was evaluated at pH 8-11 from solutions with 2.7-0.125 mM phosphate and 0.05 mM As(III) or As(V). Over 7 d, As(III) removal from solution was minimal, but As(V) removal increased with pH, and was higher in the presence of MAP compared to HAP with a maximum of 74% removal in pH 11 MAP-bearing solutions. X-ray absorption fine structure spectroscopy (XAFS) analysis of solids recovered from pH 10-11 solutions revealed different mechanisms of As(V) sorption with MAP and HAP. Arsenic forms monodentate mononuclear surface complexes with MAP through the formation of a Mg-O-As bond, but is incorporated at the near-surface of HAP forming a johnbaumite-like (Ca5(AsO4)3OH) structure. Experiments using radioactive (33)P at pH 10-11 revealed faster exchange of P at the HAP surface, which could promote more facile As incorporation. Near-surface incorporated As in HAP may be less susceptible to remobilization compared to surface adsorbates formed with MAP. Overall, both MAP and HAP may sorb As at high pH in the presence of phosphate. This is relevant to the fate of As in alkaline contaminated waters in contact with phosphate mineral phases.

  6. Injection pharyngoplasty with calcium hydroxylapatite for velopharyngeal insufficiency: patient selection and technique.

    PubMed

    Brigger, Matthew T; Ashland, Jean E; Hartnick, Christopher J

    2010-07-01

    To identify children who may benefit from calcium hydroxylapatite (CaHA) injection pharyngoplasty for symptomatic velopharyngeal insufficiency (VPI). Retrospective review of children with VPI who underwent injection pharyngoplasty with CaHA. Multidisciplinary pediatric aerodigestive center. Children with symptomatic VPI as defined by abnormal speech associated with subjective and objective measures of hypernasality. Posterior pharyngeal wall augmentation with injectable CaHA. Nasalence scores recorded as number of standard deviations (SDs) from normalized scores, and perceptual scoring recorded as standardized weighted score and caretaker satisfaction from direct report. Twelve children who had undergone injection pharyngoplasty with CaHA were identified. Of the 12 children, 8 demonstrated success at 3 months as defined by nasalence (<1 SD above normal nasalance scores), perceptual scoring (decrease in weighted score), and overall caretaker satisfaction. Four children were followed up for more than 24 months and continued to demonstrate stable success. The 4 children who failed the procedure all failed before the 3-month evaluation and demonstrated increased baseline severity of VPI as defined by increased preoperative nasalence scores (5.25 SD vs 2.4 SD above normalized scores), perceptual scores (weighted score, 4.25 vs 3.85), and characteristic nasendoscopy findings of a broad-based velopharyngeal gap or unilateral adynamism. Three of the 4 treatment failures occurred early in the senior author's (C.J.H.) experience with the technique. Injection pharyngoplasty with CaHA is a useful adjunct in the treatment of children with mild VPI. Efficacy and safety have been demonstrated more than 24 months after injection. Patient selection and operative technique are critical to the success of the procedure. Success is seen most often in children with mild VPI and small well-defined velopharyngeal gaps consistent with touch closure.

  7. Applying a user centered design methodology in a clinical context.

    PubMed

    Kashfi, Hajar

    2010-01-01

    A clinical decision support system (CDSS) is an interactive application that is used to facilitate the process of decisionmaking in a clinical context. Developing a usable CDSS is a challenging process; mostly because of the complex nature of domain knowledge and the context of use of those systems. This paper describes how a user centered design (UCD) approach can be used in a clinical context for developing a CDSS. In our effort, a design-based research methodology has been used. The outcomes of this work are as follow; a customized UCD approach is suggested that combines UCD and openEHR. Moreover, the GUI developed in the design phase and the result of the GUI evaluation is briefly presented.

  8. Piezosurgery applied to implant dentistry: clinical and biological aspects.

    PubMed

    Pereira, Cassiano Costa Silva; Gealh, Walter Cristiano; Meorin-Nogueira, Lamis; Garcia-Júnior, Idelmo Rangel; Okamoto, Roberta

    2014-07-01

    Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.

  9. The psychology of neurofeedback: Clinical intervention even if applied placebo.

    PubMed

    Thibault, Robert T; Raz, Amir

    2017-10-01

    Advocates of neurofeedback make bold claims concerning brain regulation, treatment of disorders, and mental health. Decades of research and thousands of peer-reviewed publications support neurofeedback using electroencephalography (EEG-nf); yet, few experiments isolate the act of receiving feedback from a specific brain signal as a necessary precursor to obtain the purported benefits. Moreover, while psychosocial parameters including participant motivation and expectation, rather than neurobiological substrates, seem to fuel clinical improvement across a wide range of disorders, for-profit clinics continue to sprout across North America and Europe. Here, we highlight the tenuous evidence supporting EEG-nf and sketch out the weaknesses of this approach. We challenge classic arguments often articulated by proponents of EEG-nf and underscore how psychologists and mental health professionals stand to benefit from studying the ubiquitous placebo influences that likely drive these treatment outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  10. [Genetics applied to clinical practice in neurodevelopmental disorders].

    PubMed

    Fernández-Jaén, Alberto; Cigudosa, Juan C; Martín Fernández-Mayoralas, Daniel; Suela, Javier; Fernández-Perrone, Ana L; Calleja-Pérez, Beatriz; López-Martín, Sara

    2014-02-24

    The medical literature contains a wide body of evidence supporting genetic involvement in neurodevelopmental disorders. Advances made in genetics and technology have increased the diagnostic cost-effectiveness of current studies from 3-5% to 30-40% in patients with intellectual disability or autism spectrum disorders. In this regard, chromosomal microarray studies display greater diagnostic power than conventional techniques (karyotype, subtelomeric analyses, etc.). The latest protocols in the biomedical field of the genetic study of these disorders cite chromosomal microarrays as the first-line analysis, while also recommending other specific studies depending on the patient's clinical features (fragile X syndrome, PTEN mutation, etc.). In the evaluation of other neurodevelopmental disorders (attention deficit hyperactivity disorder, learning disorders, etc.), the number of genetic tests carried out is limited and conditioned by the clinical characteristics or the patient's familial or personal history. Even in these situations, there are no genetic referral or evaluation protocols.

  11. Good clinical practice in developing countries: applying recommendations.

    PubMed

    Bompart, François; Hirsch, François; Bertoye, Pierre-Henri; Vray, Muriel

    2008-01-01

    The recommendations for clinical research in developing countries were published in 2007 and the present article deals with issues which were not initially raised or discussed in depth. In particular, we discuss specific questions linked to trials conducted in developing countries with regard to informed consent, research project review by two ethics committees, standards of care, management of biological samples, study follow-up committees, notification of Serious Adverse Events, paediatric trials, and Contract Research Organizations.

  12. Psychophysical factors that have been applied to clinical perimetry.

    PubMed

    Johnson, Chris A

    2013-09-20

    Perimetry is the most common clinical diagnostic test procedure for evaluating the status of peripheral visual function in the management of ocular and neurologic diseases. This procedure has an extended history, and its design, implementation and interpretation is dependent on many principles that have been developed through visual psychophysical studies of target size, target duration, background adaptation level, chromatic characteristics and other stimulus properties (see Greve, 1973; Johnson, 1994, chap. 17, 1996, 2008, 2010, chap. 23; Johnson & Keltner, 1998, chap. 7; Johnson & Sample, 2002, chap. 22; Johnson & Wall, 2011, chap. 35; Wall & Johnson, 2005, chap. 2 for reviews). This paper will provide a general overview of the history of perimetry, selection of stimulus parameters, development of test strategies, clinical testing conditions, new procedures and approaches to perimetry, experimental design, analysis and interpretation methods, hypothesis testing, prediction and forecasting procedures, and other related topics. It is somewhat paradoxical that although there have been major advances in all of these areas that have significantly enhanced the utility and value of this clinical diagnostic test, the fundamental methodology has remained mostly unchanged for thousands of years. It is hoped that this overview will be of assistance to investigators and clinicians who wish to use or modify this diagnostic procedure for their ongoing career activities. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Cholinesterase inhibitors: applying pharmacokinetics to clinical decision making.

    PubMed

    Gomolin, Irving H; Smith, Candace; Jeitner, Thomas M

    2011-08-01

    Cholinesterase inhibitors are indicated for the treatment of Alzheimer-type dementia. There are few direct comparative studies of adverse effects or studies to suggest clinical superiority of one inhibitor over the others. The objective of this study was to relate pharmacokinetic differences among the agents to potential clinical considerations. Population pharmacokinetics were obtained from US Food and Drug Administration-approved label information and published literature. Plasma concentration-time profiles were derived from these parameters using noncompartmental pharmacokinetic modeling. Plasma concentration profiles differed significantly among different agents and between different formulations of the same agent. The initial choice among the various cholinesterase inhibitors requires consideration to adherence and cost. Consideration to differences in pharmacokinetics among these drugs provides a better understanding for the clinical practice of dose titration, identification and management of drug-related side effects, and lapses in therapy. Pharmacokinetic considerations among the various agents and formulations provide the clinician with options to enhance therapy when these agents are chosen for treatment of patients with Alzheimer-type dementia. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

  14. [Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

    PubMed

    Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

    2015-10-01

    The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

  15. Applying Novel Nutrient Drink to Clinical Trial of Functional Dyspepsia

    PubMed Central

    Lim, Chul-Hyun; Choi, Myung-Gyu; Baeg, Myong Ki; Moon, Sung Jin; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu Yong

    2014-01-01

    Background/Aims The drink test has been regarded as a surrogate marker of gastric accommodation. The aims of this study were to develop a novel nutrient drink test (NDT) protocol and investigate its potential for application to a clinical trial of functional dyspepsia (FD). Methods A novel NDT was designed, involving drinking 125 mL of nutrient 4 times at 5-minute intervals or until maximal tolerability. Healthy volunteers and patients with FD rated their symptoms every 5 minutes for 20 minutes in a developmental study. Patients with FD were enrolled in an open trial of itopride for 4 weeks. NDT was performed before and after treatment. Improvement of integrative symptoms score during NDT after treatment for more than 50% compared with baseline was defined as responder. Results Total aggregate symptom scores, sum of symptom scores measured during NDT, were higher in FD patients (n = 40, 368.1 ± 245.3) than in controls (n = 19, 215.9 ± 171.2) (P = 0.018) in a developmental study. In an open trial of itopride, symptom scores measured during NDT decreased significantly at all time points after treatment in responders (n = 49), whereas did not in non-responders (n = 25). Total aggregate symptom score for NDT correlated significantly with integrative dyspeptic symptom score, sum of 8 symptom scores of NDI questionnaire, at baseline (r = 0.374, P = 0.001) and after treatment (r = 0.480, P < 0.001). Conclusions Our novel NDT can quantify dyspeptic symptoms and reflected therapeutic effects of itopride treatment in a clinical trial of FD patients. This NDT can be used as an effective parameter in clinical trials or drug development programs for assessing effects of novel therapies on postprandial symptoms. PMID:24840374

  16. Applying novel nutrient drink to clinical trial of functional dyspepsia.

    PubMed

    Lim, Chul-Hyun; Choi, Myung-Gyu; Baeg, Myong Ki; Moon, Sung Jin; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu Yong

    2014-04-30

    The drink test has been regarded as a surrogate marker of gastric accommodation. The aims of this study were to develop a novel nutrient drink test (NDT) protocol and investigate its potential for application to a clinical trial of functional dyspepsia (FD). A novel NDT was designed, involving drinking 125 mL of nutrient 4 times at 5-minute intervals or until maximal tolerability. Healthy volunteers and patients with FD rated their symptoms every 5 minutes for 20 minutes in a developmental study. Patients with FD were enrolled in an open trial of itopride for 4 weeks. NDT was performed before and after treatment. Improvement of integrative symptoms score during NDT after treatment for more than 50% compared with baseline was de-fined as responder. Total aggregate symptom scores, sum of symptom scores measured during NDT, were higher in FD patients (n = 40, 368.1 ± 245.3) than in controls (n = 19, 215.9 ± 171.2) (P = 0.018) in a developmental study. In an open trial of itopride, symp-tom scores measured during NDT decreased significantly at all time points after treatment in responders (n = 49), whereas did not in non-responders (n = 25). Total aggregate symptom score for NDT correlated significantly with integrative dyspeptic symptom score, sum of 8 symptom scores of NDI questionnaire, at baseline (r = 0.374, P = 0.001) and after treatment (r = 0.480, P < 0.001). Our novel NDT can quantify dyspeptic symptoms and reflected therapeutic effects of itopride treatment in a clinical trial of FD patients. This NDT can be used as an effective parameter in clinical trials or drug development programs for assessing effects of novel therapies on postprandial symptoms.

  17. The Psychiatric Cultural Formulation: Applying Medical Anthropology in Clinical Practice

    PubMed Central

    Aggarwal, Neil Krishan

    2014-01-01

    This paper considers revisions to the DSM-IV Outline for Cultural Formulation from the perspective of clinical practice. First, the paper explores the theoretical development of the Cultural Formulation. Next, a case presentation demonstrates challenges in its actual implementation. Finally, the paper recommends a set of questions for the clinician on barriers to care and countertransference. The development of a standardized, user-friendly format can increase the Cultural Formulation’s utilization among all psychiatrists beyond those specializing in cultural psychiatry. PMID:22418398

  18. Clinically applied models of bone regeneration in tissue engineering research.

    PubMed

    Einhorn, T A

    1999-10-01

    The development of new strategies for the engineering of bone regeneration requires appropriate model systems. Selection of the best model for testing a new technology depends on a host of factors. In general, the best model system is the one which most closely mimics the clinical situation for which this technology is being developed, will not heal spontaneously unless the technology is used, and will not heal when another technology is used if that technology is less advanced than the one being tested. For the purposes of developing new strategies for bone regeneration, systems which can be considered include those which model normal fracture healing, the segmental loss of bone or critical size defects, and various forms of nonunions in which fracture healing is perturbed either by mechanical, metabolic, or neurologic means. Careful experimental design and selection of the appropriate model system will enhance scientific efforts in bone regeneration research.

  19. Adherence of oral streptococci: evidence for nonspecific adsorption to saliva-coated hydroxylapatite surfaces.

    PubMed Central

    Staat, R H; Peyton, J C

    1984-01-01

    It is proposed that binding of oral streptococci to saliva-coated hydroxylapatite (SHA) surfaces is a multifactorial process involving both specific and nonspecific receptors. In this context, specific binding is described as a high-affinity, saturable interaction between the cell and binding surface. Conversely, nonspecific binding is considered to be a nonsaturable, generalized, low-affinity reaction. Experimental differentiation of specific binding from nonspecific binding was achieved with a competition assay which utilized a large excess of nonradiolabeled bacteria to compete with the 3H-labeled cells for attachment to receptors on 1.5 mg of SHA crystals. Competition assays of Streptococcus sanguis and Streptococcus mitis adhesion clearly demonstrated that the total binding isotherm was composed of a saturable specific binding reaction and a minor nonspecific binding component. This was further substantiated by analysis of nonlinear Scatchard plots of the total binding data. The competition data for Streptococcus mutans binding indicated that ca. 50% of the S. mutans binding appeared to be specific, although saturation of the SHA surfaces with bacterial cells could not be demonstrated. Experiments measuring desorption of radiolabeled cells from SHA crystals into buffer showed that ca. 50% of the bound S. mutans cells were removed after 4 h, whereas less than 5% of the S. sanguis cells were eluted from the SHA surfaces. The kinetics of attachment were studied by using an extract of Persea americana as a noncompetitive inhibitor of adherence. The total cell binding data for these experiments suggested a very rapid binding reaction followed by a slower rate of attachment. It was concluded from these three different experimental approaches that adherence of selected oral streptococci to SHA surfaces involves specific, high-affinity and nonspecific, low-affinity binding reactions. The concept is developed that in vitro streptococcal attachment to SHA can be

  20. Ultrasound in anesthesia: applying scientific principles to clinical practice.

    PubMed

    Falyar, Christian R

    2010-08-01

    The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace. The U.S. Agency for Health Care Quality and the United Kingdom National Institute for Clinical Excellence have identified the role of ultrasound in improving patient safety. Numerous studies have demonstrated the benefits of ultrasound, yet there have also been articles inferring it may not offer additional benefits to traditional landmark techniques. The major disadvantage often cited is that success is user-dependent, and using ultrasound is a unique skill that requires training and experience to become proficient. Modern ultrasound systems incorporate 2 sound technologies to provide users with specific information about what is being viewed. Brightness mode imaging and pulsed-wave Doppler can be combined to reduce potential complications associated with central venous access and regional anesthesia. Human tissue is also an important factor in ultrasound imaging. The different densities of soft tissues, bone, fluid, and air all interact with sound, creating distinctive images that can aid and potentially hinder accuracy. Comprehension of basic ultrasound principles and how it is affected by tissue will enable anesthetists to better understand what is being seen and reduce the potential for errors.

  1. Semantic Web Technology for Mapping and Applying Clinical Functional Assessment Information

    DTIC Science & Technology

    2015-05-01

    Award Number: W81XWH-13-2-0010 TITLE: Semantic Web Technology for Mapping and Applying Clinical Functional Assessment Information PRINCIPAL...SUBTITLE Semantic Web Technology for Mapping and Applying Clinical 5a. CONTRACT NUMBER W81XWH-13-2-0010 Functional Assessment Information 5b. GRANT...International Classification of Functioning, Disability, and Health (ICF). We developed the mechanisms to generate programmatically data-acquisition Web forms

  2. [Development and Effects of Assertiveness Training applying Dongsasub Training for Nursing Students in Clinical Practice].

    PubMed

    Kim, Myoungsuk

    2016-08-01

    This study was conducted to develop assertiveness training applying Dongsasub training for junior nursing students, and to verify effectiveness of the training on assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. The study design was a non-equivalent control group non-synchronized design. Participants were 63 nursing students in clinical training (31 students in the experimental group and 32 students in the control group). The assertiveness training applying Dongsasub training consisted of four sessions. Outcome variables included assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. Data were analyzed using Chi-square, Fisher's exact test and independent samples t-test with SPSS/WIN 21.0. Scores of assertiveness behavior (t=-2.49, p=.015), self-esteem (t=-4.80, p<.001) and clinical competence (t=-2.33, p=.023) were significantly higher and clinical practice stress (t=4.22, p<.001) was significantly lower in the experimental group compared to the control group. Results indicate that the assertiveness training applying Dongsasub training can be used as a nursing intervention to lower clinical practice stress and improve the clinical competence of nursing students.

  3. A collaborative project to apply and evaluate the clinical judgment model through simulation.

    PubMed

    Dillard, Nancy; Sideras, Stephanie; Ryan, Marilyn; Carlton, Kay Hodson; Lasater, Kathie; Siktberg, Linda

    2009-01-01

    As use of simulations increases in nursing education, nurse educators are challenged to evaluate students' clinical judgment skills. The purpose of this article is to describe faculty development in the use of the Lasater Clinical Judgment Rubric (LCJR); faculty application of LCJR in evaluating students' clinical judgment skills during a simulation scenario; and faculty and students' perception transference from the simulation to the clinical setting.Tanner's Clinical Judgment Model was used in an assigned adult health simulation. Quantitative and qualitative data were collected from faculty and student evaluations and students' reflective statements. Findings support the importance of simulation's contribution to clinical judgment development. However, more work remains to improve the integration of clinical judgment and use of a conceptual framework and evidence-based rubric. For long-term change, both faculty and students need ongoing practice and encouragement in applying the clinical judgment framework to clinical and simulation experiences. For application of the model, a recommendation is to incorporate the clinical judgment language into course syllabi, course assignments, and evaluations.

  4. Multimodal tissue perfusion imaging using multi-spectral and thermographic imaging systems applied on clinical data

    NASA Astrophysics Data System (ADS)

    Klaessens, John H. G. M.; Nelisse, Martin; Verdaasdonk, Rudolf M.; Noordmans, Herke Jan

    2013-03-01

    Clinical interventions can cause changes in tissue perfusion, oxygenation or temperature. Real-time imaging of these phenomena could be useful for surgical strategy or understanding of physiological regulation mechanisms. Two noncontact imaging techniques were applied for imaging of large tissue areas: LED based multispectral imaging (MSI, 17 different wavelengths 370 nm-880 nm) and thermal imaging (7.5 to 13.5 μm). Oxygenation concentration changes were calculated using different analyzing methods. The advantages of these methods are presented for stationary and dynamic applications. Concentration calculations of chromophores in tissue require right choices of wavelengths The effects of different wavelength choices for hemoglobin concentration calculations were studied in laboratory conditions and consequently applied in clinical studies. Corrections for interferences during the clinical registrations (ambient light fluctuations, tissue movements) were performed. The wavelength dependency of the algorithms were studied and wavelength sets with the best results will be presented. The multispectral and thermal imaging systems were applied during clinical intervention studies: reperfusion of tissue flap transplantation (ENT), effectiveness of local anesthetic block and during open brain surgery in patients with epileptic seizures. The LED multispectral imaging system successfully imaged the perfusion and oxygenation changes during clinical interventions. The thermal images show local heat distributions over tissue areas as a result of changes in tissue perfusion. Multispectral imaging and thermal imaging provide complementary information and are promising techniques for real-time diagnostics of physiological processes in medicine.

  5. Metabolic phenotyping applied to pre-clinical and clinical studies of acetaminophen metabolism and hepatotoxicity.

    PubMed

    Coen, Muireann

    2015-02-01

    Acetaminophen (APAP, paracetamol, N-acetyl-p-aminophenol) is a widely used analgesic that is safe at therapeutic doses but is a major cause of acute liver failure (ALF) following overdose. APAP-induced hepatotoxicity is related to the formation of an electrophilic reactive metabolite, N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified through conjugation with reduced glutathione (GSH). One method that has been applied to study APAP metabolism and hepatotoxicity is that of metabolic phenotyping, which involves the study of the small molecule complement of complex biological samples. This approach involves the use of high-resolution analytical platforms such as NMR spectroscopy and mass spectrometry to generate information-rich metabolic profiles that reflect both genetic and environmental influences and capture both endogenous and xenobiotic metabolites. Data modeling and mining and the subsequent identification of panels of candidate biomarkers are typically approached with multivariate statistical tools. We review the application of multi-platform metabolic profiling for the study of APAP metabolism in both in vivo models and humans. We also review the application of metabolic profiling for the study of endogenous metabolic pathway perturbations in response to APAP hepatotoxicity, with a particular focus on metabolites involved in the biosynthesis of GSH and those that reflect mitochondrial function such as long-chain acylcarnitines. Taken together, this body of work sheds much light on the mechanism of APAP-induced hepatotoxicity and provides candidate biomarkers that may prove of translational relevance for improved stratification of APAP-induced ALF.

  6. Case Study: Applying OpenEHR Archetypes to a Clinical Data Repository in a Chinese Hospital.

    PubMed

    Min, Lingtong; Wang, Li; Lu, Xudong; Duan, Huilong

    2015-01-01

    openEHR is a flexible and scalable modeling methodology for clinical information and has been widely adopted in Europe and Australia. Due to the reasons of differences in clinical process and management, there are few research projects involving openEHR in China. To investigate the feasibility of openEHR methodology for clinical information modelling in China, this paper carries out a case study to apply openEHR archetypes to Clinical Data Repository (CDR) in a Chinese hospital. The results show that a set of 26 archetypes are found to cover all the concepts used in the CDR. Of all these, 9 (34.6%) are reused without change, 10 are modified and/or extended, and 7 are newly defined. The reasons for modification, extension and newly definition have been discussed, including granularity of archetype, metadata-level versus data-level modelling, and the representation of relationships between archetypes.

  7. Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials.

    PubMed

    Napoles, A; Cook, E; Ginossar, T; Knight, K D; Ford, M E

    2017-01-01

    The underrepresentation of ethnically diverse populations in cancer clinical trials results in the inequitable distribution of the risks and benefits of this research. Using a case study approach, we apply a conceptual framework of factors associated with the participation of diverse population groups in cancer clinical trials developed by Dr. Jean Ford and colleagues to increase understanding of the specific strategies, and barriers and promoters addressed by these strategies, that resulted in marked success in accrual of racially and ethnically diverse populations in cancer clinical research. Results indicate that the studies presented were able to successfully engage minority participants due to the creation and implementation of multilevel, multifaceted strategies that included: culturally and linguistically appropriate outreach, education, and research studies that were accessible in local communities; infrastructure to support engagement of key stakeholders, clinicians, and organizations serving minority communities; testimonials by ethnically diverse cancer survivors; availability of medical interpretation services; and providing infrastructure that facilitated the engagement in clinical research of clinicians who care for minority patient populations. These strategic efforts were effective in addressing limited awareness of trials, lack of opportunities to participate, and acceptance of engagement in cancer clinical trials. Careful attention to the context and population characteristics in which cancer clinical trials are conducted will be necessary to address disparities in research participation and cancer outcomes. These studies illustrate that progress on minority accrual into clinical research requires intentional efforts to overcome barriers at all three stages of the accrual process: awareness, opportunity, and acceptance of participation.

  8. From the galleries to the clinic: applying art museum lessons to patient care.

    PubMed

    Miller, Alexa; Grohe, Michelle; Khoshbin, Shahram; Katz, Joel T

    2013-12-01

    Increasingly, medical educators integrate art-viewing into curricular interventions that teach clinical observation-often with local art museum educators. How can cross-disciplinary collaborators explicitly connect the skills learned in the art museum with those used at the bedside? One approach is for educators to align their pedagogical approach using similar teaching methods in the separate contexts of the galleries and the clinic. We describe two linked pedagogical exercises--Visual Thinking Strategies (VTS) in the museum galleries and observation at the bedside--from "Training the Eye: Improving the Art of Physical Diagnosis," an elective museum-based course at Harvard Medical School. It is our opinion that while strategic interactions with the visual arts can improve skills, it is essential for students to apply them in a clinical context with faculty support-requiring educators across disciplines to learn from one another.

  9. Comparsion analysis of data mining models applied to clinical research in traditional Chinese medicine.

    PubMed

    Zhao, Yufeng; Xie, Qi; He, Liyun; Liu, Baoyan; Li, Kun; Zhang, Xiang; Bai, Wenjing; Luo, Lin; Jing, Xianghong; Huo, Ruili

    2014-10-01

    To help researchers selecting appropriate data mining models to provide better evidence for the clinical practice of Traditional Chinese Medicine (TCM) diagnosis and therapy. Clinical issues based on data mining models were comprehensively summarized from four significant elements of the clinical studies: symptoms, symptom patterns, herbs, and efficacy. Existing problems were further generalized to determine the relevant factors of the performance of data mining models, e.g. data type, samples, parameters, variable labels. Combining these relevant factors, the TCM clinical data features were compared with regards to statistical characters and informatics properties. Data models were compared simultaneously from the view of applied conditions and suitable scopes. The main application problems were the inconsistent data type and the small samples for the used data mining models, which caused the inappropriate results, even the mistake results. These features, i.e. advantages, disadvantages, satisfied data types, tasks of data mining, and the TCM issues, were summarized and compared. By aiming at the special features of different data mining models, the clinical doctors could select the suitable data mining models to resolve the TCM problem.

  10. Information systems in clinical pharmacy applied to parenteral nutrition management and traceability: a systematic review.

    PubMed

    Martínez Gabarrón, Josefa; Sanz-Valero, Javier; Wanden-Berghe, Carmina

    2017-01-01

    To review the scientific literature on clinical pharmacy information systems applied to parenteral nutrition (PN) management and traceability. A systematic review of the documents retrieved from the MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts (IPA) and Google Scholar databases up to May, 2016. The terms used, as descriptors and free text, were: "Parenteral Nutrition" and "Drug Information Services". The quality of the articles was assessed using the STROBE Questionnaire. The search was completed through consultation with experts and the bibliographic review of the articles selected. From the 153 references retrieved in our search, after applying inclusion and exclusion criteria, only 6 articles were selected for review. In three of them, flowcharts or some kind of graphical notation were designed in order to develop standard management systems, while three were based on computer programs. In two of the articles selected, a comprehensive management system had been designed for PN control and traceability. PN must be integrated within a standardized system, to ensure its quality and reduce the risks associated with this therapy. The development of technologies applied to PN would enable to set up management systems that are more complete and easier to apply in a real setting. Therefore, we think it will be necessary to generate new specific articles and developments associated with PN management and traceability, in order to allow their constant monitoring and assessment. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  11. Applying knowledge-anchored hypothesis discovery methods to advance clinical and translational research: the OAMiner project

    PubMed Central

    Jackson, Rebecca D; Best, Thomas M; Borlawsky, Tara B; Lai, Albert M; James, Stephen; Gurcan, Metin N

    2012-01-01

    The conduct of clinical and translational research regularly involves the use of a variety of heterogeneous and large-scale data resources. Scalable methods for the integrative analysis of such resources, particularly when attempting to leverage computable domain knowledge in order to generate actionable hypotheses in a high-throughput manner, remain an open area of research. In this report, we describe both a generalizable design pattern for such integrative knowledge-anchored hypothesis discovery operations and our experience in applying that design pattern in the experimental context of a set of driving research questions related to the publicly available Osteoarthritis Initiative data repository. We believe that this ‘test bed’ project and the lessons learned during its execution are both generalizable and representative of common clinical and translational research paradigms. PMID:22647689

  12. Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

    PubMed

    Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

    2013-01-01

    Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline.

  13. Understanding and applying pharmacometric modelling and simulation in clinical practice and research

    PubMed Central

    2016-01-01

    Understanding the dose–concentration–effect relationship is a fundamental component of clinical pharmacology. Interpreting data arising from observations of this relationship requires the use of mathematical models; i.e. pharmacokinetic (PK) models to describe the relationship between dose and concentration and pharmacodynamic (PD) models describing the relationship between concentration and effect. Drug development requires several iterations of pharmacometric model‐informed learning and confirming. This includes modelling to understand the dose–response in preclinical studies, deriving a safe dose for first‐in‐man, and the overall analysis of Phase I/II data to optimise the dose for safety and efficacy in Phase III pivotal trials. However, drug development is not the boundary at which PKPD understanding and application stops. PKPD concepts will be useful to anyone involved in the prescribing and administration of medicines for purposes such as determining off‐label dosing in special populations, individualising dosing based on a measured biomarker (personalised medicine) and in determining whether lack of efficacy or unexpected toxicity maybe solved by adjusting the dose rather than the drug. In clinical investigator‐led study design, PKPD can be used to ensure the optimal dose is used, and crucially to define the expected effect size, thereby ensuring power calculations are based on sound prior information. In the clinical setting the most likely people to hold sufficient expertise to advise on PKPD matters will be the pharmacists and clinical pharmacologists. This paper reviews fundamental PKPD principles and provides some real‐world examples of PKPD use in clinical practice and applied clinical research. PMID:27567102

  14. Interactive anatomical and surgical live stream lectures improve students' academic performance in applied clinical anatomy.

    PubMed

    Shiozawa, Thomas; Butz, Benjamin; Herlan, Stephan; Kramer, Andreas; Hirt, Bernhard

    2017-01-01

    Tuebingen's Sectio Chirurgica (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's Sectio Chirurgica (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to provide an application-oriented approach to teaching anatomy that offers students a deeper learning experience. A cohort study was devised to determine whether students who participated in the TSC were better able to solve clinical application questions than students who did not participate. A total of 365 students participated in the dissection course during the winter term of the 2012/2013 academic year. The final examination contained 40 standard multiple-choice (S-MC) and 20 clinically-applied multiple-choice (CA-MC) items. The CA-MC items referred to clinical cases but could be answered solely using anatomical knowledge. Students who regularly participated in the TSC answered the CA-MC questions significantly better than the control group (75% and 65%, respectively; P < 0.05, Mann-Whitney U test). The groups exhibited no differences on the S-MC questions (85% and 82.5%, respectively; P > 0.05). The CA-MC questions had a slightly higher level of difficulty than the S-MC questions (0.725 and 0.801, respectively; P = 0.083). The discriminatory power of the items was comparable (S-MC median Pearson correlations: 0.321; CA-MC: 0.283). The TSC successfully teaches the clinical application of anatomical knowledge. Students who attended the TSC in addition to the dissection course were able to answer CA-MC questions significantly better than students who did not attend the TSC. Thus, attending the TSC in addition to the dissection course supported students' clinical learning goals. Anat Sci Educ 10: 46-52. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

  15. Applying a family systems lens to proxy decision making in clinical practice and research.

    PubMed

    Rolland, John S; Emanuel, Linda L; Torke, Alexia M

    2017-03-01

    When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science's evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland's Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record

  16. Applying and testing the conveniently optimized enzyme mismatch cleavage method to clinical DNA diagnosis.

    PubMed

    Niida, Yo; Kuroda, Mondo; Mitani, Yusuke; Okumura, Akiko; Yokoi, Ayano

    2012-11-01

    Establishing a simple and effective mutation screening method is one of the most compelling problems with applying genetic diagnosis to clinical use. Because there is no reliable and inexpensive screening system, amplifying by PCR and performing direct sequencing of every coding exon is the gold standard strategy even today. However, this approach is expensive and time consuming, especially when gene size or sample number is large. Previously, we developed CEL nuclease mediated heteroduplex incision with polyacrylamide gel electrophoresis and silver staining (CHIPS) as an ideal simple mutation screening system constructed with only conventional apparatuses and commercially available reagents. In this study, we evaluated the utility of CHIPS technology for genetic diagnosis in clinical practice by applying this system to screening for the COL2A1, WRN and RPS6KA3 mutations in newly diagnosed patients with Stickler syndrome (autosomal dominant inheritance), Werner syndrome (autosomal recessive inheritance) and Coffin-Lowry syndrome (X-linked inheritance), respectively. In all three genes, CHIPS detected all DNA variations including disease causative mutations within a day. Direct sequencing of all coding exons of these genes confirmed 100% sensitivity and specificity. We demonstrate high sensitivity, high cost performance and reliability of this simple system, with compatibility to all inheritance modes. Because of its low technology, CHIPS is ready to use and potentially disseminate to any laboratories in the world.

  17. Does clinical equipoise apply to cluster randomized trials in health research?

    PubMed Central

    2011-01-01

    This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, Weijer and colleagues set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the third of the questions posed, namely, does clinical equipoise apply to CRTs in health research? The ethical principle of beneficence is the moral obligation not to harm needlessly and, when possible, to promote the welfare of research subjects. Two related ethical problems have been discussed in the CRT literature. First, are control groups that receive only usual care unduly disadvantaged? Second, when accumulating data suggests the superiority of one intervention in a trial, is there an ethical obligation to act? In individually randomized trials involving patients, similar questions are addressed by the concept of clinical equipoise, that is, the ethical requirement that, at the start of a trial, there be a state of honest, professional disagreement in the community of expert practitioners as to the preferred treatment. Since CRTs may not involve physician-researchers and patient-subjects, the applicability of clinical equipoise to CRTs is uncertain. Here we argue that clinical equipoise may be usefully grounded in a trust relationship between the state and research subjects, and, as a result, clinical equipoise is applicable to CRTs. Clinical equipoise is used to argue that control groups receiving only usual care are not disadvantaged so long as the evidence supporting the experimental and control interventions is such that experts would disagree as to which is preferred. Further, while data accumulating during the course of a CRT may favor one intervention over another, clinical equipoise supports continuing the trial until the results are likely to be broadly convincing, often coinciding with the planned completion of the trial

  18. Constructivism applied to psychiatric-mental health nursing: an alternative to supplement traditional clinical education.

    PubMed

    DeCoux Hampton, Michelle

    2012-02-01

    With the popularity of accelerated pre-licensure nursing programmes and the growth in nursing student enrolments, traditional clinical education continues to be a challenge to deliver. Nursing faculty members are required to develop and implement educational innovations that achieve effective learning outcomes, while using fewer resources. The purpose of this qualitative study was to explore the effectiveness of a constructivism-based learning project to achieve specific learning outcomes and to supplement approximately 30 clinical hours in a psychiatric-mental health nursing course. Students participated in a 10-week, multistage project that examined life histories, treatment resources, and evidence-based practice, as applied to a single individual with a mental illness. Students reported increased understanding of mental health and illness, developed personal relevance associated with the knowledge gained, and learned to problem solve with regard to nursing care of individuals diagnosed with mental illness. For many students, there also appeared to be a reduction in stigmatized attitudes towards mental illness. Constructivism-based learning is a promising alternative to supplement clinical hours, while effectively achieving learning outcomes. Future research is needed to further validate the use of this method for the learning of course content, as well as the reduction of stigma.

  19. Added clinical value of applying myocardial deformation imaging to assess right ventricular function.

    PubMed

    Sokalskis, Vladislavs; Peluso, Diletta; Jagodzinski, Annika; Sinning, Christoph

    2017-06-01

    Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use. © 2017, Wiley Periodicals, Inc.

  20. Clinical analysis of the rap stress stimulator applied for crus fracture after skeletal external fixation

    PubMed Central

    Zhuang, Ping; Hong, Jiayuan; Chen, Wei; Wu, Jin

    2015-01-01

    Introduction Open crus fracture is still difficult in clinical treatment because of the delayed fracture union and high rate of nonunion after the operation. A consensus has been reached that mechanical stress can promote fracture healing. We independently developed a stress stimulator, which can provide longitudinal pressure for the fixed fracture end of the lower legs to promote fracture healing. The purpose of this study is to explore the advantages and clinical effect of the rap stress stimulator applied for open crus fracture after skeletal external fixation. Material and methods One hundred and sixty-five patients (183 limbs) who suffered from open tibia and fibula fracture received skeletal external fixation, of which 108 limbs were treated with the rap stress stimulator after external fixation and 75 limbs were treated with regular functional exercises of muscle contraction and joint activity only. Then the fracture healing time and rate of nonunion were compared between the two groups. Results The mean fracture healing time and rate of nonunion in the group treated with the rap stress stimulator were 138.27 ±4.45 days and 3.70% respectively, compared to 153.43 ±4.89 days and 10.67% in the group treated without the stimulator. Conclusions The rap stress stimulator significantly shortened the fracture healing time and reduced the rate of nonunion for treating open tibia and fibula fractures. PMID:26170856

  1. Clinical analysis of the rap stress stimulator applied for crus fracture after skeletal external fixation.

    PubMed

    Zhuang, Ping; Hong, Jiayuan; Chen, Wei; Wu, Jin; Ding, Zhenqi

    2015-06-19

    Open crus fracture is still difficult in clinical treatment because of the delayed fracture union and high rate of nonunion after the operation. A consensus has been reached that mechanical stress can promote fracture healing. We independently developed a stress stimulator, which can provide longitudinal pressure for the fixed fracture end of the lower legs to promote fracture healing. The purpose of this study is to explore the advantages and clinical effect of the rap stress stimulator applied for open crus fracture after skeletal external fixation. One hundred and sixty-five patients (183 limbs) who suffered from open tibia and fibula fracture received skeletal external fixation, of which 108 limbs were treated with the rap stress stimulator after external fixation and 75 limbs were treated with regular functional exercises of muscle contraction and joint activity only. Then the fracture healing time and rate of nonunion were compared between the two groups. The mean fracture healing time and rate of nonunion in the group treated with the rap stress stimulator were 138.27 ±4.45 days and 3.70% respectively, compared to 153.43 ±4.89 days and 10.67% in the group treated without the stimulator. The rap stress stimulator significantly shortened the fracture healing time and reduced the rate of nonunion for treating open tibia and fibula fractures.

  2. Rorschach scores in applied clinical practice: a survey of perceived validity by experienced clinicians.

    PubMed

    Meyer, Gregory J; Hsiao, Wei-Cheng; Viglione, Donald J; Mihura, Joni L; Abraham, Leah M

    2013-01-01

    We surveyed practicing clinicians who regularly used the Rorschach about the perceived clinical validity of specific Rorschach scores from many coding systems. The survey included quantitative feedback on the validity of specific variables as well as qualitative input in several areas, including the validity of specific variables, the potentially unique information that can be obtained from them, coding challenges associated with Comprehensive System (CS) codes, and recommendations for CS developments. Participants were recruited by applying a snowball sampling strategy. Based on responses from 246 experienced clinicians from 26 countries, composite judgments on rated variables were quite reliable (e.g., M α = .95 across 88 CS variables), despite limited agreement among any 2 judges. The aggregated judgments clearly differentiated among scores that were considered more and less clinically valid and the overall results aligned with recently obtained meta-analytic conclusions from the traditional validity literature (Mihura, Meyer, Dumitrascu, & Bombel, 2012). The judges also provided guidance concerning revisions and enhancements that would facilitate Rorschach-based assessment in the future. We discuss the implication of the quantitative and qualitative findings and provide suggestions for future directions based on the results.

  3. Applying Automated MR-Based Diagnostic Methods to the Memory Clinic: A Prospective Study.

    PubMed

    Klöppel, Stefan; Peter, Jessica; Ludl, Anna; Pilatus, Anne; Maier, Sabrina; Mader, Irina; Heimbach, Bernhard; Frings, Lars; Egger, Karl; Dukart, Juergen; Schroeter, Matthias L; Perneczky, Robert; Häussermann, Peter; Vach, Werner; Urbach, Horst; Teipel, Stefan; Hüll, Michael; Abdulkadir, Ahmed

    2015-01-01

    Several studies have demonstrated that fully automated pattern recognition methods applied to structural magnetic resonance imaging (MRI) aid in the diagnosis of dementia, but these conclusions are based on highly preselected samples that significantly differ from that seen in a dementia clinic. At a single dementia clinic, we evaluated the ability of a linear support vector machine trained with completely unrelated data to differentiate between Alzheimer's disease (AD), frontotemporal dementia (FTD), Lewy body dementia, and healthy aging based on 3D-T1 weighted MRI data sets. Furthermore, we predicted progression to AD in subjects with mild cognitive impairment (MCI) at baseline and automatically quantified white matter hyperintensities from FLAIR-images. Separating additionally recruited healthy elderly from those with dementia was accurate with an area under the curve (AUC) of 0.97 (according to Fig. 4). Multi-class separation of patients with either AD or FTD from other included groups was good on the training set (AUC >  0.9) but substantially less accurate (AUC = 0.76 for AD, AUC = 0.78 for FTD) on 134 cases from the local clinic. Longitudinal data from 28 cases with MCI at baseline and appropriate follow-up data were available. The computer tool discriminated progressive from stable MCI with AUC = 0.73, compared to AUC = 0.80 for the training set. A relatively low accuracy by clinicians (AUC = 0.81) illustrates the difficulties of predicting conversion in this heterogeneous cohort. This first application of a MRI-based pattern recognition method to a routine sample demonstrates feasibility, but also illustrates that automated multi-class differential diagnoses have to be the focus of future methodological developments and application studies.

  4. Applying Automated MR-Based Diagnostic Methods to the Memory Clinic: A Prospective Study

    PubMed Central

    Klöppel, Stefan; Peter, Jessica; Ludl, Anna; Pilatus, Anne; Maier, Sabrina; Mader, Irina; Heimbach, Bernhard; Frings, Lars; Egger, Karl; Dukart, Juergen; Schroeter, Matthias L.; Perneczky, Robert; Häussermann, Peter; Vach, Werner; Urbach, Horst; Teipel, Stefan; Hüll, Michael; Abdulkadir, Ahmed

    2015-01-01

    Abstract Several studies have demonstrated that fully automated pattern recognition methods applied to structural magnetic resonance imaging (MRI) aid in the diagnosis of dementia, but these conclusions are based on highly preselected samples that significantly differ from that seen in a dementia clinic. At a single dementia clinic, we evaluated the ability of a linear support vector machine trained with completely unrelated data to differentiate between Alzheimer’s disease (AD), frontotemporal dementia (FTD), Lewy body dementia, and healthy aging based on 3D-T1 weighted MRI data sets. Furthermore, we predicted progression to AD in subjects with mild cognitive impairment (MCI) at baseline and automatically quantified white matter hyperintensities from FLAIR-images. Separating additionally recruited healthy elderly from those with dementia was accurate with an area under the curve (AUC) of 0.97 (according to Fig. 4). Multi-class separation of patients with either AD or FTD from other included groups was good on the training set (AUC >  0.9) but substantially less accurate (AUC = 0.76 for AD, AUC = 0.78 for FTD) on 134 cases from the local clinic. Longitudinal data from 28 cases with MCI at baseline and appropriate follow-up data were available. The computer tool discriminated progressive from stable MCI with AUC = 0.73, compared to AUC = 0.80 for the training set. A relatively low accuracy by clinicians (AUC = 0.81) illustrates the difficulties of predicting conversion in this heterogeneous cohort. This first application of a MRI-based pattern recognition method to a routine sample demonstrates feasibility, but also illustrates that automated multi-class differential diagnoses have to be the focus of future methodological developments and application studies PMID:26401773

  5. Clinical usefulness of the clock drawing test applying rasch analysis in predicting of cognitive impairment.

    PubMed

    Yoo, Doo Han; Lee, Jae Shin

    2016-07-01

    [Purpose] This study examined the clinical usefulness of the clock drawing test applying Rasch analysis for predicting the level of cognitive impairment. [Subjects and Methods] A total of 187 stroke patients with cognitive impairment were enrolled in this study. The 187 patients were evaluated by the clock drawing test developed through Rasch analysis along with the mini-mental state examination of cognitive evaluation tool. An analysis of the variance was performed to examine the significance of the mini-mental state examination and the clock drawing test according to the general characteristics of the subjects. Receiver operating characteristic analysis was performed to determine the cutoff point for cognitive impairment and to calculate the sensitivity and specificity values. [Results] The results of comparison of the clock drawing test with the mini-mental state showed significant differences in according to gender, age, education, and affected side. A total CDT of 10.5, which was selected as the cutoff point to identify cognitive impairement, showed a sensitivity, specificity, Youden index, positive predictive, and negative predicive values of 86.4%, 91.5%, 0.8, 95%, and 88.2%. [Conclusion] The clock drawing test is believed to be useful in assessments and interventions based on its excellent ability to identify cognitive disorders.

  6. Upper limb robotics applied to neurorehabilitation: An overview of clinical practice.

    PubMed

    Duret, Christophe; Mazzoleni, Stefano

    2017-01-01

    During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders. Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.

  7. Comparative study of the thermal properties of mud and peat solutions applied in clinical practice.

    PubMed

    Beer, A M; Grozeva, A; Sagorchev, P; Lukanov, J

    2003-11-01

    Different peloids as e.g. mud and peat have been traditionally used for therapeutic purposes successfully, especially of there thermal actions. It was the aim of the experimental study to compare the thermal properties of two peloids, mud and peat, with a view to assessing their thermal effects when they are applied in clinical practice. The studies were carried out using peat of the marsh type of peats (Hochmoor), and curative Pomorie (Bulgaria) mud. As important parameters were determined the specific thermal capacity at constant pressure (Cp), the density of solutions (rho), the cooling rate (m), the coefficient of temperature transfer (a) of solutions and the coefficient of thermal conductivity (lambda) of solutions of peat and curative mud, compared to water bath. The comparative studies of the thermal properties of water and water solutions of peat and curative mud show that the thermal effect of the water bath is substantially smaller than that of the peat and mud applications. This difference is due to a greater extent to the high values of the dynamic viscosity, not allowing cooling by convection and protecting the surface of the skin upon applications of peloid solutions with a higher temperature.

  8. Applying the recent clinical trials on primary open angle glaucoma: the developing world perspective.

    PubMed

    Thomas, Ravi; Kumar, Rajesh S; Chandrasekhar, G; Parikh, Rajul

    2005-08-01

    Recent clinical trials have provided scientific guidelines for the treatment of ocular hypertension and primary open angle glaucoma. The developing world need to apply these trials in a sensible and cost effective manner. The number needed to treat (NNT) attempts to tailor treatment to the individual patient. The NNT for the average ocular hypertensive is 20. Those with intraocular pressure > or =26 mm Hg have an NNT of 6. Restricting treatment to those with lower central corneal thickness and or high cup disc ratios can further lower NNT and make treatment more cost effective. The NNT for the average patient with early POAG is 5. Targeting those at higher risk for progression, (bilateral POAG, higher IOP and or pseudo-exfoliation) can further reduce NNT. As far as the modality of treatment is concerned, provided quality can be ensured, collaborative initial glaucoma treatment study (CIGTS) could be interpreted to justify primary surgery in the developing world context. Population attributable risk percentage (PAR), a measure that reflects the public health importance of a disease was used to extrapolate results to the overall population. Ocular hypertension has an "effective" PAR of 8.5%, a value not considered high enough to warrant public health intervention. POAG had an "effective" PAR of 16%, perhaps high enough to be considered a public health problem and justify inclusion as a target disease in the Vision 2020 program. However the logistics and opportunity costs of diagnosis and treatment would probably prevent inclusion of POAG in public health budgets of most developing countries.

  9. Patients’, who applied to the anesthesia clinic, perceptions and knowledge about anesthesia in Türkiye

    PubMed Central

    Sagün, Aslinur; Birbiçer, Handan; Yapici, Gulcin

    2013-01-01

    Background: Pre-operative evaluation includes determining the patient's physiological and psychological situation, taking information about pharmacological and therapeutic history, laboratory examinations, and identifying the anesthesia risks. The aim of this study is to learn the patients’, who planned for elective surgery, knowledge and perception about anesthesia, to determine the causes of fears, to investigate whether age, gender, education level, and history of operation affect the outcome of the survey. Methods: A questionnaire consisting of 21 questions was asked to fill by the patients who applied to the anesthesia clinic. In our study, totally 250 patients, aged between 16 and 75 were included. The questionnaire consists of two parts: The first part includes demographic data such as age, gender, education level, occupation; the second part includes the questions about anesthesia experience and knowledge. Results: Of the 250 patients studied, 59% were females and 41% were males. Of these patients, 37.6% had secondary education. As occupation, the highest percentage was belonging to the housewives (33.6%). In the second part of the questionnaire, it was showed that having an anesthesia experience and high education status statistically significantly affect the level of information about anesthesia (P=0.001; P=0.001). Conclusion: In this study, it was showed that there is an important relationship between education and past anesthesia experience and having information about anesthesia and anesthetists. But, generally it was also showed that the patients not having adequate information about anesthesia and anesthetists and to provide the public more informed about anesthesia, with hospital policies and studies of increasing education level, the individual attempts of anesthetists and continuous studies for anesthesia displaying are needed. PMID:23956718

  10. Contrary influence of clinically applied sorafenib concentrations among hepatocellular carcinoma patients.

    PubMed

    Lin, Zu-Yau; Chuang, Wan-Long

    2017-02-01

    The treatment responses of sorafenib in hepatocellular carcinoma are modest which may be due to different characteristics of cancer cells or insufficient therapeutic concentrations. This study was to clarify this issue. The anti-proliferative effects and differential expressions of 8 genes related to sorafenib anti-cancer mechanisms (tyrosine kinase receptor genes: KDR, PDGFRB; RAF cascade: RAF1, BRAF, MAP2K1, MAP2K2, MAPK1, MAPK3) were investigated in primary cultured hepatocellular carcinoma cells collected from 8 patients using clinically applied sorafenib concentrations (5, 10μg/mL). The anti-proliferative effects of sorafenib at either 5 or 10μg/mL, which were related to down-regulations of KDR, PDGFRB and/or genes in the RAF cascade, were achieved only in one patient (HCC38/KMUH). However, either 5 or 10μg/mL sorafenib promoted proliferation in 4 patients (HCC29/KMUH, HCC62/KMUH, HCC87/KMUH, HCC98/KMUH). Among them, the RAF cascade, PDGFRB and/or KDR were up-regulated in 3 patients but no gene was differentially expressed in the remaining one patient (HCC87/KMUH). Increase the sorafenib concentration to 10μg/mL paradoxically up-regulated and/or obliterated the previously down-regulated genes in the RAF cascade and/or KDR in 4 patients (HCC29/KMUH, HCC76/KMUH, HCC87/KMUH, HCC98/KMUH). Significant down-regulations of the RAF cascade and PDGFRB by sorafenib but without anti-proliferative effects were detected in one patient (HCC54/KMUH). In conclusion, influence of sorafenib on proliferation is not simply through the RAF cascade. The responses of KDR, PDGFRB and the RAF cascade to sorafenib among patients are diverse or even contrary. Increase the sorafenib concentration has potential to up-regulate genes favored angiogenesis and proliferation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Applying community-based participatory research principles and approaches in clinical trials: forging a new model for cancer clinical research.

    PubMed

    Seifer, Sarena D; Michaels, Margo; Collins, Stacy

    2010-01-01

    Although an estimated 20% of adult cancer patients are medically eligible for a cancer treatment clinical trial (CCT), adult trial participation in the U.S. remains under 3%.- Participation rates are even lower among ethnic and racial minorities and the medically underserved, who tend to have higher cancer mortality rates than the population as a whole.- Given persistent cancer health disparities in these populations, cancer clinical trial participation is increasingly an issue of social justice. Community-based participatory research (CBPR) approaches have been repeatedly recommended as a key strategy for increasing and diversifying cancer clinical trial participation and enhancing their relevance and quality. In 2006, Community-Campus Partnership for Health (CCPH) and the Education Network to Advance Cancer Clinical Trials (ENACCT) received funding from the Agency for Healthcare Research and Quality and the National Cancer Institute (NCI), along with industry and nonprofit partners, to develop the first set of national recommendations to employ CBPR approaches in multisite, phase III cancer clinical trials. The Communities as Partners in Cancer Clinical Trials: Changing Research, Practice and Policy final report, developed through a national advisory committee, two stakeholder meetings and a public vetting process, makes more than fifty detailed recommendations to engage communities in specific and meaningful ways throughout the cancer clinical trial process.1 The report is the first to provide specific guidance as to how and why clinical trials should involve communities affected by cancer-from trial design to implementation to dissemination of results. This paper describes the background and rationale for the initiative, the process used to develop and disseminate the report, and the challenges and opportunities for implementing the report's community-based approaches to cancer clinical research.

  12. Developing a technology for the use of operant extinction in clinical settings: an examination of basic and applied research.

    PubMed Central

    Lerman, D C; Iwata, B A

    1996-01-01

    Extinction of operant behavior, which involves terminating the reinforcement contingency that maintains a response, is important to the development, generalization, and reduction of behavior in clinical settings. We review basic and applied research findings on variables that influence the direct and indirect effects of extinction and discuss the potential value of a general technology for the use of extinction. We suggest that current research findings are not sufficient for the development of a comprehensive, applied technology of extinction and provide extensive guidelines for further studies on factors that may affect the course of extinction in clinical settings. PMID:8926226

  13. Enhancing healthcare process design with human factors engineering and reliability science, part 2: applying the knowledge to clinical documentation systems.

    PubMed

    Boston-Fleischhauer, Carol

    2008-02-01

    The demand to redesign healthcare processes that achieve efficient, effective, and safe results is never-ending. Part 1 of this 2-part series introduced human factors engineering and reliability science as important knowledge to enhance existing operational and clinical process design methods in healthcare organizations. In part 2, the author applies this knowledge to one of the most common operational processes in healthcare: clinical documentation. Specific implementation strategies and anticipated results are discussed, along with organizational challenges and recommended executive responses.

  14. Practicing Handoffs Early: Applying a Clinical Framework in the Anatomy Laboratory

    ERIC Educational Resources Information Center

    Lazarus, Michelle D.; Dos Santos, Jason A.; Haidet, Paul M.; Whitcomb, Tiffany L.

    2016-01-01

    The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation,…

  15. Practicing Handoffs Early: Applying a Clinical Framework in the Anatomy Laboratory

    ERIC Educational Resources Information Center

    Lazarus, Michelle D.; Dos Santos, Jason A.; Haidet, Paul M.; Whitcomb, Tiffany L.

    2016-01-01

    The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation,…

  16. Informatics systems to assess and apply clinical research on dental restorative materials.

    PubMed

    Anusavice, K J

    2003-12-01

    Dental biomaterials are used clinically for one or more of the following purposes: to restore function, to enhance esthetics, and to prevent or arrest demineralization of tooth structure. Studies of the clinical performance of restorations and prostheses made from these materials have generally focused on quality assessment and survival statistics. Data from these studies should provide probabilities of specific treatment outcomes that are useful for practicing dentists. However, the utility of these data is limited by the lack of national and international standards for assessing these clinical outcomes. Standardized approaches toward clinical informatics and treatment-decision analysis are urgently needed to minimize the variability of clinical outcomes reported in publications associated with direct and indirect restorative materials used for dental restorations and prostheses.

  17. Venlafaxine versus applied relaxation for generalized anxiety disorder: a randomized controlled study on clinical and electrophysiological outcomes.

    PubMed

    Zullino, Daniele; Chatton, Anne; Fresard, Emmanuelle; Stankovic, Miroslava; Bondolfi, Guido; Borgeat, François; Khazaal, Yasser

    2015-03-01

    Some components of generalized anxiety disorder, such as physical symptoms, are thought to reflect autonomic nervous system arousal. This study primarily assessed the relationships between psychophysiological and clinical measures using venlafaxine extended release or applied relaxation, and secondarily, the impact of combination treatment in patients not remitting after 8 weeks. Fifty-eight patients were randomly assigned to 8 weeks of treatment with either venlafaxine or applied relaxation (Phase I). Non-remitted patients received combination treatment for an additional 8 weeks (Phase II). Assessments included the Hamilton Anxiety Scale (HAM-A), Beck Depression Inventory, Penn State Worry Questionnaire and the Stroop Color-Word Task coupled with electrophysiological measures (skin conductance and frontalis electromyography (EMG)). In Phase 1, a time effect was found for the clinical and skin conductance measures. Thirteen patients from each group were in remission. In Phase 2, seven additional patients remitted. Baseline psychophysiological measures were not associated with baseline clinical variables or with clinical outcomes. Independently of treatment allocation, a reduction in frontal EMG values at week 4 was significantly associated with a decrease in HAM-A scores at week 8. At week 4, responders from the applied relaxation group had lower electrophysiological activity than the venlafaxine group. Baseline psychophysiological measures were not linked with clinical measures at study inclusion or with treatment response. Frontal EMG response at week 4 is a possible predictor of treatment response. Treatment combination enhances treatment response after initial failure.

  18. Perceptions of virtual reality among therapists who do not apply this technology in clinical practice.

    PubMed

    Schwartzman, Deborah; Segal, Robert; Drapeau, Martin

    2012-08-01

    Research has documented the usefulness of virtual reality (VR) in treating a number of psychopathologies. Despite its recognized clinical utility, VR remains underutilized in clinical practice. For the purpose of this study, 262 therapists who reported that they did not currently use VR in psychotherapy were surveyed about their perceptions of the use of this technology in clinical practice. Results suggest that reluctance in using this technology stems from beliefs about the required training, equipment, and financial costs and from unfamiliarity with the various benefits and applications of VR. The significance of promoting greater use of this new technology is discussed. (c) 2012 APA, all rights reserved.

  19. Applying Senge's concepts of organizational learning to clinical outcomes research and practice.

    PubMed

    Wallace, C J

    1998-09-01

    The purpose of this article is to use Senge's concepts of organizational learning as a framework for discussing issues and challenges in clinical outcomes research. Clinical outcomes research is about learning how to improve clinical practice. A learning organization balances attention to the structure and the culture in order to produce effective results. Future health care leaders will need to understand and attend to the importance of the organization's structure, but their greatest contribution will be in attending to the organizational culture to produce enduring organizational change.

  20. Toxicogenomics and clinical toxicology: an example of the connection between basic and applied sciences.

    PubMed

    Ferrer-Dufol, Ana; Menao-Guillen, Sebastian

    2009-04-10

    The relationship between basic research and its potential clinical applications is often a difficult subject. Clinical toxicology has always been very dependent on experimental research whose usefulness has been impaired by the existence of huge differences in the toxicity expression of different substances, inter- and intra-species which make it difficult to predict clinical effects in humans. The new methods in molecular biology developed in the last decades are furnishing very useful tools to study some of the more relevant molecules implied in toxicokinetic and toxicodynamic processes. We aim to show some meaningful examples of how recent research developments with genes and proteins have clear applications to understand significant clinical matters, such as inter-individual variations in susceptibility to chemicals, and other phenomena related to the way some substances act to induce variations in the expression and functionality of these targets.

  1. [Analysis of Applying Chinese Medical Clinical Pathway for Treating Attention-deficit Hyperactivity Disorder].

    PubMed

    Guo, Yu-qing; Han, Xin-min; Zhu, Xian-kang; Zhou, Zheng; Ma, Bing-xiang; Zhang, Bao-qing; Li, Yan-ning; Feng, Yu-lin; Xue, Zheng; Wang, Yong-hong; Li, Yi-min; Jiang, Zhi-mei; Xu, Jin-xing; Yue, Wei-zhen; Xiang, Xi-xiong

    2015-12-01

    To evaluate the application effect of Chinese medical clinical pathway for treating attention-deficit hyperactivity disorder (ADHD), and to provide evidence for further improving clinical pathways. Totally 270 ADHD children patients were recruited and treated at pediatrics clinics of 9 cooperative hospitals from December 2011 to December 2012. The treatment course for all was 3 months. Scores of attention deficit and hyperactivity rating scale, scores of behavior, Conners index of hyperactivity (CIH), and Chinese medical syndrome scores were compared between before and after treatment. The efficacy difference in various sexes, ages, and disease courses were evaluated by judging standards for Chinese medical syndrome and ADHD. Fifteen children patients who entered clinical pathway dropped out, and the rest 255 completed this trial. Compared with before treatment, total scores of attention deficit and hyperactivity rating scale, scores of attention deficit and hyperactivity rating scale, CIH, and Chinese medical syndrome scores obviously decreased (all P < 0.01). The total effective rate in disease efficacy was 87.8% (224/255 cases), and the total effective rate in Chinese medical syndrome curative effect was 87.5% (223/255 cases). The clinical curative effect was not influenced by age, gender, or course of disease when statistically analyzed from judging standards for Chinese medical syndrome or for disease efficacy. Intervention by Chinese medical clinical pathway could improve ADHD patients' symptoms, and its efficacy was not influenced by sex, age, or course of disease.

  2. Applying active learning to assertion classification of concepts in clinical text.

    PubMed

    Chen, Yukun; Mani, Subramani; Xu, Hua

    2012-04-01

    Supervised machine learning methods for clinical natural language processing (NLP) research require a large number of annotated samples, which are very expensive to build because of the involvement of physicians. Active learning, an approach that actively samples from a large pool, provides an alternative solution. Its major goal in classification is to reduce the annotation effort while maintaining the quality of the predictive model. However, few studies have investigated its uses in clinical NLP. This paper reports an application of active learning to a clinical text classification task: to determine the assertion status of clinical concepts. The annotated corpus for the assertion classification task in the 2010 i2b2/VA Clinical NLP Challenge was used in this study. We implemented several existing and newly developed active learning algorithms and assessed their uses. The outcome is reported in the global ALC score, based on the Area under the average Learning Curve of the AUC (Area Under the Curve) score. Results showed that when the same number of annotated samples was used, active learning strategies could generate better classification models (best ALC-0.7715) than the passive learning method (random sampling) (ALC-0.7411). Moreover, to achieve the same classification performance, active learning strategies required fewer samples than the random sampling method. For example, to achieve an AUC of 0.79, the random sampling method used 32 samples, while our best active learning algorithm required only 12 samples, a reduction of 62.5% in manual annotation effort.

  3. Quantitative assessment of the benefits of specific information technologies applied to clinical studies in developing countries.

    PubMed

    Avilés, William; Ortega, Oscar; Kuan, Guillermina; Coloma, Josefina; Harris, Eva

    2008-02-01

    Clinical studies and trials require accessibility of large amounts of high-quality information in a timely manner, often daily. The integrated application of information technologies can greatly improve quality control as well as facilitate compliance with established standards such as Good Clinical Practice (GCP) and Good Laboratory Practice (GLP). We have customized and implemented a number of information technologies, such as personal data assistants (PDAs), geographic information system (GIS), and barcode and fingerprint scanning, to streamline a pediatric dengue cohort study in Managua, Nicaragua. Quantitative data was obtained to assess the actual contribution of each technology in relation to processing time, accuracy, real-time access to data, savings in consumable materials, and time to proficiency in training sessions. In addition to specific advantages, these information technologies benefited not only the study itself but numerous routine clinical and laboratory processes in the health center and laboratories of the Nicaraguan Ministry of Health.

  4. Feasibility of Applying the Extended ICF Core Set for Stroke to Clinical Settings in Rehabilitation: A Preliminary Study

    PubMed Central

    Han, Kyu Yong; Kim, Hyo Jong

    2015-01-01

    Objective To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke. Methods We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke. Results Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component. Conclusion The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire. PMID:25750873

  5. Clinical studies involving probiotics: when FDA's investigational new drug rubric applies-and when it may not.

    PubMed

    Degnan, Fred H

    2012-01-01

    Researchers from a diverse array of scientific disciplines have focused and continue to focus on opportunities and areas for responsible clinical research involving the possible beneficial health effects of "probiotics." Investigators and researchers should be aware that not all clinical research involving probiotics reasonably falls within the requirements of the "investigational new drug" (IND) rubric administered and enforced by the US Food and Drug Administration. In determining whether an IND application is required before a clinical study may lawfully commence, investigators and researchers as well as institutional review boards should consider the regulatory classification, e.g., "drug," "new drug," "food," "food additive," "dietary supplement," etc. that applies to the substance under investigation. A potential probiotic product can fall along a continuum of regulatory classifications, each having implications on the nature and degree of regulatory requirements for clinical research and, ultimately, for claim substantiation and market access.

  6. Applying extracellular vesicles based therapeutics in clinical trials – an ISEV position paper

    PubMed Central

    Lener, Thomas; Gimona, Mario; Aigner, Ludwig; Börger, Verena; Buzas, Edit; Camussi, Giovanni; Chaput, Nathalie; Chatterjee, Devasis; Court, Felipe A.; del Portillo, Hernando A.; O'Driscoll, Lorraine; Fais, Stefano; Falcon-Perez, Juan M.; Felderhoff-Mueser, Ursula; Fraile, Lorenzo; Gho, Yong Song; Görgens, André; Gupta, Ramesh C.; Hendrix, An; Hermann, Dirk M.; Hill, Andrew F.; Hochberg, Fred; Horn, Peter A.; de Kleijn, Dominique; Kordelas, Lambros; Kramer, Boris W.; Krämer-Albers, Eva-Maria; Laner-Plamberger, Sandra; Laitinen, Saara; Leonardi, Tommaso; Lorenowicz, Magdalena J.; Lim, Sai Kiang; Lötvall, Jan; Maguire, Casey A.; Marcilla, Antonio; Nazarenko, Irina; Ochiya, Takahiro; Patel, Tushar; Pedersen, Shona; Pocsfalvi, Gabriella; Pluchino, Stefano; Quesenberry, Peter; Reischl, Ilona G.; Rivera, Francisco J.; Sanzenbacher, Ralf; Schallmoser, Katharina; Slaper-Cortenbach, Ineke; Strunk, Dirk; Tonn, Torsten; Vader, Pieter; van Balkom, Bas W. M.; Wauben, Marca; Andaloussi, Samir El; Théry, Clotilde; Rohde, Eva; Giebel, Bernd

    2015-01-01

    Extracellular vesicles (EVs), such as exosomes and microvesicles, are released by different cell types and participate in physiological and pathophysiological processes. EVs mediate intercellular communication as cell-derived extracellular signalling organelles that transmit specific information from their cell of origin to their target cells. As a result of these properties, EVs of defined cell types may serve as novel tools for various therapeutic approaches, including (a) anti-tumour therapy, (b) pathogen vaccination, (c) immune-modulatory and regenerative therapies and (d) drug delivery. The translation of EVs into clinical therapies requires the categorization of EV-based therapeutics in compliance with existing regulatory frameworks. As the classification defines subsequent requirements for manufacturing, quality control and clinical investigation, it is of major importance to define whether EVs are considered the active drug components or primarily serve as drug delivery vehicles. For an effective and particularly safe translation of EV-based therapies into clinical practice, a high level of cooperation between researchers, clinicians and competent authorities is essential. In this position statement, basic and clinical scientists, as members of the International Society for Extracellular Vesicles (ISEV) and of the European Cooperation in Science and Technology (COST) program of the European Union, namely European Network on Microvesicles and Exosomes in Health and Disease (ME-HaD), summarize recent developments and the current knowledge of EV-based therapies. Aspects of safety and regulatory requirements that must be considered for pharmaceutical manufacturing and clinical application are highlighted. Production and quality control processes are discussed. Strategies to promote the therapeutic application of EVs in future clinical studies are addressed. PMID:26725829

  7. Pilot Study Examining the Safety and Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine Over a 12-Month Period to Correct Temporal Fossa Volume Loss.

    PubMed

    Juhász, Margit L W; Levin, Melissa K; Marmur, Ellen S

    2017-08-29

    Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.

  8. Treatment of pediatric overweight: an examination of feasibility and effectiveness in an applied clinical setting

    USDA-ARS?s Scientific Manuscript database

    OBJECTIVE: To examine the effectiveness and feasibility of an evidence-based treatment for weight loss in children. METHODS: A total of 41 children who were overweight and their families were provided a modified version of the Traffic Light Diet (TLD) in an applied setting. Children who received tr...

  9. Interactive Anatomical and Surgical Live Stream Lectures Improve Students' Academic Performance in Applied Clinical Anatomy

    ERIC Educational Resources Information Center

    Shiozawa, Thomas; Butz, Benjamin; Herlan, Stephan; Kramer, Andreas; Hirt, Bernhard

    2017-01-01

    Tuebingen's "Sectio Chirurgica" (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's "Sectio Chirurgica" (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to…

  10. Automatic Domain Adaptation of Word Sense Disambiguation Based on Sublanguage Semantic Schemata Applied to Clinical Narrative

    ERIC Educational Resources Information Center

    Patterson, Olga

    2012-01-01

    Domain adaptation of natural language processing systems is challenging because it requires human expertise. While manual effort is effective in creating a high quality knowledge base, it is expensive and time consuming. Clinical text adds another layer of complexity to the task due to privacy and confidentiality restrictions that hinder the…

  11. Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial

    ERIC Educational Resources Information Center

    Pistorello, Jacqueline; Fruzzetti, Alan E.; MacLane, Chelsea; Gallop, Robert; Iverson, Katherine M.

    2012-01-01

    Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a…

  12. Experiences of Master's Students Regarding Clinical Supervision in an Applied Psychology Programme in South Africa

    ERIC Educational Resources Information Center

    Nel, Lindi; Fouche, Paul

    2017-01-01

    This study explored and described the experiences regarding clinical supervision of master's students in professional psychology programmes in South Africa. Four participants were purposively selected from four different universities. The participants engaged in reflective writings and in-depth interviews over a one-year span. Data were analysed…

  13. Automatic Domain Adaptation of Word Sense Disambiguation Based on Sublanguage Semantic Schemata Applied to Clinical Narrative

    ERIC Educational Resources Information Center

    Patterson, Olga

    2012-01-01

    Domain adaptation of natural language processing systems is challenging because it requires human expertise. While manual effort is effective in creating a high quality knowledge base, it is expensive and time consuming. Clinical text adds another layer of complexity to the task due to privacy and confidentiality restrictions that hinder the…

  14. Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial

    ERIC Educational Resources Information Center

    Pistorello, Jacqueline; Fruzzetti, Alan E.; MacLane, Chelsea; Gallop, Robert; Iverson, Katherine M.

    2012-01-01

    Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a…

  15. Interactive Anatomical and Surgical Live Stream Lectures Improve Students' Academic Performance in Applied Clinical Anatomy

    ERIC Educational Resources Information Center

    Shiozawa, Thomas; Butz, Benjamin; Herlan, Stephan; Kramer, Andreas; Hirt, Bernhard

    2017-01-01

    Tuebingen's "Sectio Chirurgica" (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's "Sectio Chirurgica" (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to…

  16. PIGE - Resonance profiling applied to a clinical test of flouride varnishes

    NASA Astrophysics Data System (ADS)

    Zschau, H. E.; Plier, F.; Otto, G.; Wyrwich, C.; Treide, A.

    1992-03-01

    A clinical in-vivo experiment had been carried out to compare two caries preventing fluorine varnishes. The fluorine depth profiles in the near surface region of tooth enamel were measured using the 935 keV resonance of the nuclear reaction 19F( p, p' γ) 19F. The results can be understood by studying the flourine anamnese of the patients.

  17. Critical action research applied in clinical placement development in aged care facilities.

    PubMed

    Xiao, Lily D; Kelton, Moira; Paterson, Jan

    2012-12-01

    The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas' communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year-levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.

  18. Experiences of Master's Students Regarding Clinical Supervision in an Applied Psychology Programme in South Africa

    ERIC Educational Resources Information Center

    Nel, Lindi; Fouche, Paul

    2017-01-01

    This study explored and described the experiences regarding clinical supervision of master's students in professional psychology programmes in South Africa. Four participants were purposively selected from four different universities. The participants engaged in reflective writings and in-depth interviews over a one-year span. Data were analysed…

  19. Clinical Efficacy of Self-applied Blue Light Therapy for Mild-to-Moderate Facial Acne.

    PubMed

    Gold, Michael H; Andriessen, Anneke; Biron, Julie; Andriessen, Hinke

    2009-03-01

    This study was an evaluation of the performance of self-applied, blue light, light-emitting diode therapy in the treatment of mild-to-moderate inflammatory acne on the face, concerning: 1) time to improvement and/or resolution of the number of blemishes and lesions on the face; 2) quality of skin condition; 3) occurrence and count of the number of new blemishes and lesions; and 4) ease of product use; patient comfort, wellbeing, and satisfaction during the treatment period; and safety of treatment. Subjects (N=21) were included according to the inclusion/exclusion criteria and after they had given informed consent. The blue light treatment was conducted over an eight-week period. For study data management and analysis, SPSS 16.0 statistical software was used. Data management and analysis was performed independently using, where appropriate, ANOVA, student t-test, and Mann-Whitney test for N=20. Tests were carried out at the five-percent significance level. The confidence interval was 95 percent. Twenty-one subjects concluded the study (18/21 were female and 3/21 were male). Upon the first outbreak of acne, subjects had a mean age of 15 years (range 8-28 years), and 19 subjects had mild-to-moderate acne for a mean duration of 13.1 years. During the study period with self-applied blue light treatment, the total number of comedones on the face had significantly reduced for the assessment at Day 7 (p<0.019) and at Day 28 (p<0.001). The total number of open comedones (blackheads) on the face during the treatment period was reduced significantly (p<0.02) for assessment at treatment Day 7 (p<0.005) and for the assessment at Day 28. The total number of closed comedones (whiteheads) on the face during the treatment period, was reduced significantly (p<0.007) for the assessment at Day 28. The total number of papules during treatment had reduced significantly for assessment at Day 7 (p<0.048) and Day 28 (p<0.005). The total number of pustules during treatment had reduced, but

  20. Applying Clinical Practice Guidelines to the Complex Patient: Insights for Practice and Policy from Stroke Rehabilitation.

    PubMed

    Nelson, Michelle L A; Grudniewicz, Agnes; Albadry, Sarah

    2016-01-01

    In Canada, policy makers are working to align services with the Stroke Rehabilitation Best Practice Recommendations (SRBPR). Complicating the application of clinical practice guidelines (CPGs) is the fact that most strokes occur in the context of other diagnoses. We sought to understand clinicians' use of the CPGs and ascertain how much guidance regarding multimorbidity was available in the SRBPR. Study results indicated that using the recommendations was problematic due to a perceived lack of guidance regarding comorbidities and multimorbidity, and concerns regarding the applicability to "real-life patients." Comorbidities were mentioned in less than half of the recommendations, but no explicit guidance was provided regarding the management of comorbidities. Given the prevalence of multimorbidity in stroke rehabilitation, this clinical context is ideal for development and testing of CPGs that account for multimorbidity and other complexity factors. Results may also suggest limitations to using CPGs in the development of activity-based funding models.

  1. A Comparative Study of Supervised Learning as Applied to Acronym Expansion in Clinical Reports

    PubMed Central

    Joshi, Mahesh; Pakhomov, Serguei; Pedersen, Ted; Chute, Christopher G.

    2006-01-01

    Electronic medical records (EMR) constitute a valuable resource of patient specific information and are increasingly used for clinical practice and research. Acronyms present a challenge to retrieving information from the EMR because many acronyms are ambiguous with respect to their full form. In this paper we perform a comparative study of supervised acronym disambiguation in a corpus of clinical notes, using three machine learning algorithms: the naïve Bayes classifier, decision trees and Support Vector Machines (SVMs). Our training features include part-of-speech tags, unigrams and bigrams in the context of the ambiguous acronym. We find that the combination of these feature types results in consistently better accuracy than when they are used individually, regardless of the learning algorithm employed. The accuracy of all three methods when using all features consistently approaches or exceeds 90%, even when the baseline majority classifier is below 50%. PMID:17238371

  2. A comparative study of supervised learning as applied to acronym expansion in clinical reports.

    PubMed

    Joshi, Mahesh; Pakhomov, Serguei; Pedersen, Ted; Chute, Christopher G

    2006-01-01

    Electronic medical records (EMR) constitute a valuable resource of patient specific information and are increasingly used for clinical practice and research. Acronyms present a challenge to retrieving information from the EMR because many acronyms are ambiguous with respect to their full form. In this paper we perform a comparative study of supervised acronym disambiguation in a corpus of clinical notes, using three machine learning algorithms: the naïve Bayes classifier, decision trees and Support Vector Machines (SVMs). Our training features include part-of-speech tags, unigrams and bigrams in the context of the ambiguous acronym. We find that the combination of these feature types results in consistently better accuracy than when they are used individually, regardless of the learning algorithm employed. The accuracy of all three methods when using all features consistently approaches or exceeds 90%, even when the baseline majority classifier is below 50%.

  3. Applying non-synchronized e-learning to the nursing clinical ladder system.

    PubMed

    Leu, Li-Jung; Liao, Hsueh-Chih; Chang, I-Chiu; Su, Zhi-Yuan

    2010-10-01

    The time and spatial constraints of face-to-face learning often affect nursing staff's inclination to enroll in ladder system training classes. Hence, their competence in clinical care may be unable to meet the requirements of the hospitals they work at. The e-learning mechanism offers a way to overcome such constraints. However, the differences in learners' achievement and satisfaction between traditional face-to-face and non-synchronized e-learning classes in the nursing clinical ladder system have not been thoroughly investigated. In this study, 155 nursing personnel serving at the case hospital, enrolled in N1/N2 ladder courses, were invited to participate as the subjects. The results showed that those who attended face-to-face learning classes reported higher satisfaction but achieved less in class than those in the e-learning class. The factors which influence the subjects' satisfaction with e-learning were investigated and summarized.

  4. Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

    PubMed

    Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

    2015-12-01

    There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

  5. Applied cognitive psychology: Implications of cognitive psychology for clinical psychology and psychotherapy.

    PubMed

    Eysenck, Michael W

    2004-04-01

    Cognitive psychology has made numerous contributions to clinical psychology, and these contributions are considered especially with reference to the anxiety disorders. It is argued that there are four major contributions that can be identified. First, the cognitive approach has led to the development of complex models showing the main cognitive processes and structures of relevance to an understanding of anxiety disorders. Second, controlled laboratory studies permit a more detailed investigation of cognitive biases in anxious patients than generally is feasible in more naturalistic settings. Third, the cognitive approach provides relevant evidence with respect to the issue of whether cognitive biases play a role in the development and maintenance of anxiety disorders. Fourth, the enhanced understanding of the anxiety disorders that has arisen from the cognitive approach has had beneficial effects on therapeutic practice in a number of significant ways. In sum, it is claimed that clinical psychology has benefited considerably from cognitive theory and research.

  6. Interdisciplinary collaboration applied to clinical research: an example of remote monitoring in lung transplantation

    PubMed Central

    VanWormer, Arin; Robiner, William; Finkelstein, Stanley

    2012-01-01

    Collaboration across disciplines is vital in clinical practice. It is also needed to generate high-quality actionable research, yet few frameworks for interdisciplinary collaboration exit to promote effective communications among researchers with common boals, but varied backgrounds. A review of that has been learned about collaboration was undertaken to determine attributes of effective interdisciplinary collaboration and barriers to its realization in patients undergoing lung transplantation. PMID:22475710

  7. Interdisciplinary collaboration applied to clinical research: an example of remote monitoring in lung transplantation.

    PubMed

    VanWormer, Arin; Lindquist, Ruth; Robiner, William; Finkelstein, Stanley

    2012-01-01

    Collaboration across disciplines is vital in clinical practice. It is also needed to generate high-quality actionable research, yet few frameworks for interdisciplinary collaboration exit to promote effective communications among researchers with common goals, but varied backgrounds. A review of what has been learned about collaboration was undertaken to determine attributes of effective interdisciplinary collaboration and barriers to its realization in patients undergoing lung transplantation.

  8. Clinical issues in shared decision‐making applied to breast cancer

    PubMed Central

    Moumjid, Nora; Carrère, Marie‐Odile; Charavel, Marie; Brémond, Alain

    2003-01-01

    Abstract Objectives  To assess (1) the clinical issues addressed during the medical encounter; (2) the feasibility of the process of shared decision‐making in clinical practice and (3) patients’ desires concerning the question of ‘who should take the decision in breast cancer treatments?’ Design  Qualitative pilot study based on clinical encounters using decision boards and information booklets. Setting  Centre Léon Bérard, a comprehensive cancer centre in the Rhône‐Alpes region of France. Participants  One breast cancer surgeon and 22 breast cancer patients. Main outcome measures  Analysis of patients’ reactions to a shared decision‐making process concerning surgery and chemotherapy, and analysis of its practical feasibility (i.e. duration of the consultations). Results  (1) Twenty‐one patients participated in the decision regarding surgery; all chose conservative treatment; 15 patients had their own say about chemotherapy (nine chose no chemotherapy, six chose chemotherapy). (2) Participating in treatment choice generated anxiety for a majority of patients. Some were dissatisfied because they had to make a choice and consequently to give up the other option. Finally, some were uncertain about making the right choice. Nevertheless, most were satisfied with the information given and the possibility of participating to the treatment decision‐making process. (3) The total duration of the entire process of shared decision‐making is consistent with the time spent with patients with such a severe disease. Discussion/conclusion  Most of the patients expressed their satisfaction regarding the possibility to participate in treatment decision‐making, knowing that offering treatment choice is very unusual in France. From this pilot study it appears that shared decision‐making is feasible in clinical practice. Nevertheless, a quantitative study based on a large sample of patients is necessary to: (1) confirm this hypothesis, (2) ensure

  9. Applied biomechanics in articular injuries: perspectives in the basic investigation of articular injuries and clinical application.

    PubMed

    Olson, Steven A; Brown, Thomas D; Athanasiou, Kyriacos A; Natoli, Roman M; Dirschl, Douglas R

    2011-01-01

    Joint injury is an important cause of arthritis. Although the treatment of injury, in general, has been widely studied, the contribution of injury to the development of posttraumatic arthritis is still a relatively understudied area. One of the most perplexing aspects of investigating articular injuries is the complex nature of the injury itself and the multiple facets of the injury mechanism that can potentially lead to the development of arthritis. A symposium by the Orthopaedic Research Society and the American Academy of Orthopaedic Surgeons was designed to examine the spectrum of basic science to clinical investigation in the role of biomechanics in the study of joint injury and subsequent posttraumatic arthritis. Four perspectives in the clinical aspects of managing articular injuries were investigated, including the clinical applications of basic science findings, the challenges and advancements in measuring and modeling articular fractures, the relationship of articular cartilage mechanical injuries and osteoarthritis, and the controlled creation of an intra-articular fracture to permit observations of the natural history of posttraumatic arthritis.

  10. Internet based clinical trial protocols -- as applied to a study of warfarin pharmacogenetics.

    PubMed

    Lindh, Jonatan D; Kublickas, Marius; Westgren, Magnus; Rane, Anders

    2004-11-01

    To describe and evaluate the use of an Internet-based study protocol in a multicentre study of genetic risk factors in anticoagulant treatment. A web-based study protocol, similar to existing anticoagulation medical record systems, was developed for entry of clinical data. It was also supplied with a separate interface for study monitoring. Measures were taken to assure the confidentiality of transferred data. In addition, software modifications were made to enable automated transfer of clinical data from an existing medical record system to the study database. The system has been in use since March 2002, and at present 39 centres have included 909 patients with a dropout rate of 2.8%. The need for education of participating clinicians has been satisfactorily provided for by means of written instructions and telephone support. Our study demonstrates the usability of Internet-based data acquisition techniques in a full-scale multicentre clinical trial. The main advantages of such a protocol are automated data validation and standardization, fast data transfer independent of geographical distance, user feedback, synchronization of protocol updates and automatic data formatting facilitating statistical analyses. Safety and accessibility are possibly cumbersome areas and should be addressed duly.

  11. Clinical parameters and biomarkers of oxidative stress in agricultural workers who applied copper-based pesticides.

    PubMed

    Arnal, Nathalie; Astiz, Mariana; de Alaniz, María J T; Marra, Carlos A

    2011-09-01

    Copper based-pesticides are widely used in agricultural practice throughout the world. We studied the (i) concentration of Cu and proteins involved in Cu homeostasis, (ii) plasma redox status, and (iii) biomarkers of exposure in Cu-based pesticide applicators in order to compare them with clinical biochemical tests. Thirty-one professional applicators and 32 control subjects were recruited. Oxidative stress biomarkers, ceruloplasmin (CRP), metallothioneins (MTs), copper, hematological parameters, and biochemical markers for pancreatic, hepatic and renal function were measured in plasma. Copper was increased in the exposed group compared to the control group concomitantly with TBARS, protein carbonyls, and nitrate+nitrite levels. In the exposed group, α-tocopherol and the FRAP assay were lower and LDH, transaminases, GGT, ALP, urea, creatinine, CRP and MTs were higher than in the control group. The relative leukocyte subclasses were also different between the two groups. Clinical chemistry tests did not surpass the upper reference limit. Our results suggest that the incorporation of oxidative stress biomarkers to biochemical/clinical tests should be considered for validation and included in the human health surveillance protocols. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Applied Proteogenomics OrganizationaL Learning and Outcomes (APOLLO) Network - Office of Cancer Clinical Proteomics Research

    Cancer.gov

    In the spirit of collaboration inspired by the Vice President’s Cancer Moonshot, the Department of Veterans Affairs (VA), the Department of Defense (DoD), and the National Cancer Institute (NCI) are proud to announce a new tri-agency coalition (APOLLO Network — Applied Proteogenomics OrganizationaL Learning and Outcomes) that will help cancer patients by enabling their oncologists to more rapidly and accurately identify effective drugs to treat cancer based on a patient’s unique proteogenomic profile.

  13. Applied Proteogenomics OrganizationaL Learning and Outcomes (APOLLO) Network - Office of Cancer Clinical Proteomics Research

    Cancer.gov

    In the spirit of collaboration inspired by the Vice President’s Cancer Moonshot, the Department of Veterans Affairs (VA), the Department of Defense (DoD), and the National Cancer Institute (NCI) are proud to announce a new tri-agency coalition (APOLLO Network — Applied Proteogenomics OrganizationaL Learning and Outcomes) that will help cancer patients by enabling their oncologists to more rapidly and accurately identify effective drugs to treat cancer based on a patient’s unique proteogenomic profile.

  14. Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS

    PubMed Central

    Gupta, Satish Kumar; Nutan

    2013-01-01

    Microbicides, primarily used as topical pre-exposure prophylaxis, have been proposed to prevent sexual transmission of HIV. This review covers the trends and challenges in the development of safe and effective microbicides to prevent sexual transmission of HIV Initial phases of microbicide development used such surfactants as nonoxynol-9 (N-9), C13G, and sodium lauryl sulfate, aiming to inactivate the virus. Clinical trials of microbicides based on N-9 and C31G failed to inhibit sexual transmission of HIV. On the contrary, N-9 enhanced susceptibility to sexual transmission of HIV-1. Subsequently, microbicides based on polyanions and a variety of other compounds that inhibit the binding, fusion, or entry of virus to the host cells were evaluated for their efficacy in different clinical setups. Most of these trials failed to show either safety or efficacy for prevention of HIV transmission. The next phase of microbicide development involved antiretroviral drugs. Microbicide in the form of 1% tenofovir vaginal gel when tested in a Phase IIb trial (CAPRISA 004) in a coitally dependent manner revealed that tenofovir gel users were 39% less likely to become HIV-infected compared to placebo control. However, in another trial (VOICE MTN 003), tenofovir gel used once daily in a coitally independent mode failed to show any efficacy to prevent HIV infection. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS 001) employing a coitally dependent dosing regimen. Further, long-acting microbicide-delivery systems (vaginal ring) for slow release of such antiretroviral drugs as dapivirine are also undergoing clinical trials. Discovering new markers as correlates of protective efficacy, novel long-acting delivery systems with improved adherence in the use of microbicides, discovering new compounds effective against a broad spectrum of HIV strains, developing multipurpose technologies incorporating additional features of efficacy against other

  15. The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review

    PubMed Central

    Rugno, Fernanda Capella; Carlo, Marysia Mara Rodrigues do Prado De

    2016-01-01

    ABSTRACT Objective: to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). Method: integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. Results: the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. Conclusion: POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC. PMID:27533273

  16. Interactive tele-education applied to a distant clinical microbiology specialization university course.

    PubMed

    Andreazzi, Denise B; Rossi, Flávia; Wen, Chao L

    2011-09-01

    The microbiology laboratory provides a strategic support for infectious disease diagnosis and also alerts the medical community about bacterial resistance to antibiotics. The microbiologists' training is a challenge in Brazil, a country with an extensive territory, a diverse population, and disparity of resource allocation. The aim of this study was to implement an interactive tele-educational course in clinical microbiology to reach distant laboratory workers and to improve their professional skills. The course scientific content was defined according to competences associated, distributed in 560 h, with laboratory practices (knowledge matrix-contextual education). The 11-module course structure comprised 70% distance learning, 22% on campus (integrated modules), and 8% monographs. The group included 7 physicians and 21 microbiologists from 20 different Brazilian cities. The time flexibility and location were the two main reasons for student participation, thus decreasing absences to the workplace, different from the traditional teaching methodologies. The group performance was measured by monthly evaluations, and 1 year postcourse, the researcher visited their workplace. There was significant improvement in microbiological practices performed before compared with after group participation. Therefore, 76.9% of laboratory practices were modified because of the knowledge acquired in the course. Students showed behavioral changes in relation to performance in infection control as well as on the dissemination of their knowledge. This specialization course using distance education did not compromise the quality. This educational methodology represents an alternative to teach clinical microbiology to laboratory workers from remote hospitals, as a nationwide continuing educational strategy.

  17. Audio spectrum analysis of umbilical artery Doppler ultrasound signals applied to a clinical material.

    PubMed

    Thuring, Ann; Brännström, K Jonas; Jansson, Tomas; Maršál, Karel

    2014-12-01

    Analysis of umbilical artery flow velocity waveforms characterized by pulsatility index (PI) is used to evaluate fetoplacental circulation in high-risk pregnancies. However, an experienced sonographer may be able to further differentiate between various timbres of Doppler audio signals. Recently, we have developed a method for objective audio signal characterization; the method has been tested in an animal model. In the present pilot study, the method was for the first time applied to human pregnancies. Doppler umbilical artery velocimetry was performed in 13 preterm fetuses before and after two doses of 12 mg betamethasone. The auditory measure defined by the frequency band where the spectral energy had dropped 15 dB from its maximum level (MAXpeak-15 dB ), increased two days after betamethasone administration (p = 0.001) parallel with a less pronounced decrease in PI (p = 0.04). The new auditory parameter MAXpeak-15 dB reflected the changes more sensitively than the PI did.

  18. Clinical efficiency of applying low-intensity laser therapy in treating dyscirculatory encephalopathy

    NASA Astrophysics Data System (ADS)

    Putilina, M. V.; Kozlov, V. I.; Vakhtin, V. I.

    2001-04-01

    An investigation was made of applying laser therapy combined with drug preparations in treating 300 patients affected by dyscirculatory encephalopathy. Neurological and neuropsychological examinations together with electroencephalography, rheoencephalography, computerized tomography, and magnetic resonance imaging were used to assess the patients' states prior to and after the treatment. It was found that the combined application of laser therapy and drug preparations produced a more pronounced therapeutic effect as compared with that produced by the separate application of laser therapy and drug preparations. The results obtained allowed us to conclude that the 0.89 micrometers laser infrared radiation increased patients' susceptibility to drugs. Moreover, the combined laser therapy improved the cerebral bloodflow and activated the metabolic and plastic functions of neurons. This decreased or eliminated late complications provoked by the cerebral blood circulation insufficiency.

  19. Parenting Coordination: Applying Clinical Thinking to the Management and Resolution of Post-Divorce Conflict.

    PubMed

    Demby, Steven L

    2016-05-01

    There is a small but significant number of parents who remain stuck in a high level of conflict with each other after the legal conclusion of their divorce. Exposure to chronically high levels of parental conflict is a strong risk factor negatively affecting both children's short- and long-term adjustment. Parenting coordination is a nonadversarial, child-focused dispute-resolution process designed to help divorced parents contain their conflict to protect children from its negative effect. Parenting coordination is a hybrid role combining different skills and conflict-resolution approaches. In high-conflict divorce, each parent's internalization of relationship patterns constructed from past experiences contributes to the intractable nature of the interparent conflict. A case presentation illustrates how this clinical perspective enhances the parenting coordinator's ability to work with parents to manage and contain their parenting conflicts with each other.

  20. Terror management theory applied clinically: implications for existential-integrative psychotherapy.

    PubMed

    Lewis, Adam M

    2014-01-01

    Existential psychotherapy and Terror Management Theory (TMT) offer explanations for the potential psychological effects of death awareness, although their respective literatures bases differ in clarity, research, and implications for treating psychopathology. Existential therapy is often opaque to many therapists, in part due to the lack of consensus on what constitutes its practice, limited published practical examples, and few empirical studies examining its efficacy. By contrast, TMT has an extensive empirical literature base, both within social psychology and spanning multiple disciplines, although previously unexplored within clinical and counseling psychology. This article explores the implications of a proposed TMT integrated existential therapy (TIE), bridging the gap between disciplines in order to meet the needs of the aging population and current challenges facing existential therapists.

  1. Structure and Measurement of Depression in Youth: Applying Item Response Theory to Clinical Data

    PubMed Central

    Cole, David A.; Cai, Li; Martin, Nina C.; Findling, Robert L; Youngstrom, Eric A.; Garber, Judy; Curry, John F.; Hyde, Janet S.; Essex, Marilyn J.; Compas, Bruce E.; Goodyer, Ian M.; Rohde, Paul; Stark, Kevin D.; Slattery, Marcia J.; Forehand, Rex

    2013-01-01

    Goals of the paper were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3403 clinic and nonclinic children and adolescents from 12 contributing samples, all of whom received the Kiddie Schedule of Affective Disorders and Schizophrenia for school-aged children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Results further demonstrated that utilization of IRT-based information about symptom severity and discriminability in the measurement of depression severity can reduce measurement error and increase measurement fidelity. PMID:21534696

  2. Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

    PubMed Central

    Daudelin, Denise H.; Selker, Harry P.; Leslie, Laurel K.

    2015-01-01

    There is growing appreciation that process improvement holds promise for improving the quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

  3. The main challenges that remain in applying high-throughput sequencing to clinical diagnostics.

    PubMed

    Loeffelholz, Michael; Fofanov, Yuriy

    2015-01-01

    Over the last 10 years, the quality, price and availability of high-throughput sequencing instruments have improved to the point that this technology may be close to becoming a routine tool in the diagnostic microbiology laboratory. Two groups of challenges, however, have to be resolved in order to move this powerful research technology into routine use in the clinical microbiology laboratory. The computational/bioinformatics challenges include data storage cost and privacy concerns, requiring analysis to be performed without access to cloud storage or expensive computational infrastructure. The logistical challenges include interpretation of complex results and acceptance and understanding of the advantages and limitations of this technology by the medical community. This article focuses on the approaches to address these challenges, such as file formats, algorithms, data collection, reporting and good laboratory practices.

  4. Clinical experience in applying endoscopic Nd:YAG laser to treat 451 esophagostenotic cases

    NASA Astrophysics Data System (ADS)

    Wang, Rui-Zhong; Wang, Zhen-he; Lu, Kuang-sheng; Yang, Xiao-zhi; Lu, Bo-kao

    1991-07-01

    This paper is to report and analyze our clinical experience in ap].ying endosoopi. c Nd:YAG laser to treat 451 esophagostenoses (1197 peraon times) including all kinds of then. All kinds of esophagostexiosis were mainly characterized by having difficulties swallowing foods. Some of their esophagus were even oompletely obstructed and could not drink even a drop of water On the basis of experint&xts in animals, fresh organs of the body, we started to treat all kinds of esophagostenosis with endoscopio Nd:YAG laser in 1985. By the end of 1989, 451 patients bad been treated in our hospital. Boh the patients and we felt satisfactory with the results we gain.

  5. Introducing community integrated nursing teams: How one Clinical Commissioning Group applied an evidence-based approach.

    PubMed

    Lees, Carolyn; Hutchison, Trudy; O'Brien, Sarah

    2017-06-02

    The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach.

  6. Management of osteogenesis imperfecta type I in pregnancy; a review of literature applied to clinical practice.

    PubMed

    Cozzolino, Mauro; Perelli, Federica; Maggio, Luana; Coccia, Maria Elisabetta; Quaranta, Michela; Gizzo, Salvatore; Mecacci, Federico

    2016-06-01

    Osteogenesis imperfecta (OI) is a rare heritable heterogenous disorder characterized by bone fragility and susceptibility to fractures with a wide spectrum of clinical expression due to defects in collagen type I biosynthesis. The purpose of the review is to highlight the practical norms in pregnancies with osteogenesis imperfecta. We carried out a literature review in MEDLINE on OI during pregnancy, focusing on diagnosis, therapy and delivery. We reviewed 28 articles (case reports, original articles and reviews). Pregnant women affected by type I OI should be closely monitored to assess fetal well-being and detect pregnancy-related complications associated with an increased risk for osteoporosis, restrictive pulmonary disease, cephalopelvic disproportion and other problems related to connective tissue disorders. Mode of delivery remains controversial and should be determined on an individual basis. In conclusion, women affected by type I OI represent a subset of patients whose pregnancies should be considered high risk and warrant a multidisciplinary approach in a referral center.

  7. Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study.

    PubMed

    Thomas, Kim S; Ormerod, Anthony D; Craig, Fiona E; Greenlaw, Nicola; Norrie, John; Mitchell, Eleanor; Mason, James M; Johnston, Graham A; Wahie, Shyamal; Williams, Hywel C

    2016-11-01

    Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG. This was a prospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence. Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence. Our study did not include a randomized comparator. Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  8. Antiplatelet therapy in acute coronary syndrome (ACS): applying new science to clinical decisions.

    PubMed

    Becker, Richard C; Gibson, C Michael; Jennings, Lisa K; Morrow, David A

    2010-10-15

    The platelet is central to the pathogenesis of acute coronary syndromes (ACS), and antiplatelet therapy has demonstrated a significant reduction in the risk for ischemic events in patients with ACS. For patients with unstable angina or non-ST elevation myocardial infarctions, regardless of whether a conservative or invasive (i.e., percutaneous intervention) treatment approach is used, current guidelines recommend combination antiplatelet therapies, including aspirin with the thienopyridines clopidogrel or prasugrel and/or a glycoprotein IIb/IIIa inhibitor. However, there remains a significant incidence of arterial thrombosis in patients receiving currently available antiplatelet therapy, indicating the need for improved and/or alternative agents and targets. Recent landmark clinical trials of new oral antiplatelet therapies, including the thienopyridine prasugrel and the investigational reversible oral adenosine diphosphate antagonist ticagrelor, indicate they have a faster onset of action, result in a more predictable response, and provide improved efficacy compared to clopidogrel, the current standard of care. Other promising potential targets under investigation to reduce the contribution of the platelet to ACS pathophysiology include von Willebrand factor, thromboxane A(2), and protease-activated receptor-1. Of these, the protease-activated receptor-1 antagonist vorapaxar (SCH 530348) is furthest along in clinical development, with phase II data showing profound inhibition of platelet aggregation and a large phase III development program under way. A fundamental lingering issue is whether improved prevention and treatment of thrombosis can be separated from an increase in hemorrhage or bleeding, and clinicians must continue to consider the potential risks and benefits when individualizing antiplatelet therapy for patients with ACS. Copyright © 2010. Published by Elsevier Inc.

  9. Effectiveness of applying flipped learning to clinical nursing practicums for nursing students in Korea: A randomized controlled trial.

    PubMed

    Kim, Hyun Sook; Kim, Mi Young; Cho, Mi-Kyoung; Jang, Sun Joo

    2017-07-25

    The purpose of this study was to develop flipped learning models for clinical practicums and compare their effectiveness regarding learner motivation toward learning, satisfaction, and confidence in performing core nursing skills among undergraduate nursing students in Korea. This study was a randomized clinical trial designed to compare the effectiveness of 2 flipped learning models. Data were collected for 3 days from October 21 to 23, 2015 before the clinical practicum was implemented and for 2 weeks from October 26 to December 18, 2015 during the practicum period. The confidence of the students in performing core nursing skills was likely to increase after they engaged in the clinical practicum in both study groups. However, while learner confidence and motivation were not affected by the type of flipped learning, learner satisfaction did differ between the 2 groups. The findings indicate that applying flipped learning allows students to conduct individualized learning with a diversity of clinical cases at their own level of understanding and at their own pace before they participate in real-world practicums. © 2017 John Wiley & Sons Australia, Ltd.

  10. Selection of clinical features for pattern recognition applied to gait analysis.

    PubMed

    Altilio, Rosa; Paoloni, Marco; Panella, Massimo

    2017-04-01

    This paper deals with the opportunity of extracting useful information from medical data retrieved directly from a stereophotogrammetric system applied to gait analysis. A feature selection method to exhaustively evaluate all the possible combinations of the gait parameters is presented, in order to find the best subset able to classify among diseased and healthy subjects. This procedure will be used for estimating the performance of widely used classification algorithms, whose performance has been ascertained in many real-world problems with respect to well-known classification benchmarks, both in terms of number of selected features and classification accuracy. Precisely, support vector machine, Naive Bayes and K nearest neighbor classifiers can obtain the lowest classification error, with an accuracy greater than 97 %. For the considered classification problem, the whole set of features will be proved to be redundant and it can be significantly pruned. Namely, groups of 3 or 5 features only are able to preserve high accuracy when the aim is to check the anomaly of a gait. The step length and the swing speed are the most informative features for the gait analysis, but also cadence and stride may add useful information for the movement evaluation.

  11. The clinical utility of force/displacement analysis of muscle testing in applied kinesiology.

    PubMed

    Caruso, W; Leisman, G

    2001-01-01

    Manual muscle testing procedures are the subject of a force and displacement analysis. Equipment was fabricated, tested, and employed to gather force, displacement, and time data for examining muscle test parameters as practiced by applied kinesiology (A.K.) clinicians. Simple mathematical procedures are used to process the data in an effort to find potential patterns of force and displacement which would correspond to the testing of strong and weak muscles on healthy subjects. Particular attention is paid to the leading edge of the force pulses, as most clinicians report that they derive most of their assessment from the initial thrust imparted on the patient's limb. An analysis of the simple linear regression of the slope of the leading edge of a force pulse reveals that a high dx/dF is indicative of a weak muscle test result (as perceived by the tester), and a low dx/dF is indicative of a strong muscle test. Thresholds for dx/dF are determined to discriminate between inhibited and facilitated muscle test results. The data lay the groundwork for future studies that examine the objectivity of A.K. muscle testing.

  12. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial.

    PubMed

    Ploughman, Michelle; Corbett, Dale

    2004-09-01

    To determine the efficacy, safety, and compliance with forced-use therapy (FUT) applied without additional "shaping" therapy during the rehabilitation phase of stroke. Prospective, randomized controlled trial. Tertiary mixed rehabilitation center. Consecutive sample of 30 inpatients or outpatients with first stroke showing minimal movement of the arm and hand. Subjects who scored below 26 on the Mini-Mental State Examination were excluded. Seven subjects either did not provide consent or withdrew from the study. The remaining subjects were randomized into the control group (n=13) and the FUT group (n=10). FUT involved wearing a thick constraint mitten on the sound arm for as many as 6 hours a day. The Chedoke McMaster Impairment Inventory for arm, hand, postural control, and shoulder pain; Action Research Arm Test; grip strength; and FIM instrument. FUT subjects experienced 20% more recovery of the arm than did control subjects and more recovery of postural control (P=.04). Men benefited most from the program, and there was a tendency for FUT subjects to have more shoulder pain. Compliance was related to cognitive status. FUT, without shaping therapy, appears to augment arm recovery, but a larger sample is required to confirm these findings. The FUT mitten was safe and well tolerated; however, more research is needed to determine the relation between FUT and hemiplegic shoulder pain.

  13. Windowed persistent homology: A topological signal processing algorithm applied to clinical obesity data

    PubMed Central

    Derksen, Harm; Burant, Charles F.

    2017-01-01

    Overweight and obesity are highly prevalent in the population of the United States, affecting roughly 2/3 of Americans. These diseases, along with their associated conditions, are a major burden on the healthcare industry in terms of both dollars spent and effort expended. Volitional weight loss is attempted by many, but weight regain is common. The ability to predict which patients will lose weight and successfully maintain the loss versus those prone to regain weight would help ease this burden by allowing clinicians the ability to skip treatments likely to be ineffective. In this paper we introduce a new windowed approach to the persistent homology signal processing algorithm that, when paired with a modified, semimetric version of the Hausdorff distance, can differentiate the two groups where other commonly used methods fail. The novel approach is tested on accelerometer data gathered from an ongoing study at the University of Michigan. While most standard approaches to signal processing show no difference between the two groups, windowed persistent homology and the modified Hausdorff semimetric show a clear separation. This has significant implications for clinical decision making and patient care. PMID:28498844

  14. [Selective digestive decontamination. Why don't we apply the evidence in the clinical practice?].

    PubMed

    Taylor, N; van Saene, H K F; Abella, A; Silvestri, L; Vucic, M; Peric, M

    2007-04-01

    Selective digestive decontamination (SDD) is a prophylactic strategy whose objective is to reduce the incidence of infections, mainly mechanical ventilation associated pneumonia in patients who require intensive cares, preventing or eradicating the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. Fifty-four randomized clinical trials (RCTs) and 9 meta-analysis have evaluated SDD. Thirty eight RCTs show a significant reduction of the infections and 4 of mortality. All the meta-analyses show a significant reduction of the infections and 5 out of the 9 meta-analyses report a significant reduction in mortality. Thus, 5 patients from the ICU with SDD must be treated to prevent pneumonia and 12 patients from the ICU should be treated to prevent one death. The data that show benefit of the SDD on mortality have an evidence grade 1 or recommendation grade A (supported by at least two level 1 investigations). The aim of this review is to explain the pathogeny of infections in critical patients, describe selective digestive decontamination, analyze the evidence available on it efficacy and the potential adverse effects and discuss the reasons published by the experts who advise against the use of SDD, even though it is recognized as the best intervention evaluated in intensive cares to reduce morbidity and mortality of the infections.

  15. Applying Independent Component Analysis to Clinical fMRI at 7 T

    PubMed Central

    Robinson, Simon Daniel; Schöpf, Veronika; Cardoso, Pedro; Geissler, Alexander; Fischmeister, Florian Ph. S.; Wurnig, Moritz; Trattnig, Siegfried; Beisteiner, Roland

    2013-01-01

    Increased BOLD sensitivity at 7 T offers the possibility to increase the reliability of fMRI, but ultra-high field is also associated with an increase in artifacts related to head motion, Nyquist ghosting, and parallel imaging reconstruction errors. In this study, the ability of independent component analysis (ICA) to separate activation from these artifacts was assessed in a 7 T study of neurological patients performing chin and hand motor tasks. ICA was able to isolate primary motor activation with negligible contamination by motion effects. The results of General Linear Model (GLM) analysis of these data were, in contrast, heavily contaminated by motion. Secondary motor areas, basal ganglia, and thalamus involvement were apparent in ICA results, but there was low capability to isolate activation in the same brain regions in the GLM analysis, indicating that ICA was more sensitive as well as more specific. A method was developed to simplify the assessment of the large number of independent components. Task-related activation components could be automatically identified via these intuitive and effective features. These findings demonstrate that ICA is a practical and sensitive analysis approach in high field fMRI studies, particularly where motion is evoked. Promising applications of ICA in clinical fMRI include presurgical planning and the study of pathologies affecting subcortical brain areas. PMID:24032007

  16. Tissue spectrophotometry and thermographic imaging applied to routine clinical prediction of amputation level viability

    NASA Astrophysics Data System (ADS)

    Hanson, Jon M.; Harrison, David K.; Hawthorn, Ian E.

    2002-06-01

    About 5% of British males over 50 years develop peripheral arterial occlusive disease. Of these about 2% ultimately require lower limb amputation. In 1995 we proposed a new technique using lightguide spectrophotometry to measure the oxygen saturation level of haemoglobin (SO2) in the skin as a method for predicting tissue viability. This technique, in combination with thermographic imaging, was compared with skin blood flow measurements using the I125)4- Iodoantipyrine (IAP) clearance technique. The optical techniques gave a sensitivity and selectivity of 1.0 for the prediction of successful outcome of a below knee amputation compared with a specificity of 93% using the traditional IAP technique at a below knee to above knee amputation ratio (BKA:AKA) of 75%. The present study assesses the routine clinical application of these optical techniques. The study is ongoing, but the data to date comprises 22 patients. 4 patients were recommended for above knee amputation (AKA) and 18 patients for below knee amputation on the basis of thermographic and tissue SO2 measurements. All but one of the predicted BKA amputations healed. The study to date produces evidence of 94% healing rate (specificity) for a BKA:AKA ratio of 82%. This compares favorably with the previous figures given above.

  17. Studying abroad: Exploring factors influencing nursing students' decisions to apply for clinical placements in international settings.

    PubMed

    Kent-Wilkinson, Arlene; Dietrich Leurer, Marie; Luimes, Janet; Ferguson, Linda; Murray, Lee

    2015-08-01

    For over 15 years the College of Nursing at the University of Saskatchewan has facilitated study abroad clinical placements in a number of countries to enhance student learning. Nursing students often find their study abroad experience to be a defining moment in their educational program, and in their personal and professional growth. The main objective of this research was to explore factors influencing nursing students' decisions to study abroad. A descriptive longitudinal design study was conducted using an online survey. The Study Abroad Survey was distributed to all undergraduate and graduate nursing students, in all years of all programs, at all sites of the College of Nursing, University of Saskatchewan in Saskatchewan, Canada. A total of 1058 nursing students registered in the 2013-2014 academic year were surveyed. The data were collected using an online survey administered by Campus Labs™ (2014). Students indicated that their interest in study abroad international experiences was high (84%), with many perceived benefits, but barriers to participation were also high for these students. Financial barriers topped the list (71%), followed by family responsibilities (30%) and job obligations (23%). The research highlights the factors behind student decision making related to international placements, and provides the basis for improvements to the College of Nursing's International Study Abroad Program (ISAP). Previous travel and international service learning, resulting in increased perceived value of a study abroad experience may prove to be the more significant factor influencing decision making, rather than financial barrier. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. A study of neonatal swimming (water therapy) applied in clinical obstetrics.

    PubMed

    Zhao, S; Xie, L; Hu, H; Xia, J; Zhang, W; Ye, N; Chen, B

    2005-01-01

    To study the significance of some clinical parameters related to neonatal 'swimming' (water therapy) during hospitalization. Normal newborns were randomly divided into two groups to observe their birth weight, weight before discharge,time of first defecation and meconium turning yellow. Group one was the swimming (study) group, comprising a total of 223 newborns including 127 babies delivered after spontaneous vaginal delivery and 96 babies after Cesarean section. Group two was the bathing (control) group, comprising 154 newborns including 109 babies delivered after spontaneous vaginal delivery and 45 babies after Cesarean section. There was no significant difference in birth weight between the two groups (p > 0.05). However, the mean weight before discharge of the babies in the study group was 3.29 + 0.35 and 3.51 + 0.40 kg, spontaneous vaginal delivery vs. Cesarean section, compared with 3.09 + 0.38 and 3.17 + 0.48 kg, respectively, in the control group (p < 0.01). The corresponding mean times of meconium turning yellow were 39.15 + 15.88 and 39.02 + 13.60 h in the study group compared with 48.01 + 19.42 and 55.67 + 25.05 h in the control group. This difference was significant (p < 0.01), as was the difference between the time of first defecation (p < 0.05). Neonatal swimming can accelerate babies' growth in the early stage.

  19. Dogs'olfactory diagnostics applied on human species: state of the art and clinical perspectives.

    PubMed

    Palmieri, B; Nardo, B; Lippi, G; Palmieri, L; Vadalà, M; Laurino, C

    2016-01-01

    Dogs'smell ability is about 10000-100000 more developed than humans' one. Dogs smell is usually exploited in forensic medicine, to find missing people and specific substances showing peculiar sensorial features. In clinic, there is the possibility to take advantage of dogs smell, which are conveniently trained, for the screening of cancers and other diseases. The common feature is the presence of molecules in organic samples that may be considered as biomarkers of a specific pathology. In cancer, scientific evidences exist about screening of melanoma, lung, breast, rectum, ovarian, prostate and bladder cancer. Instead, other pathologies manifest the presence of organic volatile compounds in biologic materials, such as spit, faeces and urine that may be studied by dogs smell in order to identify the presence of a specific disease. This review shows the state of the art of actual dogs' olfactory ability based on scientific principles and the advantages and the disadvantages of this method. The authors also reveal some potential pathologies joined by the presence of organic volatile compounds, which may be investigated by dogs smell.

  20. [Lysis of the incus long process and incudostapedial rebridging ossiculoplasty: comparative study of titanium-gold angle prosthesis Plester-type versus Martin Incudo prosthesis hydroxylapatite].

    PubMed

    Faye, M B; Martin, C; Schmerber, S

    2013-01-01

    We report two surgical techniques devised to restore a disrupted incudostapedial joint. Thirty patients underwent rebridging of distal portion of incus long process in the ENT Department of University of Grenoble and Saint-Etienne, between October 1998 and September 2002. Two types of ossicular prostheses were used: A titanium-gold angle prosthesis according to Plester Winkel Kurz (n = 16 patients), and a hydroxylapatite prosthesis as Martin Incudo Prosthesis (n = 14 patients). The average hearing gain in short term is of 8.30 dB for the Martin-Incudo group. It is of 5.23 dB in the Winkel group. Seven and three cases of failures (Residual Rinne > 20 dB) were noticed respectively in the groups Martin-Incudo and Winkel. Seven and four cases of labyrinthisation were observed respectively in the groups Martin-Incudo and Winkel. The average hearing gain in long term is 3.43 dB in the Martin-Incudo group; and 2.85 dB among patients with Winkel Kurz prosthesis. Average residual Rinne is higher than 20 dB in the Winkel group. The hearing gain is not statistically significant between the two groups (p > 0.05). The titanium partial prosthesis did not give good functional results. In the case of a limited lysis (< 2 mm) of the distal portion of incus, we use the cement or cartilage interposition. When ossicular chain cannot be preserved entirely, we privilege incus transposition or a titanium PORP. The Martin-Incudo prosthesis seems interesting in the event of lysis of 2 mm of the long process of incus, nevertheless engineering changes are necessary in order to make rigid the incudostapedial joint.

  1. Ca(2+)-induced self-assembly of Bombyx mori silk sericin into a nanofibrous network-like protein matrix for directing controlled nucleation of hydroxylapatite nano-needles.

    PubMed

    Yang, Mingying; Zhou, Guanshan; Shuai, Yajun; Wang, Jie; Zhu, Liangjun; Mao, Chuanbin

    2015-03-28

    Bone biomineralization is a well-regulated protein-mediated process where hydroxylapatite (HAP) crystals are nucleated with preferred orientation within self-assembled protein matrix. Mimicking this process is a promising approach to the production of bone-like protein/mineral nanocomposites for bone repair and regeneration. Towards the goal of fabricating such nanocomposites from sericin, a protein spun by Bombyx mori (B.mori) silkworm, and bone mineral HAP, for the first time we investigated the chemical mechanism underpinning the synergistic processes of the conformational change/self-assembly of B.mori sericin ( BS ) as well as the nucleation of HAP on the resultant self-assembled BS matrix. We found that BS , rich in anionic amino acid residues, could bind Ca(2+) ions from the HAP precursor solution through electrostatic attraction. The Ca(2+)binding drove the conformational change of BS from random coils into β-sheets and its concomitant self-assembly into interconnected nanofibrous network-like protein matrix, which initiated the nucleation and growth of HAP crystals. HAP crystals directed by the resultant self-assembled BS matrix grew preferentially along their crystallographic c-axis, leading to the formation of HAP nano-needles. The HAP nano-needles in the self-assembled BS matrix were subsequently aggregated into globules, probably driven by the hydrogen bonding between C=O groups of BS and O-H groups of HAP nano-needles. The present work sheds light on the chemical mechanisms of BS self-assembly and the controlled mineralization directed by the self-assembled matrix. We also found that the resultant nanocomposites could promote the osteogenic differentiation of human bone marrow-derived mesenchymal stem cells. Thus our work also generates a biomimetic approach to bone-like silk protein/mineral nanocomposite scaffolds that can find potential applications in bone repair and regeneration.

  2. Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance.

    PubMed

    Siddiqui, M Minhaj; Truong, Hong; Rais-Bahrami, Soroush; Stamatakis, Lambros; Logan, Jennifer; Walton-Diaz, Annerleim; Turkbey, Baris; Choyke, Peter L; Wood, Bradford J; Simon, Richard M; Pinto, Peter A

    2015-06-01

    Multiparametric magnetic resonance imaging may be beneficial in the search for rational ways to decrease prostate cancer intervention in patients on active surveillance. We applied a previously generated nomogram based on multiparametric magnetic resonance imaging to predict active surveillance eligibility based on repeat biopsy outcomes. We reviewed the records of 85 patients who met active surveillance criteria at study entry based on initial biopsy and who then underwent 3.0 Tesla multiparametric magnetic resonance imaging with subsequent magnetic resonance imaging/ultrasound fusion guided prostate biopsy between 2007 and 2012. We assessed the accuracy of a previously published nomogram in patients on active surveillance before confirmatory biopsy. For each cutoff we determined the number of biopsies avoided (ie reliance on magnetic resonance imaging alone without rebiopsy) over the full range of nomogram cutoffs. We assessed the performance of the multiparametric magnetic resonance imaging active surveillance nomogram based on a decision to perform biopsy at various nomogram generated probabilities. Based on cutoff probabilities of 19% to 32% on the nomogram the number of patients who could be spared repeat biopsy was 27% to 68% of the active surveillance cohort. The sensitivity of the test in this interval was 97% to 71% and negative predictive value was 91% to 81%. Multiparametric magnetic resonance imaging based nomograms may reasonably decrease the number of repeat biopsies in patients on active surveillance by as much as 68%. Analysis over the full range of nomogram generated probabilities allows patient and caregiver preference based decision making on the risk assumed for the benefit of fewer repeat biopsies. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Clinical trials and E-health: impact of new information technology applied to clinical trials (including source data-medical records) and to human and drug research.

    PubMed

    Béhier, Jehan-Michel; Reynier, Jean-Charles; Bertoye, Pierre-Henri; Vray, Muriel

    2010-01-01

    Within the last few years, new technology has come to play an important part in our professional and private daily environment. Healthcare has not escaped this progressive mutation with computers reaching the bedside. Clinical research has also shown growing interest in these new tools available to the clinical investigator, the patient, as well as to specialist departments for diagnosis and follow-up of patients, and to the different professions in clinical research. If the use of new technology seems to make life easier, by centralizing data or by simplifying data-sharing between different teams, it is still a matter of private data which must remain reliable, confidential and secure, whether it is being used in ordinary healthcare or in academic or industrial research. The aim of the round table was to estimate the impact of new information technology applied to clinical trials (including source data-medical records) and to human and drug research. First, an inventory was made of the development of these new technologies in the healthcare system. The second point developed was identification of expected benefits in order to issue guidelines for their good use and hazard warnings in clinical trials. Finally, the impact of these new technologies on the investigator as well as the project manager was analysed.

  4. Diagnosing major depressive disorder V: applying the DSM-IV exclusion criteria in clinical practice.

    PubMed

    Zimmerman, Mark; McGlinchey, Joseph B; Chelminski, Iwona; Young, Diane

    2006-07-01

    To be diagnosed with DSM-IV major depressive disorder (MDD), a patient must meet five out of nine symptom criteria, one of which is depressed mood or pervasive loss of interest or pleasure. Once a patient has reached this symptom threshold, there are several exclusionary criteria that need to be passed to receive the diagnosis. The symptoms must cause significant distress or impairment in functioning, the symptoms cannot be caused by substance use or a general medical condition, and the symptoms cannot be better accounted for by bereavement. Finally, the presence of psychotic symptoms not coincident with the depressive symptoms excludes the diagnosis. We are not aware of any studies of psychiatric patients that have examined the impact of all of these exclusionary rules on the diagnosis of MDD in clinical practice. It is important for clinicians to know how often each of these factors might exclude the diagnosis of MDD so that they can be more or less vigilant to their presence. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project was to examine the impact of the DSM-IV exclusion rules on the diagnosis of MDD. In total, 38 (3.0%) of the 947 patients meeting the DSM-IV symptom inclusion criteria were excluded from a diagnosis of MDD or bipolar depression. These results suggest that the DSM-IV exclusion criteria for MDD had only a modest impact on diagnosis in psychiatric outpatients. It is likely that the results of a study of the impact of the DSM-IV depression exclusion criteria will depend on where the study is conducted. The potential influence of different settings on diagnostic exclusion is discussed.

  5. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use.

    PubMed

    Cicchetti, Americo; Berrino, Alexandra; Casini, Marina; Codella, Paola; Facco, Giuseppina; Fiore, Alessandra; Marano, Giuseppe; Marchetti, Marco; Midolo, Emanuela; Minacori, Roberta; Refolo, Pietro; Romano, Federica; Ruggeri, Matteo; Sacchini, Dario; Spagnolo, Antonio G; Urbina, Irene; Vaglio, Stefania; Grazzini, Giuliano; Liumbruno, Giancarlo M

    2016-07-01

    Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.

  6. Clinical effects of acrylic resilient denture liners applied to mandibular complete dentures on the alveolar ridge.

    PubMed

    Kimoto, S; Kimoto, K; Gunji, A; Kawai, Y; Murakami, H; Tanaka, K; Syu, K; Aoki, H; Toyoda, M; Kobayashi, K

    2007-11-01

    The purpose of this study was to investigate whether resilient denture liners has the potential to decrease problems affecting the alveolar ridge mucosa during the first adjustment session following the initial fitting of the denture. Interventions were complete denture treatment with permanent acrylic resilient denture liner dentures (RLD) in mandibles and conventional heat-activated acrylic resin dentures (ARD) in mandibles. Maxillary dentures were fabricated with conventional heat-activated ARD. Seventy-four subjects were randomly allocated to the RLD and ARD groups by random permuted blocks within the strata method after obtaining written informed consent. A randomized controlled parallel clinical trial with two hospital centres was conducted from April 2004 to July 2006. The problems were comprehensively evaluated by three outcomes with subjective and objective factors as follows: (i) numbers of sore spots, (ii) duration of wearing dentures and (iii) pain perception with 100 mm Visual Analog Scale. The numbers of sore spots in the mandibular support and border areas for the RLD group were significantly less than those for the ARD groups (P < 0.05). The RLD wearers were able to wear their dentures an additional day longer than the ARD wearers (P < 0.05). The maxillary and mandibular pain ratings for the RLD group were significantly lower than those for the ARD group (P < 0.05). Application of resilient denture liners to mandibular complete dentures provided edentulous patients with fewer problems affecting the alveolar during the first adjustment session following the initial fitting of the denture when compared with conventional denture treatments.

  7. Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial

    PubMed Central

    Pistorello, Jacqueline; Fruzzetti, Alan E.; MacLane, Chelsea; Gallop, Robert; Iverson, Katherine M.

    2012-01-01

    Objective College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students to an optimized control condition, and analyzed baseline global functioning as a moderator. Method The intent-to-treat (ITT) sample included 63 college students between the ages of 18 and 25 who were suicidal at baseline, reported at least one lifetime non-suicidal self-injurious (NSSI) act or suicide attempt, and met three or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or an optimized Treatment as Usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments. Both treatments lasted 7–12 months and included both individual and group components. Assessments were conducted at pretreatment, 3-months, 6-months, 9-months, 12-months, and 18-months (follow-up). Results Mixed effects analyses (ITT sample) revealed that DBT, compared to the control condition, showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and psychotropic medication use, and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up. No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who were lower functioning at pretreatment. Conclusions DBT is an effective treatment for suicidal, multi-problem college students. Future research should examine the implementation of DBT in CCCs in a stepped care approach. PMID:22730955

  8. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use

    PubMed Central

    Cicchetti, Americo; Berrino, Alexandra; Casini, Marina; Codella, Paola; Facco, Giuseppina; Fiore, Alessandra; Marano, Giuseppe; Marchetti, Marco; Midolo, Emanuela; Minacori, Roberta; Refolo, Pietro; Romano, Federica; Ruggeri, Matteo; Sacchini, Dario; Spagnolo, Antonio G.; Urbina, Irene; Vaglio, Stefania; Grazzini, Giuliano; Liumbruno, Giancarlo M.

    2016-01-01

    Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains. Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed. PMID:27403740

  9. Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics.

    PubMed

    Coury, Jennifer; Schneider, Jennifer L; Rivelli, Jennifer S; Petrik, Amanda F; Seibel, Evelyn; D'Agostini, Brieshon; Taplin, Stephen H; Green, Beverly B; Coronado, Gloria D

    2017-06-19

    The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in health care settings, although its documented use in pragmatic clinical research is rare. A recent pragmatic clinical research study, called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), used this process to optimize the research implementation of an automated colon cancer screening outreach program in intervention clinics. We describe the process of using this PDSA approach, the selection of PDSA topics by clinic leaders, and project leaders' reactions to using PDSA in pragmatic research. STOP CRC is a cluster-randomized pragmatic study that aims to test the effectiveness of a direct-mail fecal immunochemical testing (FIT) program involving eight Federally Qualified Health Centers in Oregon and California. We and a practice improvement specialist trained in the PDSA process delivered structured presentations to leaders of these centers; the presentations addressed how to apply the PDSA process to improve implementation of a mailed outreach program offering colorectal cancer screening through FIT tests. Center leaders submitted PDSA plans and delivered reports via webinar at quarterly meetings of the project's advisory board. Project staff conducted one-on-one, 45-min interviews with project leads from each health center to assess the reaction to and value of the PDSA process in supporting the implementation of STOP CRC. Clinic-selected PDSA activities included refining the intervention staffing model, improving outreach materials, and changing workflow steps. Common benefits of using PDSA cycles in pragmatic research were that it provided a structure for staff to focus on improving the program and it allowed staff to test the change they wanted to see. A commonly reported challenge was measuring the success of the PDSA process with the available electronic medical record tools. Understanding how the PDSA process can be applied to pragmatic

  10. The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review.

    PubMed

    Rugno, Fernanda Capella; Carlo, Marysia Mara Rodrigues do Prado De

    2016-08-15

    to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC. identificar e avaliar as evidências encontradas na literatura científica internacional, referentes à aplicação da Palliative Outcome Scale (POS) na prática clínica e nas pesquisas em Cuidados Paliativos (CPs). revisão integrativa da literatura, por meio da busca de publicações nos periódicos indexados nas bases de dados PubMed/MEDLINE, LILACS, SciELO e CINAHL, entre os anos de 1999 e 2014. a amostra final do estudo constituiu-se de 11 artigos. Na análise dos dados, os artigos foram classificados em 2 unidades de análise (estudos que utilizam a POS como recurso na pesquisa e estudos que utilizam a POS na prática clínica), nas quais as informações foram apresentadas na forma de subtemas referentes às publicações dos estudos selecionados, com destaque para a síntese dos resultados. a POS se destacou como um importante instrumento de medidas de resultados para a avalia

  11. PhysioNet: physiologic signals, time series and related open source software for basic, clinical, and applied research.

    PubMed

    Moody, George B; Mark, Roger G; Goldberger, Ary L

    2011-01-01

    PhysioNet provides free web access to over 50 collections of recorded physiologic signals and time series, and related open-source software, in support of basic, clinical, and applied research in medicine, physiology, public health, biomedical engineering and computing, and medical instrument design and evaluation. Its three components (PhysioBank, the archive of signals; PhysioToolkit, the software library; and PhysioNetWorks, the virtual laboratory for collaborative development of future PhysioBank data collections and PhysioToolkit software components) connect researchers and students who need physiologic signals and relevant software with researchers who have data and software to share. PhysioNet's annual open engineering challenges stimulate rapid progress on unsolved or poorly solved questions of basic or clinical interest, by focusing attention on achievable solutions that can be evaluated and compared objectively using freely available reference data.

  12. It's Only a Phase: Applying the 5 Phases of Clinical Trials to the NSCR Model Improvement Process

    NASA Technical Reports Server (NTRS)

    Elgart, S. R.; Milder, C. M.; Chappell, L. J.; Semones, E. J.

    2017-01-01

    NASA limits astronaut radiation exposures to a 3% risk of exposure-induced death from cancer (REID) at the upper 95% confidence level. Since astronauts approach this limit, it is important that the estimate of REID be as accurate as possible. The NASA Space Cancer Risk 2012 (NSCR-2012) model has been the standard for NASA's space radiation protection guidelines since its publication in 2013. The model incorporates elements from U.S. baseline statistics, Japanese atomic bomb survivor research, animal models, cellular studies, and radiation transport to calculate astronaut baseline risk of cancer and REID. The NSCR model is under constant revision to ensure emerging research is incorporated into radiation protection standards. It is important to develop guidelines, however, to determine what new research is appropriate for integration. Certain standards of transparency are necessary in order to assess data quality, statistical quality, and analytical quality. To this effect, all original source code and any raw data used to develop the code are required to confirm there are no errors which significantly change reported outcomes. It is possible to apply a clinical trials approach to select and assess the improvement concepts that will be incorporated into future iterations of NSCR. This poster describes the five phases of clinical trials research, pre-clinical research, and clinical research phases I-IV, explaining how each step can be translated into an appropriate NSCR model selection guideline.

  13. Effect of a national focused course on academic medicine for UK candidates applying for a Clinical Academic Programme.

    PubMed

    Khajuria, A; Cheng, K; Levy, J

    2017-03-01

    Background Academic medicine is crucial for healthcare advancement. However, recruitment of junior doctors into academia remains an area of concern globally. In the UK, a national integrated clinical academic pathway was developed to address these issues, with the Academic Foundation Programme as the 'first opportunity for research'. We aimed to evaluate whether a focused course on academic medicine could enhance knowledge, confidence and preparedness of candidates wishing to apply for an academic programme. Methods UK medical students attended a national course conducted by current UK Academic Foundation Programme doctors that comprised lectures on academic medicine and various aspects of the Academic Foundation Programme. An online questionnaire-based cross-sectional study was conducted with participants rating measures including knowledge, preparedness and confidence related to Academic Foundation Programme applications. Outcomes were measured using Likert scales (1=low; 5=high). Results In total, 103 out of 155 attendees from 11 different UK medical schools responded to the survey (66% response rate). Pre and post-course data showed increase in participants' knowledge (median score 2 vs 4, p < 0.0001), understanding of the application process (median score 2 vs 4, p < 0.0001), confidence (median score 2 vs 4, p < 0.0001) and preparedness (median score 2 vs 4, p < 0.0001) in applying for the Academic Foundation Programme. Conclusion To our knowledge this is the first study in the available literature that demonstrates a focused course on academic medicine may enhance UK medical students' knowledge, confidence and preparedness in applying for a clinical academic programme. Further research will ascertain whether such courses can augment trainee numbers undertaking and remaining within academic medicine.

  14. Environmental risk assessment of replication competent viral vectors applied in clinical trials: potential effects of inserted sequences.

    PubMed

    van den Akker, Eric; van der Vlugt, Cecile J B; Bleijs, Diederik A; Bergmans, Hans E

    2013-12-01

    Risk assessments of clinical applications involving genetically modified viral vectors are carried out according to general principles that are implemented in many national and regional legislations, e.g., in Directive 2001/18/EC of the European Union. Recent developments in vector design have a large impact on the concepts that underpin the risk assessments of viral vectors that are used in clinical trials. The use of (conditionally) replication competent viral vectors (RCVVs) may increase the likelihood of the exposure of the environment around the patient, compared to replication defective viral vectors. Based on this assumption we have developed a methodology for the environmental risk assessment of replication competent viral vectors, which is presented in this review. Furthermore, the increased likelihood of exposure leads to a reevaluation of what would constitute a hazardous gene product in viral vector therapies, and a keen interest in new developments in the inserts used. One of the trends is the use of inserts produced by synthetic biology. In this review the implications of these developments for the environmental risk assessment of RCVVs are highlighted, with examples from current clinical trials. The conclusion is drawn that RCVVs, notwithstanding their replication competency, can be applied in an environmentally safe way, in particular if adequate built-in safeties are incorporated, like conditional replication competency, as mitigating factors to reduce adverse environmental effects that could occur.

  15. Aesthetic applications of calcium hydroxylapatite volumizing filler: an evidence-based review and discussion of current concepts: (part 1 of 2).

    PubMed

    Emer, Jason; Sundaram, Hema

    2013-12-01

    Calcium hydroxylapatite filler (CaHA; Radiesse) is a synthetic, non-animal derived product composed of minerals that occur naturally in bone and teeth. Following its development in the US, initial approval by the US FDA for non-aesthetic indications and CE marking in Europe, it was used off FDA-labeling for aesthetic purposes. Its use has grown further since its FDA approval in 2006 for long-lasting correction of moderate to severe wrinkles and folds. It is a popular filler for volume restoration to the face, and also to nonfacial areas such as the dorsum of the hands. The first article of this two-part series provides an evidence-based review of study data pertaining to the mechanism of action and biocompatibility of CaHA filler, and its safety, efficacy and tolerability when used for aesthetic purposes. The review includes data from a number of prospective, controlled comparative studies, from several retrospective studies, and from a meta-analysis of reported complications from alloplastic filler procedures over a 20-year period. The study methodology and number of study subjects are sufficiently robust to provide a high Evidence Level for much of the data. CaHA has good safety, efficacy and tolerability profiles that are comparable to those of hyaluronic acid (HA) fillers. It provides an initial, immediate volume replacement for up to 12 months followed by longer term correction due to biostimulation, resulting in collagenesis. Evidence Level II studies show longevity of 30 months or more after nasolabial fold implantation. Other studies demonstrate the appropriateness of CaHA filler for volume restoration to areas including the mid face, lower face and hands. CaHA is classified as an adjustable filler, whereas HA is fully reversible by hyaluronidase digestion. For this reason, and also because of CaHA's high viscosity and elasticity, evidence-based and experiential consensus suggests its avoidance in highly mobile areas (e.g. lips) or in anatomically

  16. Can Clinical Scenario Videos Improve Dental Students' Perceptions of the Basic Sciences and Ability to Apply Content Knowledge?

    PubMed

    Miller, Cynthia Jayne; Metz, Michael James

    2015-12-01

    Dental students often have difficulty understanding the importance of basic science classes, such as physiology, for their future careers. To help alleviate this problem, the aim of this study was to create and evaluate a series of video modules using simulated patients and custom-designed animations that showcase medical emergencies in the dental practice. First-year students in a dental physiology course formatively assessed their knowledge using embedded questions in each of the three videos; 108 to 114 of the total 120 first-year students answered the questions, for a 90-95% response rate. These responses indicated that while the students could initially recognize the cause of the medical emergency, they had difficulty in applying their knowledge of physiology to the scenario. In two of the three videos, students drastically improved their ability to answer high-level clinical questions at the conclusion of the video. Additionally, when compared to the previous year of the course, there was a significant improvement in unit exam scores on clinically related questions (6.2% increase). Surveys were administered to the first-year students who participated in the video modules and fourth-year students who had completed the course prior to implementation of any clinical material. The response rate for the first-year students was 96% (115/120) and for the fourth-year students was 57% (68/120). The first-year students indicated a more positive perception of the physiology course and its importance for success on board examinations and their dental career than the fourth-year students. The students perceived that the most positive aspects of the modules were the clear applications of physiology to real-life dental situations, the interactive nature of the videos, and the improved student comprehension of course concepts. These results suggest that online modules may be used successfully to improve students' perceptions of the basic sciences and enhance their ability to

  17. Making good theory practical: five lessons for an Applied Social Identity Approach to challenges of organizational, health, and clinical psychology.

    PubMed

    Haslam, S Alexander

    2014-03-01

    Social identity research was pioneered as a distinctive theoretical approach to the analysis of intergroup relations but over the last two decades it has increasingly been used to shed light on applied issues. One early application of insights from social identity and self-categorization theories was to the organizational domain (with a particular focus on leadership), but more recently there has been a surge of interest in applications to the realm of health and clinical topics. This article charts the development of this Applied Social Identity Approach, and abstracts five core lessons from the research that has taken this forward. (1) Groups and social identities matter because they have a critical role to play in organizational and health outcomes. (2) Self-categorizations matter because it is people's self-understandings in a given context that shape their psychology and behaviour. (3) The power of groups is unlocked by working with social identities not across or against them. (4) Social identities need to be made to matter in deed not just in word. (5) Psychological intervention is always political because it always involves some form of social identity management. Programmes that seek to incorporate these principles are reviewed and important challenges and opportunities for the future are identified. © 2014 The British Psychological Society.

  18. Analyzing Patients' Values by Applying Cluster Analysis and LRFM Model in a Pediatric Dental Clinic in Taiwan

    PubMed Central

    Lin, Shih-Yen; Liu, Chih-Wei

    2014-01-01

    This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs. PMID:25045741

  19. Analyzing patients' values by applying cluster analysis and LRFM model in a pediatric dental clinic in Taiwan.

    PubMed

    Wu, Hsin-Hung; Lin, Shih-Yen; Liu, Chih-Wei

    2014-01-01

    This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs.

  20. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

    PubMed

    Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

    In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. Clinical Effects of a Topically Applied Toll-like Receptor 9 Agonist in Active Moderate-to-Severe Ulcerative Colitis

    PubMed Central

    Atreya, Raja; Bloom, Stuart; Scaldaferri, Franco; Gerardi, Viviana; Admyre, Charlotte; Karlsson, Åsa; Knittel, Thomas; Kowalski, Jan; Lukas, Milan; Löfberg, Robert; Nancey, Stephane; Petryka, Robert; Rydzewska, Grazyna; Schnabel, Robert; Seidler, Ursula; Neurath, Markus F.

    2016-01-01

    Background and Aims: Toll-like receptors [TLRs] are potential drug targets for immunomodulation. We determined the safety and efficacy of the TLR-9 agonist DNA-based immunomodulatory sequence 0150 [DIMS0150] in ulcerative colitis [UC] patients refractory to standard therapy. Methods: In this randomized, double-blind, placebo-controlled trial, 131 patients with moderate-to-severe active UC were randomized to receive two single doses of the oligonucleotide DIMS0150 [30 mg] or placebo administered topically during lower GI endoscopy at baseline and Week 4. The primary endpoint was clinical remission, defined as Clinical Activity Index [CAI] ≤4, at Week 12. Secondary endpoints included mucosal healing and symptomatic remission of key patient-reported outcomes [absence of blood in stool and weekly stool frequency <35]. Results: There was no statistical significant difference between the groups in the induction of clinical remission at Week 12, with 44.4% in the DIMS0150 group vs. 46.5% in the placebo group. However, the proportion of patients who achieved symptomatic remission was 32.1% in the DIMS0150 group vs. 14.0% in the placebo group at Week 4 [p = 0.020], and 44.4% vs. 27.9% at Week 8 [p = 0.061]. More patients on DIMS0150 compared with those on placebo had mucosal healing [34.6% vs. 18.6%; p = 0.09] and histological improvement regarding the Geboes score [30.9% vs. 9.3%; p = 0.0073] at Week 4. Significantly more patients on DIMS0150 were in clinical remission with mucosal healing at Week 4: 21% vs. 4.7% in the placebo group [p = 0.02]. DIMS0150 was well tolerated, and no safety signals compared with placebo were evident. Conclusions: Therapy with the topically applied TLR-9 agonist DIMS0150 is a promising and well-tolerated novel therapeutic option for treatment-refractory, chronic active UC patients, warranting further clinical trials. PMID:27208386

  2. Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.

    PubMed

    Bonetti, Debbie; Pitts, Nigel B; Eccles, Martin; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Glidewell, Liz; Thomas, Ruth; Maclennan, Graeme; Clarkson, Jan E; Walker, Anne

    2006-10-01

    This study applies psychological theory to the implementation of evidence-based clinical practice. The first objective was to see if variables from psychological frameworks (developed to understand, predict and influence behaviour) could predict an evidence-based clinical behaviour. The second objective was to develop a scientific rationale to design or choose an implementation intervention. Variables from the Theory of Planned Behaviour, Social Cognitive Theory, Self-Regulation Model, Operant Conditioning, Implementation Intentions and the Precaution Adoption Process were measured, with data collection by postal survey. The primary outcome was the number of intra-oral radiographs taken per course of treatment collected from a central fee claims database. Participants were 214 Scottish General Dental Practitioners. At the theory level, the Theory of Planned Behaviour explained 13% variance in the number of radiographs taken, Social Cognitive Theory explained 7%, Operant Conditioning explained 8%, Implementation Intentions explained 11%. Self-Regulation and Stage Theory did not predict significant variance in radiographs taken. Perceived behavioural control, action planning and risk perception explained 16% of the variance in number of radiographs taken. Knowledge did not predict the number of radiographs taken. The results suggest an intervention targeting predictive psychological variables could increase the implementation of this evidence-based practice, while influencing knowledge is unlikely to do so. Measures which predicted number of radiographs taken also predicted intention to take radiographs, and intention accounted for significant variance in behaviour (adjusted R(2)=5%: F(1,166)=10.28, p<.01), suggesting intention may be a possible proxy for behavioural data when testing an intervention prior to a service-level trial. Since psychological frameworks incorporate methodologies to measure and change component variables, taking a theory-based approach

  3. Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis

    PubMed Central

    Buffel du Vaure, Céline; Ravaud, Philippe; Baron, Gabriel; Barnes, Caroline; Gilberg, Serge; Boutron, Isabelle

    2016-01-01

    Objectives To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines. Design Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. Data sources National Guideline Clearinghouse index of US clinical practice guidelines. Study selection We identified the most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (ie hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression). Data extraction From the guidelines, we extracted all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45–64 years with moderate severity of conditions. Simulation modelling approach For each HRA identified, we performed a literature review to determine the potential workload in terms of time spent on this HRA. Then, we used a simulation modelling approach to estimate the potential workload needed to comply with these recommended HRAs for patients with several of these chronic conditions. Results Depending on the concomitant chronic condition, patients with 3 chronic conditions complying with all the guidelines would have to take a minimum of 6 to a maximum of 13 medications per day, visit a health caregiver a minimum of 1.2 to a maximum of 5.9 times per month and spend a mean (SD) of 49.6 (27.3) to 71.0 (34.5) h/month in HRAs. The potential workload increased greatly with increasing number of concomitant conditions, rising to 18 medications per day, 6.6 visits per month and 80.7 (35.8) h/month in HRAs for patients with 6 chronic conditions. PMID:27006342

  4. Multicultural Training Applied in Clinical Practice: Reflections from a Euro-American Female Counselor-in-Training Working with Mexican Immigrants

    ERIC Educational Resources Information Center

    Paynter, Clara K.; Estrada, Diane

    2009-01-01

    The clinical experience of a Euro-American female counselor-in-training providing bilingual family therapy services to Mexican immigrants is described. Cultural themes encountered when applying academic discourse to clinical work are raised in the context of case studies in which the student therapist works from a postmodern client-as-expert…

  5. The mPED randomized controlled clinical trial: applying mobile persuasive technologies to increase physical activity in sedentary women protocol.

    PubMed

    Fukuoka, Yoshimi; Komatsu, Judith; Suarez, Larry; Vittinghoff, Eric; Haskell, William; Noorishad, Tina; Pham, Kristin

    2011-12-14

    Despite the significant health benefits of regular physical activity, approximately half of American adults, particularly women and minorities, do not meet the current physical activity recommendations. Mobile phone technologies are readily available, easily accessible and may provide a potentially powerful tool for delivering physical activity interventions. However, we need to understand how to effectively apply these mobile technologies to increase and maintain physical activity in physically inactive women. The purpose of this paper is to describe the study design and protocol of the mPED (mobile phone based physical activity education) randomized controlled clinical trial that examines the efficacy of a 3-month mobile phone and pedometer based physical activity intervention and compares two different 6-month maintenance interventions. A randomized controlled trial (RCT) with three arms; 1) PLUS (3-month mobile phone and pedometer based physical activity intervention and 6-month mobile phone diary maintenance intervention), 2) REGULAR (3-month mobile phone and pedometer based physical activity intervention and 6-month pedometer maintenance intervention), and 3) CONTROL (pedometer only, but no intervention will be conducted). A total of 192 physically inactive women who meet all inclusion criteria and successfully complete a 3-week run-in will be randomized into one of the three groups. The mobile phone serves as a means of delivering the physical activity intervention, setting individualized weekly physical activity goals, and providing self-monitoring (activity diary), immediate feedback and social support. The mobile phone also functions as a tool for communication and real-time data capture. The primary outcome is objectively measured physical activity. If efficacy of the intervention with a mobile phone is demonstrated, the results of this RCT will be able to provide new insights for current behavioral sciences and mHealth. ClinicalTrials.gov#:NCTO1280812.

  6. Towards Quantitative Whole Organ Thermoacoustics with a Clinical Array plus One Very Low Frequency Channel Applied to Prostate Cancer Imaging

    PubMed Central

    Patch, Sarah K.; Hull, David; See, William A.; Hanson, George W.

    2016-01-01

    Thermoacoustics has the potential to provide quantitative images of intrinsic tissue properties, most notably electrical conductivity in Siemens/meter, much as shear wave elastography provides tissue stiffness in kPa. Although thermoacoustic imaging with optical excitation has been commercialized for small animals, it has not yet made the transition to clinic for whole organ imaging in humans. The purpose of this work was to develop and validate specifications for a clinical ultrasound array for quantitative whole organ thermoacoustic imaging. Imaging a large organ requires exciting thermoacoustic pulses throughout the volume and broadband detection of those pulses because tomographic image reconstruction preserves frequency content. Applying the half-wavelength limit to a 200-micron inclusion inside a 7.5 cm diameter organ requires measurement sensitivity to frequencies ranging from 4 MHz down to 10 kHz, respectively. A dual-transducer system utilizing a P4-1 array connected to a Verasonics V1 system as well as a focused single element transducer sensitive to lower frequencies was developed. Very high frequency (VHF) irradiation generated thermoacoustic pulses throughout a 6 × 6 × 5 cm3 volume. In the VHF regime, electrical conductivity drives thermoacoustic signal production. Simultaneous acquisition of thermoacoustic pulses by both transducers enabled comparison of transducer performance. Data from the clinical array generated a stack of 96-images with separation of 0.3 mm, whereas the single element transducer imaged only in a single plane. In-plane resolution and quantitative accuracy were quantified at isocenter. The array provided volumetric imaging capability with superior resolution whereas the single element transducer provided superior quantitative accuracy in axial images. Combining axial images from both transducers preserved resolution of the P4-1 array and improved image contrast. Neither transducer was sensitive to frequencies below 50 k

  7. Integration of health care process analysis in the design of a clinical information system: applying to the blood transfusion process.

    PubMed Central

    Staccini, P.; Joubert, M.; Quaranta, J. F.; Fieschi, D.; Fieschi, M.

    2000-01-01

    Hospital information systems have to support quality improvement objectives. The requirements of the system have to meet users' needs in relation to both the quality (efficacy, conformity, safety) and the monitoring of all health care activities (traceability). Information analysts need complementary methods to conceptualize clinical information systems that provide actors with immediate individual benefits and guide collective behavioral changes. A methodology is proposed to elicit users' needs using a process-oriented analysis, and it is applied to the field of blood transfusion. We defined a process data model, the main components of which are: activities, resources, constrains, guidelines and indicators. Although some aspects of activity, such as "where", "what else", and "why" are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for this approach to be generalised within the organisation, for the processes to be interrelated, and for their characteristics to be assessed. PMID:11079999

  8. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder.

    PubMed

    Dugas, Michel J; Brillon, Pascale; Savard, Pierre; Turcotte, Julie; Gaudet, Adrienne; Ladouceur, Robert; Leblanc, Renée; Gervais, Nicole J

    2010-03-01

    This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR), and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly 1-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12-, and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR. 2009. Published by Elsevier Ltd.

  9. Integration of health care process analysis in the design of a clinical information system: applying to the blood transfusion process.

    PubMed

    Staccini, P; Joubert, M; Quaranta, J F; Fieschi, D; Fieschi, M

    2000-01-01

    Hospital information systems have to support quality improvement objectives. The requirements of the system have to meet users' needs in relation to both the quality (efficacy, conformity, safety) and the monitoring of all health care activities (traceability). Information analysts need complementary methods to conceptualize clinical information systems that provide actors with immediate individual benefits and guide collective behavioral changes. A methodology is proposed to elicit users' needs using a process-oriented analysis, and it is applied to the field of blood transfusion. We defined a process data model, the main components of which are: activities, resources, constrains, guidelines and indicators. Although some aspects of activity, such as "where", "what else", and "why" are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for this approach to be generalised within the organisation, for the processes to be interrelated, and for their characteristics to be assessed.

  10. Radiosynovectomy of the elbow joint synovitis in rheumatoid arthritis treated with Lutetium - 177 labeled hydroxylapatite (Lu-177 HA) particulates; first case report and image of Lu -177 HA in the elbow joint.

    PubMed

    Kamaleshwaran, Koramadai Karuppusamy; Rajamani, Venkataraman; Thirumalaisamy, Subbiah Gounder; Chakraborty, Sudipta; Kalarikal, Radhakrishnan; Mohanan, Vyshakh; Shinto, Ajit Sugunan

    2014-10-01

    Rheumatoid arthritis is a chronic disease that is mainly characterized by asymmetric erosive synovitis, particularly affecting the peripheral joints. Radiation synovectomy or radiosynovectomy, also known as radiosynoviorthesis was first described in 1950's as a adjuvant treatment for rheumatoid arthritis. Radiosynovectomy is based on the irradiation of the joint synovium by the intra-articular administration of various β-emitting radiopharmaceuticals. Lu-177 has presence of gamma photons of imagable energy with low abundance which provides the additional benefit of carrying out simultaneous scintigraphy. We describe the first case report of use of Lu-177 hydroxylapatite particulates in a 35-year-old female patient who was presented with elbow joint synovitis due to rheumatoid arthritis.

  11. Why Uninsured Free Clinic Patients Don't Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State.

    PubMed

    Kamimura, Akiko; Tabler, Jennifer; Chernenko, Alla; Aguilera, Guadalupe; Nourian, Maziar M; Prudencio, Liana; Ashby, Jeanie

    2016-02-01

    Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals' intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics' ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.

  12. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of placing preventive fissure sealants.

    PubMed

    Bonetti, Debbie; Johnston, Marie; Clarkson, Jan E; Grimshaw, Jeremy; Pitts, Nigel B; Eccles, Martin; Steen, Nick; Thomas, Ruth; Maclennan, Graeme; Glidewell, Liz; Walker, Anne

    2010-04-08

    Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants. Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value. Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention. The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour

  13. Clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor in oral implantology.

    PubMed

    Duka, Milos; Lazić, Zoran; Stamatović, Novak; Tatić, Zoran; Bubalo, Marija; Veljović, Milić

    2007-09-01

    Bupivacaine (Marcaine), homologue of mepivacaine, chemically related to lidocaine, is used as a local anesthetic for local infiltration, peripheral nerve block, retrobulbar block, symphathetic block, and caudal and epidural anesthesia. The aim of this investigation was to determine and to compare clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor. This investigation included a total of 30 randomly selected patients, who ranged in age from 30-60 years, with partial or total anodontia in the molar region of the mandible. These patients with total or partial edentulous molar part of the mandible, scheduled for dental implantation placement, were asked to participate in the study. In the first phase of the investigation, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine with a vasoconstrictor (adrenalin, 1: 200,000) in the right side of the mandible. After administering local anesthesia, the placement of blade, cylindrical, transdental (B.C.T.) implants was performed. In the second stage of the investigation, in 7-10 days period after the first oral surgery, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine, but without a vasoconstrictor, in the left side of the mandible. After administering local anesthesia, the placement of B.C.T. implants was performed. During the performance of both oral surgery procedures, the following clinical parameters of the local anesthetic effects were monitored: latent period, duration and the potency of anesthesia, and the evaluation of the postoperative pain level. The latent period under local anesthesia with 3.5 cm3 of 0.5% bupivacaine and vasoconstrictor was statistically significantly shorter than without vasoconstrictor. The duration of local anesthesia was longer without vasoconstrictor. There was no difference in the potency of anesthesia with or without a vasoconstrictor, while the lowest level of postoperative

  14. Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics

    PubMed Central

    Eccles, Martin P; Grimshaw, Jeremy M; Johnston, Marie; Steen, Nick; Pitts, Nigel B; Thomas, Ruth; Glidewell, Elizabeth; Maclennan, Graeme; Bonetti, Debbie; Walker, Anne

    2007-01-01

    Background Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the

  15. Developing a Technology for the Use of Operant Extinction in Clinical Settings: An Examination of Basic and Applied Research.

    ERIC Educational Resources Information Center

    Lerman, Dorothea C.; Iwata, Brian A.

    1996-01-01

    Basic and applied research on variables that influence the extinction of operant behaviors is reviewed and applied to the treatment of behavior disorders. The potential value of a general technology for the use of behavioral extinction is discussed. The paper concludes that current research findings are not sufficient for the development of a…

  16. Applied clinical pharmacology and public health in rural Asia – preventing deaths from organophosphorus pesticide and yellow oleander poisoning

    PubMed Central

    Eddleston, Michael

    2013-01-01

    Self-poisoning with pesticides or plants is a major clinical problem in rural Asia, killing several hundred thousand people every year. Over the last 17 years, our clinical toxicology and pharmacology group has carried out clinical studies in the North Central Province of Sri Lanka to improve treatment and reduce deaths. Studies have looked at the effectiveness of anti-digoxin Fab in cardiac glycoside plant poisoning, multiple dose activated charcoal in all poisoning, and pralidoxime in moderate toxicity organophosphorus insecticide poisoning. More recently, using a Haddon matrix as a guide, we have started conducting public health and animal studies to find strategies that may work outside of the hospital. Based on the 2009 GSK Research in Clinical Pharmacology prize lecture, this review shows the evolution of the group's research from a clinical pharmacology approach to one that studies possible interventions at multiple levels, including the patient, the community and government legislation. PMID:22943579

  17. Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients with Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study

    ERIC Educational Resources Information Center

    Karupaiah, Tilakavati; Wong, Kimberly; Chinna, Karuthan; Arasu, Kanimolli; Chee, Winnie Siew Swee

    2015-01-01

    The CORFIS ("Community-Based Cardiovascular Risk Factors Intervention Strategies") program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in…

  18. Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients with Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study

    ERIC Educational Resources Information Center

    Karupaiah, Tilakavati; Wong, Kimberly; Chinna, Karuthan; Arasu, Kanimolli; Chee, Winnie Siew Swee

    2015-01-01

    The CORFIS ("Community-Based Cardiovascular Risk Factors Intervention Strategies") program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in…

  19. Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic.

    PubMed

    Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; Christo, Paul J; Hough, Douglas; Aron, Ravi; Ulatowski, John A

    2015-02-01

    This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time. Prospective quality improvement. Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States. Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months. Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session. Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor. The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times. Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians. Wiley Periodicals, Inc.

  20. Design of a nursing clinical decision support system applying nursing diagnosis and nursing evaluation model based data mining.

    PubMed

    Kim, Hyungyung; Kim, Insook; Chae, Yougmoon

    2006-01-01

    This study a methodological study; to acquire knowledge on the nursing process by steps of knowledge definition, collection, and representation; then, to design a data warehouse and nursing process clinical decision support system.

  1. Applied clinical pharmacology and public health in rural Asia--preventing deaths from organophosphorus pesticide and yellow oleander poisoning.

    PubMed

    Eddleston, Michael

    2013-05-01

    Self-poisoning with pesticides or plants is a major clinical problem in rural Asia, killing several hundred thousand people every year. Over the last 17 years, our clinical toxicology and pharmacology group has carried out clinical studies in the North Central Province of Sri Lanka to improve treatment and reduce deaths. Studies have looked at the effectiveness of anti-digoxin Fab in cardiac glycoside plant poisoning, multiple dose activated charcoal in all poisoning, and pralidoxime in moderate toxicity organophosphorus insecticide poisoning. More recently, using a Haddon matrix as a guide, we have started conducting public health and animal studies to find strategies that may work outside of the hospital. Based on the 2009 GSK Research in Clinical Pharmacology prize lecture, this review shows the evolution of the group's research from a clinical pharmacology approach to one that studies possible interventions at multiple levels, including the patient, the community and government legislation. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  2. Applying MetaMap to Medline for identifying novel associations in a large clinical dataset: a feasibility analysis

    PubMed Central

    Hanauer, David A; Saeed, Mohammed; Zheng, Kai; Mei, Qiaozhu; Shedden, Kerby; Aronson, Alan R; Ramakrishnan, Naren

    2014-01-01

    Objective We describe experiments designed to determine the feasibility of distinguishing known from novel associations based on a clinical dataset comprised of International Classification of Disease, V.9 (ICD-9) codes from 1.6 million patients by comparing them to associations of ICD-9 codes derived from 20.5 million Medline citations processed using MetaMap. Associations appearing only in the clinical dataset, but not in Medline citations, are potentially novel. Methods Pairwise associations of ICD-9 codes were independently identified in both the clinical and Medline datasets, which were then compared to quantify their degree of overlap. We also performed a manual review of a subset of the associations to validate how well MetaMap performed in identifying diagnoses mentioned in Medline citations that formed the basis of the Medline associations. Results The overlap of associations based on ICD-9 codes in the clinical and Medline datasets was low: only 6.6% of the 3.1 million associations found in the clinical dataset were also present in the Medline dataset. Further, a manual review of a subset of the associations that appeared in both datasets revealed that co-occurring diagnoses from Medline citations do not always represent clinically meaningful associations. Discussion Identifying novel associations derived from large clinical datasets remains challenging. Medline as a sole data source for existing knowledge may not be adequate to filter out widely known associations. Conclusions In this study, novel associations were not readily identified. Further improvements in accuracy and relevance for tools such as MetaMap are needed to realize their expected utility. PMID:24928177

  3. How to apply case reports in clinical practice using surrogate models via example of the trigeminocardiac reflex.

    PubMed

    Sandu, Nora; Chowdhury, Tumul; Schaller, Bernhard J

    2016-04-06

    Case reports are an increasing source of evidence in clinical medicine. Until a few years ago, such case reports were emerged into systematic reviews and nowadays they are often fitted to the development of clinical (thinking) models. We describe this modern progress of knowledge creation by the example of the trigeminocardiac reflex that was first described in 1999 by a case series and was developed over the cause-and-effect relationship, triangulation to systematic reviews and finally to thinking models. Therefore, this editorial not only underlines the increasing and outstanding importance of (unique) case reports in current science, but also in current clinical decision-making and therefore also that of specific journals like the Journal of Medical Case Reports.

  4. Now or Later?: An Empirical Investigation of When and Why Students Apply to Clinical Psychology PhD Programs

    ERIC Educational Resources Information Center

    Zimak, Eric H.; Edwards, Katie M.; Johnson, Shannon M.; Suhr, Julie

    2011-01-01

    This study used a national sample of PhD students in clinical psychology (N = 1,034) to explore when students decided to pursue their graduate degree, reasons for their decisions, and associated satisfaction. Results indicated that immediately after completing their undergraduate degree, 57% of current graduate students reported postponing…

  5. Simulation for clinical repeated-dose pharmacokinetic trials applying a peak-and-trough sampling design to estimate oral clearance.

    PubMed

    Ishida, Kazuya; Kayano, Yuichiro; Taguchi, Masato; Hashimoto, Yukiya

    2007-11-01

    We performed a simulation for the clinical pharmacokinetic study, in which blood was sampled at two time points corresponding to the peak concentration (C(peak)) and trough concentration (C(trough)) following repetitive oral drug administration to subjects. We estimated the approximate oral clearance (CL/F(approx)) as 2.D/(C(peak).tau+C(trough).tau), where D is the dose, and tau is the dosing interval. The CL/F(approx) value was accurate for drugs with a long-elimination half-life, and the estimation error of the CL/F value was slightly increased for drugs with a shorter elimination half-life. The accuracy of CL/F(approx) in each subject was not affected by the magnitude of the interindividual pharmacokinetic variability, but was significantly decreased by the larger measurement error of drug concentrations (or intraindividual pharmacokinetic variability). We further performed several computer simulations to mimic statistical hypothesis testing following the clinical repeated-dose pharmacokinetic trials. The statistical power to detect the difference of oral clearance between two groups was marginally dependent on the measurement error of drug concentration, but was highly dependent on the interindividual pharmacokinetic variability. These findings suggested that the peak-and-trough sampling design to estimate the CL/F(approx) value is useful for clinical repeated-dose pharmacokinetic trials, and that the study design and protocol should be evaluated carefully by computer simulation prior to a real clinical trial.

  6. Now or Later?: An Empirical Investigation of When and Why Students Apply to Clinical Psychology PhD Programs

    ERIC Educational Resources Information Center

    Zimak, Eric H.; Edwards, Katie M.; Johnson, Shannon M.; Suhr, Julie

    2011-01-01

    This study used a national sample of PhD students in clinical psychology (N = 1,034) to explore when students decided to pursue their graduate degree, reasons for their decisions, and associated satisfaction. Results indicated that immediately after completing their undergraduate degree, 57% of current graduate students reported postponing…

  7. Clinical study of tooth shade lightening from dentist-supervised, patient-applied treatment with two 10% carbamide peroxide gels.

    PubMed

    Cibirka, R M; Myers, M; Downey, M C; Nelson, S K; Browning, W D; Hawkins, I K; Dickinson, G L

    1999-01-01

    Prescribed, patient-applied tooth lightening agents, or nightguard vital bleaching, typically utilizes a 10% carbamide peroxide agent applied during nocturnal hours. The purpose of this randomized double-blind study was to compare the amount of tooth color change in two groups of subjects using dentist-supervised, patient-applied 10% carbamide peroxide gel. One group used Opalescence (Ultradent Products Inc., South Jordan, Utah) and the other NiteWhite Excel (Discus Dental, Inc., Los Angeles, California). Evaluation of tooth color for the six maxillary anterior teeth was done using a Vita shade guide at baseline, 1, 2, and 4 weeks. Subjects were instructed to apply the gel nocturnally using a custom-made soft tray 8 hours per day for 2 weeks. The 16 tabs of the shade guide were ranked according to value from darkest to lightest. The number (1-16) that correlated to the shade tab selected as the match for each tooth was the outcome variable. A Kruskal-Wallis one way analysis of variance on ranks was used. The test revealed no statistically significant difference between Opalescence and NiteWhite Excel for lightening the teeth (p = .807). The color change was still significant after 2 weeks without further bleaching activity. The baseline evaluation of the maxillary incisors and canines for all subjects, regardless of group, demonstrated a significant shade difference, with the canines being darker. This difference was not seen after 2 weeks of active bleaching or at the 4-week evaluation. In this study comparing bleaching products, patients using Opalescence and NiteWhite Excel experienced a significant change in the color of their teeth relative to baseline values after 2 weeks of active treatment.

  8. A waste walk through clinical pharmacy: how do the 'seven wastes' of Lean techniques apply to the practice of clinical pharmacists.

    PubMed

    Green, Christopher F; Crawford, Victoria; Bresnen, Gaynor; Rowe, Philip H

    2015-02-01

    This study used a 'Lean' technique, the 'waste walk' to evaluate the activities of clinical pharmacists with reference to the seven wastes described in 'Lean' including 'defects', 'unnecessary motion', 'overproduction', 'transport of products or material', 'unnecessary waiting', 'unnecessary inventory' and 'inappropriate processing'. The objectives of the study were to categorise the activities of ward-based clinical pharmacists into waste and non-waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category. This study was carried out in a district general hospital in the North West of England. Staff were observed using work-sampling techniques, to categorise activity into waste and non-waste, with waste activities being allocated to each of the seven wastes described earlier and subdivided into recurrent themes. Twenty different pharmacists were observed for 1 h on two separate occasions. Of 1440 observations, 342 (23.8%) were categorised as waste with 'defects' and 'unnecessary motion' accounting for the largest proportions of waste activity. Observation of clinical pharmacists' activities has identified that a significant proportion of their time could be categorised as 'waste'. There are practical steps that could be implemented in order to ensure their time is used as productively as possible. Given the challenges facing the UK National Health Service, the adoption of 'Lean' techniques provides an opportunity to improve quality and productivity while reducing costs. © 2014 Royal Pharmaceutical Society.

  9. Applying the wisdom of stepping down inhaled corticosteroids in patients with COPD: a proposed algorithm for clinical practice

    PubMed Central

    Kaplan, Alan G

    2015-01-01

    Current guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend limiting the use of inhaled corticosteroids (ICS) to patients with more severe disease and/or increased exacerbation risk. However, there are discrepancies between guidelines and real-life practice, as ICS are being overprescribed. In light of the increasing concerns about the clinical benefit and long-term risks associated with ICS use, therapy needs to be carefully weighed on a case-by-case basis, including in patients already on ICS. Several studies sought out to determine the effects of withdrawing ICS in patients with COPD. Early studies have deterred clinicians from reducing ICS in patients with COPD as they reported that an abrupt withdrawal of ICS precipitates exacerbations, and results in a deterioration in lung function and symptoms. However, these studies were fraught with numerous methodological limitations. Recently, two randomized controlled trials and a real-life prospective study revealed that ICS can be safely withdrawn in certain patients. Of these, the WISDOM (Withdrawal of Inhaled Steroids During Optimized Bronchodilator Management) trial was the largest and first to examine stepwise withdrawal of ICS in patients with COPD receiving maintenance therapy of long-acting bronchodilators (ie, tiotropium and salmeterol). Even with therapy being in line with the current guidelines, the findings of the WISDOM trial indicate that not all patients benefit from including ICS in their treatment regimen. Indeed, only certain COPD phenotypes seem to benefit from ICS therapy, and validated markers that predict ICS response are urgently warranted in clinical practice. Furthermore, we are now better equipped with a larger armamentarium of novel and more effective long-acting β2-agonist/long-acting muscarinic antagonist combinations that can be considered by clinicians to optimize bronchodilation and allow for safer ICS withdrawal. In addition to providing a review of

  10. [Subtypes of cocaine addicts with and without associated problematic alcohol use: towards a neuropsychology of personality applied to clinical practice].

    PubMed

    Pedrero Pérez, Eduardo J; Ruiz Sánchez de León, José M

    2012-01-01

    It is important to know which personality factors are associated with addiction so to distinguish addicts that require specialized treatment from those who do not, and to identify those addicts who achieve abstinence from those who continue their substance use despite the negative consequences. Cloninger's model includes biological and psychosocial variables that can be characterized in neuropsychological terms. Two samples were analyzed: individuals who had begun cocaine addiction treatment (n=183) and a non-clinical population sample (n = 183), matched for sex, age and educational level. Alcohol abuse/dependence was monitored as an independent variable. Significant differences and large effect size were found between addicts and non-clinical population in Novelty Seeking and Self-Directedness, and to a lesser extent, in Harm Avoidance. These differences increase when problematic use of alcohol is added. According to the profile of traits, clusters of addicts were established and differences were obtained in variables such as functional/dysfunctional impulsivity, dysexecutive symptoms and perceived stress. Six clusters were identified, some of minor severity, the most severely problematic clusters being characterized by higher levels of dysfunctional impulsivity, more dysexecutive symptoms and higher levels of perceived stress. Self-Directedness seems to reflect the deficit of prefrontal systems in the regulation of behavior, as well as in emotion and impulse control. It is proposed that evaluation of the personality is more useful than the mere assessment of symptoms for classifying addicts, determining their needs and designing a therapeutic itinerary.

  11. Routing cancer immunology and immunotherapy from the lab to the clinic 4-5 th March 2014, Center for Applied Medical Research and University Clinic, Pamplona, Spain.

    PubMed

    Aznar, M Ángela; Melero, Ignacio; Quetglas, José I

    2014-07-24

    New approaches to generate effective anticancer responses by either inducing immune responses or inhibiting immunosuppression are under development to improve efficacy in patients. On March 4-5th, 2014, a symposium was held in Pamplona, Spain, to report the new strategies showing preclinical and clinical results regarding translational research efforts on the topic. Participants interacted through oral presentations of 15 speakers and further discussions on topics that included novel therapeutic agents for cancer immunotherapy, viral vectors and interferon-based approaches, experimental tumor imaging and immunostimulatory monoclonal antibodies. Promising agents to target cancer cells and therapeutic approaches that are under translation from bench to patients were presented.

  12. Routing cancer immunology and immunotherapy from the lab to the clinic 4–5 th March 2014, Center for Applied Medical Research and University Clinic, Pamplona, Spain

    PubMed Central

    2014-01-01

    New approaches to generate effective anticancer responses by either inducing immune responses or inhibiting immunosuppression are under development to improve efficacy in patients. On March 4-5th, 2014, a symposium was held in Pamplona, Spain, to report the new strategies showing preclinical and clinical results regarding translational research efforts on the topic. Participants interacted through oral presentations of 15 speakers and further discussions on topics that included novel therapeutic agents for cancer immunotherapy, viral vectors and interferon-based approaches, experimental tumor imaging and immunostimulatory monoclonal antibodies. Promising agents to target cancer cells and therapeutic approaches that are under translation from bench to patients were presented. PMID:25060862

  13. Stereoscopic three-dimensional visualization applied to multimodal brain images: clinical applications and a functional connectivity atlas.

    PubMed

    Rojas, Gonzalo M; Gálvez, Marcelo; Vega Potler, Natan; Craddock, R Cameron; Margulies, Daniel S; Castellanos, F Xavier; Milham, Michael P

    2014-01-01

    Effective visualization is central to the exploration and comprehension of brain imaging data. While MRI data are acquired in three-dimensional space, the methods for visualizing such data have rarely taken advantage of three-dimensional stereoscopic technologies. We present here results of stereoscopic visualization of clinical data, as well as an atlas of whole-brain functional connectivity. In comparison with traditional 3D rendering techniques, we demonstrate the utility of stereoscopic visualizations to provide an intuitive description of the exact location and the relative sizes of various brain landmarks, structures and lesions. In the case of resting state fMRI, stereoscopic 3D visualization facilitated comprehension of the anatomical position of complex large-scale functional connectivity patterns. Overall, stereoscopic visualization improves the intuitive visual comprehension of image contents, and brings increased dimensionality to visualization of traditional MRI data, as well as patterns of functional connectivity.

  14. No More Fighting and Biting During Mouth Care: Applying the Theoretical Constructs of Threat Perception to Clinical Practice

    PubMed Central

    Jablonski, Rita A.; Therrien, Barbara; Kolanowski, Ann

    2012-01-01

    The purpose of this article is to describe how the neurobiological principles of threat perception and fear response can support clinical approaches to prevent and reduce care-resistant behaviors during mouth care. Nursing home residents who exhibit care-resistant behavior are at risk for poor oral health because daily oral hygiene may not be consistently provided. Poor oral health predisposes these older people to systemic problems such as pneumonia, cerebral vascular accidents, and hyperglycemia. Care-resistant behavior is a fear-evoked response to nurses’ unintentionally threatening behavior during mouth care. Nurses can safely and effectively provide mouth care to persons with dementia who resist care by using personalized combinations of 15 threat reduction strategies. PMID:22216691

  15. No more fighting and biting during mouth care: applying the theoretical constructs of threat perception to clinical practice.

    PubMed

    Jablonski, Rita A; Therrien, Barbara; Kolanowski, Ann

    2011-01-01

    The purpose of this article is to describe how the neurobiological principles of threat perception and fear response can support clinical approaches to prevent and reduce care-resistant behaviors during mouth care. Nursing home residents who exhibit care-resistant behavior are at risk for poor oral health because daily oral hygiene may not be consistently provided. Poor oral health predisposes these older people to systemic problems such as pneumonia, cerebral vascular accidents, and hyperglycemia. Care-resistant behavior is a fear-evoked response to nurses' unintentionally threatening behavior during mouth care. Nurses can safely and effectively provide mouth care to persons with dementia who resist care by using personalized combinations of 15 threat reduction strategies.

  16. Stereoscopic three-dimensional visualization applied to multimodal brain images: clinical applications and a functional connectivity atlas

    PubMed Central

    Rojas, Gonzalo M.; Gálvez, Marcelo; Vega Potler, Natan; Craddock, R. Cameron; Margulies, Daniel S.; Castellanos, F. Xavier; Milham, Michael P.

    2014-01-01

    Effective visualization is central to the exploration and comprehension of brain imaging data. While MRI data are acquired in three-dimensional space, the methods for visualizing such data have rarely taken advantage of three-dimensional stereoscopic technologies. We present here results of stereoscopic visualization of clinical data, as well as an atlas of whole-brain functional connectivity. In comparison with traditional 3D rendering techniques, we demonstrate the utility of stereoscopic visualizations to provide an intuitive description of the exact location and the relative sizes of various brain landmarks, structures and lesions. In the case of resting state fMRI, stereoscopic 3D visualization facilitated comprehension of the anatomical position of complex large-scale functional connectivity patterns. Overall, stereoscopic visualization improves the intuitive visual comprehension of image contents, and brings increased dimensionality to visualization of traditional MRI data, as well as patterns of functional connectivity. PMID:25414626

  17. MO-F-304-01: Applying PDSA to a Practical Clinical Problem: Variation in Procedural Doses Among Interventional Radiologists

    SciTech Connect

    Jones, A.

    2015-06-15

    With the current Maintenance of Certification (MOC) requirement for a practice quality improvement (PQI) project every 3 years, we all (well, most of us) find ourselves searching for projects that are both manageable and likely to have a positive impact on our clinical practice. In this session we will walk through the use of the Plan, Do, Study, Act (PDSA) cycle to address a common finding in practices where fluoroscopically guided interventions (FGI) are performed: variation in procedural doses among physicians. We will also examine strategies to secure physician support using carrots, not sticks. Learning Objectives: Review the PDSA cycle and its application to PQI. Discuss strategies for action in the example presented. Examine strategies for successful group PQI projects. A. Kyle Jones: Owner, FluoroSafety Joseph R. Steele: Consultant, FluoroSafety.

  18. Applying PET to Broaden the Diagnostic Utility of the Clinically Validated CA19.9 Serum Biomarker for Oncology

    PubMed Central

    Viola-Villegas, Nerissa Therese; Rice, Samuel L.; Carlin, Sean; Wu, Xiaohong; Evans, Michael J.; Sevak, Kuntal K.; Drobjnak, Marija; Ragupathi, Govind; Sawada, Ritsuko; Scholz, Wolfgang W.; Livingston, Philip O.; Lewis, Jason S.

    2014-01-01

    Despite their considerable advantages, many circulating biomarkers have well-documented limitations. One prominent shortcoming in oncology is a high frequency of false-positive indications for malignant disease in upfront diagnosis. Because one common cause of false positivism is biomarker production from benign disorders in unrelated host tissues, we hypothesized that probing the sites of biomarker secretion with an imaging tool could be a broadly useful strategy to deconvolute the meaning of foreboding but inconclusive circulating biomarker levels. Methods In preparation to address this hypothesis clinically, we developed 89Zr-5B1, a fully human, antibody-based radiotracer targeting tumor-associated CA19.9 in the preclinical setting. Results 89Zr-5B1 localized to multiple tumor models representing diseases with undetectable and supraphysiologic serum CA19.9 levels. Among these, 89Zr-5B1 detected orthotopic models of pancreatic ductal adenocarcinoma, an elusive cancer for which the serum assay is measured in humans but with limited specificity in part because of the frequency of CA19.9 secretion from benign hepatic pathologies. Conclusion In this report, a general strategy to supplement some of the shortcomings of otherwise highly useful circulating biomarkers with immunoPET is described. To expedite the clinical validation of this model, a human monoclonal antibody to CA19.9 (a highly visible but partially flawed serum biomarker for several cancers) was radiolabeled and evaluated, and the compelling preclinical evidence suggests that the radiotracer may enhance the fidelity of diagnosis and staging of pancreatic ductal adenocarcinoma, a notoriously occult cancer. PMID:24029655

  19. Applying PET to broaden the diagnostic utility of the clinically validated CA19.9 serum biomarker for oncology.

    PubMed

    Viola-Villegas, Nerissa Therese; Rice, Samuel L; Carlin, Sean; Wu, Xiaohong; Evans, Michael J; Sevak, Kuntal K; Drobjnak, Marija; Ragupathi, Govind; Sawada, Ritsuko; Scholz, Wolfgang W; Livingston, Philip O; Lewis, Jason S

    2013-11-01

    Despite their considerable advantages, many circulating biomarkers have well-documented limitations. One prominent shortcoming in oncology is a high frequency of false-positive indications for malignant disease in upfront diagnosis. Because one common cause of false positivism is biomarker production from benign disorders in unrelated host tissues, we hypothesized that probing the sites of biomarker secretion with an imaging tool could be a broadly useful strategy to deconvolute the meaning of foreboding but inconclusive circulating biomarker levels. In preparation to address this hypothesis clinically, we developed (89)Zr-5B1, a fully human, antibody-based radiotracer targeting tumor-associated CA19.9 in the preclinical setting. (89)Zr-5B1 localized to multiple tumor models representing diseases with undetectable and supraphysiologic serum CA19.9 levels. Among these, (89)Zr-5B1 detected orthotopic models of pancreatic ductal adenocarcinoma, an elusive cancer for which the serum assay is measured in humans but with limited specificity in part because of the frequency of CA19.9 secretion from benign hepatic pathologies. In this report, a general strategy to supplement some of the shortcomings of otherwise highly useful circulating biomarkers with immunoPET is described. To expedite the clinical validation of this model, a human monoclonal antibody to CA19.9 (a highly visible but partially flawed serum biomarker for several cancers) was radiolabeled and evaluated, and the compelling preclinical evidence suggests that the radiotracer may enhance the fidelity of diagnosis and staging of pancreatic ductal adenocarcinoma, a notoriously occult cancer.

  20. Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fibreglass Material

    PubMed Central

    Bitar, KM; Ferdhany, ME; Saw, A

    2016-01-01

    Introduction: Hip spica casting is an important component of treatment for developmental dysplasia of the hip (DDH) and popular treatment method for femur fractures in children. Breakage at the hip region is a relatively common problem of this cast. We have developed a three-slab technique of hip spica application using fibreglass as the cast material. The purpose of this review was to evaluate the physical durability of the spica cast and skin complications with its use. Methodology: A retrospective review of children with various conditions requiring hip spica immobilisation which was applied using our method. Study duration was from 1st of January 2014 until 31st December 2015. Our main outcomes were cast breakage and skin complications. For children with hip instability, the first cast would be changed after one month, and the second cast about two months later. Results: Twenty-one children were included, with an average age of 2.2 years. The most common indication for spica immobilisation was developmental dysplasia of the hip. One child had skin irritation after spica application. No spica breakage was noted. Conclusion: This study showed that the three-slab method of hip spica cast application using fibreglass material was durable and safe with low risk of skin complications. PMID:28553442

  1. Optimizing Clinical Drug Product Performance: Applying Biopharmaceutics Risk Assessment Roadmap (BioRAM) and the BioRAM Scoring Grid.

    PubMed

    Dickinson, Paul A; Kesisoglou, Filippos; Flanagan, Talia; Martinez, Marilyn N; Mistry, Hitesh B; Crison, John R; Polli, James E; Cruañes, Maria T; Serajuddin, Abu T M; Müllertz, Anette; Cook, Jack A; Selen, Arzu

    2016-11-01

    The aim of Biopharmaceutics Risk Assessment Roadmap (BioRAM) and the BioRAM Scoring Grid is to facilitate optimization of clinical performance of drug products. BioRAM strategy relies on therapy-driven drug delivery and follows an integrated systems approach for formulating and addressing critical questions and decision-making (J Pharm Sci. 2014,103(11): 3777-97). In BioRAM, risk is defined as not achieving the intended in vivo drug product performance, and success is assessed by time to decision-making and action. Emphasis on time to decision-making and time to action highlights the value of well-formulated critical questions and well-designed and conducted integrated studies. This commentary describes and illustrates application of the BioRAM Scoring Grid, a companion to the BioRAM strategy, which guides implementation of such an integrated strategy encompassing 12 critical areas and 6 assessment stages. Application of the BioRAM Scoring Grid is illustrated using published literature. Organizational considerations for implementing BioRAM strategy, including the interactions, function, and skillsets of the BioRAM group members, are also reviewed. As a creative and innovative systems approach, we believe that BioRAM is going to have a broad-reaching impact, influencing drug development and leading to unique collaborations influencing how we learn, and leverage and share knowledge. Published by Elsevier Inc.

  2. Clinical practice standards and ethical issues applied to a virtual group intervention for spousal caregivers of people with Alzheimer's.

    PubMed

    Serafini, Julie Dergal; Damianakis, Thecla; Marziali, Elsa

    2007-01-01

    Advances in technology have improved access to health and social services by offering more abundant and convenient choices for clients. In particular, the use of technology for delivering services to older adults and their families offers new possibilities for service delivery, by reaching people who are often isolated, and have difficulty accessing traditional services. Despite the continued advances in technology development and its integration into healthcare delivery, health care practitioners need to consider how to adapt and uphold clinical practice standards and address ethical issues in an e-health environment. Given the gap in the literature with respect to discussing these issues, this paper illustrates relevant issues in the context of developing and evaluating an Internet-based intervention for spousal caregivers of persons with dementia. Based on a four year project, a psychotherapeutic group intervention was delivered via the Internet to three groups of spousal caregivers. This article identifies some of the key practice standards and ethical issues that arise when using computer technology to deliver a psychotherapeutic group intervention. The article will also provide examples of relevant issues related to maintaining practice standards and ethical procedures that need to be addressed during the application of a computer-based psychotherapeutic group intervention for spousal caregivers of people with dementia.

  3. The secret of the care of the patient is in knowing and applying the evidence about effective clinical communication.

    PubMed

    Frankel, R M; Sherman, H B

    2015-11-01

    American physicians and dentists conduct approximately 140 000-160 000 patient interviews in a practice lifetime, making the interview the most frequently performed medical procedure. Over the past 75 years, a steadily growing stream of scientific research has confirmed the fact that patient-clinician communication affects the course, direction, and both biomedical and functional outcomes of care. The field of clinical communication research has matured from anecdotes and aphorisms about 'bedside manner' to sophisticated randomized control trials and evidence-based outcomes that have been translated into reliable practice guidelines. Several key skills or habits of practice have been identified and studied in terms of their efficacy and effectiveness. These include the importance of agenda-setting, eliciting patients' perspectives about the nature of their ailments, communicating caring and concern, and testing for patient comprehension and agreement with proposed treatments. In addition to being effective, interpersonal communication can be deeply satisfying as well as offering a lower probability of law suits in the event of an adverse outcome. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Applying clinically proven human techniques for contraception and fertility to endangered species and zoo animals: a review.

    PubMed

    Silber, Sherman J; Barbey, Natalie; Lenahan, Kathy; Silber, David Z

    2013-12-01

    Reversible contraception that does not alter natural behavior is a critical need for managing zoo populations. In addition to reversible contraception, other fertility techniques perfected in humans may be useful, such as in vitro fertilization (IVF) or oocyte and embryo banking for endangered species like amphibians and Mexican wolves (Canis lupus baileyi). Furthermore, the genetics of human fertility can give a better understanding of fertility in more exotic species. Collaborations were established to apply human fertility techniques to the captive population. Reversible vasectomy might be one solution for reversible contraception that does not alter behavior. Reversible approaches to vasectomy, avoiding secondary epididymal disruption, were attempted in South American bush dogs (Speothos venaticus), chimpanzees (Pan troglodytes), gorillas (Gorilla gorilla), Przewalski's horse (Equus przewalski poliakov), and Sika deer (Cervus nippon) in a variety of zoos around the world. These techniques were first perfected in > 4,000 humans before attempting them in zoo animals. In vitro fertilization with gestational surrogacy was used to attempt to break the vicious cycle of hand rearing of purebred orangutans, and egg and ovary vitrification in humans have led to successful gamete banking for Mexican wolves and disappearing amphibians. The study of the human Y chromosome has even explained a mechanism of extinction related to global climate change. The best results with vasectomy reversal (normal sperm counts, pregnancy, and live offspring) were obtained when the original vasectomy was performed "open-ended," so as to avoid pressure-induced epididymal disruption. The attempt at gestational surrogacy for orangutans failed because of severe male infertility and the lack of success with human ovarian hyperstimulation protocols. Vitrification of oocytes is already being employed for the Amphibian Ark Project and for Mexican wolves. Vasectomy can be a reversible contraception

  5. Virtual reality, augmented reality, and robotics applied to digestive operative procedures: from in vivo animal preclinical studies to clinical use

    NASA Astrophysics Data System (ADS)

    Soler, Luc; Marescaux, Jacques

    2006-04-01

    Technological innovations of the 20 th century provided medicine and surgery with new tools, among which virtual reality and robotics belong to the most revolutionary ones. Our work aims at setting up new techniques for detection, 3D delineation and 4D time follow-up of small abdominal lesions from standard mecial images (CT scsan, MRI). It also aims at developing innovative systems making tumor resection or treatment easier with the use of augmented reality and robotized systems, increasing gesture precision. It also permits a realtime great distance connection between practitioners so they can share a same 3D reconstructed patient and interact on a same patient, virtually before the intervention and for real during the surgical procedure thanks to a telesurgical robot. In preclinical studies, our first results obtained from a micro-CT scanner show that these technologies provide an efficient and precise 3D modeling of anatomical and pathological structures of rats and mice. In clinical studies, our first results show the possibility to improve the therapeutic choice thanks to a better detection and and representation of the patient before performing the surgical gesture. They also show the efficiency of augmented reality that provides virtual transparency of the patient in real time during the operative procedure. In the near future, through the exploitation of these systems, surgeons will program and check on the virtual patient clone an optimal procedure without errors, which will be replayed on the real patient by the robot under surgeon control. This medical dream is today about to become reality.

  6. Applying self-determination theory for improved understanding of physiotherapists' rationale for using research in clinical practice: a qualitative study in Sweden.

    PubMed

    Dannapfel, Petra; Peolsson, Anneli; Ståhl, Christian; Öberg, Birgitta; Nilsen, Per

    2014-01-01

    Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists' use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

  7. Dependence of Hearing Changes on the Dose of Intratympanically-Applied Gentamicin: A Metaanalysis using Mathematical Simulations of Clinical Drug Delivery Protocols

    PubMed Central

    Salt, Alec N.; Gill, Ruth M.; Plontke, Stefan K.

    2008-01-01

    Objective To establish safe dosing protocols for the treatment of Meniere’s patients with intratympanic gentamicin. Study Design A validated computer model of gentamicin dispersion in the inner ear fluids was used to calculate cochlear drug levels resulting from specific clinical delivery protocols. Dosing in the cochlea was compared with changes of hearing sensitivity for 568 patients following 19 clinical protocols. Methods Cochlear drug levels were calculated based on the concentration and volume of gentamicin applied, the time the drug remained in the middle ear, and on the specific timing of injections. Time courses were quantified in terms of the maximum concentration (Cmax) and the area under the curve (AUC) of the drug at specific cochlear locations. Results Drug levels resulting from single, “one-shot” injections were typically lower than those from repeated or continuous application protocols. Comparison of hearing sensitivity changes with gentamicin dosing revealed a flat curve with a near-zero mean for lower doses, suggesting that hearing changes with doses over this range were probably unrelated to the applied drug. Higher intracochlear doses were generated with repeated or continuous delivery protocols, which in some cases caused substantial hearing losses and an increased incidence of deafened ears. Conclusions One-shot application protocols produce gentamicin doses in the cochlea that have minimal risk to hearing at the frequencies tested. Repeated or continuous application protocols result in higher doses that in some cases damage hearing. The high variability of hearing changes even with low gentamicin doses, calls into question the rationale for using individual hearing changes to titrate the applied dose. PMID:18806480

  8. Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

    PubMed

    Maggio, Lauren A; Cate, Olle Ten; Irby, David M; O'Brien, Bridget C

    2015-11-01

    Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

  9. Medical students’ satisfaction with the Applied Basic Clinical Seminar with Scenarios for Students, a novel simulation-based learning method in Greece

    PubMed Central

    2016-01-01

    Purpose: The integration of simulation-based learning (SBL) methods holds promise for improving the medical education system in Greece. The Applied Basic Clinical Seminar with Scenarios for Students (ABCS3) is a novel two-day SBL course that was designed by the Scientific Society of Hellenic Medical Students. The ABCS3 targeted undergraduate medical students and consisted of three core components: the case-based lectures, the ABCDE hands-on station, and the simulation-based clinical scenarios. The purpose of this study was to evaluate the general educational environment of the course, as well as the skills and knowledge acquired by the participants. Methods: Two sets of questions were distributed to the participants: the Dundee Ready Educational Environment Measure (DREEM) questionnaire and an internally designed feedback questionnaire (InEv). A multiple-choice examination was also distributed prior to the course and following its completion. A total of 176 participants answered the DREEM questionnaire, 56 the InEv, and 60 the MCQs. Results: The overall DREEM score was 144.61 (±28.05) out of 200. Delegates who participated in both the case-based lectures and the interactive scenarios core components scored higher than those who only completed the case-based lecture session (P=0.038). The mean overall feedback score was 4.12 (±0.56) out of 5. Students scored significantly higher on the post-test than on the pre-test (P<0.001). Conclusion: The ABCS3 was found to be an effective SBL program, as medical students reported positive opinions about their experiences and exhibited improvements in their clinical knowledge and skills. PMID:27012313

  10. The Effect of Information About Gynecological Examination on the Anxiety Level of Women Applying to Gynecology Clinics: A Prospective, Randomized, Controlled Study

    PubMed Central

    Ulker, Kahraman; Kivrak, Yuksel

    2016-01-01

    Background: Crowded hospital outpatient clinics and endless waiting lines that make patients feel overlooked tend to exaggerate patients’ anxiety levels. In addition, fear of pain, shyness, religious and traditional thoughts, women’s sexual role in society, and previous information and experience also contribute to people’s anxiety levels with regard to gynecologic examination. Objectives: We aimed to analyze the effect of specific information about gynecologic examination on anxiety levels of women applying to gynecology clinics. Materials and Methods: In this randomized prospective study, the women applying for a gynecological examination were randomly allocated into control, intervention 1, and intervention 2 groups. Power analysis indicated that in order to achieve a one-point decrease from the previous anxiety score of 43.85 ± 5.41 at one side alpha 0.05 with a power of 80%, at least 79 women were needed in each group. Four medical school students interviewed 75 women (25 in control, 25 in intervention 1, and 25 in intervention 2). The data were collected using the demographic, social, and economic data form, and the Turkish version of the state-trait anxiety inventory (STAI). The women in the intervention 1 and 2 groups were instructed to read a paper that contained brief information about the gynecological examination procedure and the profits obtained from forests, respectively. All participants, including the women in the control group, filled the STAI by themselves. The three groups were compared appropriately. Results: The demographics pertaining to age, gravidity and parity, miscarriage, induced abortion, ectopic pregnancy, offspring number, place of residence, working status, education level and previous experience of gynecological examination did not differ among the groups (P > 0.05). According to the STAI scores, all groups had mild state (control: 40.20 ± 10.53, intervention 1: 42.00 ± 11.98, and intervention 2: 39.53 ± 10.32) and severe

  11. Prophylactic vertebroplasty procedure applied with a resorbable bone cement can decrease the fracture risk of sandwich vertebrae: long-term evaluation of clinical outcomes

    PubMed Central

    Jia, Pu; Tang, Hai; Chen, Hao; Bao, Li; Feng, Fei; Yang, He; Li, Jinjun

    2017-01-01

    A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty, which has a risk of developing new fractures. The purpose of our study was to (i) investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to (ii) evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement. From June 2011 to 2014, we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty. Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group. The others were the non-prevention group. All patients were examined by spinal radiographs within 1 day, 6 months, 12 months, 24 months and thereafter. The incidence of sandwich vertebra is 8.25% (55/667) in our study. Most sandwich vertebrae (69.01%, 49/71) are distributed in the thoracic–lumbar junction. There are 24 sandwich vertebrae (18 patients) and 47 sandwich vertebrae (37 patients) in either prevention group or non-prevention group, respectively. No significant difference is found between age, sex, body mass index, bone mineral density, cement disk leakage, sandwich vertebrae distribution or Cobb angle in the two groups. In the follow-up, 8 out of 37 (21.6%) patients (with eight sandwich vertebrae) developed new fractures in non-prevention’ group, whereas no new fractures were detected in the prevention group. Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up. However, in the non-prevention group, we found that Cobb angle increased and vertebral height lost significantly (P < 0.05). Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae. PMID:28149529

  12. Toward Quantitative Whole Organ Thermoacoustics With a Clinical Array Plus One Very Low-Frequency Channel Applied to Prostate Cancer Imaging.

    PubMed

    Patch, Sarah K; Hull, David; See, William A; Hanson, George W

    2016-02-01

    Thermoacoustics has the potential to provide quantitative images of intrinsic tissue properties, most notably electrical conductivity in Siemens/meter, much as shear wave elastography provides tissue stiffness in kilopascal. Although thermoacoustic imaging with optical excitation has been commercialized for small animals, it has not yet made the transition to clinic for whole organ imaging in humans. The purpose of this work was to develop and validate specifications for a clinical ultrasound array for quantitative whole organ thermoacoustic imaging. Imaging a large organ requires exciting thermoacoustic pulses throughout the volume and broadband detection of those pulses because tomographic image reconstruction preserves frequency content. Applying the half-wavelength limit to a [Formula: see text] inclusion inside a 7.5-cm diameter organ requires measurement sensitivity to frequencies ranging from 4 MHz to 10 kHz, respectively. A dual-transducer system utilizing a P4-1 array connected to a Verasonics V1 system as well as a focused single-element transducer sensitive to lower frequencies was developed. Very high-frequency (VHF) irradiation generated thermoacoustic pulses throughout a [Formula: see text] volume. In the VHF regime, electrical conductivity drives thermoacoustic signal production. Simultaneous acquisition of thermoacoustic pulses by both transducers enabled comparison of transducer performance. Data from the clinical array generated a stack of 96 images with a separation of 0.3 mm, whereas the single-element transducer imaged only in a single plane. In-plane resolution and quantitative accuracy were quantified at isocenter. The array provided volumetric imaging capability with superior resolution whereas the single-element transducer provided superior quantitative accuracy in axial images. Combining axial images from both transducers preserved resolution of the P4-1 array and improved image contrast. Neither transducer was sensitive to frequencies

  13. Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients With Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study.

    PubMed

    Karupaiah, Tilakavati; Wong, Kimberly; Chinna, Karuthan; Arasu, Kanimolli; Chee, Winnie Siew Swee

    2015-06-01

    The CORFIS (Community-Based Cardiovascular Risk Factors Intervention Strategies) program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in CORFIS patients with hypertension. Based on submitted diet and exercise records (n = 209), adherence to sodium reduction, regular exercise, and increasing fruit and vegetable intake behaviors were quantified against weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. Patients were categorized at 6 months into nonadherent/N-A (Precontemplation, Contemplation, and Preparation), newly adherent/NA (Action) and totally adherent/TA (Maintenance) groups. Self-reported adherence records did not meet recommended targets for healthful behaviors, but clinical benefits were achieved by adherent groups as indicated by effect size (Cohen's d) comparisons. SBP reduction was associated with adherence to sodium reduction in NA (d = 0.60, p < .001) and TA (d = 0.45, p < .001) compared to N-A (d = 0.13, p > .05). Marginally increasing fruit and vegetable consumption (Δ = 0.41 servings) resulted in sizeable reductions in weight for NA (d = 0.81, p < .001) > TA (d = 0.54, p < .001) > N-A (d = 0.21, p > .05) and in WC for NA (d = 0.68, p < .00) > TA (d = 0.53, p < .001) > N-A (d = 0.52, p > .05). Exercise behavior was least successful as pedometer counting was below 10,000 steps but sizeable weight and WC reductions were largest for NA (d = 0.71 and 0.79, respectively) > TA (d = 0.60 and 0.53, respectively) > N-A (d = 0.33 and 0.35, respectively). Patients reporting a shift to positive stages of change behaviors enjoyed clinically beneficial reductions in SBP, DBP, weight, and WC. © 2014 Society for Public Health Education.

  14. Prospective, randomized, double-blind, clinical evaluation of Aloe vera Barbadensis, applied in combination with a tongue protector to treat burning mouth syndrome.

    PubMed

    López-Jornet, Pia; Camacho-Alonso, Fabio; Molino-Pagan, Diana

    2013-04-01

    The aim of this study was to evaluate the efficacy of aloe vera (AV) applied in combination with a tongue protector, comparing this with a placebo. A total of 75 patients with burning mouth syndrome (BMS) were divided into three groups randomly: Group I (tongue protector three times a day), Group II (tongue protector and 0.5 ml AV at 70% three times a day) and Group III (tongue protector and 0.5 ml placebo three times a day). Symptoms were evaluated by visual analogue scale (VAS), while patient psychological profiles were assessed using the Hospital Anxiety-Depression scale and their quality of life using the Oral Health Impact Profile 49 (OHIP-49). Treatment continued for 3 months. Visual analogue scale pain values improved for all three study groups but without statistically significant differences between the groups (P = 0.210). Regarding quality of life, no significant differences were found between groups with the exception of the OHIP-49 score for handicap. The overall clinical improvement was greater for Group II, with a difference almost reaching significance. The concomitant prescription of tongue protector and AV is effective for treating patients with BMS. © 2012 John Wiley & Sons A/S. All rights reserved.

  15. Validity of the Severity of Dependence Scale (SDS) construct applying the item response theory to a non-clinical sample of heroin users.

    PubMed

    Gonzalez-Saiz, Francisco; Lozano, Oscar M; Ballesta, Rosario; Silva, Teresa; Brugal, Maria Teresa; Bilbao, Izaskun; Barrio, Gregorio; Domingo-Salvany, Antonia; Bravo, Maria Jose; De la Fuente, Luis; Del Proyecto Itinere, Grupo

    2008-01-01

    The purpose of this work is to study the validity of the Severity of Dependence Scale (SDS) construct by applying Rasch models to a non-clinical sample of heroin abusers. 982 (73% men) young people 30 years old or under (mean age 25.9 years) participated. All of them were captured from the community in the metropolitan areas of Madrid, Barcelona and Seville, between April 2002 and December 2003. Dimensionality of the scale and calibration of items were studied using the Rating Scale model, which is a Rasch-type model. A factorial analysis was also performed to check the dimensionality of the scale. The analysis of fit shows that all the items have infit and outfit values between +/- 2 logits, indicating that the data fit the model and that it may be assumed to be unidimensional. The principal components analysis also showed the existence of a principal factor that explains 52.5% of the variance observed. Item calibration found that they are between +0.89 and -1.04 logits on the scale. The results show unidimensional structure of the SDS scale. Item calibration shows they are distributed along the continuum, which must be taken into account when calculating total scores. The study's limitations are noted.

  16. Our Totally Intra-Articular "Needle-Anchor" Tenodesis Technique Applied in Isolated Long Head of the Biceps Tendinopathy: Clinical and Functional Results in 60 Patients.

    PubMed

    Vitali, Matteo; Pedretti, Alberto; Naim Rodriguez, Nadim; Valenti, Mario; Fraschini, Gianfranco

    2016-03-01

    The disorders of the long head of the biceps (LHB) are a common cause of shoulder pain. Among all surgical treatments used to resolve LHB tendon disorders, tenodesis is one of the most frequent.The literature describes many arthroscopic and open surgical techniques, but there is still no general consensus on the standard of care.The purpose of this paper is to describe the clinical and functional outcomes of our totally intra-articular "Needle-Anchor" arthroscopic tenodesis technique applied to isolated LHB tendinopathy. We present a case study of 60 patients with an isolated LHB tendon disorder, treated with our totally intra-articular Needle-Anchor arthroscopic technique between 2011 and 2013.All patients were assessed preoperatively with University of California, Los Angeles (UCLA) and Constant-Murley (CS) shoulder scores and the visual analogue scale (VAS) for subjective pain assessment. Imaging studies were performed through magnetic resonance imaging. Patients were reevaluated with a follow-up at 3 and 12 months with VAS, UCLA, and CS scores.Statistical analysis was performed with the Mann-Whitney score where values of P<0.05 were considered as significant. CS showed a significant (P<0.05) improvement at 3 and 12 months follow-up, 81.54 ± 7.5 and 88.90 ± 5.2, respectively; when compared with preoperative values of 55.14 ± 9.8.Moreover, the UCLA score showed significant improvement (P<0.05) at the same follow-ups with values of 28.49 ± 2.1 and 30.88 ± 1.7, respectively, with preoperative scores of 14.03 ± 2.4.VAS values were significant at both follow-ups, 2.54 ± 0.2 and 0.58 ± 0.08, respectively, when compared with preoperative values of 5.34 ± 0.3. Biceps tenodesis performed with our Needle-Anchor technique applied to selected patients affected by isolated LHB pathology demonstrated to be effective both in terms of pain and functionality. Moreover, the described technique proved to be reliable, safe, time efficient, easily reproducible, and

  17. Effect of Topically-Applied Hyaluronic-Acid on Pain and Palatal Epithelial Wound Healing: An Examiner-Blind, Randomized, Controlled Clinical Trial.

    PubMed

    Yıldırım, Selin; Özener, Hafize Öztürk; Doğan, Başak; Kuru, Bahar

    2017-09-15

    This study aimed to evaluate the effects of two different concentrations of topical hyaluronic-acid on post-operative patient discomfort and wound healing of palatal donor sites following free gingival graft (FGG) surgery. Thirty-six patients requiring FGG were randomly assigned into three groups in an examiner-blind, randomized-controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% hyaluronic-acid gels were used in the test-1 and -2 groups, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups whereas the wound was covered only with periodontal dressing in the control group. On days 3-7-14 and 21, pain and burning sensation were recorded by using visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3-7-14-21-42. Test groups experienced less pain than the control group on days 3 and 7 (P<0.001 and P<0.001, respectively). The mean VAS score for burning sensation was higher in the control group on day 3 compared to the test-1 and -2 groups (P=0.033 and P=0.020, respectively). CE in all patients was achieved on day 21 in both test groups while it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P<0.001 and P<0.001, respectively) and 42 (P=0.004 and P=0.002, respectively). Topical application of hyaluronic-acid exhibits positive impact on post-operative pain, burning sensation and accelerates palatal wound healing in terms of epithelization and color match.

  18. Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population.

    PubMed

    Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

    2013-03-01

    Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VHA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to "diagnose" barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other 4 enrolled in CCHT usual care. Although barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

  19. Chronic disease management for recently homeless Veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population

    PubMed Central

    Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M.; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

    2013-01-01

    Background Though vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a “digital divide” in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Administration (VA) HIT care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. Methods CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to “diagnose” barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Subjects Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other four enrolled in CCHT usual care. Results Though barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. Conclusions HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment. PMID:23407011

  20. Applied Stratigraphy

    NASA Astrophysics Data System (ADS)

    Lucas, Spencer G.

    Stratigraphy is a cornerstone of the Earth sciences. The study of layered rocks, especially their age determination and correlation, which are integral parts of stratigraphy, are key to fields as diverse as geoarchaeology and tectonics. In the Anglophile history of geology, in the early 1800s, the untutored English surveyor William Smith was the first practical stratigrapher, constructing a geological map of England based on his own applied stratigraphy. Smith has, thus, been seen as the first “industrial stratigrapher,” and practical applications of stratigraphy have since been essential to most of the extractive industries from mining to petroleum. Indeed, gasoline is in your automobile because of a tremendous use of applied stratigraphy in oil exploration, especially during the latter half of the twentieth century. Applied stratigraphy, thus, is a subject of broad interest to Earth scientists.

  1. Applied oceanography

    SciTech Connect

    Bishop, J.M.

    1984-01-01

    This book combines oceanography principles and applications such as marine pollution, resources, and transportation. It is divided into two main parts treating the basic principles of physical oceanography, and presenting a unique systems framework showing how physical oceanography, marine ecology, economics, and government policy may be combined to define the newly developing field of applied oceanography.

  2. Applied Enzymology.

    ERIC Educational Resources Information Center

    Manoharan, Asha; Dreisbach, Joseph H.

    1988-01-01

    Describes some examples of chemical and industrial applications of enzymes. Includes a background, a discussion of structure and reactivity, enzymes as therapeutic agents, enzyme replacement, enzymes used in diagnosis, industrial applications of enzymes, and immobilizing enzymes. Concludes that applied enzymology is an important factor in…

  3. Applied Enzymology.

    ERIC Educational Resources Information Center

    Manoharan, Asha; Dreisbach, Joseph H.

    1988-01-01

    Describes some examples of chemical and industrial applications of enzymes. Includes a background, a discussion of structure and reactivity, enzymes as therapeutic agents, enzyme replacement, enzymes used in diagnosis, industrial applications of enzymes, and immobilizing enzymes. Concludes that applied enzymology is an important factor in…

  4. Is the Information about a Test Important? Applying the Methods of Evidence-Based Medicine to the Clinical Examination of Swallowing

    ERIC Educational Resources Information Center

    Rosenbek, John C.; McCullough, Gary H.; Wertz, Robert T.

    2004-01-01

    A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report.…

  5. Is the Information about a Test Important? Applying the Methods of Evidence-Based Medicine to the Clinical Examination of Swallowing

    ERIC Educational Resources Information Center

    Rosenbek, John C.; McCullough, Gary H.; Wertz, Robert T.

    2004-01-01

    A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report.…

  6. Applied Nanotoxicology.

    PubMed

    Hobson, David W; Roberts, Stephen M; Shvedova, Anna A; Warheit, David B; Hinkley, Georgia K; Guy, Robin C

    2016-01-01

    Nanomaterials, including nanoparticles and nanoobjects, are being incorporated into everyday products at an increasing rate. These products include consumer products of interest to toxicologists such as pharmaceuticals, cosmetics, food, food packaging, household products, and so on. The manufacturing of products containing or utilizing nanomaterials in their composition may also present potential toxicologic concerns in the workplace. The molecular complexity and composition of these nanomaterials are ever increasing, and the means and methods being applied to characterize and perform useful toxicologic assessments are rapidly advancing. This article includes presentations by experienced toxicologists in the nanotoxicology community who are focused on the applied aspect of the discipline toward supporting state of the art toxicologic assessments for food products and packaging, pharmaceuticals and medical devices, inhaled nanoparticle and gastrointestinal exposures, and addressing occupational safety and health issues and concerns. This symposium overview article summarizes 5 talks that were presented at the 35th Annual meeting of the American College of Toxicology on the subject of "Applied Nanotechnology." © The Author(s) 2016.

  7. Applied Nanotoxicology

    PubMed Central

    Hobson, David W.; Roberts, Stephen M.; Shvedova, Anna A.; Warheit, David B.; Hinkley, Georgia K.; Guy, Robin C.

    2016-01-01

    Nanomaterials, including nanoparticles and nanoobjects, are being incorporated into everyday products at an increasing rate. These products include consumer products of interest to toxicologists such as pharmaceuticals, cosmetics, food, food packaging, household products, and so on. The manufacturing of products containing or utilizing nanomaterials in their composition may also present potential toxicologic concerns in the workplace. The molecular complexity and composition of these nanomaterials are ever increasing, and the means and methods being applied to characterize and perform useful toxicologic assessments are rapidly advancing. This article includes presentations by experienced toxicologists in the nanotoxicology community who are focused on the applied aspect of the discipline toward supporting state of the art toxicologic assessments for food products and packaging, pharmaceuticals and medical devices, inhaled nanoparticle and gastrointestinal exposures, and addressing occupational safety and health issues and concerns. This symposium overview article summarizes 5 talks that were presented at the 35th Annual meeting of the American College of Toxicology on the subject of “Applied Nanotechnology.” PMID:26957538

  8. A clinical education program for speech-language pathologists applying reflective practice, evidence-based practice and case-based learning.

    PubMed

    Meilijson, Sara; Katzenberger, Irit

    2014-01-01

    This paper presents a comprehensive clinical education program for speech-language pathology students while considering the learning process and gradual acquisition of knowledge and skills for becoming a practicing speech-language pathologist. It describes the clinical speech and language education program for speech-language pathology students at Hadassah Academic College Jerusalem (HAC) based on three facets of learning: reflective practice, evidence-based practice and case-based learning. Also described are the choice of the model of learning and its implementation. The clinical education program presented reflects the professional development of the faculty at HAC as well as recent trends in clinical education methods. © 2015 S. Karger AG, Basel.

  9. Applying Judgment Analysis Theory and Methods to Obtain an Insight Into Clinical Judgments: Implementation and Findings With a Simulated Neonatal Intensive Care Unit Setup.

    PubMed

    Nadler, Izhak; Globus, Omer; Pessach-Gelblum, Liat; Strauss, Zipora; Sela, Rina; Ziv, Amitai

    2016-06-01

    Clinicians who provide acute care are required to quickly identify and judge the illness severity of patients who experience deterioration in their clinical state. Accuracy of judgments can only be tested with respect to a valid reference, but in most health care areas, there is no such score. Judgment analysis theory and methods are presented and proposed as a framework to obtain insight into clinical judgments. A study in a simulated neonatal intensive care unit setup is described to demonstrate the applicability of the proposed methodology. Sixteen participants from a neonatal intensive care unit department reviewed 31 clips of simulated cases. The participants were directed to use a 5-point scale to rate their personal interpretation regarding the illness severity of the simulated patient. Judgment analysis techniques were used to identify the judgment capabilities of the participants and to determine factors that influence those capabilities. Most participants interpreted the clinical signs information consistently, but interpretation varied remarkably between clinicians, providing possible explanation to the differences between the clinicians' judgments. Significant correlations were found between the doctors' years of medical experience and attributes of their judgments. Judgment analysis can be used to obtain insight into clinical judgments and to identify and quantify factors that affect clinicians' judgments. Judgment analysis can promote health care by enhancing clinical assessment teaching, by providing objective and personalized feedback to team members about their judgment performance, and by introducing a unified and objective method to study elements that affect clinical judgments.

  10. Clinical Evaluation of self and professionally applied desensitizing agents in relieving dentin hypersensitivity after a single topical application: A Randomized Controlled Trial

    PubMed Central

    Khatri, Sachin G.; Acharya, Shashidhar

    2014-01-01

    Objectives: The objective of this study is to evaluate the efficacy of self and professionally applied desensitizing agents in relieving dentinal hypersensitivity after single direct topical application. Study Design: This was a randomized controlled trial conducted among 57 patients. 8% Arginine paste was self-applied by the subject and Gluma desensitizer was applied by investigator. Numeric rating scale was used to measure hypersensitivity after tactile stimulus, Schiff scale was used for cold and air blast stimuli respectively. Scores were recorded at baseline, immediately, 15 and 30 days after the application. Friedman, Wilcoxon test as post hoc was used to analyze within group differences, between group differences analyzed using Mann Whitney U test (P<0.05 considered significant). Results: 8% Arginine paste elicited significantly higher reductions in sensitivity (P<0.05) than that of Gluma group at all follow ups. There was a significant decrease in hypersensitivity for both the groups from baseline till final follow-up (P<0.05) for all three stimuli. 8% Arginine paste was found to be more effective than Gluma desensitizer in providing immediate relief from dentine hypersensitivity and also sustained the effect significantly for a period of 30 days. Conclusions: Self applied 8% Arginine paste is effective than professionally applied Gluma desensitizer in relieving dentinal hypersensitivity immediately and over a period of one month. Key words:Dentine hypersensitivity, arginine, gluma, desensitizing agents. PMID:25593653

  11. Applied Geophysics

    NASA Astrophysics Data System (ADS)

    Telford, W. M.; Geldart, L. P.; Sheriff, R. E.

    1990-10-01

    Completely revised and updated, this new edition of the popular and highly regarded textbook, Applied Geophysics, describes the physical methods involved in exploration for hydrocarbons and minerals. These tools include gravity, magnetic, seismic, electrical, electromagnetic, and radioactivity studies. All aspects of these methods are described, including theoretical considerations, data acquisition, and data processing and interpretation, with the objective of locating concentrations of natural resources and defining their extent. In the past fourteen years or so since the writing of Applied Geophysics, there have been many changes in the field of exploration geophysics. The authors give full treatment to changes in this field, which include improved techniques for calculating gravity fields, the use of proton-precession and optically-pumped magnetometers, improved quality of seismic data, magnetotelluric as a practical exploration method, new electromagnetic exploration methods, the use of gamma-ray spectrometers in radioactive exploration, and improved well-logging techniques. The intent is to be practical, and thus many actual examples and problems are given. Moreover, wherever possible in this edition the authors adopt the use of Système Internationale (SI) units, which were not in standared use at the time of the first edition. The reader needs only a general background knowledge of geology, physics, and mathematics. Most of the math can be skipped by those interested only in the results. Advanced mathematical concepts are explained in the appendix.

  12. A Randomized Clinical Trial Comparison between Pivotal Response Treatment (PRT) and Structured Applied Behavior Analysis (ABA) Intervention for Children with Autism

    ERIC Educational Resources Information Center

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaee, Mohammad; Rafiee, Seyed Majid

    2014-01-01

    Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two applied behavior analysis (ABA) intervention procedures, a…

  13. Applied geodesy

    SciTech Connect

    Turner, S.

    1987-01-01

    This volume is based on the proceedings of the CERN Accelerator School's course on Applied Geodesy for Particle Accelerators held in April 1986. The purpose was to record and disseminate the knowledge gained in recent years on the geodesy of accelerators and other large systems. The latest methods for positioning equipment to sub-millimetric accuracy in deep underground tunnels several tens of kilometers long are described, as well as such sophisticated techniques as the Navstar Global Positioning System and the Terrameter. Automation of better known instruments such as the gyroscope and Distinvar is also treated along with the highly evolved treatment of components in a modern accelerator. Use of the methods described can be of great benefit in many areas of research and industrial geodesy such as surveying, nautical and aeronautical engineering, astronomical radio-interferometry, metrology of large components, deformation studies, etc.

  14. Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.

    PubMed

    Fischman, Daniel

    2010-01-01

    Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care. Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other. This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

  15. Comparison of Clinical Success of Applying a Kind of Fissure Sealant on the Lower Permanent Molar Teeth in Dry and Wet Conditions

    PubMed Central

    Eskandarian, Tahereh; Baghi, Saeid; Alipoor, Abbas

    2015-01-01

    Statement of the Problem Fissure sealant therapy is among the most effective methods of preventing dental caries. However, it is lengthy and isolation of the teeth is difficult in this procedure especially in young children. Using new hydrophilic fissure sealant may reduce such problems. Purpose This study aimed to evaluate the clinical success of a hydrophilic fissure sealant on the lower permanent molar teeth in dry and wet conditions. Materials and Method This clinical trial assessed 31 patients (mean age 8.13±1.77 years) who needed fissure sealant therapy on their first or second mandibular permanent molar. Having performed dental prophylaxis, the teeth were etched and rinsed. Then one of the two was randomly selected and sealed with smartseal & loc in isolated and dry conditions; while, the other was wetted on the etched enamel by using a saliva-contaminated micro brush, and was then sealed with the same fissure as the first tooth. Six and 12 months later, two independent observers examined the clinical success of sealant through checking the marginal integrity, marginal discoloration, and anatomical form. Data were analyzed by using SPSS software, version 16. The bivariate Chi-square and Exact Fisher tests were used to compare the clinical success of the two treatment methods. Results There was a high interpersonal reliability between the two examiners (K= 0.713). After 12 months, 90.3% clinical success was observed in dry conditions and 83.9% in wet conditions for smartseal & loc; however, the difference was not statistically significant (p= 0.0707). Conclusion According to the results of this study, it seems that using new hydrophilic fissure sealant can reduce technical sensitivities and consequently decreases the apprehensions on saliva contamination of etched enamel during treatment procedures. PMID:26331144

  16. Overcoming the problem of diagnostic heterogeneity in applying measurement-based care in clinical practice: the concept of psychiatric vital signs.

    PubMed

    Zimmerman, Mark; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy; Galione, Janine N

    2012-02-01

    Measurement-based care refers to the use of standardized scales to measure the outcome of psychiatric treatment. Diagnostic heterogeneity poses a challenge toward the adoption of a measurement-based care approach toward outcome evaluation in clinical practice. In the present article, we propose adopting the concept of psychiatric vital signs to facilitate measurement-based care. Medical vital signs are measures of basic physiologic functions that are routinely determined in medical settings. Vital signs are often a primary outcome measure, and they are also often adjunctive measurements. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the frequency of depression and anxiety in a diagnostically heterogeneous group of psychiatric outpatients to determine the appropriateness of considering their measurement as psychiatric vital signs. Three thousand psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV supplemented with items from the Schedule for Affective Disorders and Schizophrenia. We determined the frequency of depression and anxiety evaluated according to the Schedule for Affective Disorders and Schizophrenia items. In the entire sample of 3000 patients, 79.3% (n = 2378) reported clinically significant depression of at least mild severity, 64.4% (n = 1932) reported anxiety of at least mild severity, and 87.4% (n = 2621) reported either anxiety or depression. In all 10 diagnostic categories examined, most patients had clinically significant anxiety or depression of at least mild severity. These findings support the routine assessment of anxiety and depression in clinical practice because almost all patients will have these problems as part of their initial presentation. Even for those patients without depression or anxiety, the case could be made that the measurement of depression and anxiety is relevant and analogous to measuring certain physiologic

  17. Applying a Real-Time PCR Assay for Histoplasma capsulatum to Clinically Relevant Formalin-Fixed Paraffin-Embedded Human Tissue

    PubMed Central

    Koepsell, Scott A.; Hinrichs, Steven H.

    2012-01-01

    A real-time PCR assay to detect Histoplasma capsulatum in formalin-fixed, paraffin-embedded (FFPE) tissue is described. The assay had an analytical sensitivity of 6 pg/μl of fungal DNA, analytical specificity of 100%, and clinical sensitivity of 88.9%. This proof-of-concept study may aid in the diagnosis of histoplasmosis from FFPE tissue. PMID:22855519

  18. Systematic Care Management: A Comprehensive Approach to Catastrophic Injury Management Applied to a Catastrophic Burn Injury Population - Clinical, Utilization, Economic, and Outcome Data in Support of the Model

    DTIC Science & Technology

    2010-10-01

    pected neonatal sepsis : a costly problem in neonatal intensive care. J Perinatol 2005;25:265–9. 15. Fetteroff D, Holt AE, Tucker T, Khan K...clinical factors that also commonly impacted the health status of the patients included pneumonia (38%), sepsis (31%), inhalation injury (19%), adult... neonates , end of life care, and complex cancers).13–15 With the evolution of health care reforms and the health care system, it will be increasingly

  19. Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact.

    PubMed

    Prange-Lasonder, Gerdienke B; Radder, Bob; Kottink, Anke I R; Melendez-Calderon, Alejandro; Buurke, Jaap H; Rietman, Johan S

    2017-07-01

    Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance 'lifting full cans' in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.

  20. Guidelines of the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections: As Applied to Oral and Maxillofacial Clinical Practice.

    PubMed

    Bhargava, Darpan; Deshpande, Ashwini; Sreekumar, K; Koneru, Ganesh; Rastogi, Shobhit

    2013-09-01

    The purpose of this paper was to undertake a systematic review of literature on methicillin-resistant Staphylococcus aureus infections in oral and maxillofacial online data-bases and discuss the Infectious Diseases Society of America (IDSA) guidelines and its applications in maxillofacial clinical practice. The available literature in oral and maxillofacial online databases was searched. The only inclusion criterion was to review published reports, abstracts and retrospective studies with emphasis on the treatment of clinical cases with methicillin-resistant S. aureus infections. Clinical Practice Guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant S. aureus infections in adults and children was reviewed and included in the study. Out of 18 articles found with the search terms "Methicillin-resistant S. aureus" and "MRSA" in the online databases 12 articles met the inclusion criteria for this study. The relevant data was extracted and tabulated. Conclusions were drawn and discussed based on the reviewed maxillofacial literature and the Guidelines by the IDSA.

  1. Additional notes on clinical repeated-dose pharmacokinetic trials applying a peak-and-trough sampling design to estimate oral clearance.

    PubMed

    Takaai, Mari; Kayano, Yuichiro; Shimizu, Takako; Taguchi, Masato; Hashimoto, Yukiya

    2008-01-01

    In the previous study, we performed a simulation of a clinical pharmacokinetic trial, in which blood was sampled at two time points corresponding to the peak concentration (C(peak)) and trough concentration (C(trough)) following repetitive oral administration at the dose, D, and dosing interval, tau. The approximate oral clearance (CL/F(approx)), estimated as 2 x D/(C(peak) x tau+C(trough) x tau), is accurate for drugs with an elimination half-life comparative to or longer than tau; however, it was suggested that we might not use CL/F(approx) for drugs with a considerably short elimination half-life relative to tau. In the present study, we evaluated the accuracy of the alternative oral clearance (CL/F(exp)) estimated by the simple monoexponential model. In contrast to CL/F(approx), CL/F(exp) was accurate for drugs with a short elimination half-life relative to tau. The present finding in conjunction with our previous study suggested that the peak-and-trough sampling design is promising for the clinical repeated-dose pharmacokinetic trial for drugs with not only slow but also rapid elimination from the body. We think that the accuracy and precision of the two analysis methods to estimate oral clearance (CL/F(approx) and CL/F(exp)) for a target drug should be evaluated carefully before and after a real clinical trial.

  2. Using Anatomic Magnetic Resonance Image Information to Enhance Visualization and Interpretation of Functional Images: A Comparison of Methods Applied to Clinical Arterial Spin Labeling Images.

    PubMed

    Zhao, Li; Dai, Weiying; Soman, Salil; Hackney, David B; Wong, Eric T; Robson, Philip M; Alsop, David C

    2017-02-01

    Functional imaging provides hemodynamic and metabolic information and is increasingly being incorporated into clinical diagnostic and research studies. Typically functional images have reduced signal-to-noise ratio and spatial resolution compared to other non-functional cross sectional images obtained as part of a routine clinical protocol. We hypothesized that enhancing visualization and interpretation of functional images with anatomic information could provide preferable quality and superior diagnostic value. In this work, we implemented five methods (frequency addition, frequency multiplication, wavelet transform, nonsubsampled contourlet transform and intensity-hue-saturation) and a newly proposed ShArpening by Local Similarity with Anatomic images (SALSA) method to enhance the visualization of functional images, while preserving the original functional contrast and quantitative signal intensity characteristics over larger spatial scales. Arterial spin labeling blood flow MR images of the brain were visualization enhanced using anatomic images with multiple contrasts. The algorithms were validated on a numerical phantom and their performance on images of brain tumor patients were assessed by quantitative metrics and neuroradiologist subjective ratings. The frequency multiplication method had the lowest residual error for preserving the original functional image contrast at larger spatial scales (55%-98% of the other methods with simulated data and 64%-86% with experimental data). It was also significantly more highly graded by the radiologists (p<0.005 for clear brain anatomy around the tumor). Compared to other methods, the SALSA provided 11%-133% higher similarity with ground truth images in the simulation and showed just slightly lower neuroradiologist grading score. Most of these monochrome methods do not require any prior knowledge about the functional and anatomic image characteristics, except the acquired resolution. Hence, automatic implementation on

  3. [Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year].

    PubMed

    Tárraga Marcos, M L; Panisello Royo, J M; Carbayo Herencia, J A; Rosich Domenech, N; Alins Presas, J; Castell Panisello, E; Tárraga López, P J

    2017-09-12

    To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Microbiological features of vancomycin in the 21st century: minimum inhibitory concentration creep, bactericidal/static activity, and applied breakpoints to predict clinical outcomes or detect resistant strains.

    PubMed

    Jones, Ronald N

    2006-01-01

    The results of vancomycin susceptibility tests document that the drug continues to have activity against a wide variety of gram-positive pathogens. The subsequent emergence of vancomycin-resistant enterococci, the persistent failure of vancomycin therapy against strains tested as susceptible, and the more recent discoveries of vancomycin-intermediate or -resistant Staphylococcus aureus strains have compromised the use of vancomycin. Although analyses of surveillance studies fail to demonstrate "minimum inhibitory concentration creep" among populations of wild-type enterococci, streptococci, or staphylococci, enterococci with acquired resistance to vancomycin continue to evolve. The dominantly used automated commercial tests poorly recognize vancomycin-intermediate S. aureus, heteroresistant vancomycin-intermediate S. aureus, and vancomycin-resistant S. aureus isolates, which necessitates the use of expensive supplemental screening tests. Monitoring for appropriate serum levels of vancomycin and determinations of the bactericidal activity of vancomycin appear to best predict clinical outcome, thus creating additional diagnostic burdens for clinical laboratories. Improvements in current test methods with breakpoint criteria and expanded use of the vancomycin bactericidal assays to detect "tolerant" strains will be required to increase the value of vancomycin treatment or to refocus therapy toward the use of newer, alternative agents.

  5. Applied breath analysis: an overview of the challenges and opportunities in developing and testing sensor technology for human health monitoring in aerospace and clinical applications

    PubMed Central

    Hunter, Gary W; Dweik, Raed A

    2010-01-01

    The aerospace industry requires the development of a range of chemical sensor technologies for such applications as leak detection, emission monitoring, fuel leak detection, environmental monitoring, and fire detection. A family of chemical sensors are being developed based on micromachining and microfabrication technology to fabricate microsensors with minimal size, weight, and power consumption, and the use of nanomaterials and structures to develop sensors with improved stability combined with higher sensitivity. However, individual sensors are limited in the amount of information that they can provide in environments that contain multiple chemical species. Thus, sensor arrays are being developed to address detection needs in such multi-species environments. These technologies and technical approaches have direct relevance to breath monitoring for clinical applications. This paper gives an overview of developing cutting-edge sensor technology and possible barriers to new technology implementation. This includes lessons learned from previous microsensor development, recent work in development of a breath monitoring system, and future directions in the implementation of cutting edge sensor technology. Clinical applications and the potential impact to the biomedical field of miniaturized smart gas sensor technology are discussed. PMID:20622933

  6. Application of the threshold of toxicological concern concept when applied to pharmaceutical manufacturing operations intended for short-term clinical trials.

    PubMed

    Bercu, Joel P; Dolan, David G

    2013-02-01

    In the manufacture of pharmaceuticals, if a multiproduct facility shares equipment amongst drug substances/products it is incumbent upon the manufacturer to demonstrate removal of the pharmaceutical through a robust cleaning validation/verification program. Removal must be to below limits considered acceptable from a quality and toxicological perspective. In order to address the toxicological concerns, an acceptable daily exposure (ADE) was developed which is the "dose that is unlikely to cause an adverse effect if...exposed, by any route...at or below this dose every day for a lifetime" (ISPE, 2010). For compounds in development, defaulted ADEs were proposed by Dolan et al. (2005) and adopted by the International Society of Pharmaceutical Engineers (ISPE) as conservative cutoffs for compounds with limited data. In Phase 1 clinical trials, exposure is typically short-term (single dose or repeated doses for ≤30 days) compared to the chronic doses used to derive ADE and defaulted ADEs. An analysis of publicly available databases for toxicological and pharmacological effects supports the use of 10-fold higher defaulted values when the residual drug substance is in a developmental pharmaceutical intended for Phase 1 clinical trials (exposure ≤30 days). Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Applied breath analysis: an overview of the challenges and opportunities in developing and testing sensor technology for human health monitoring in aerospace and clinical applications.

    PubMed

    Hunter, Gary W; Dweik, Raed A

    2008-09-01

    The aerospace industry requires the development of a range of chemical sensor technologies for such applications as leak detection, emission monitoring, fuel leak detection, environmental monitoring, and fire detection. A family of chemical sensors are being developed based on micromachining and microfabrication technology to fabricate microsensors with minimal size, weight, and power consumption, and the use of nanomaterials and structures to develop sensors with improved stability combined with higher sensitivity. However, individual sensors are limited in the amount of information that they can provide in environments that contain multiple chemical species. Thus, sensor arrays are being developed to address detection needs in such multi-species environments. These technologies and technical approaches have direct relevance to breath monitoring for clinical applications. This paper gives an overview of developing cutting-edge sensor technology and possible barriers to new technology implementation. This includes lessons learned from previous microsensor development, recent work in development of a breath monitoring system, and future directions in the implementation of cutting edge sensor technology. Clinical applications and the potential impact to the biomedical field of miniaturized smart gas sensor technology are discussed.

  8. Applying Behavior Change Theories and Qualitative Methods in Substance Misuse Implementation Research: Conceptualizing the Adoption of Breaking Free Online in Real-World Clinical Practice.

    PubMed

    Dugdale, Stephanie; Elison, Sarah; Davies, Glyn; Ward, Jonathan

    2017-06-01

    There is insufficient research examining the implementation of complex novel interventions within health care. This may be due to a lack of qualitative research providing subjective insights into these implementation processes. The authors investigate the advantages of applying behavior change theories to conceptualize qualitative data describing the processes of implementation of complex interventions. Breaking Free Online (BFO), a digital treatment intervention for substance misuse, is described as an example of a complex intervention. The authors review previous qualitative research which explored initial diffusion, or spread, of the BFO program, and its subsequent normalization as part of standard treatment for substance misuse within the health and social care charity, "Change, Grow, Live" (CGL). The use of behavior change models to structure qualitative interview findings enabled identification of facilitators and barriers to the use of BFO within CGL. These findings have implications for the development of implementation research in novel health care interventions.

  9. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

    PubMed Central

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

    2015-01-01

    Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with a structured ABA approach on disruptive behavior during language intervention in the public schools. A Randomized Clinical Trial (RCT) design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior. PMID:25953148

  10. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism.

    PubMed

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

    2015-09-01

    Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

  11. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Structured Applied Behavior Analysis (ABA) Intervention for Children with Autism

    PubMed Central

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaee, Mohammad; Rafiee, Seyed Majid

    2014-01-01

    Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two ABA intervention procedures, a naturalistic approach, Pivotal Response Treatment (PRT) with a structured ABA approach in a school setting. A Randomized Clinical Trial design using two groups of children, matched according to age, sex and mean length of utterance was used to compare the interventions. The data showed that the PRT approach was significantly more effective in improving targeted and untargeted areas after three months of intervention. The results are discussed in terms of variables that produce more rapid improvements in communication for children with ASD. PMID:24840596

  12. Applied investigation of person-specific and context-specific factors on postoperative recovery and clinical outcomes of patients undergoing gastrointestinal cancer surgery: multicentre European study

    PubMed Central

    Markar, Sheraz R; Mavroveli, Stella; Petrides, Konstantinos V; Scarpa, Marco; Christophe, Veronique; Castoro, Carlo; Mariette, Christophe; Lagergren, Pernilla; Hanna, George B

    2016-01-01

    Introduction Cancer treatments have greatly advanced over the past two decades causing survival improvements and reduced complications from cancer surgery. However, the cancer diagnosis and the effects of treatment modalities pose a major risk to patients' psychological well-being. Given current interest and emerging evidence about the importance of psychological and social factors on cancer survival and coping with cancer treatments, this study will build and expand research in order to identify key modifiable psychosocial variables that contribute to better physical and mental health following gastrointestinal cancer (GIC) surgery. Objectives To elucidate the incidence of postoperative psychiatric morbidity within 6 months following GIC surgery. To identify key measurable modifiable preoperative psychological factors that can significantly affect postoperative psychiatric morbidity in patients undergoing surgery for GIC. To clarify the changes seen in a patient's psychological well-being during their treatment pathway for GIC. Methods and analysis This multicentre study has an observational longitudinal study design. In total, 1000 patients will be screened with a multicomponent psychological questionnaire at four different time points: at diagnosis, preoperatively, 1 and 6 months after surgery. Data from this questionnaire will be linked to postoperative complications including psychiatric morbidity, length of hospital stay and recovery to normal activity. Ethics and dissemination NHS Health Research Authority approval was gained on (REC reference 15.LO/1847) for the completion of this study. Multiple platforms will be used for the dissemination of the research data, including international clinical and patient group presentations and publication of research outputs in a high impact clinical journal. PMID:27798009

  13. PSYCHOANALYSIS AS APPLIED AESTHETICS.

    PubMed

    Richmond, Stephen H

    2016-07-01

    The question of how to place psychoanalysis in relation to science has been debated since the beginning of psychoanalysis and continues to this day. The author argues that psychoanalysis is best viewed as a form of applied art (also termed applied aesthetics) in parallel to medicine as applied science. This postulate draws on a functional definition of modernity as involving the differentiation of the value spheres of science, art, and religion. The validity criteria for each of the value spheres are discussed. Freud is examined, drawing on Habermas, and seen to have erred by claiming that the psychoanalytic method is a form of science. Implications for clinical and metapsychological issues in psychoanalysis are discussed. © 2016 The Psychoanalytic Quarterly, Inc.

  14. Applying Joint Mobilization at Different Cervical Vertebral Levels does not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomized Clinical Trial

    PubMed Central

    Aquino, Rafaela L; Caires, Priscila M; Furtado, Fernanda C; Loureiro, Aline V; Ferreira, Paulo H; Ferreira, Manuela L

    2009-01-01

    The aim of the present study was to compare the effects of applying joint mobilization at symptomatic and asymptomatic cervical levels in patients with chronic nonspecific neck pain. Forty-eight patients aged between 18 and 65 years and presenting nonspecific neck pain with a minimum duration of 3 months were recruited for the study. Included patients were randomized to one of two treatment groups: (i) control group: the most symptomatic vertebral level was mobilized; (ii) experimental group: a randomly selected vertebral level was chosen and mobilized. All patients received one treatment session. Pain intensity in resting position during the most painful active cervical movement as well as during vertebral palpation was quantified using an 11-point pain scale. Follow-up measures were taken immediately after intervention by a blinded assessor. The results showed no significant difference in pain intensity immediately after treatment between groups (symptomatic level treated vs. randomly chosen cervical vertebral level treated) during resting position, painful active movement, or vertebral palpation. Within-group comparisons showed significant pain relief after treatment during the most painful active movement as well as during vertebral palpation for both groups, but not during resting position. Significant change in immediate pain intensity during painful active movement and vertebral palpation was achieved after vertebral mobilization. however, both groups presented similar pain reductions suggesting that pain reduction due to joint mobilization is not specific to the vertebral level being mobilized. PMID:20046551

  15. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice.

    PubMed

    Grimshaw, Jeremy M; Eccles, Martin P; Steen, Nick; Johnston, Marie; Pitts, Nigel B; Glidewell, Liz; Maclennan, Graeme; Thomas, Ruth; Bonetti, Debbie; Walker, Anne

    2011-05-28

    Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance explained by individual

  16. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice

    PubMed Central

    2011-01-01

    Background Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Methods Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Results Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance

  17. Histomorhological and clinical evaluation of maxillary alveolar ridge reconstruction after craniofacial trauma by applying combination of allogeneic and autogenous bone graft.

    PubMed

    De Ponte, Francesco Saverio; Falzea, Roberto; Runci, Michele; Siniscalchi, Enrico Nastro; Lauritano, Floriana; Bramanti, Ennio; Cervino, Gabriele; Cicciu, Marco

    2017-02-01

    A variety of techniques and materials for the rehabilitation and reconstruction of traumatized maxillary ridges prior to dental implants placement have been described in literature. Autogenous bone grafting is considered ideal by many researchers and it still remains the most predictable and documented method. The aim of this report is to underline the effectiveness of using allogeneic bone graft for managing maxillofacial trauma. A case of a 30-year-old male with severely atrophic maxillary ridge as a consequence of complex craniofacial injury is presented here. Augmentation procedure in two stages was performed using allogeneic and autogenous bone grafts in different areas of the osseous defect. Four months after grafting, during the implants placement surgery, samples of both sectors were withdrawn and submitted to histological evaluation. On the examination of the specimens, treated by hematoxylin and eosin staining, the morphology of integrated allogeneic bone grafts was revealed to be similar to the autologous bone. Our clinical experience shows how the allogeneic bone graft presented normal bone tissue architecture and is highly vascularized, and it can be used for reconstruction of severe trauma of the maxilla.

  18. A randomized clinical trial of the efficacy of applying a simple protocol of boiled Anethum Graveolens seeds on pain intensity and duration of labor stages.

    PubMed

    Hekmatzadeh, Seyedeh Fatemeh; Bazarganipour, Fatemeh; Malekzadeh, Jonmohamad; Goodarzi, Fatemeh; Aramesh, Shahintaj

    2014-12-01

    This study aimed to test the effects of boiled Anethum Graveolens seeds on pain intensity and duration of labor stages. A randomized clinical trial was conducted on 153 eligible participants who had regular uterine contractions. Participants were allocated to either intervention or control group receiving boiled Anethum Graveolens seeds or routine care, respectively. Preparation of Anethum Graveolens boiled solution was as follows: 10g (two tablespoons) of seed in 100cc water boiled for 10min. After filtration, this solution used by intervention group only once after starting active phase (3-4cm of cervix dilatation). Participants were followed up to the delivery time. Data were analyzed using T, and Chi square tests. Findings showed that the length of the all stages of labor were significantly lower in intervention compared to control group in except for second stage in primiparous. The second stage of labor in primiparous participants in intervention group was shorter than control group, although the difference is not significant. Moreover, intervention group had a significantly better dilatation and effacement scores after 1, 2, 3 and 4h following the intervention compared to control group. Results supported the boiled Anethum Graveolens seeds as an effective way to progress of the labor. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Efficacy and safety of topically applied Symphytum herb extract cream in the treatment of ankle distortion: results of a randomized controlled clinical double blind study.

    PubMed

    Kucera, Miroslav; Barna, Milos; Horácek, Ondrej; Kováriková, Jaroslava; Kucera, Alexander

    2004-11-01

    In a controlled, double blind, randomized multicentre study, the efficacy and safety of the topical comfrey product Traumaplant (10% active ingredient of a 2.5:1 aqueous ethanolic pressed juice of freshly harvested, cultivated comfrey herb (Symphytum x uplandicum NYMAN), corresponding to 25 g of fresh herb per 100 g of cream; n = 104) was tested against a 1% product (corresponding to 2.5 g of fresh comfrey herb in 100 g of cream; n = 99) in 203 patients with acute ankle distortion. With the high concentration, decrease of the scores for pain on active motion, pain at rest and functional impairment was highly significant and clinically relevant on days T3-4 as well as T7 (p < 0.001). Amelioration of swellings as compared to reference was also significant on day 3-4 (p < 0.01). Efficacy was judged good to excellent in 85.6% of cases with verum and in 65.7% of cases with reference on day 3-4. Overall tolerability was excellent.

  20. Boosting Quality Registries with Clinical Decision Support Functionality*. User Acceptance of a Prototype Applied to HIV/TB Drug Therapy.

    PubMed

    Wannheden, Carolina; Hvitfeldt-Forsberg, Helena; Eftimovska, Elena; Westling, Katarina; Ellenius, Johan

    2017-08-11

    The care of HIV-related tuberculosis (HIV/TB) is complex and challenging. Clinical decision support (CDS) systems can contribute to improve quality of care, but more knowledge is needed on factors determining user acceptance of CDS. To analyze physicians' and nurses' acceptance of a CDS prototype for evidence-based drug therapy recommendations for HIV/TB treatment. Physicians and nurses were involved in designing a CDS prototype intended for future integration with the Swedish national HIV quality registry. Focus group evaluation was performed with ten nurses and four physicians, respectively. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to analyze acceptance. We identified several potential benefits with the CDS prototype as well as some concerns that could be addressed by redesign. There was also concern about dependence on physician attitudes, as well as technical, organizational, and legal issues. Acceptance evaluation at a prototype stage provided rich data to improve the future design of a CDS prototype. Apart from design and development efforts, substantial organizational efforts are needed to enable the implementation and maintenance of a future CDS system.

  1. Clinical update: transendoscopic laser surgery for treatment of epiglottic entrapment: Nd:YAG and 808-nm diode laser applied individually and in combination

    NASA Astrophysics Data System (ADS)

    Tate, Lloyd P.; Tudor, R. A.

    1999-06-01

    Hospital records reviewed from 1986-1998 determined that 18 horses were presented for correction of epiglottic entrapment by the aryepiglottic fold. All horses had a history of an abnormal respiratory noise and/or exercise intolerance. In conjunction with epiglottic entrapment, 10 horses had dorsal displacement of the soft palate. Initial confirmation of the epiglottic entrapment was made by endoscopic examination. In addition, 3 horses had radiographs taken of the larynx and pharyngeal region to determine the length of the epiglottis.Laser surgical treatment was performed on the horses in a standing position under sedation. The treatment consisted of axially dividing the aryepiglottic fold from the base of the epiglottis to the tip or beyond by means of a laser fiber introduced through the biopsy channel of an endoscope. The Nd:YAG laser was applied transendoscopically to 11 horses using free fiber technique. Three horses received transendoscopic laser correction using the 808-nm diode laser with the fiber in contact configuration. A combination of both 808-nm diode laser and Nd:YAG lasers were used to facilitate correction in the last 4 horses. Partial re-entrapment occurred in 2 out of the 3 cases in which the 808-nm diode laser was used as a single modality for correction. This did not occur in the horses that received either the Nd:YAG laser treatment or Nd:YAG laser treatment in combination with the 808-nm diode laser. Horses that received either 808-nm diode laser irradiation alone or 808-nm diode laser irradiation in combination with Nd:YAG laser appeared to have less swelling than those that received only Nd:YAG irradiation.

  2. Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

    PubMed Central

    2011-01-01

    Background The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and

  3. MO-G-BRE-05: Clinical Process Improvement and Billing in Radiation Oncology: A Case Study of Applying FMEA for CPT Code 77336 (continuing Medical Physics Consultation)

    SciTech Connect

    Spirydovich, S; Huq, M

    2014-06-15

    Purpose: The improvement of quality in healthcare can be assessed by Failure Mode and Effects Analysis (FMEA). In radiation oncology, FMEA, as applied to the billing CPT code 77336, can improve both charge capture and, most importantly, quality of the performed services. Methods: We created an FMEA table for the process performed under CPT code 77336. For a given process step, each member of the assembled team (physicist, dosimetrist, and therapist) independently assigned numerical values for: probability of occurrence (O, 1–10), severity (S, 1–10), and probability of detection (D, 1–10) for every failure mode cause and effect combination. The risk priority number, RPN, was then calculated as a product of O, S and D from which an average RPN was calculated for each combination mentioned above. A fault tree diagram, with each process sorted into 6 categories, was created with linked RPN. For processes with high RPN recommended actions were assigned. 2 separate R and V systems (Lantis and EMR-based ARIA) were considered. Results: We identified 9 potential failure modes and corresponding 19 potential causes of these failure modes all resulting in unjustified 77336 charge and compromised quality of care. In Lantis, the range of RPN was 24.5–110.8, and of S values – 2–10. The highest ranking RPN of 110.8 came from the failure mode described as “end-of-treatment check not done before the completion of treatment”, and the highest S value of 10 (RPN=105) from “overrides not checked”. For the same failure modes, within ARIA electronic environment with its additional controls, RPN values were significantly lower (44.3 for end-of-treatment missing check and 20.0 for overrides not checked). Conclusion: Our work has shown that when charge capture was missed that also resulted in some services not being performed. Absence of such necessary services may result in sub-optimal quality of care rendered to patients.

  4. “Outside-in” Technique, Clinical Results, and Indications with Transforaminal Lumbar Endoscopic Surgery: a Retrospective Study on 220 Patients on Applied Radiographic Classification of Foraminal Spinal Stenosis

    PubMed Central

    2014-01-01

    Objective To analyze and describe appropriate surgical indications for endoscopically performed transforaminal decompression with the outside-in technique with foraminoplasty in patients with lateral stenosis with and without herniated disc. Background and Significance Endoscopic microdiscectomy is growing in popularity for the removal of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression as well. Materials and Methods A retrospective study of 220 consecutive patients undergoing percutaneous endoscopic transforaminal foraminoplasty and microdiscectomy at 228 levels was conducted with intent of identifying appropriate surgical indications in patients with monoradiculopathy. The mean follow up was 46 months ranging from 26 to 54 months. Preoperatively, foraminal and lateral recess stenosis was graded on preoperative MRI and CT scans by dividing the lumbar neuroforamen into three zones: a) entry zone, b) middle zone, and c) exit zone. In addition, the presence of disc herniation causing neural element compression in the lateral recess and neuroforamen was noted. Disc herniations, if present, were recorded as either extruded and contained disc herniations. Surgical outcomes were classified according to the Macnab criteria. In addition, reductions in VAS scores were assessed. Results According to the Macnab criteria, excellent and good results were obtained in 85% (186/220) of patients with monoradiculopathy. The mean VAS score decreased from 7.5 ± 1.5 preoperatively to 2.8 ± 1.9 at the final follow-up (P < 0.01). Concomitant extruded disc herniations and contained disc bulges were recorded in 24 and 82 patients, respectively. There were no approach-related complications. Clinical failures occurred in patients with bony stenosis in the lateral recess and entry zone of the neuroforamen. Less favorable outcomes were observed in patients with concomitant contained disc herniations when

  5. Mentoring concepts applied to clinical practice.

    PubMed

    Parker, D

    1992-08-01

    An alternative to traditional forms of orientation using mentoring or related concepts is one possible solution to motivate and inspire nurses during a time when this profession is faced with nursing shortages and burnout. This article will address the advantages and disadvantages to mentoring based on a literature review and personal experience.

  6. Applying Clinical Neuropsychology in the Public Schools.

    ERIC Educational Resources Information Center

    Federhar, David B.

    Neuropsychology is an area in which the functioning or integrity of the brain is linked to measurable human behavior. This paper describes the use of the Reitan batteries (Reitan and Davison; 1974) in public school settings for documenting and prescribing appropriate academic programs. Three individual case studies are presented. Case 1 is a 16…

  7. Studies on corrosion resistance and bio-activity of plasma spray deposited hydroxylapatite (HA) based TiO2 and ZrO2 dispersed composite coatings on titanium alloy (Ti-6Al-4V) and the same after post spray heat treatment

    NASA Astrophysics Data System (ADS)

    Kumari, Renu; Majumdar, Jyotsna Dutta

    2017-10-01

    In the present study, the effect of plasma spray deposited hydroxylapatite (HA) based TiO2 dispersed (HA + 50 wt.% TiO2), coating and post spray heat treatment to be referred as HA-TiO2 (heat treated at 650 °C for 2 h) and ZrO2 dispersed (HA + 10 wt.% ZrO2), to be referred as HA-ZrO2 coating (heat treated at 750 °C for 2 h) on corrosion resistance and bioactivity of Ti-6Al-4V substrate has been undertaken. There is partial decomposition of HA to tri-calcium-phosphate (Ca3(PO4)2) and formation of CaTiO3 phase in HA-TiO2 coating and CaZrO3 phase in the HA-ZrO2 coating. Corrosion study in Hank's solution shows that there is shifting of corrosion potential (Ecorr) towards active potential (-1.1 V(SCE) for as-sprayed and post spray heat treated HA-TiO2 coating, -1.1 V(SCE) for as-sprayed HA-ZrO2 coating and -1 V(SCE) for HA-ZO2 coating after post spray heat treatment), and deterioration in pitting corrosion (Epit) resistance in as-sprayed coatings and the same after heat treatment (-0.7 V(SCE) for both HA-TiO2 and HA-ZrO2 coating as compared to as received substrate (-0.3 V(SCE)). The corrosion rate was increased for both the coatings with a maximum increase in HA-ZrO2 coating. Bioactivity test shows a higher degree of apatite deposition in as-sprayed coating and the same after heat treatment as compared to as received Ti-6Al-4V though the as-sprayed one showed a superior behavior.

  8. Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension.

    PubMed

    Jung, Jae Yoon; Hong, Jong Soo; Ahn, Chang Ho; Yoon, Ji Young; Kwon, Hyuck Hoon; Suh, Dae Hun

    2012-04-01

    Acne treatments using laser and light devices have been reported to have varying degrees of efficacy. However, there has been no study of treatment of acne using a dual mode (quasi-long pulse and Q-switched mode) 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension. To evaluate the clinical efficacy, safety, and histological changes of new laser treatment method for acne vulgaris. Twenty-two patients received 3 sessions of quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension at 2-week intervals in a randomized split face manner. At the final visit, the inflammatory acne lesions were reduced on the laser-treated side by 58.6% (P < .001), but increased on the untreated side by 5%. The noninflammatory acne lesions were reduced on the laser-treated side by 52.4% (P < .001). Sebum output reduction, inflammatory cell and cytokine reductions, a decrease of the thickness of a perifollicular stratum corneum and a full epithelium, and skin rejuvenation effect were found. The histopathologic examination of the acne lesions showed decreased inflammation and immunostaining intensity for interleukin 8, matrix metalloproteinase-9, toll-like receptor-2, and nuclear factor kappa B, and tumor necrosis factor alpha was reduced significantly. No severe adverse reactions were reported. All patients reported mild transient erythema that disappeared in a few hours. The number of subjects studied was small. This laser treatment was rapid and effective for treating not only the inflammatory but also the noninflammatory acne lesions when compared with the control side. The histopathologic findings correlated well with the clinical acne grade and treatment response. This novel laser treatment appears to be safe and effective for acne treatment. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  9. Determination of Clinical and Socio-demographical Differences of Adolescents Applying to a Treatment Center with Family Encouragement or the Decision of the Probation Office and Determination of Predictive Factors in Maintaining Soberness among Probation Cases

    PubMed Central

    YÜNCÜ, Zeki; AYDIN, Rezzan; AYDIN, Cahide; ÖZBARAN, Burcu; KÖSE, Sezen

    2016-01-01

    Introduction This study has two objectives. The first objective of this study was the determination of some basic clinical and socio-demographical differences among the adolescents with substance abuse who apply to a treatment center with support from their family or by order of the probation office. The other objective of this study was the determination of the predictive factors in maintaining soberness among adolescents who successfully complete the probation treatment process. Methods The target population of this study is young adults under 19 years of age who apply to a substance addiction center for adolescents as a result of encouragement from their family or ordered by the Probation Office between 2005 and 2013. These two groups were analyzed in terms of socio-demographical characteristics such as age, the age at which they tried the substance, the age at which they applied to the treatment center, sex, substances they used, education period, employment history, and street life experience. The Statistical Package for the Social Sciences (SPSS) 18.0 software was used for the statistical analysis. Results It was detected that among the cases who applied to the treatment center with family support, their education period was longer than probation (PR) cases (p<0.0001), and the rates of previous treatment, their mother being alive, and having street life experiences were more frequent (p values: <0.0001; =0.010; =0.027; <0.0001, respectively) and employment history was higher among PR cases (p<0.0001). In terms of the substances used, ecstasy, alcohol, inhalants, and volatile substances are more common among those applying with family support (p=0.018; 0.001; <0.0001, respectively). However, use of cannabis was found to be more common among PR cases (p<0.0001). It was found that PR cases who successfully completed their treatment process had married parents (p=0.008) and had more years of education (p=0.004). It can be predicted that if the subject is well

  10. Determination of methylphenidate and ritalinic acid in blood, plasma and oral fluid from adolescents and adults using protein precipitation and liquid chromatography tandem mass spectrometry--a method applied on clinical and forensic investigations.

    PubMed

    Josefsson, Martin; Rydberg, Irene

    2011-07-15

    A validated, accurate and sensitive LC-MS/MS method for determination of racemic methylphenidate and its metabolite ritalinic acid has been developed. The analytes were quantified by tandem mass spectrometry operating in positive electrospray ionization mode with multiple reaction monitoring. Blood, plasma and oral fluid samples of 100μl were prepared by simple precipitation with 200μl of an aqueous solution of zinc sulphate in methanol. Corresponding deuterated internal standards were used for quantification. Calibrations for methylphenidate and ritalinic acid were linear within the selected range of 0.2-30ng/ml and 10-1500ng/ml in blood or plasma and in the range of 1-500ng/ml and 0.25-125ng/ml in oral fluid, respectively. The method was successfully applied for the analysis of samples from patients treated with methylphenidate in the dose range of 36-72mg/day and some representative ante mortem and post mortem samples from clinical and forensic toxicological investigations. A three to fourfold higher concentration of methylphenidate was found in oral fluid compared with blood while for ritalinic acid the concentrations were about 25-fold lower in oral fluid.

  11. 42 CFR 55a.107 - What other regulations apply?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... FOR BLACK LUNG CLINICS General Provisions § 55a.107 What other regulations apply? Other regulations which apply to the Black Lung Clinics Program include, but are not limited to, the following: 42 CFR...

  12. 42 CFR 55a.107 - What other regulations apply?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... FOR BLACK LUNG CLINICS General Provisions § 55a.107 What other regulations apply? Other regulations which apply to the Black Lung Clinics Program include, but are not limited to, the following: 42...

  13. 42 CFR 55a.107 - What other regulations apply?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... FOR BLACK LUNG CLINICS General Provisions § 55a.107 What other regulations apply? Other regulations which apply to the Black Lung Clinics Program include, but are not limited to, the following: 42...

  14. 42 CFR 55a.107 - What other regulations apply?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... FOR BLACK LUNG CLINICS General Provisions § 55a.107 What other regulations apply? Other regulations which apply to the Black Lung Clinics Program include, but are not limited to, the following: 42...

  15. 42 CFR 55a.107 - What other regulations apply?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... FOR BLACK LUNG CLINICS General Provisions § 55a.107 What other regulations apply? Other regulations which apply to the Black Lung Clinics Program include, but are not limited to, the following: 42...

  16. Applying microfluidics to electrophysiology.

    PubMed

    Eddington, David T

    2007-01-01

    Microfluidics can be integrated with standard electrophysiology techniques to allow new experimental modalities. Specifically, the motivation for the microfluidic brain slice device is discussed including how the device docks to standard perfusion chambers and the technique of passive pumping which is used to deliver boluses of neuromodulators to the brain slice. By simplifying the device design, we are able to achieve a practical solution to the current unmet electrophysiology need of applying multiple neuromodulators across multiple regions of the brain slice. This is achieved by substituting the standard coverglass substrate of the perfusion chamber with a thin microfluidic device bonded to the coverglass substrate. This was then attached to the perfusion chamber and small holes connect the open-well of the perfusion chamber to the microfluidic channels buried within the microfluidic substrate. These microfluidic channels are interfaced with ports drilled into the edge of the perfusion chamber to access and deliver stimulants. This project represents how the field of microfluidics is transitioning away from proof-of concept device demonstrations and into practical solutions for unmet experimental and clinical needs.

  17. Applying Microfluidics to Electrophysiology

    PubMed Central

    Eddington, David T.

    2007-01-01

    Microfluidics can be integrated with standard electrophysiology techniques to allow new experimental modalities. Specifically, the motivation for the microfluidic brain slice device is discussed including how the device docks to standard perfusion chambers and the technique of passive pumping which is used to deliver boluses of neuromodulators to the brain slice. By simplifying the device design, we are able to achieve a practical solution to the current unmet electrophysiology need of applying multiple neuromodulators across multiple regions of the brain slice. This is achieved by substituting the standard coverglass substrate of the perfusion chamber with a thin microfluidic device bonded to the coverglass substrate. This was then attached to the perfusion chamber and small holes connect the open-well of the perfusion chamber to the microfluidic channels buried within the microfluidic substrate. These microfluidic channels are interfaced with ports drilled into the edge of the perfusion chamber to access and deliver stimulants. This project represents how the field of microfluidics is transitioning away from proof-of concept device demonstrations and into practical solutions for unmet experimental and clinical needs. PMID:18989410

  18. Experimental coating defects in hydroxylapatite-coated implants.

    PubMed

    Cook, S D; Thomas, K A; Kay, J F

    1991-04-01

    Defects in hydroxyapatite (HA)-coated metallic implant systems, including cracks, flakes, or scratches, may occur at the time of surgery or in time because of in vivo loading. Such defects may affect the bone-implant interface response because of increased local metallic corrosion and ion release. Using a canine transcortical push-out model, the interface mechanics and histology of HA-coated titanium and cobalt-chromium-molybdenum alloy implants with and without coating defects were evaluated. The coating defects extended through the HA material to the underlying metallic substrate. Interface mechanical testing and undecalcified histologic techniques were used to evaluate differences in interface response at three, five, six, ten, 12, and 32 weeks postimplantation. There were no statistically significant differences between the HA-coated implants with and without defects for either interface shear strength or stiffness; however, both HA-coated implant types developed significantly greater interface strength and stiffness when compared to uncoated metallic implants. Histologically, in all areas away from the defect, a progression to nearly complete mineralization of osseous tissue directly onto the HA-coated surface was observed with no interpositional fibrous tissue layer. At early time periods (up to six weeks) in the area of the coating defect, bone apposition and mineralization appeared to stop at the edge of the HA coating. At later time periods (greater than ten weeks), the area of the defect was filled with mineralized osseous tissue in approximately one-half of the specimens. A thin fibrous interpositional layer was observed at the interface of the exposed metal substrate.

  19. [Mandibular ridge augmentation with hydroxylapatite and its extension].

    PubMed

    Huang, H; Mercier, P

    1996-01-01

    The results of 5 years follow-up of 84 cases of mandibular residual ridge augmented with hydroxlapatite (HA), followed by ridge extension, are reported. The first surgical procedures, subperiosteal HA insertion, and the second stage of total lowering of the floow of the mouth, vestibuloplasty and skin graft are detailedly described. The ridge is augmented by the first surgery, disturbance of the fraenums of the lip, buccal and tongue and muscles are eliminated by the second surgery, to increase denture retention and stability, improve wear resisting of tissue covered over the artifical ridge and eliminate pain and uncomfort when wearing denture. The results of five years follow-up show that two stages reconstruction are better than HA insertion only. HA is a kind of ideal material of bone replacement, which is not resorbed in most cases.

  20. The Applied Mathematics Laboratory.

    ERIC Educational Resources Information Center

    Siegel, Martha J.

    This report describes the Applied Mathematics Laboratory (AML) operated by the Department of Mathematics at Towson State University, Maryland. AML is actually a course offered to selected undergraduates who are given the opportunity to apply their skills in investigating industrial and governmental problems. By agreement with sponsoring…

  1. What are applied ethics?

    PubMed

    Allhoff, Fritz

    2011-03-01

    This paper explores the relationships that various applied ethics bear to each other, both in particular disciplines and more generally. The introductory section lays out the challenge of coming up with such an account and, drawing a parallel with the philosophy of science, offers that applied ethics may either be unified or disunified. The second section develops one simple account through which applied ethics are unified, vis-à-vis ethical theory. However, this is not taken to be a satisfying answer, for reasons explained. In the third section, specific applied ethics are explored: biomedical ethics; business ethics; environmental ethics; and neuroethics. These are chosen not to be comprehensive, but rather for their traditions or other illustrative purposes. The final section draws together the results of the preceding analysis and defends a disunity conception of applied ethics.

  2. The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) applied to pivotal phase III randomized-controlled trials of tyrosine kinase inhibitors in first-line for advanced non-small cell lung cancer with activating epidermal growth factor receptor mutations.

    PubMed

    Giuliani, Jacopo; Remo, Andrea; Bonetti, Andrea

    2017-02-01

    To examine the magnitude of the clinical benefit from first-line tyrosine kinase inhibitors (TKIs) advanced non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR)-mutations. Areas covered: The present evaluation was restricted to pivotal phase III RCTs in first-line for advanced NSCLC with activating EGFR-mutations. We have subsequently applied the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above pivotal phase III RCTs, to derive a relative ranking of the magnitude of clinically meaningful benefit. Our study evaluated 8 phase III RCTs (including 1710 patients). The ESMO-MCBS reached high grade (grade 4) for all TKIs treatments with at least one phase III RCT for each TKI. Expert commentary: Combining pharmacological costs of drugs with the measure of efficacy, afatinib has the lowest difference in costs per month-PFS gained and a comparable high grade of magnitude of clinical benefit.

  3. Applied Physics at Strathclyde.

    ERIC Educational Resources Information Center

    Patterson, H.; Twidell, J. W.

    1979-01-01

    Outlines and describes the content of an applied physics course offered for the four year honors and the three year pass degrees. The course stresses three components: principal subjects, industrial projects, and subsidiary subjects. (GA)

  4. Mesothelioma Applied Research Foundation

    MedlinePlus

    ... Percentage Donations Tribute Wall Other Giving/Fundraising Opportunities Bitcoin Donation Form FAQs Mesothelioma Awareness Day: Find out ... Percentage Donations Tribute Wall Other Giving/Fundraising Opportunities Bitcoin Donation Form FAQs © 2017 Mesothelioma Applied Research Foundation, ...

  5. Geomorphology: Pure and applied

    SciTech Connect

    Hart, M.G.

    1986-01-01

    The book summarizes the history of intellectual debate in geomorphology and describes modern developments both ''pure'' and ''applied.'' The history begins well before W.M. Davis and follows through to such debates as those concerned with the Pleistocene. Modern developments in pure geomorphology are cast in terms of chapters on form, process, materials, and methods analysis. The applied chapters concentrate on environmental hazards and resources, and their management.

  6. Applied Learning Networks (ALN)

    DTIC Science & Technology

    2007-01-01

    AFRL-IF-RS-TR-2007-7 Final Technical Report January 2007 APPLIED LEARNING NETWORKS (ALN) University of Southern California...any other person or corporation; or convey any rights or permission to manufacture, use, or sell any patented invention that may relate to them...1-0051 4. TITLE AND SUBTITLE APPLIED LEARNING NETWORKS (ALN) 5c. PROGRAM ELEMENT NUMBER 62301E 5d. PROJECT NUMBER T981 5e. TASK NUMBER US

  7. Following the Rules Set by Accreditation Agencies and Governing Bodies to Maintain In-Compliance Status: Applying Critical Thinking Skills When Evaluating the Need for Change in the Clinical Laboratory.

    PubMed

    Byrne, Karen M; Levy, Kimberly Y; Reese, Erika M

    2016-05-01

    Maintaining an in-compliance clinical laboratory takes continuous awareness and review of standards, regulations, and best practices. A strong quality assurance program and well informed leaders who maintain professional networks can aid in this necessary task. This article will discuss a process that laboratories can follow to interpret, understand, and comply with the rules and standards set by laboratory accreditation bodies.

  8. Clinical and microbiological effects of an essential-oil-containing mouth rinse applied in the "one-stage full-mouth disinfection" protocol--a randomized doubled-blinded preliminary study.

    PubMed

    Cavalca Cortelli, Sheila; Cavallini, Fabiana; Regueira Alves, Marcello Faria; Alves Bezerra, Arnaud; Queiroz, Celso Silva; Cortelli, José Roberto

    2009-06-01

    The aim of this randomized double-blinded preliminary study was to evaluate the clinical and microbiological long-term effects of an essential-oil-containing mouth rinse as the active agent utilized in the "one-stage full-mouth disinfection protocol." Probing pocket depth and plaque and gingival indices were evaluated by the same calibrated examiner in all teeth of 20 moderate chronic periodontitis subjects. Presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis were determined by polymerase chain reaction in nonstimulated saliva, tongue dorsum, and pooled subgingival samples. The subjects were randomized into two groups: full-mouth disinfection plus essential oils (Listerine) or full-mouth disinfection plus placebo. Clinical and microbial parameters were evaluated at baseline (T0), 45 (T1) and 180 (T2) days after therapy and analyzed using analysis of variance, Student t, and Wilcoxon tests (p < 0.05). No significant differences were observed between groups regarding clinical measurements at baseline. However, in the later examinations, T1 and T2, the test group always presented higher reductions of pocket depth, plaque index, and gingival index compared to the control group. The essential-oils group revealed significant reduction on occurrence of P. gingivalis in saliva comparing baseline and 45 days; this difference still remain at 180 days. The essential-oil-containing mouth rinse demonstrated beneficial effects on clinical parameters. Microbiological findings were less consistent. The results of this preliminary study suggest further investigations.

  9. Clinical research: up from 'clinical epidemiology'.

    PubMed

    Miettinen, Olli S; Bachmann, Lucas M; Steurer, Johann

    2009-12-01

    Clinical research must be understood to be the foundation of scientific medicine of the clinical type. But the essence of scientific clinical medicine remains a matter of profound confusion, even in clinical academia, and so does the essence of clinical research. The confusion now revolves, principally, around 'clinical epidemiology'. We address clinical research in the meaning of quintessentially 'applied' clinical research, which we take to be the foundation of the scientific knowledge base of clinical medicine, of gnosis (dia-, etio-, pro-) in it. More specifically, we address the essence, priorities, and status quo of this research - and argue that the requisite theory of this is not a matter of 'clinical epidemiology' but of theory of clinical research endogenous to clinical (rather than epidemiological) academia.

  10. Applied Astronomy: Asteroid Prospecting

    NASA Astrophysics Data System (ADS)

    Elvis, M.

    2013-09-01

    In the age of asteroid mining the ability to find promising ore-bearing bodies will be valuable. This will give rise to a new discipline- "Applied Astronomy". Just as most geologists work in industry, not in academia, the same will be true of astronomers. Just how rare or common ore-rich asteroids are likely to be, and the skills needed to assay their value, are discussed here, with an emphasis on remote - telescopic - methods. Also considered are the resources needed to conduct extensive surveys of asteroids for prospecting purposes, and the cost and timescale involved. The longer-term need for applied astronomers is also covered.

  11. On applying cognitive psychology.

    PubMed

    Baddeley, Alan

    2013-11-01

    Recent attempts to assess the practical impact of scientific research prompted my own reflections on over 40 years worth of combining basic and applied cognitive psychology. Examples are drawn principally from the study of memory disorders, but also include applications to the assessment of attention, reading, and intelligence. The most striking conclusion concerns the many years it typically takes to go from an initial study, to the final practical outcome. Although the complexity and sheer timescale involved make external evaluation problematic, the combination of practical satisfaction and theoretical stimulation make the attempt to combine basic and applied research very rewarding. © 2013 The British Psychological Society.

  12. Applied Music (Individual Study).

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin.

    Background information and resources to help students in grades 9-12 in Texas pursue an individual study contract in applied music is presented. To fulfill a contract students must publicly perform from memory, with accompaniment as specified, three selections from a list of approved music for their chosen field (instrument or voice). Material…

  13. Essays on Applied Microeconomics

    ERIC Educational Resources Information Center

    Mejia Mantilla, Carolina

    2013-01-01

    Each chapter of this dissertation studies a different question within the field of Applied Microeconomics. The first chapter examines the mid- and long-term effects of the 1998 Asian Crisis on the educational attainment of Indonesian children ages 6 to 18, at the time of the crisis. The effects are identified as deviations from a linear trend for…

  14. Applied research on glucansucrases

    USDA-ARS?s Scientific Manuscript database

    Although glycansucrases have been known for over 70 years, they remain relatively unknown except to a small group of researchers. Practical, applied research on glycansucrases has been focused on certain key areas. The earliest of these was the development of blood plasma extenders from dextran, d...

  15. Applied Vocational Mathematics.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

    Developed for use in teaching a two-semester, one-unit course, this course guide is intended to aid the high school instructor in teaching mathematical problem-solving and computational skills to vocational education students. The state-adopted textbook for general mathematics III, "Applied General Mathematics" serves as the major…

  16. Applied Linguistics in Europe

    ERIC Educational Resources Information Center

    de Bot, Kees

    2004-01-01

    In this contribution developments in Applied Linguistics in Europe are linked to major social changes that have taken place over the last decades. These include: The decline of the USSR and the end of the cold war; The development of the EEC and the EU and fading of borders; The economic growth of Western Europe; Labor migration from the south to…

  17. Applied Music (Individual Study).

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin.

    Background information and resources to help students in grades 9-12 in Texas pursue an individual study contract in applied music is presented. To fulfill a contract students must publicly perform from memory, with accompaniment as specified, three selections from a list of approved music for their chosen field (instrument or voice). Material…

  18. Applied Behavior Analysis

    ERIC Educational Resources Information Center

    Szapacs, Cindy

    2006-01-01

    Teaching strategies that work for typically developing children often do not work for those diagnosed with an autism spectrum disorder. However, teaching strategies that work for children with autism do work for typically developing children. In this article, the author explains how the principles and concepts of Applied Behavior Analysis can be…

  19. Africa and Applied Linguistics.

    ERIC Educational Resources Information Center

    Makoni, Sinfree, Ed.; Meinhof, Ulrike H., Ed.

    2003-01-01

    This collection of articles includes: "Introducing Applied Linguistics in Africa" (Sinfree Makoni and Ulrike H. Meinhof); "Language Ideology and Politics: A Critical Appraisal of French as Second Official Language in Nigeria" (Tope Omoniyi); "The Democratisation of Indigenous Languages: The Case of Malawi" (Themba…

  20. Applied Statistics with SPSS

    ERIC Educational Resources Information Center

    Huizingh, Eelko K. R. E.

    2007-01-01

    Accessibly written and easy to use, "Applied Statistics Using SPSS" is an all-in-one self-study guide to SPSS and do-it-yourself guide to statistics. What is unique about Eelko Huizingh's approach is that this book is based around the needs of undergraduate students embarking on their own research project, and its self-help style is designed to…

  1. Applied Linguistics in Europe

    ERIC Educational Resources Information Center

    de Bot, Kees

    2004-01-01

    In this contribution developments in Applied Linguistics in Europe are linked to major social changes that have taken place over the last decades. These include: The decline of the USSR and the end of the cold war; The development of the EEC and the EU and fading of borders; The economic growth of Western Europe; Labor migration from the south to…

  2. Africa and Applied Linguistics.

    ERIC Educational Resources Information Center

    Makoni, Sinfree, Ed.; Meinhof, Ulrike H., Ed.

    2003-01-01

    This collection of articles includes: "Introducing Applied Linguistics in Africa" (Sinfree Makoni and Ulrike H. Meinhof); "Language Ideology and Politics: A Critical Appraisal of French as Second Official Language in Nigeria" (Tope Omoniyi); "The Democratisation of Indigenous Languages: The Case of Malawi" (Themba…

  3. Signals: Applying Academic Analytics

    ERIC Educational Resources Information Center

    Arnold, Kimberly E.

    2010-01-01

    Academic analytics helps address the public's desire for institutional accountability with regard to student success, given the widespread concern over the cost of higher education and the difficult economic and budgetary conditions prevailing worldwide. Purdue University's Signals project applies the principles of analytics widely used in…

  4. Essays on Applied Microeconomics

    ERIC Educational Resources Information Center

    Mejia Mantilla, Carolina

    2013-01-01

    Each chapter of this dissertation studies a different question within the field of Applied Microeconomics. The first chapter examines the mid- and long-term effects of the 1998 Asian Crisis on the educational attainment of Indonesian children ages 6 to 18, at the time of the crisis. The effects are identified as deviations from a linear trend for…

  5. Signals: Applying Academic Analytics

    ERIC Educational Resources Information Center

    Arnold, Kimberly E.

    2010-01-01

    Academic analytics helps address the public's desire for institutional accountability with regard to student success, given the widespread concern over the cost of higher education and the difficult economic and budgetary conditions prevailing worldwide. Purdue University's Signals project applies the principles of analytics widely used in…

  6. Applied Statistics with SPSS

    ERIC Educational Resources Information Center

    Huizingh, Eelko K. R. E.

    2007-01-01

    Accessibly written and easy to use, "Applied Statistics Using SPSS" is an all-in-one self-study guide to SPSS and do-it-yourself guide to statistics. What is unique about Eelko Huizingh's approach is that this book is based around the needs of undergraduate students embarking on their own research project, and its self-help style is designed to…

  7. Quality in applied science

    NASA Astrophysics Data System (ADS)

    Sten, T.

    1993-12-01

    Science is in many senses a special kind of craft and only skilled craftsmen are able to distinguish good work from bad. Due to the variation in approaches, methods and even philosophical basis, it is nearly impossible to derive a general set of quality criteria for scientific work outside specific research traditions. Applied science introduces a new set of quality criteria having to do with the application of results in practical situations and policy making. A scientist doing basic research relates mainly to the scientific community of which he is a member, while in applied contract research the scientist has to consider the impact of his results both for the immediate users and upon interest groups possibly being affected. Application thus raises a whole new set of requirements having to do with business ethics, policy consequences and societal ethics in general.

  8. Applied Meteorology Unit (AMU)

    NASA Technical Reports Server (NTRS)

    Bauman, William; Lambert, Winifred; Wheeler, Mark; Barrett, Joe; Watson, Leela

    2007-01-01

    This report summarizes the Applied Meteorology Unit (AMU) activities for the second quarter of Fiscal Year 2007 (January - March 2007). Tasks reported on are: Obiective Lightning Probability Tool, Peak Wind Tool for General Forecasting, Situational Lightning Climatologies for Central Florida, Anvil Threat Corridor Forecast Tool in AWIPS, Volume Averaqed Heiqht lnteq rated Radar Reflectivity (VAHIRR), Tower Data Skew-t Tool, and Weather Research and Forecastini (WRF) Model Sensitivity Study

  9. Nanoengineering Applied to Tungsten

    DTIC Science & Technology

    2006-05-01

    and R. Z. Valiev ARL-RP- 123 May 2006 A reprint from the Proceedings of the Sixth International Conference on Tungsten, Refractory...Ground, MD 21005-5066 ARL-RP- 123 May 2006 Nanoengineering Applied to Tungsten Q. Wei University of North Carolina-Charlotte B. E...ORGANIZATION REPORT NUMBER ARL-RP- 123 10. SPONSOR/MONITOR’S ACRONYM(S) 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 11. SPONSOR

  10. Applied Cognitive Science.

    DTIC Science & Technology

    1983-12-01

    Cognitive Science Inter action lReplacement Focus on Person Focus on System m~odels ~Ment Models M;7l t Systems change Explanation and Cognitive Undestanding ... relationships between elements but leaves specific attributes of the elements behind. Hence it is a mapping only of the Applied Cognitive Science 12...structural relationships between elements rather than a complete mapping of all the properties of elements in the two systems. We can illustrate these ideas

  11. Applied biotechnology in nematology.

    PubMed

    Caswell-Chen, E P; Williamson, V M; Westerdahl, B B

    1993-12-01

    During the past two decades, rapid advances in biotechnology and molecular biology have affected the understanding and treatment of human and plant diseases. The human and Caenorhabditis elegans genome-sequencing projects promise further techniques and results useful to applied nematology. Of course, biotechnology is not a panacea for nematological problems, but it provides many powerful tools that have potential use in applied biology and nematode management. The tools will facilitate research on a range of previously intractable problems in nematology, from identification of species and pathotypes to the development of resistant cultivars that have been inaccessible because of technical limitations. However, to those unfamiliar or not directly involved with the new technologies and their extensive terminology, the benefits of the advances in biotechnology may not be readily discerned. The sustainable agriculture of the future will require ecology-based management, and successful integrated nematode management will depend on combinations of control tactics to reduce nematode numbers. In this review we discuss how biotechnology may influence nematode management, define terminology relative to potential applications, and present current and future avenues of research in applied nematology, including species identification, race and pathotype identification, development of resistant cultivars, definition of nematode-host interactions, nematode population dynamics, establishment of optimal rotations, the ecology of biological control and development of useful biological control agents, and the design of novel nematicides.

  12. Applied science. Introduction.

    PubMed

    Bud, Robert

    2012-09-01

    Such categories as applied science and pure science can be thought of as "ideological." They have been contested in the public sphere, exposing long-term intellectual commitments, assumptions, balances of power, and material interests. This group of essays explores the contest over applied science in Britain and the United States during the nineteenth century. The essays look at the concept in the context of a variety of neighbors, including pure science, technology, and art. They are closely related and connected to contemporary historiographic debate. Jennifer Alexander links the issues raised to a recent paper by Paul Forman. Paul Lucier and Graeme Gooday deal with the debates in the last quarter of the century in the United States and Britain, respectively. Robert Bud deals with the earlier part of the nineteenth century, with an eye specifically on the variety of concepts hybridized under the heading of "applied science." Eric Schatzberg looks at the erosion of the earlier concept of art. As a whole, the essays illuminate both long-term changes and nuanced debate and are themselves intended to provoke further reflection on science in the public sphere.

  13. Scientific methodology applied.

    PubMed

    Lussier, A

    1975-04-01

    The subject of this symposium is naproxen, a new drug that resulted from an investigation to find a superior anti-inflammatory agent. It was synthesized by Harrison et al. in 1970 at the Syntex Institute of Organic Chemistry and Biological Sciences. How can we chart the evolution of this or any other drug? Three steps are necessary: first, chemical studies (synthesis, analysis); second, animal pharmacology; third, human pharmacology. The last step can additionally be divided into four phases: metabolism and toxicology of the drug in normal volunteers; dose titration and initial clinical trials with sick subjects (pharmacometry); confirmatory clinical trials when the drug is accepted on the market and revaluation (familiarization trials). To discover the truth about naproxen, we must all participate actively with a critical mind, following the principles of scientific methodology. We shall find that the papers to be presented today all deal with the third step in the evaluation process--clinical pharmacology. It is quite evident that the final and most decisive test must be aimed at the most valuable target: the human being. The end product of this day's work for each of us should be the formation of an opinion based on solid scientific proofs. And let us hope that we will all enjoy fulfilling the symposium in its entire etymological meaning this evening. In vino veritas.

  14. Applied ALARA techniques

    SciTech Connect

    Waggoner, L.O.

    1998-02-05

    The presentation focuses on some of the time-proven and new technologies being used to accomplish radiological work. These techniques can be applied at nuclear facilities to reduce radiation doses and protect the environment. The last reactor plants and processing facilities were shutdown and Hanford was given a new mission to put the facilities in a safe condition, decontaminate, and prepare them for decommissioning. The skills that were necessary to operate these facilities were different than the skills needed today to clean up Hanford. Workers were not familiar with many of the tools, equipment, and materials needed to accomplish:the new mission, which includes clean up of contaminated areas in and around all the facilities, recovery of reactor fuel from spent fuel pools, and the removal of millions of gallons of highly radioactive waste from 177 underground tanks. In addition, this work has to be done with a reduced number of workers and a smaller budget. At Hanford, facilities contain a myriad of radioactive isotopes that are 2048 located inside plant systems, underground tanks, and the soil. As cleanup work at Hanford began, it became obvious early that in order to get workers to apply ALARA and use hew tools and equipment to accomplish the radiological work it was necessary to plan the work in advance and get radiological control and/or ALARA committee personnel involved early in the planning process. Emphasis was placed on applying,ALARA techniques to reduce dose, limit contamination spread and minimize the amount of radioactive waste generated. Progress on the cleanup has,b6en steady and Hanford workers have learned to use different types of engineered controls and ALARA techniques to perform radiological work. The purpose of this presentation is to share the lessons learned on how Hanford is accomplishing radiological work.

  15. Applied Meteorology Unit (AMU)

    NASA Technical Reports Server (NTRS)

    Bauman, William H., Jr.; Crawford, Winifred; Short, David; Barrett, Joe; Watson, Leela

    2008-01-01

    This report summarizes the Applied Meteorology Unit (AMU) activities for the second quarter of Fiscal Year 2008 (January - March 2008). Projects described are: (1) Peak Wind Tool for User Launch Commit Criteria (LCC), (2) Peak Wind Tool for General Forecasting, (3) Situational Lightning Climatologies for Central Florida. Phase III, (4) Volume Averaged Height Integrated Radar Reflectivity (VAHIRR), (5) Impact of Local Sensors, (6) Radar Scan Strategies for the PAFB WSR-74C Replacement and (7) WRF Wind Sensitivity Study at Edwards Air Force Base.

  16. Applied Meteorology Unit (AMU)

    NASA Technical Reports Server (NTRS)

    Bauman, William; Crawford, Winifred; Barrett, Joe; Watson, Leela; Wheeler, Mark

    2010-01-01

    This report summarizes the Applied Meteorology Unit (AMU) activities for the first quarter of Fiscal Year 2010 (October - December 2009). A detailed project schedule is included in the Appendix. Included tasks are: (1) Peak Wind Tool for User Launch Commit Criteria (LCC), (2) Objective Lightning Probability Tool, Phase III, (3) Peak Wind Tool for General Forecasting, Phase II, (4) Upgrade Summer Severe Weather Tool in Meteorological Interactive Data Display System (MIDDS), (5) Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS) Update and Maintainability, (5) Verify 12-km resolution North American Model (MesoNAM) Performance, and (5) Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) Graphical User Interface.

  17. NASA Applied Sciences Program

    NASA Technical Reports Server (NTRS)

    Frederick, Martin

    2006-01-01

    This presentation highlights the NASA Applied Sciences Program. The goal of the program is to extend the results of scientific research and knowledge beyond the science community to contribute to NASA's partners' applications of national priority, such as agricultural efficiency, energy management and Homeland Security. Another purpose of the program's scientific research is to increase knowledge of the Earth-Sun system to enable improved predictions of climate, weather, and natural hazards. The program primarily optimizes benefits for citizens by contributing to partnering on applications that are used by state, local and tribal governments.

  18. The eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer recovery program for underserved individuals living with cancer in Alberta: protocol development for a randomized wait-list controlled clinical trial

    PubMed Central

    2013-01-01

    Background Elevated stress can exacerbate cancer symptom severity, and after completion of primary cancer treatments, many individuals continue to have significant distress. Mindfulness-Based Cancer Recovery (MBCR) is an 8-week group psychosocial intervention consisting of training in mindfulness meditation and yoga designed to mitigate stress, pain, and chronic illness. Efficacy research shows face-to-face (F2F) MBCR programs have positive benefits for cancer patients; however barriers exist that impede participation in F2F groups. While online MBCR groups are available to the public, none have been evaluated. Primary objective: determine whether underserved patients are willing to participate in and complete an online MBCR program. Secondary objectives: determine whether online MBCR will mirror previous efficacy findings from F2F MBCR groups on patient-reported outcomes. Method/design The study includes cancer patients in Alberta, exhibiting moderate distress, who do not have access to F2F MBCR. Participants will be randomized to either online MBCR, or waiting for the next available group. An anticipated sample size of 64 participants will complete measures online pre and post treatment or waiting period. Feasibility will be tracked through monitoring numbers eligible and participating through each stage of the protocol. Discussion 47 have completed/completing the intervention. Data suggest it is possible to conduct a randomized waitlist controlled trial of online MBCR to reach underserved cancer survivors. Trial registration Clinical Trials.gov Identifier: NCT01476891 PMID:23414206

  19. Applied Impact Physics Research

    NASA Astrophysics Data System (ADS)

    Wickert, Matthias

    2013-06-01

    Applied impact physics research is based on the capability to examine impact processes for a wide range of impact conditions with respect to velocity as well as mass and shape of the projectile. For this reason, Fraunhofer EMI operates a large variety of launchers that address velocities up to ordnance velocities as single stage powder gun but which can also be operated as two-stage light gas guns achieving the regime of low earth orbital velocity. Thereby for projectile masses of up to 100 g hypervelocity impact phenomena up to 7.8 km/s can be addressed. Advanced optical diagnostic techniques like microsecond video are used as commercial systems but - since impact phenomena are mostly related with debris or dust - specialized diagnostics are developed in-house like x-ray cinematography and x-ray tomography. Selected topics of the field of applied impact physics will be presented like the interesting behavior of long rods penetrating low-density materials or experimental findings at hypervelocity for this class of materials as well as new x-ray diagnositic techniques.

  20. [Implantation of collagen coated hydroxyapatite particles. A clinical-histological study in humans].

    PubMed

    Sanz, M; Bascones, A; Kessler, A; García Nuñez, J; Newman, M G; Robertson, M A; Carranza, F A

    1989-05-01

    In this study, histologic behaviour of collagen coated hydroxylapatite particles implanted in human periodontal osseous defects has been analyzed. This material was surgically implanted in four patients, and reentry and block biopsies were carried out 4 and 6 months later. The histologic results demonstrate that this material is well tolerated by surrounding tissues, not eliciting an inflammatory reaction. At four months, the hydroxylapatite particles appear encapsulated by a very cellular connective tissue and at 6 months are found in direct contact with osteoid and mature bone. This material acts as a filler material, being fully biocompatible and stimulating an osseoconductive reaction of the adjacent alveolar bone.

  1. Applied computational aerodynamics

    SciTech Connect

    Henne, P.A.

    1990-01-01

    The present volume discusses the original development of the panel method, the mapping solutions and singularity distributions of linear potential schemes, the capabilities of full-potential, Euler, and Navier-Stokes schemes, the use of the grid-generation methodology in applied aerodynamics, subsonic airfoil design, inverse airfoil design for transonic applications, the divergent trailing-edge airfoil innovation in CFD, Euler and potential computational results for selected aerodynamic configurations, and the application of CFD to wing high-lift systems. Also discussed are high-lift wing modifications for an advanced-capability EA-6B aircraft, Navier-Stokes methods for internal and integrated propulsion system flow predictions, the use of zonal techniques for analysis of rotor-stator interaction, CFD applications to complex configurations, CFD applications in component aerodynamic design of the V-22, Navier-Stokes computations of a complete F-16, CFD at supersonic/hypersonic speeds, and future CFD developments.

  2. Methods of applied dynamics

    NASA Technical Reports Server (NTRS)

    Rheinfurth, M. H.; Wilson, H. B.

    1991-01-01

    The monograph was prepared to give the practicing engineer a clear understanding of dynamics with special consideration given to the dynamic analysis of aerospace systems. It is conceived to be both a desk-top reference and a refresher for aerospace engineers in government and industry. It could also be used as a supplement to standard texts for in-house training courses on the subject. Beginning with the basic concepts of kinematics and dynamics, the discussion proceeds to treat the dynamics of a system of particles. Both classical and modern formulations of the Lagrange equations, including constraints, are discussed and applied to the dynamic modeling of aerospace structures using the modal synthesis technique.

  3. NASA Applied Sciences Program

    NASA Technical Reports Server (NTRS)

    Estes, Sue M.; Haynes, J. A.

    2009-01-01

    NASA's strategic Goals: a) Develop a balanced overall program of science, exploration, and aeronautics consistent with the redirection of human spaceflight program to focus on exploration. b) Study Earth from space to advance scientific understanding and meet societal needs. NASA's partnership efforts in global modeling and data assimilation over the next decade will shorten the distance from observations to answers for important, leading-edge science questions. NASA's Applied Sciences program will continue the Agency's efforts in benchmarking the assimilation of NASA research results into policy and management decision-support tools that are vital for the Nation's environment, economy, safety, and security. NASA also is working with NOAH and inter-agency forums to transition mature research capabilities to operational systems, primarily the polar and geostationary operational environmental satellites, and to utilize fully those assets for research purposes.

  4. Applying robotics to HAZMAT

    NASA Technical Reports Server (NTRS)

    Welch, Richard V.; Edmonds, Gary O.

    1994-01-01

    The use of robotics in situations involving hazardous materials can significantly reduce the risk of human injuries. The Emergency Response Robotics Project, which began in October 1990 at the Jet Propulsion Laboratory, is developing a teleoperated mobile robot allowing HAZMAT (hazardous materials) teams to remotely respond to incidents involving hazardous materials. The current robot, called HAZBOT III, can assist in locating characterizing, identifying, and mitigating hazardous material incidents without risking entry team personnel. The active involvement of the JPL Fire Department HAZMAT team has been vital in developing a robotic system which enables them to perform remote reconnaissance of a HAZMAT incident site. This paper provides a brief review of the history of the project, discusses the current system in detail, and presents other areas in which robotics can be applied removing people from hazardous environments/operations.

  5. Applied Routh approximation

    NASA Technical Reports Server (NTRS)

    Merrill, W. C.

    1978-01-01

    The Routh approximation technique for reducing the complexity of system models was applied in the frequency domain to a 16th order, state variable model of the F100 engine and to a 43d order, transfer function model of a launch vehicle boost pump pressure regulator. The results motivate extending the frequency domain formulation of the Routh method to the time domain in order to handle the state variable formulation directly. The time domain formulation was derived and a characterization that specifies all possible Routh similarity transformations was given. The characterization was computed by solving two eigenvalue-eigenvector problems. The application of the time domain Routh technique to the state variable engine model is described, and some results are given. Additional computational problems are discussed, including an optimization procedure that can improve the approximation accuracy by taking advantage of the transformation characterization.

  6. Applied antineutrino physics workshop.

    SciTech Connect

    Lund, James C.

    2008-01-01

    This workshop is the fourth one of a series that includes the Neutrino Geophysics Conference at Honolulu, Hawaii, which I attended in 2005. This workshop was organized by the Astro-Particle and Cosmology laboratory in the recently opened Condoret building of the University of Paris. More information, including copies of the presentations, on the workshop is available on the website: www.apc.univ-paris7.fr/AAP2007/. The workshop aims at opening neutrino physics to various fields such that it can be applied in geosciences, nuclear industry (reactor and spent fuel monitoring) and non-proliferation. The workshop was attended by over 60 people from Europe, USA, Asia and Brazil. The meeting was also attended by representatives of the Comprehensive nuclear-Test Ban Treaty (CTBT) and the International Atomic Energy Agency (IAEA). The workshop also included a workshop dinner on board of a river boat sailing the Seine river.

  7. Lessons learned and applied

    PubMed Central

    Hebert, Corey Joseph; Hall, Corey M.; Odoms, La’ Nyia J.

    2012-01-01

    Most vaccines available in the United States (US) have been incorporated into vaccination schedules for infants and young children, age groups particularly at risk of contracting infectious diseases. High universal vaccination coverage is responsible for substantially reducing or nearly eliminating many of the diseases that once killed thousands of children each year in the US. Despite the success of infant vaccinations, periods of low vaccination coverage and the limited immunogenicity and duration of protection of certain vaccines have resulted in sporadic outbreaks, allowing some diseases to spread in communities. These challenges suggest that expanded vaccination coverage to younger infants and adolescents, and more immunogenic vaccines, may be needed in some instances. This review focuses on the importance of infant immunization and explores the successes and challenges of current early childhood vaccination programs and how these lessons may be applied to other invasive diseases, such as meningococcal disease. PMID:22617834

  8. Applied physiology of diving.

    PubMed

    Lin, Y C

    1988-01-01

    Recreational diving is a popular sport, although human ability to stay in and under water is severely limited physiologically. An understanding of these limitations enhances safety and enjoyment of sports diving. Breath-hold diving involves head-out water immersion, apnoea and submersion, exercise, cold stress, and pressure exposure. Each of these components, by itself, elicits prominent and specific physiological effects. Combination of these factors produces a unique and interesting physiological response generally known as diving reflex. Humans display weak diving responses, but exhibit no oxygen conservation function. Nevertheless, application of diving-induced physiological changes is now finding its way into clinical practice. Apnoea, face immersion, and head-out water immersion all show promise of clinical application. There are several spin-offs from diving research worth noting. Diuresis, enhancement of cardiac performance, and redistribution of blood flow, all produced by head-out water immersion, have been shown to be clinically useful, besides providing physiological data useful to space travel. Results from investigations on apnoea have been shown to be relevant to the following: treating some forms of cardiac arrhythmias; understanding drowning, sudden infant death syndrome and sleep apnoea; and confirming hyperventilation as the major cause of drowning. In comparison to marine mammals, humans are poor divers because of severe physiological constraints which limit their breath-hold time, diving depth, and ability to conserve body heat. Although under special circumstances humans can achieve unusually long breath-hold time and reach exceptional depth with a single breath, the sustainable working time and depth are only about 1 minute and 5 metres, respectively. Hypothermia inevitably results in divers working in the ocean. Without thermal protection, the intolerable limit of 35 degrees C is reached within 30 minutes in winter (10 degrees C) water and

  9. Applying evolutionary anthropology.

    PubMed

    Gibson, Mhairi A; Lawson, David W

    2015-01-01

    Evolutionary anthropology provides a powerful theoretical framework for understanding how both current environments and legacies of past selection shape human behavioral diversity. This integrative and pluralistic field, combining ethnographic, demographic, and sociological methods, has provided new insights into the ultimate forces and proximate pathways that guide human adaptation and variation. Here, we present the argument that evolutionary anthropological studies of human behavior also hold great, largely untapped, potential to guide the design, implementation, and evaluation of social and public health policy. Focusing on the key anthropological themes of reproduction, production, and distribution we highlight classic and recent research demonstrating the value of an evolutionary perspective to improving human well-being. The challenge now comes in transforming relevance into action and, for that, evolutionary behavioral anthropologists will need to forge deeper connections with other applied social scientists and policy-makers. We are hopeful that these developments are underway and that, with the current tide of enthusiasm for evidence-based approaches to policy, evolutionary anthropology is well positioned to make a strong contribution.

  10. Applying Evolutionary Anthropology

    PubMed Central

    Gibson, Mhairi A; Lawson, David W

    2015-01-01

    Evolutionary anthropology provides a powerful theoretical framework for understanding how both current environments and legacies of past selection shape human behavioral diversity. This integrative and pluralistic field, combining ethnographic, demographic, and sociological methods, has provided new insights into the ultimate forces and proximate pathways that guide human adaptation and variation. Here, we present the argument that evolutionary anthropological studies of human behavior also hold great, largely untapped, potential to guide the design, implementation, and evaluation of social and public health policy. Focusing on the key anthropological themes of reproduction, production, and distribution we highlight classic and recent research demonstrating the value of an evolutionary perspective to improving human well-being. The challenge now comes in transforming relevance into action and, for that, evolutionary behavioral anthropologists will need to forge deeper connections with other applied social scientists and policy-makers. We are hopeful that these developments are underway and that, with the current tide of enthusiasm for evidence-based approaches to policy, evolutionary anthropology is well positioned to make a strong contribution. PMID:25684561

  11. Applied equine genetics

    PubMed Central

    FINNO, C. J.; BANNASCH, D. L.

    2015-01-01

    Summary Genome sequencing of the domestic horse and subsequent advancements in the field of equine genomics have led to an explosion in the development of tools for mapping traits and diseases and evaluating gene expression. The objective of this review is to discuss the current progress in the field of equine genomics, with specific emphasis on assembly and analysis of the reference sequence and subsequent sequencing of a Quarter Horse mare; the genomic tools currently available to researchers and their implications in genomic investigations in the horse; the genomics of Mendelian and non-Mendelian traits; the genomics of performance traits and considerations regarding genetic testing in the horse. The whole-genome sequencing of a Quarter Horse mare has provided additional variants within the equine genome that extend past single nucleotide polymorphisms to include insertions/deletions and copy number variants. Equine single nucleotide polymorphism arrays have allowed for the investigation of both simple and complex genetic traits while DNA microarrays have provided a tool for examining gene expression across various tissues and with certain disease conditions. Recently, next-generation sequencing has become more affordable and both whole-genome DNA sequencing and transcriptome-wide RNA sequencing are methodologies that are being applied to equine genomic research. Research in the field of equine genomics continues to expand rapidly as the cost of genotyping and sequencing decreases, resulting in a need for quality bioinformatics software and expertise to appropriately handle both the size and complexity of these data. PMID:24802051

  12. Applied model validation

    NASA Astrophysics Data System (ADS)

    Davies, A. D.

    1985-07-01

    The NBS Center for Fire Research (CFR) conducts scientific research bearing on the fire safety of buildings, vehicles, tunnels and other inhabited structures. Data from controlled fire experiments are collected, analyzed and reduced to the analytical formulas that appear to underly the observed phenomena. These results and more general physical principles are then combined into models to predict the development of environments that may be hostile to humans. This is a progress report of an applied model validation case study. The subject model is Transport of Fire, Smoke and Gases (FAST). Products from a fire in a burn room exit through a connected corridor to outdoors. Cooler counterflow air in a lower layer feeds the fire. The model predicts corridor layer temperatures and thicknesses vs. time, given enclosure, fire and ambient specifications. Data have been collected from 38 tests using several fire sizes, but have not been reduced. Corresponding model results, and model and test documentation are yet to come. Considerable modeling and calculation is needed to convert instrument readings to test results comparable with model outputs so that residual differences may be determined.

  13. [Echinocandins: Applied pharmacology].

    PubMed

    Azanza Perea, José Ramón

    2016-01-01

    The echinocandins share pharmacodynamic properties, although there are some interesting differences in their pharmacokinetic behaviour in the clinical practice. They are not absorbed by the oral route. They have a somewhat special distribution in the organism, as some of them can reach high intracellular concentrations while, with some others, the concentration is reduced. They are highly bound to plasma proteins, thus it is recommended to administer a loading dose for anidulafungin and caspofungin, although this procedure is not yet clear with micafungin. Echinocandins are excreted via a non-microsomal metabolism, so the urinary concentration is very low. Some carrier proteins that take part in the biliary clearance process are probably involved in the interactions described with caspofungin and micafungin. These two drugs must be used with caution in patients with severely impaired hepatic function, while all of them can be used without special precautions when there is renal impairment or the patient requires renal replacement therapy. Copyright © 2016 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Applied Historical Astronomy

    NASA Astrophysics Data System (ADS)

    Stephenson, F. Richard

    2014-01-01

    F. Richard Stephenson has spent most of his research career -- spanning more than 45 years -- studying various aspects of Applied Historical Astronomy. The aim of this interdisciplinary subject is the application of historical astronomical records to the investigation of problems in modern astronomy and geophysics. Stephenson has almost exclusively concentrated on pre-telescopic records, especially those preserved from ancient and medieval times -- the earliest reliable observations dating from around 700 BC. The records which have mainly interested him are of eclipses (both solar and lunar), supernovae, sunspots and aurorae, and Halley's Comet. The main sources of early astronomical data are fourfold: records from ancient and medieval East Asia (China, together with Korea and Japan); ancient Babylon; ancient and medieval Europe; and the medieval Arab world. A feature of Stephenson's research is the direct consultation of early astronomical texts in their original language -- either working unaided or with the help of colleagues. He has also developed a variety of techniques to help interpret the various observations. Most pre-telescopic observations are very crude by present-day standards. In addition, early motives for skywatching were more often astrological rather than scientific. Despite these drawbacks, ancient and medieval astronomical records have two remarkable advantages over modern data. Firstly, they can enable the investigation of long-term trends (e.g. in the terrestrial rate of rotation), which in the relatively short period covered by telescopic observations are obscured by short-term fluctuations. Secondly, over the lengthy time-scale which they cover, significant numbers of very rare events (such as Galactic supernovae) were reported, which have few -- if any-- counterparts in the telescopic record. In his various researches, Stephenson has mainly focused his attention on two specific topics. These are: (i) long-term changes in the Earth's rate of

  15. Essays in applied microeconomics

    NASA Astrophysics Data System (ADS)

    Wang, Xiaoting

    In this dissertation I use Microeconomic theory to study firms' behavior. Chapter One introduces the motivations and main findings of this dissertation. Chapter Two studies the issue of information provision through advertisement when markets are segmented and consumers' price information is incomplete. Firms compete in prices and advertising strategies for consumers with transportation costs. High advertising costs contribute to market segmentation. Low advertising costs promote price competition among firms and improves consumer welfare. Chapter Three also investigates market power as a result of consumers' switching costs. A potential entrant can offer a new product bundled with an existing product to compensate consumers for their switching cost. If the primary market is competitive, bundling simply plays the role of price discrimination, and it does not dominate unbundled sales in the process of entry. If the entrant has market power in the primary market, then bundling also plays the role of leveraging market power and it dominates unbundled sales. The market for electric power generation has been opened to competition in recent years. Chapter Four looks at issues involved in the deregulated electricity market. By comparing the performance of the competitive market with the social optimum, we identify the conditions under which market equilibrium generates socially efficient levels of electric power. Chapter Two to Four investigate the strategic behavior among firms. Chapter Five studies the interaction between firms and unemployed workers in a frictional labor market. We set up an asymmetric job auction model, where two types of workers apply for two types of job openings by bidding in auctions and firms hire the applicant offering them the most profits. The job auction model internalizes the determination of the share of surplus from a match, therefore endogenously generates incentives for an efficient division of the matching surplus. Microeconomic

  16. Applied large eddy simulation.

    PubMed

    Tucker, Paul G; Lardeau, Sylvain

    2009-07-28

    Large eddy simulation (LES) is now seen more and more as a viable alternative to current industrial practice, usually based on problem-specific Reynolds-averaged Navier-Stokes (RANS) methods. Access to detailed flow physics is attractive to industry, especially in an environment in which computer modelling is bound to play an ever increasing role. However, the improvement in accuracy and flow detail has substantial cost. This has so far prevented wider industrial use of LES. The purpose of the applied LES discussion meeting was to address questions regarding what is achievable and what is not, given the current technology and knowledge, for an industrial practitioner who is interested in using LES. The use of LES was explored in an application-centred context between diverse fields. The general flow-governing equation form was explored along with various LES models. The errors occurring in LES were analysed. Also, the hybridization of RANS and LES was considered. The importance of modelling relative to boundary conditions, problem definition and other more mundane aspects were examined. It was to an extent concluded that for LES to make most rapid industrial impact, pragmatic hybrid use of LES, implicit LES and RANS elements will probably be needed. Added to this further, highly industrial sector model parametrizations will be required with clear thought on the key target design parameter(s). The combination of good numerical modelling expertise, a sound understanding of turbulence, along with artistry, pragmatism and the use of recent developments in computer science should dramatically add impetus to the industrial uptake of LES. In the light of the numerous technical challenges that remain it appears that for some time to come LES will have echoes of the high levels of technical knowledge required for safe use of RANS but with much greater fidelity.

  17. Applied physiology of swimming.

    PubMed

    Lavoie, J M; Montpetit, R R

    1986-01-01

    Scientific research in swimming over the past 10 to 15 years has been oriented toward multiple aspects that relate to applied and basic physiology, metabolism, biochemistry, and endocrinology. This review considers recent findings on: 1) specific physical characteristics of swimmers; 2) the energetics of swimming; 3) the evaluation of aerobic fitness in swimming; and 4) some metabolic and hormonal aspects related to swimmers. Firstly, the age of finalists in Olympic swimming is not much different from that of the participants from other sports. They are taller and heavier than a reference population of the same age. The height bias in swimming may be the reason for lack of success from some Asian and African countries. Experimental data point toward greater leanness, particularly in female swimmers, than was seen 10 years ago. Overall, female swimmers present a range of 14 to 19% body fat whereas males are much lower (5 to 10%). Secondly, the relationship between O2 uptake and crawl swimming velocity (at training and competitive speeds) is thought to be linear. The energy cost varies between strokes with a dichotomy between the 2 symmetrical and the 2 asymmetrical strokes. Energy expenditure in swimming is represented by the sum of the cost of translational motion (drag) and maintenance of horizontal motion (gravity). The cost of the latter decreases as speed increases. Examination of the question of size-associated effects on the cost of swimming using Huxley's allometric equation (Y = axb) shows an almost direct relationship with passive drag. Expressing energy cost in litres of O2/m/kg is proposed as a better index of technical swimming ability than the traditional expression of VO2/distance in L/km. Thirdly, maximal direct conventional techniques used to evaluate maximal oxygen consumption (VO2 max) in swimming include free swimming, tethered swimming, and flume swimming. Despite the individual peculiarities of each method, with similar experimental conditions

  18. Essays in applied economics

    NASA Astrophysics Data System (ADS)

    Arano, Kathleen

    Three independent studies in applied economics are presented. The first essay looks at the US natural gas industrial sector and estimates welfare effects associated with the changes in natural gas regulatory policy over the past three decades. Using a disequilibrium model suited to the natural gas industry, welfare transfers and deadweight losses are calculated. Results indicate that deregulation policies, beginning with the NGPA of 1978, have caused the industry to become more responsive to market conditions. Over time, regulated prices converge toward the estimated equilibrium prices. As a result of this convergence, deadweight losses associated with regulation are also diminished. The second essay examines the discounted utility model (DU), the standard model used for intertemporal decision-making. Prior empirical studies challenge the descriptive validity of the model. This essay addresses the four main inconsistencies that have been raised: domain dependence, magnitude effects, time effects, and gain/loss asymmetries. These inconsistencies, however, may be the result of the implicit assumption of linear utility and not a failure of the DU model itself. In order to test this hypothesis, data was collected from in-class surveys of economics classes at Mississippi State University. A random effects model for panel data estimation which accounts for individual specific effects was then used to impute discount rates measured in terms of dollars and utility. All four inconsistencies were found to be present when the dollar measures were used. Using utility measures of the discount rate resolved the inconsistencies in some cases. The third essay brings together two perspectives in the study of religion and economics: modeling religious behavior using economic tools and variables, and modeling economic behavior using religious variables. A system of ordered probit equations is developed to simultaneously model religious activities and economic outcomes. Using data

  19. Essays in Applied Microeconomics

    NASA Astrophysics Data System (ADS)

    Ge, Qi

    This dissertation consists of three self-contained applied microeconomics essays on topics related to behavioral economics and industrial organization. Chapter 1 studies how sentiment as a result of sports event outcomes affects consumers' tipping behavior in the presence of social norms. I formulate a model of tipping behavior that captures consumer sentiment following a reference-dependent preference framework and empirically test its relevance using the game outcomes of the NBA and the trip and tipping data on New York City taxicabs. While I find that consumers' tipping behavior responds to unexpected wins and losses of their home team, particularly in close game outcomes, I do not find evidence for loss aversion. Coupled with the findings on default tipping, my empirical results on the asymmetric tipping responses suggest that while social norms may dominate loss aversion, affect and surprises can result in freedom on the upside of tipping. Chapter 2 utilizes a novel data source of airline entry and exit announcements and examines how the incumbent airlines adjust quality provisions as a response to their competitors' announcements and the role of timing in such responses. I find no evidence that the incumbents engage in preemptive actions when facing probable entry and exit threats as signaled by the competitors' announcements in either short term or long term. There is, however, evidence supporting their responses to the competitors' realized entry or exit. My empirical findings underscore the role of timing in determining preemptive actions and suggest that previous studies may have overestimated how the incumbent airlines respond to entry threats. Chapter 3, which is collaborated with Benjamin Ho, investigates the habit formation of consumers' thermostat setting behavior, an often implicitly made decision and yet a key determinant of home energy consumption and expenditures. We utilize a high frequency dataset on household thermostat usage and find that

  20. Facilitating applied information technology research.

    PubMed

    Glaser, John P

    2005-01-01

    Most healthcare organizations need to develop an understanding of the role, maturity, and utility of new information technologies. Performing this research can present a series of challenges. For example, IT staff may not know how to obtain resources; the research may show promising results but fail to be implemented; and organizations may not develop a thoughtful portfolio of research projects. To minimize these problems, applied information technology research must be managed. This paper describes the information technology research process at Partners HealthCare. The research process is a management process designed to identify important research topics, solicit IT staff proposals to investigate topics, prioritize and fund research projects, and communicate and disseminate research results. Sample research topics include the role of RFID, the impact of Internet-based e-visits, and approaches for integrating speech and direct input for clinical information systems. The paper describes the goals and activities of the research process and the role of the research council. The research proposal review process is discussed, and an inventory of approved research projects is reviewed. The paper discusses several challenges involved in creating and managing the research process.

  1. Instructions for Applying | Division of Cancer Prevention

    Cancer.gov

    This is NOT a grant application - if successful, funds will not be transferred to your institution to support your project. Rather, this is an application to access the scientific capabilities and resources of the NCI with the goal of moving promising cancer chemopreventive agents into clinical testing. If successful, you will partner with the NCI in developing a drug development pipeline. | Apply to access the scientific capabilities and resources of the NCI with the goal of moving promising cancer chemopreventive agents into clinical testing.

  2. How to Apply | Office of Cancer Clinical Proteomics Research

    Cancer.gov

    The Antibody Characterization Program opens the reagent target request to the research community approximately one to two times per year. Interested researchers with readily available protein/peptides can submit a request using a form provided when the opportunity is open. The Antibody Scientific Committee evaluates proposed antibody targets based on their relatedness to cancer, the availability of commercial antibodies/affinity binders for the target, and justification and contribution to existing NCI-funded projects.

  3. Learning and applying biosciences to clinical practice in nursing.

    PubMed

    Smales, K

    The study of biosciences by nursing students, while perceived by most as relevant, presents particular challenges for many during pre- registration programmes. This article describes a literature review of the teaching and learning of biosciences in nursing curricula. Four areas are explored: the relevance of bioscience in pre-registration nursing; difficulties experienced by nursing students learning biosciences; lecturer attributes in facilitating learning; and teaching and assessment methods.

  4. Clinical neuroimaging

    SciTech Connect

    Gilman, S.; Mazziotta, J.C.

    1989-01-01

    Designed for practicing neurologists and neurosurgeons, this reference focuses on the newest techniques in computed assisted tomography. Text material covers basic principles of computed tomography, as well as the clinical advantages and disadvantages of each modality. The anatomical and/or physiological processes measured by XCT, PET, SPECT and MRI are first discussed in terms of the normal patient, and then applied to the diagnosis and treatment of patients with neurological disease (primarily of the brain). Emphasis is placed on areas of difficult diagnosis, such as differentiating recurrent tumor from radiation necrosis, early diagnosis of dementia, selection of patients for extracranial-intracranial bypass procedures, and localization of epileptic foci.

  5. Applying incentive sensitization models to behavioral addiction.

    PubMed

    Rømer Thomsen, Kristine; Fjorback, Lone O; Møller, Arne; Lou, Hans C

    2014-09-01

    The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical symptoms and underlying neurobiology. We examine the relevance of this theory for Gambling Disorder and point to predictions for future studies. The theory promises a significant contribution to the understanding of behavioral addiction and opens new avenues for treatment.

  6. Basic and applied research on choice responding.

    PubMed Central

    Fisher, W W; Mazur, J E

    1997-01-01

    Choice responding refers to the manner in which individuals allocate their time or responding among available response options. In this article, we first review basic investigations that have identified and examined variables that influence choice responding, such as response effort and reinforcement rate, immediacy, and quality. We then describe recent bridge and applied studies that illustrate how the results of basic research on choice responding can help to account for human behavior in natural environments and improve clinical assessments and interventions. PMID:9316255

  7. Applied Behavior Analysis in Education.

    ERIC Educational Resources Information Center

    Cooper, John O.

    1982-01-01

    Applied behavioral analysis in education is expanding rapidly. This article describes the dimensions of applied behavior analysis and the contributions this technology offers teachers in the area of systematic applications, direct and daily measurement, and experimental methodology. (CJ)

  8. Task force on applied mathematics

    NASA Technical Reports Server (NTRS)

    Prieto, A.

    1979-01-01

    Tomas Garza relates how the Research Center for Applied Mathematics Systems and Services in Mexico became the Research Institute for Applied Mathematics and Systems and what the type of work performed is.

  9. Topically applied vitamins and their cutaneous effects.

    PubMed

    Grammaticopoulos, George T; Furtunopoulos, Demetrios G; Zisova, Lilia G

    2004-01-01

    The number of cosmetic products which include vitamins as a constituent has increased three-fold since 1991. Vitamins are commonly used as ingredients of products designed to improve the appearance and health of the skin; for this reason the cutaneous benefits of such products are actively researched by dermatologists and chemists. The present study does a review of the action of topically applied vitamins for local use which improves the function of the skin. We specifically consider the biologic activity of topically applied vitamins, their stability and usefulness. Ways of stabilizing different kinds of vitamins, as well as their stability to oxygen, light, temperature, acids, and bases, are shown. The conclusion suggested by the review is that the efficiency of topically applied vitamins is dependent not only on their good stabilization and concentration but also on the clinical individual tests that can determine the best product for each particular patient.

  10. The Routledge Applied Linguistics Reader

    ERIC Educational Resources Information Center

    Wei, Li, Ed.

    2011-01-01

    "The Routledge Applied Linguistics Reader" is an essential collection of readings for students of Applied Linguistics. Divided into five sections: Language Teaching and Learning, Second Language Acquisition, Applied Linguistics, Identity and Power and Language Use in Professional Contexts, the "Reader" takes a broad…

  11. The Routledge Applied Linguistics Reader

    ERIC Educational Resources Information Center

    Wei, Li, Ed.

    2011-01-01

    "The Routledge Applied Linguistics Reader" is an essential collection of readings for students of Applied Linguistics. Divided into five sections: Language Teaching and Learning, Second Language Acquisition, Applied Linguistics, Identity and Power and Language Use in Professional Contexts, the "Reader" takes a broad…

  12. 42 CFR 52d.8 - Other HHS regulations that apply.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Other HHS regulations that apply. 52d.8 Section 52d.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.8 Other HHS regulations that apply. Several...

  13. 42 CFR 52d.8 - Other HHS regulations that apply.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Other HHS regulations that apply. 52d.8 Section 52d.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.8 Other HHS regulations that apply. Several...

  14. 42 CFR 52d.8 - Other HHS regulations that apply.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Other HHS regulations that apply. 52d.8 Section 52d.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.8 Other HHS regulations that apply. Several...

  15. 42 CFR 52d.8 - Other HHS regulations that apply.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Other HHS regulations that apply. 52d.8 Section 52d.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.8 Other HHS regulations that apply. Several...

  16. 42 CFR 52d.8 - Other HHS regulations that apply.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Other HHS regulations that apply. 52d.8 Section 52d.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.8 Other HHS regulations that apply. Several...

  17. Clinical professional governance for detailed clinical models.

    PubMed

    Goossen, William; Goossen-Baremans, Anneke

    2013-01-01

    This chapter describes the need for Detailed Clinical Models for contemporary Electronic Health Systems, data exchange and data reuse. It starts with an explanation of the components related to Detailed Clinical Models with a brief summary of knowledge representation, including terminologies representing clinic relevant "things" in the real world, and information models that abstract these in order to let computers process data about these things. Next, Detailed Clinical Models are defined and their purpose is described. It builds on existing developments around the world and accumulates in current work to create a technical specification at the level of the International Standards Organization. The core components of properly expressed Detailed Clinical Models are illustrated, including clinical knowledge and context, data element specification, code bindings to terminologies and meta-information about authors, versioning among others. Detailed Clinical Models to date are heavily based on user requirements and specify the conceptual and logical levels of modelling. It is not precise enough for specific implementations, which requires an additional step. However, this allows Detailed Clinical Models to serve as specifications for many different kinds of implementations. Examples of Detailed Clinical Models are presented both in text and in Unified Modelling Language. Detailed Clinical Models can be positioned in health information architectures, where they serve at the most detailed granular level. The chapter ends with examples of projects that create and deploy Detailed Clinical Models. All have in common that they can often reuse materials from earlier projects, and that strict governance of these models is essential to use them safely in health care information and communication technology. Clinical validation is one point of such governance, and model testing another. The Plan Do Check Act cycle can be applied for governance of Detailed Clinical Models

  18. A Survey of Applied Linguistics.

    ERIC Educational Resources Information Center

    Wardhaugh, Ronald, Ed.; Brown, H. Douglas, Ed.

    This book provides a comprehensive review of the major areas of applied linguistics with original contributions by fourteen scholars. The following chapters are included: (1) "What is Applied Linguistics?" by H. Douglas Brown; (2) "Language Development," by Lois Bloom; (3) "First Language Teaching," by Jean Malmstrom (discusses the teaching of…

  19. The Fleming Applied Projects Program

    ERIC Educational Resources Information Center

    Spasov, Peter

    2004-01-01

    Applied Projects is a program where every technology student engages in an intensive team project full time during the final academic semester. A wide range of enterprises provide the real-world problems that form the basis of student projects. This article describes the program and how Fleming College uses this program for applied research. To…

  20. Development of the Applied Baccalaureate

    ERIC Educational Resources Information Center

    Townsend, Barbara K.; Bragg, Debra D.; Ruud, Collin M.

    2009-01-01

    Increasing demands for economic competitiveness and educational effectiveness have led states and institutions to implement new approaches to facilitating baccalaureate completion. This study examined one of these approaches, the applied baccalaureate degree, which is designed to incorporate applied associate course work and degrees once…

  1. An Option in Applied Microbiology.

    ERIC Educational Resources Information Center

    Lee, William E., III

    1988-01-01

    Describes a program option for undergraduate chemical engineering students interested in biotechnology. Discusses how this program is deployed at the University of Southern Florida. Lists courses which apply to this program. Discusses the goals of teaching applied microbiology to engineering majors. (CW)

  2. Motivating employees. Applying motivational theories to nursing.

    PubMed

    Pustai, I

    1989-12-01

    Managers provide the critical link between the delivery of nursing care and the administration. It is vital for nurse managers to provide a work environment that supports professional nursing practices. Staff nurses are taught how to carry out clinical functions. For them to develop and practice advanced clinical skills, managers have to buffer the pressures of daily operations. They must ask themselves, "Am I committed to my employees?" "Am I an enthusiastic role model for my employees?" "Do I use positive motivating techniques?" "Do I know each of my employees personally as a unique individual?" "What can I do to create an environment that supports my employees?" and "How can I make each of my employees feel respected and worthy?" If the manager, whether experienced or not, can answer these questions honestly and apply motivational techniques differently, he or she will be the best kind of manager: a true leader.

  3. Heavy-Ion Imaging Applied To Medicine

    NASA Astrophysics Data System (ADS)

    Fabrikant, J. I.; Tobias, C. A.; Capp, M. P.; Benton, E. V.; Holley, W. R.

    1980-08-01

    Heavy particle radiography is a newly developed noninvasive low dose imaging procedure with increased resolution of minute density differences in soft tissues of the body. The method utilizes accelerated high energy ions, primarily carbon and neon, at the BEVALAC accelerator at the Lawrence Berkeley Laboratory. The research program applied to medicine utilizes heavy-ion radiography for low dose mammography, for treatment planning for cancer patients, and for imaging and accurate densitometry of skeletal structures and brain and spinal neoplasms. The presentation will be illustrated with clinical cases under study. Discussion will include the potential of heavy-ion imaging, and particularly reconstruction tomography, as an adjunct to existing diagnostic imaging procedures in medicine, both for the applications to the diagnosis, management and treatment of clinical cancer in man, but also for the early detection of small soft tissue tumors at low radiation dose.

  4. Clinical Trials

    MedlinePlus

    ... Sponsors Why Are They Important How Do They Work Who Can Participate What To Expect During Benefits and Risks How They Protect Participants Finding Clinical Trials Links Children & Clinical Studies NHLBI Trials Clinical Trial Websites What Are Clinical ...

  5. How to Apply | FNLCR Staging

    Cancer.gov

    Getting started— You can begin byviewing current job openings. From this link you can also create a profile, apply online, and register for job alerts. Confirmation email — We will send you an automated confirmation email to let you k

  6. Clinical Instruction for Professional Practice

    ERIC Educational Resources Information Center

    Gardner, Greg; Sexton, Patrick; Guyer, M. Susan; Willeford, K. Sean; Levy, Linda S.; Barnum, Mary G.; Fincher, A. Louise

    2009-01-01

    Objective: To present the principles of adult learning and mentoring to help clinical instructors better educate athletic training students (ATSs) during their clinical experiences, with the end result being a better prepared, competent entry-level practitioner. Background: The principles of adult learning must be applied to ATS clinical education…

  7. Clinical Instruction for Professional Practice

    ERIC Educational Resources Information Center

    Gardner, Greg; Sexton, Patrick; Guyer, M. Susan; Willeford, K. Sean; Levy, Linda S.; Barnum, Mary G.; Fincher, A. Louise

    2009-01-01

    Objective: To present the principles of adult learning and mentoring to help clinical instructors better educate athletic training students (ATSs) during their clinical experiences, with the end result being a better prepared, competent entry-level practitioner. Background: The principles of adult learning must be applied to ATS clinical education…

  8. Applied Linguistics in Society. Papers from the Annual Meeting of the British Association for Applied Linguistics (20th, Nottingham, England, United Kingdom, September 1987). British Studies in Applied Linguistics, 3.

    ERIC Educational Resources Information Center

    Grunwell, Pamela, Ed.

    A selection of papers from the 1987 meeting of the applied linguistics association includes the following: "Applied Linguistics in Society" (John Trim); "European Developments in Applied Linguistics" (Theo van Els); "Translation and Interpretation: Retrospect and Prospect" (Peter Newmark); "Clinical Linguistics:…

  9. Applying Sociology to the Teaching of Applied Sociology.

    ERIC Educational Resources Information Center

    Wallace, Richard Cheever

    A college-level applied sociology course in which students use sociological theory or research methodology to solve social problems is described. Guidelines for determining appropriate projects are: (1) the student must feel there is a substantial need for the project; (2) the project must be approachable through recognized sociological…

  10. Applying Sociology to the Teaching of Applied Sociology.

    ERIC Educational Resources Information Center

    Wallace, Richard Cheever

    A college-level applied sociology course in which students use sociological theory or research methodology to solve social problems is described. Guidelines for determining appropriate projects are: (1) the student must feel there is a substantial need for the project; (2) the project must be approachable through recognized sociological…

  11. Applied photonic therapy in veterinary medicine

    NASA Astrophysics Data System (ADS)

    Wood, Terry R.; McLaren, Brian C.

    2005-04-01

    There can be no question that specific systemic physiological results occur, when red light (660nm) is applied to the skin, it is now more a question of detailed mechanisms. Before gathering statistically signifcant clinical trial data, it is important to first enumerate the type of results observed in practice. Case histories are presented highlighting the use of photonic therapy in veterinary medicine. Over 900 surgical procedures have been performed and documented, utilizing the principles of photonic therapy, and while hemostasis, pain relief, and nausea relief, were the primary goals, the peri-operative death rate, the post-operative seroma, and post-operative infection were reduced to almost zero, and there was a noticeable increase in the healing rate. Scientifically applied photonic therapy, rather than supplanting conventional veterinary medicine, compliments and increases the veterinarian's set of skills. This paper proposes a hypothesis of how 660 nm light applied to specific points on the skin, produces various physiological changes in animals. By using animals, there can be no placebo, hypnotic or psychosomatic confounding effects.

  12. From art to applied science.

    PubMed

    Schatzberg, Eric

    2012-09-01

    Before "applied science" and "technology" became keywords, the concept of art was central to discourse about material culture and its connections to natural knowledge. By the late nineteenth century, a new discourse of applied science had replaced the older discourse of art. This older discourse of art, especially as presented in Enlightenment encyclopedias, addressed the relationship between art and science in depth. But during the nineteenth century the concept of fine art gradually displaced the broader meanings of "art," thus undermining the utility of the term for discourse on the relationship between knowledge and practice. This narrowed meaning of "art" obscured key aspects of the industrial world. In effect, middle-class agents of industrialism, including "men of science," used the rhetoric of "applied science" and, later, "technology" to cement the exclusion of artisanal knowledge from the discourse of industrial modernity.

  13. Women in applied behavior analysis

    PubMed Central

    McSweeney, Frances K.; Donahoe, Patricia; Swindell, Samantha

    2000-01-01

    The status of women in applied behavior analysis was examined by comparing the participation of women in the Journal of Applied Behavior Analysis (JABA) to their participation in three similar journals. For all journals, the percentage of articles with at least one female author, the percentage of authors who are female, and the percentage of articles with a female first author increased from 1978 to 1997. Participation by women in JABA was equal to or greater than participation by women in the comparison journals. However, women appeared as authors on papers in special sections of Behavior Modification substantially more often when the editor was female than when the editor was male. In addition, female membership on the editorial boards of JABA, Behavior Modification, and Behaviour Research and Therapy failed to increase from 1978 to 1997. We conclude that a “glass ceiling” reduces the participation of women at the highest levels of applied behavior analysis and related fields. PMID:22478351

  14. Applied Remote Sensing Program (ARSP)

    NASA Technical Reports Server (NTRS)

    Johnson, J. D.; Foster, K. E.; Mouat, D. A.; Miller, D. A.; Conn, J. S.

    1976-01-01

    The activities and accomplishments of the Applied Remote Sensing Program during FY 1975-1976 are reported. The principal objective of the Applied Remote Sensing Program continues to be designed projects having specific decision-making impacts as a principal goal. These projects are carried out in cooperation and collaboration with local, state and federal agencies whose responsibilities lie with planning, zoning and environmental monitoring and/or assessment in the application of remote sensing techniques. The end result of the projects is the use by the involved agencies of remote sensing techniques in problem solving.

  15. Toward an Applied Administrative Science.

    ERIC Educational Resources Information Center

    Dunbar, Roger L. M.

    1983-01-01

    A study of 65 articles from the 1981 volumes of "Administrative Science Quarterly" and "Harvard Business Review," using smallest space analysis, found that the few studies adopting subjective (instead of objective) approaches to analyzing organizational change were most likely to provide a basis for an applied administrative…

  16. Applied Learning for Middle Schoolers.

    ERIC Educational Resources Information Center

    Miller, Paula; And Others

    1995-01-01

    From leading garden tours to planning a visit for Japanese teachers and participating in community theater, middle schoolers at Fort Worth's Applied Learning Academy learn academic content by working on community projects. Students' writing skills soared as they developed, edited, and field-tested brochures and trail-guide maps for their botanical…

  17. Toward an Applied Administrative Science.

    ERIC Educational Resources Information Center

    Dunbar, Roger L. M.

    1983-01-01

    A study of 65 articles from the 1981 volumes of "Administrative Science Quarterly" and "Harvard Business Review," using smallest space analysis, found that the few studies adopting subjective (instead of objective) approaches to analyzing organizational change were most likely to provide a basis for an applied administrative…

  18. Case Studies in Applied Mathematics.

    ERIC Educational Resources Information Center

    Mathematical Association of America, Washington, DC.

    This collection of nine case studies in applied mathematics was written primarily for the use of the instructor by a Conference sponsored by the Committee on the Undergraduate Program in Mathematics (CUPM). Each chapter contains exercises of varying degrees of difficulty and several include student projects. The materials were used on a trial…

  19. Applying Creativity Research to Cooking

    ERIC Educational Resources Information Center

    Beghetto, Ronald A.; Kaufman, James C.; Hatcher, Ryan

    2016-01-01

    What, if any, benefit might there be to applying creativity research to cooking? The purpose of this paper was to address this question. Specifically, we draw on concepts and theories from creativity research to help clarify what is meant by creative cooking. This includes exploring creative cooking through the lens of the 4-C and Propulsion…

  20. Applied Mathematics. Florida Teaching Supplement.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Div. of Vocational, Adult, and Community Education.

    The information in this supplementary notebook is intended to provide teachers with additional materials, ideas and suggestions, and activities to help in implementing the first 21 units of the Applied Mathematics modules that help develop and refine job-related mathematics skills. An introduction lists the 36 units of the complete Applied…

  1. Conditional Independence in Applied Probability.

    ERIC Educational Resources Information Center

    Pfeiffer, Paul E.

    This material assumes the user has the background provided by a good undergraduate course in applied probability. It is felt that introductory courses in calculus, linear algebra, and perhaps some differential equations should provide the requisite experience and proficiency with mathematical concepts, notation, and argument. The document is…

  2. Applying Creativity Research to Cooking

    ERIC Educational Resources Information Center

    Beghetto, Ronald A.; Kaufman, James C.; Hatcher, Ryan

    2016-01-01

    What, if any, benefit might there be to applying creativity research to cooking? The purpose of this paper was to address this question. Specifically, we draw on concepts and theories from creativity research to help clarify what is meant by creative cooking. This includes exploring creative cooking through the lens of the 4-C and Propulsion…

  3. Applied Linguistics Research on Asianness

    ERIC Educational Resources Information Center

    Kobayashi, Yoko

    2011-01-01

    As China is increasingly occupying the world's attention, its explosively expanding economical and political clout has also been felt in the applied linguistics domain, with the discussion on China's/Chinese language issues growing by leaps and bounds (e.g. China's English education policies, Chinese language classes in the West). Amid the world's…

  4. Applied Learning for Middle Schoolers.

    ERIC Educational Resources Information Center

    Miller, Paula; And Others

    1995-01-01

    From leading garden tours to planning a visit for Japanese teachers and participating in community theater, middle schoolers at Fort Worth's Applied Learning Academy learn academic content by working on community projects. Students' writing skills soared as they developed, edited, and field-tested brochures and trail-guide maps for their botanical…

  5. World Englishes and Applied Linguistics.

    ERIC Educational Resources Information Center

    Kachru, Braj B.

    This paper addresses the issue of the relationship between World Englishes (WE) and applied linguistics. The diffusion of English is seen in terms of three concentric circles: the Inner Circle (first-language varieties, e.g., the United States, United Kingdom), the Outer Circle (English-as-a-Second-Language varieties), and the Expanding Circle…

  6. Applied Remote Sensing Program (ARSP)

    NASA Technical Reports Server (NTRS)

    Mouat, D. A.; Johnson, J. D.; Foster, K. E.

    1977-01-01

    Descriptions of projects engaged by the Applied Remote Sensors Program in the state of Arizona are contained in an annual report for the fiscal year 1976-1977. Remote sensing techniques included thermal infrared imagery in analog and digital form and conversion of data into thermograms. Delineation of geologic areas, surveys of vegetation and inventory of resources were also presented.

  7. Applied aerodynamics: Challenges and expectations

    NASA Technical Reports Server (NTRS)

    Peterson, Victor L.; Smith, Charles A.

    1993-01-01

    Aerospace is the leading positive contributor to this country's balance of trade, derived largely from the sale of U.S. commercial aircraft around the world. This powerfully favorable economic situation is being threatened in two ways: (1) the U.S. portion of the commercial transport market is decreasing, even though the worldwide market is projected to increase substantially; and (2) expenditures are decreasing for military aircraft, which often serve as proving grounds for advanced aircraft technology. To retain a major share of the world market for commercial aircraft and continue to provide military aircraft with unsurpassed performance, the U.S. aerospace industry faces many technological challenges. The field of applied aerodynamics is necessarily a major contributor to efforts aimed at meeting these technological challenges. A number of emerging research results that will provide new opportunities for applied aerodynamicists are discussed. Some of these have great potential for maintaining the high value of contributions from applied aerodynamics in the relatively near future. Over time, however, the value of these contributions will diminish greatly unless substantial investments continue to be made in basic and applied research efforts. The focus: to increase understanding of fluid dynamic phenomena, identify new aerodynamic concepts, and provide validated advanced technology for future aircraft.

  8. Applied Linguistics Research on Asianness

    ERIC Educational Resources Information Center

    Kobayashi, Yoko

    2011-01-01

    As China is increasingly occupying the world's attention, its explosively expanding economical and political clout has also been felt in the applied linguistics domain, with the discussion on China's/Chinese language issues growing by leaps and bounds (e.g. China's English education policies, Chinese language classes in the West). Amid the world's…

  9. Basic research vs. applied research.

    PubMed

    Reulen, H J

    2002-01-01

    Research rotation is an important component in the education of a neurosurgical resident. The selection of the area of research is essential. There are many arguments in favour of selecting research projects to be close to the individual trainee's clinical interest. Studies far away from the individual's clinical interest in most cases are less productive and will not be pursued later. There are also many advantages if a cooperation is planned with other institutions. The programme director or staff members play an important role in the selection of the research project, of an appropriate laboratory or institution, and in the process of financing a research rotation.

  10. Clinical decision modeling system

    PubMed Central

    Shi, Haiwen; Lyons-Weiler, James

    2007-01-01

    Background Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint) probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives are unknown or even unspecified. Methods We designed a Java-based software resource, the Clinical Decision Modeling System (CDMS), to implement Naïve Decision Modeling, and provide a use case based on published performance evaluation measures of various strategies for breast and lung cancer detection. Because cost estimates for many of the newer methods are not yet available, we assume equal cost. Our use case reveals numerous potentially high-performance combinations of clinical options for the detection of breast and lung cancer. Results Naïve Decision Modeling is a highly practical applied strategy which guides investigators through the process of establishing evidence-based integrative translational clinical research priorities. CDMS is not designed for clinical decision support. Inputs include performance evaluation measures and costs of various clinical options. The software finds trees with expected emergent performance characteristics and average cost per patient that meet stated filtering criteria. Key to the utility of the software is sophisticated graphical elements, including a tree browser, a receiver-operator characteristic surface plot, and a histogram of expected average cost per patient. The analysis pinpoints the potentially most relevant pairs of clinical options ('critical pairs') for which empirical estimates of conditional dependence may be critical. The assumption of independence can be tested with retrospective studies prior to the initiation of clinical trials designed to

  11. Modeling Applied to Problem Solving

    NASA Astrophysics Data System (ADS)

    Pawl, Andrew; Barrantes, Analia; Pritchard, David E.

    2009-10-01

    Modeling Applied to Problem Solving (MAPS) is a pedagogy that helps students transfer instruction to problem solving in an expert-like manner. Declarative and Procedural syllabus content is organized and learned (not discovered) as a hierarchy of General Models. Students solve problems using an explicit Problem Modeling Rubric that begins with System, Interactions and Model (S.I.M.). System and Interactions are emphasized as the key to a strategic description of the system and the identification of the appropriate General Model to apply to the problem. We have employed the pedagogy in a three-week review course for students who received a D in mechanics. The course was assessed by a final exam retest as well as pre and post C-LASS surveys, yielding a one standard deviation improvement in the students' ability to solve final exam problems and a statistically significant positive shift in 7 of the 9 categories in the C-LASS.

  12. Transcription Against an Applied Force

    NASA Astrophysics Data System (ADS)

    Yin, Hong; Wang, Michelle D.; Svoboda, Karel; Landick, Robert; Block, Steven M.; Gelles, Jeff

    1995-12-01

    The force produced by a single molecule of Escherichia coli RNA polymerase during transcription was measured optically. Polymerase immobilized on a surface was used to transcribe a DNA template attached to a polystyrene bead 0.5 micrometer in diameter. The bead position was measured by interferometry while a force opposing translocation of the polymerase along the DNA was applied with an optical trap. At saturating nucleoside triphosphate concentrations, polymerase molecules stalled reversibly at a mean applied force estimated to be 14 piconewtons. This force is substantially larger than those measured for the cytoskeletal motors kinesin and myosin and exceeds mechanical loads that are estimated to oppose transcriptional elongation in vivo. The data are consistent with efficient conversion of the free energy liberated by RNA synthesis into mechanical work.

  13. NIIEFA accelerators for applied purposes

    NASA Astrophysics Data System (ADS)

    Vorogushin, M. F.; Strokach, A. P.; Filatov, O. G.

    2016-12-01

    Since the foundation of the institute, we have designed and delivered more than three hundred different accelerators to Russia and abroad: cyclotrons, linear accelerators, and neutron generators. The technical characteristics of our equipment makes it competitive on the international market. Here we present the application, main parameters, and status of accelerators manufactured by NIIEFA, as well as prospects for the development of electrophysical systems for applied purposes.

  14. An Applied Physicist Does Econometrics

    NASA Astrophysics Data System (ADS)

    Taff, L. G.

    2010-02-01

    The biggest problem those attempting to understand econometric data, via modeling, have is that economics has no F = ma. Without a theoretical underpinning, econometricians have no way to build a good model to fit observations to. Physicists do, and when F = ma failed, we knew it. Still desiring to comprehend econometric data, applied economists turn to mis-applying probability theory---especially with regard to the assumptions concerning random errors---and choosing extremely simplistic analytical formulations of inter-relationships. This introduces model bias to an unknown degree. An applied physicist, used to having to match observations to a numerical or analytical model with a firm theoretical basis, modify the model, re-perform the analysis, and then know why, and when, to delete ``outliers'', is at a considerable advantage when quantitatively analyzing econometric data. I treat two cases. One is to determine the household density distribution of total assets, annual income, age, level of education, race, and marital status. Each of these ``independent'' variables is highly correlated with every other but only current annual income and level of education follow a linear relationship. The other is to discover the functional dependence of total assets on the distribution of assets: total assets has an amazingly tight power law dependence on a quadratic function of portfolio composition. Who knew? )

  15. Towards "open applied" Earth sciences

    NASA Astrophysics Data System (ADS)

    Ziegler, C. R.; Schildhauer, M.

    2014-12-01

    Concepts of open science -- in the context of cyber/digital technology and culture -- could greatly benefit applied and secondary Earth science efforts. However, international organizations (e.g., environmental agencies, conservation groups and sustainable development organizations) that are focused on applied science have been slow to incorporate open practices across the spectrum of scientific activities, from data to decisions. Myriad benefits include transparency, reproducibility, efficiency (timeliness and cost savings), stakeholder engagement, direct linkages between research and environmental outcomes, reduction in bias and corruption, improved simulation of Earth systems and improved availability of science in general. We map out where and how open science can play a role, providing next steps, with specific emphasis on applied science efforts and processes such as environmental assessment, synthesis and systematic reviews, meta-analyses, decision support and emerging cyber technologies. Disclaimer: The views expressed in this paper are those of the authors and do not necessarily reflect the views or policies of the organizations for which they work and/or represent.

  16. Fire retardancy using applied materials

    NASA Technical Reports Server (NTRS)

    Feldman, R.

    1971-01-01

    An example of advanced technology transfer from the Little Joe, Surveyor, Comsat, re-entry and Apollo age to everyday fire protection needs is presented. Utilizing the principle of sublimation cooling for thermostatic temperature control, the material meets a wide range of fire retardancy and heat transmission control requirements. Properties vary from flexible tape for conduits and electrical cables to rigid coatings for column protection, with a broad spectrum of sublimation temperatures available. The material can be applied in the field or in the factory, utilizing mass production techniques, yielding a product that is reliable, effective, widely available and low in cost.

  17. Applying STAMP in Accident Analysis

    NASA Technical Reports Server (NTRS)

    Leveson, Nancy; Daouk, Mirna; Dulac, Nicolas; Marais, Karen

    2003-01-01

    Accident models play a critical role in accident investigation and analysis. Most traditional models are based on an underlying chain of events. These models, however, have serious limitations when used for complex, socio-technical systems. Previously, Leveson proposed a new accident model (STAMP) based on system theory. In STAMP, the basic concept is not an event but a constraint. This paper shows how STAMP can be applied to accident analysis using three different views or models of the accident process and proposes a notation for describing this process.

  18. Aerospace reliability applied to biomedicine.

    NASA Technical Reports Server (NTRS)

    Lalli, V. R.; Vargo, D. J.

    1972-01-01

    An analysis is presented that indicates that the reliability and quality assurance methodology selected by NASA to minimize failures in aerospace equipment can be applied directly to biomedical devices to improve hospital equipment reliability. The Space Electric Rocket Test project is used as an example of NASA application of reliability and quality assurance (R&QA) methods. By analogy a comparison is made to show how these same methods can be used in the development of transducers, instrumentation, and complex systems for use in medicine.

  19. Aerospace reliability applied to biomedicine.

    NASA Technical Reports Server (NTRS)

    Lalli, V. R.; Vargo, D. J.

    1972-01-01

    An analysis is presented that indicates that the reliability and quality assurance methodology selected by NASA to minimize failures in aerospace equipment can be applied directly to biomedical devices to improve hospital equipment reliability. The Space Electric Rocket Test project is used as an example of NASA application of reliability and quality assurance (R&QA) methods. By analogy a comparison is made to show how these same methods can be used in the development of transducers, instrumentation, and complex systems for use in medicine.

  20. Applying quantum principles to psychology

    NASA Astrophysics Data System (ADS)

    Busemeyer, Jerome R.; Wang, Zheng; Khrennikov, Andrei; Basieva, Irina

    2014-12-01

    This article starts out with a detailed example illustrating the utility of applying quantum probability to psychology. Then it describes several alternative mathematical methods for mapping fundamental quantum concepts (such as state preparation, measurement, state evolution) to fundamental psychological concepts (such as stimulus, response, information processing). For state preparation, we consider both pure states and densities with mixtures. For measurement, we consider projective measurements and positive operator valued measurements. The advantages and disadvantages of each method with respect to applications in psychology are discussed.

  1. Finite element analysis applied to cornea reshaping.

    PubMed

    Cabrera Fernández, Delia; Niazy, A M; Kurtz, R M; Djotyan, G P; Juhasz, T

    2005-01-01

    A 2-D finite element model of the cornea is developed to simulate corneal reshaping and the resulting deformation induced by refractive surgery. In the numerical simulations, linear and nonlinear elastic models are applied when stiffness inhomogeneities varying with depth are considered. Multiple simulations are created that employ different geometric configurations for the removal of the corneal tissue. Side-by-side comparisons of the different constitutive laws are also performed. To facilitate the comparison, the material property constants are identified from the same experimental data, which are obtained from mechanical tests on corneal strips and membrane inflation experiments. We then validate the resulting models by comparing computed refractive power changes with clinical results. Tissue deformations created by simulated corneal tissue removal using finite elements are consistent with clinically observed postsurgical results. The model developed provides a much more predictable refractive outcome when the stiffness inhomogeneities of the cornea and nonlinearities of the deformations are included in the simulations. Finite element analysis is a useful tool for modeling surgical effects on the cornea and developing a better understanding of the biomechanics of the cornea. The creation of patient-specific simulations would allow surgical outcomes to be predicted based on individualized finite element models.

  2. Development of clinical sites.

    PubMed

    O'Brien, Mary

    2015-02-01

    Clinical experiences are vital to all types of healthcare educational programs. Supervised clinical experiences provide the opportunity for the learner to apply didactic knowledge and theory to real world situations and hone skills necessary for entry into practice. Nurse anesthesia programs utilize a wide variety of clinical sites to expose student registered nurse anesthetists to experiences that will prepare them clinically, academically and professionally to enter practice as a Certified Registered Nurse Anesthetist. This article describes the process of developing a clinical site. A thorough evaluation will determine the types of experiences meant to be offered at the site, the resources available to house and educate the students, and how to evaluate the effectiveness of the clinical site. Open communication between the clinical coordinator and the program director or designee is essential to ensure success of the clinical site. The Council on Accreditation of Nurse Anesthesia Educational Programs has resources available to guide those interested in becoming a clinical site, as well as for program administrators who seek to add new experiences to their programs.

  3. The Representation of Applied Psychology Areas in Introductory Psychology Textbooks

    ERIC Educational Resources Information Center

    Haselhuhn, Charlotte W.; Clopton, Kerri L.

    2008-01-01

    Many psychology majors indicate helping others as a reason for majoring in psychology, yet many enter positions not closely related to the field. This discrepancy may be due to a lack of student knowledge of the applied areas of psychology. The purpose of this study was to investigate the coverage of clinical, counseling,…

  4. Defining and Applying a Functionality Approach to Intellectual Disability

    ERIC Educational Resources Information Center

    Luckasson, R.; Schalock, R. L.

    2013-01-01

    Background: The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation. Methods: The authors synthesise current…

  5. 42 CFR 68a.3 - Who is eligible to apply?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Who is eligible to apply? 68a.3 Section 68a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) CLINICAL RESEARCH LOAN REPAYMENT PROGRAM FOR INDIVIDUALS...

  6. 42 CFR 68a.3 - Who is eligible to apply?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Who is eligible to apply? 68a.3 Section 68a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) CLINICAL RESEARCH LOAN REPAYMENT PROGRAM FOR INDIVIDUALS...

  7. 42 CFR 68a.3 - Who is eligible to apply?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Who is eligible to apply? 68a.3 Section 68a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) CLINICAL RESEARCH LOAN REPAYMENT PROGRAM FOR INDIVIDUALS...

  8. The Representation of Applied Psychology Areas in Introductory Psychology Textbooks

    ERIC Educational Resources Information Center

    Haselhuhn, Charlotte W.; Clopton, Kerri L.

    2008-01-01

    Many psychology majors indicate helping others as a reason for majoring in psychology, yet many enter positions not closely related to the field. This discrepancy may be due to a lack of student knowledge of the applied areas of psychology. The purpose of this study was to investigate the coverage of clinical, counseling,…

  9. Topical and Applied Interests of Introductory Psychology Students

    ERIC Educational Resources Information Center

    Stalder, Daniel R.; Stec, Deborah A.

    2007-01-01

    Using forced-choice and continuous measures, introductory psychology students reported highest interest for the topical areas of clinical and social psychology (over biological, cognitive, and developmental) and for the applied areas of education and health (over business, environment, and law) at both the beginning and end of semesters. Among…

  10. Topical and Applied Interests of Introductory Psychology Students

    ERIC Educational Resources Information Center

    Stalder, Daniel R.; Stec, Deborah A.

    2007-01-01

    Using forced-choice and continuous measures, introductory psychology students reported highest interest for the topical areas of clinical and social psychology (over biological, cognitive, and developmental) and for the applied areas of education and health (over business, environment, and law) at both the beginning and end of semesters. Among…

  11. Defining and Applying a Functionality Approach to Intellectual Disability

    ERIC Educational Resources Information Center

    Luckasson, R.; Schalock, R. L.

    2013-01-01

    Background: The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation. Methods: The authors synthesise current…

  12. Ethics applied to pharmacy practice.

    PubMed

    Dessing, R P

    2000-02-01

    This article tries to develop an ethical reasoning that can be applied to (the practice of) pharmacy. Only general principles, based on accepted values in western society, lead to guidelines for ethical behaviour. Such essential values are personal autonomy, democracy and solidarity. The principle of nonmaleficience can be derived from these. Results of this analysis can be applied to health care and pharmacy practice. Subchapters deal with questions such as budget limitations and the autonomy of the patient versus that of the care provider. It concludes that protocols are important tools for ethical behaviour in every day practice. The ethical problem appears to be the unequal access to the health care system. An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of nonmaleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within our profession. A definition of target groups for pharmaceutical care will facilitate this task. A suggestion for a general code of ethics for pharmacists is proposed and compared with the code of ethics as currently accepted by the International Pharmaceutical Federation (FIP)-council.

  13. Comprehensive Environmental Assessment Applied to ...

    EPA Pesticide Factsheets

    In September 2013, EPA announced the availability of the final report, Comprehensive Environmental Assessment Applied to Multiwalled Carbon Nanotube Flame-Retardant Coatings in Upholstery Textiles: A Case Study Presenting Priority Research Gaps for Future Risk Assessments. This final report presents a case study of multiwalled carbon nanotubes (MWCNTs); it focuses on the specific example of MWCNTs as used in flame-retardant coatings applied to upholstery textiles. This case study is organized around the comprehensive environmental assessment (CEA) framework, which structures available information pertaining to the product life cycle, environmental transport and fate, exposure-dose in receptors (i.e., humans, ecological populations, and the environment), and potential impacts in these receptors. A group of experts representing multiple disciplines and multiple sector perspectives used an earlier draft of the case study in conjunction with a structured workshop process to identify and prioritize research gaps that, if pursued, could inform future MWCNT assessment efforts. The final report is not a health, risk, or exposure assessment and as such does not draw conclusions about potential risks, or present an exhaustive review of the literature. Rather, it presents the MWCNT research priorities that experts identified in this application of CEA in order to aid research planning throughout the scientific community. The outcomes of these research efforts may subsequ

  14. Comprehensive Environmental Assessment Applied to ...

    EPA Pesticide Factsheets

    In September 2013, EPA announced the availability of the final report, Comprehensive Environmental Assessment Applied to Multiwalled Carbon Nanotube Flame-Retardant Coatings in Upholstery Textiles: A Case Study Presenting Priority Research Gaps for Future Risk Assessments. This final report presents a case study of multiwalled carbon nanotubes (MWCNTs); it focuses on the specific example of MWCNTs as used in flame-retardant coatings applied to upholstery textiles. This case study is organized around the comprehensive environmental assessment (CEA) framework, which structures available information pertaining to the product life cycle, environmental transport and fate, exposure-dose in receptors (i.e., humans, ecological populations, and the environment), and potential impacts in these receptors. A group of experts representing multiple disciplines and multiple sector perspectives used an earlier draft of the case study in conjunction with a structured workshop process to identify and prioritize research gaps that, if pursued, could inform future MWCNT assessment efforts. The final report is not a health, risk, or exposure assessment and as such does not draw conclusions about potential risks, or present an exhaustive review of the literature. Rather, it presents the MWCNT research priorities that experts identified in this application of CEA in order to aid research planning throughout the scientific community. The outcomes of these research efforts may subsequ

  15. Nose: Applied Aspects in Dermatology

    PubMed Central

    Lakshmi, Dammaningala Venkataramaiah; Shilpa, Kanathur; Nataraja, Holavanahally Veerabhadrappa; Divya, Kallapa Gorur

    2016-01-01

    Nose is the most prominent part of the mid-face and has important physiological, aesthetic and psychological functions. Skin diseases on the nose are commonly seen by dermatologists, otorhinolaryngologists, and plastic surgeons. Because of its exposed, highly visible localization, lesions on the skin of the nose are often noticed by patients themselves, typically very early in the course of the disease. Similarly, the dermatological lexicon is well known with descriptive terminologies, synonyms, acronyms, eponyms, toponyms, misnomers. We have tried to compile the anatomical applications of nose in cosmetology and dermatosurgery subspecialities with nasal eponyms and signs encountered in clinical dermatology that would be helpful for residents. PMID:27057038

  16. Applying critical thinking to nursing.

    PubMed

    Price, Bob

    2015-08-19

    Critical thinking and writing are skills that are not easy to acquire. The term 'critical' is used differently in social and clinical contexts. Nursing students need time to master the inquisitive and ruminative aspects of critical thinking that are required in academic environments. This article outlines what is meant by critical thinking in academic settings, in relation to both theory and reflective practice. It explains how the focus of a question affects the sort of critical thinking required and offers two taxonomies of learning, to which students can refer when analysing essay requirements. The article concludes with examples of analytical writing in reference to theory and reflective practice.

  17. Situational Supervision for Athletic Training Clinical Education

    ERIC Educational Resources Information Center

    Levy, Linda S.; Gardner, Greg; Barnum, Mary G.; Willeford, K. Sean; Sexton, Patrick; Guyer, M. Susan; Fincher, A. Louise

    2009-01-01

    Introduction: The medical education model provides the basis for athletic training students to learn theoretical and practical skills. Clinical rotations are completed where they apply what they have learned under the direct supervision of a clinical instructor (CI) or approved clinical instructor (ACI). Approved clinical instructors are taught…

  18. Situational Supervision for Athletic Training Clinical Education

    ERIC Educational Resources Information Center

    Levy, Linda S.; Gardner, Greg; Barnum, Mary G.; Willeford, K. Sean; Sexton, Patrick; Guyer, M. Susan; Fincher, A. Louise

    2009-01-01

    Introduction: The medical education model provides the basis for athletic training students to learn theoretical and practical skills. Clinical rotations are completed where they apply what they have learned under the direct supervision of a clinical instructor (CI) or approved clinical instructor (ACI). Approved clinical instructors are taught…

  19. A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation

    PubMed Central

    Downie, Jeanine; Beer, Jacob

    2012-01-01

    Treatment protocols exist for vascular obstruction due to injections with hyaluronic acids. Options for vascular insult due to non-hyaluronic acid products are less defined. The authors report two cases of vascular insult due to calcium hydroxylapatite and discuss treatment options. Patients who have vascular occlusion due to calcium hydroxylapatite require immediate intervention. The authors’ suggested protocol is elucidated and presented as a basis for future discussions and clinical trials. PMID:22808309

  20. Applied physiology at the bedside to drive resuscitation algorithms

    PubMed Central

    Holder, Andre L.; Pinsky, Michael R.

    2014-01-01

    Hemodynamic instability is associated with significant morbidity and mortality. Goal-directed therapeutic algorithms have been used in various clinical settings to reverse or prevent organ damage and death that could occur with a low oxygen delivery state. Most current resuscitative algorithms use static physiologic measures to determine if a patient will respond to proven therapies. While static parameters are useful in identifying the potential for clinical instability, they cannot tell us how patients will respond to an intervention. Applied physiology, through the use of functional hemodynamic monitoring can predict the body's reaction to therapy because they are based on cardiovascular dynamics. A growing body of evidence supports the use of applied physiologic principles in goal directed therapeutic algorithms for appropriate and effective resuscitation/optimization. Over time, applied physiology should be incorporated into standardized protocol-driven care to improve outcomes in patients experiencing, or at risk for hemodynamic instability. PMID:25479921

  1. Applied public-key steganography

    NASA Astrophysics Data System (ADS)

    Guillon, Pierre; Furon, Teddy; Duhamel, Pierre

    2002-04-01

    We consider the problem of hiding information in a steganographic framework, i.e. embedding a binary message within an apparently innocuous content, in order to establish a suspicion-free digital communication channel. The adversary is passive as no intentional attack is foreseen. The only threat is that she discovers the presence of a hidden communication. The main goal of this article is to find if the Scalar Costa Scheme, a recently published embedding method exploiting side information at the encoder, is suitable for that framework. We justify its use assessing its security level with respect to the Cachin's criterion. We derive a public-key stego-system following the ideas of R. Anderson and P. Petitcolas. This technique is eventually applied to PCM audio contents. Experimental performances are detailed in terms of bit-rate and Kullback-Leibler distance.

  2. Implementing an Applied Science Program

    NASA Technical Reports Server (NTRS)

    Rickman, Doug; Presson, Joan

    2007-01-01

    The work implied in the NASA Applied Science Program requires a delicate balancing act for the those doing it. At the implementation level there are multiple tensions intrinsic to the program. For example each application of an existing product to a decision support process requires deep knowledge about the data and deep knowledge about the decision making process. It is highly probable no one person has this range of knowledge. Otherwise the decision making process would already be using the data. Therefore, a team is required. But building a team usually requires time, especially across agencies. Yet the program mandates efforts of relatively short duration. Further, those who know the data are scientists, which makes them essential to the program. But scientists are evaluated on their publication record. Anything which diverts a scientist from the research for his next publication is an anathema to him and potential death to their career. Trying to get another agency to use NASA data does not strike most scientists as material inherently suitable for publication. Also, NASA wishes to rapidly implement often substantial changes to another agency's process. For many reasons, such as budget and program constraints, speed is important. But the owner of a decision making process is tightly constrained, usually by law, regulation, organization and custom. Changes when made are slow, cautious, even hesitant, and always done according a process specific to the situation. To manage this work MSFC must balance these and other tensions. Some things we have relatively little control over, such as budget. These we try to handle by structural techniques. For example by insisting all of our people work on multiple projects simultaneously we inherently have diversification of funding for all of our people. In many cases we explicitly use some elements of tension to be productive. For example the need for the scientists to constantly publish is motivation to keep tasks short and

  3. Implementing an Applied Science Program

    NASA Technical Reports Server (NTRS)

    Rickman, Doug; Presson, Joan

    2007-01-01

    The work implied in the NASA Applied Science Program requires a delicate balancing act for the those doing it. At the implementation level there are multiple tensions intrinsic to the program. For example each application of an existing product to a decision support process requires deep knowledge about the data and deep knowledge about the decision making process. It is highly probable no one person has this range of knowledge. Otherwise the decision making process would already be using the data. Therefore, a team is required. But building a team usually requires time, especially across agencies. Yet the program mandates efforts of relatively short duration. Further, those who know the data are scientists, which makes them essential to the program. But scientists are evaluated on their publication record. Anything which diverts a scientist from the research for his next publication is an anathema to him and potential death to their career. Trying to get another agency to use NASA data does not strike most scientists as material inherently suitable for publication. Also, NASA wishes to rapidly implement often substantial changes to another agency's process. For many reasons, such as budget and program constraints, speed is important. But the owner of a decision making process is tightly constrained, usually by law, regulation, organization and custom. Changes when made are slow, cautious, even hesitant, and always done according a process specific to the situation. To manage this work MSFC must balance these and other tensions. Some things we have relatively little control over, such as budget. These we try to handle by structural techniques. For example by insisting all of our people work on multiple projects simultaneously we inherently have diversification of funding for all of our people. In many cases we explicitly use some elements of tension to be productive. For example the need for the scientists to constantly publish is motivation to keep tasks short and

  4. Data Understanding Applied to Optimization

    NASA Technical Reports Server (NTRS)

    Buntine, Wray; Shilman, Michael

    1998-01-01

    The goal of this research is to explore and develop software for supporting visualization and data analysis of search and optimization. Optimization is an ever-present problem in science. The theory of NP-completeness implies that the problems can only be resolved by increasingly smarter problem specific knowledge, possibly for use in some general purpose algorithms. Visualization and data analysis offers an opportunity to accelerate our understanding of key computational bottlenecks in optimization and to automatically tune aspects of the computation for specific problems. We will prototype systems to demonstrate how data understanding can be successfully applied to problems characteristic of NASA's key science optimization tasks, such as central tasks for parallel processing, spacecraft scheduling, and data transmission from a remote satellite.

  5. [Basic science and applied science].

    PubMed

    Pérez-Tamayo, R

    2001-01-01

    A lecture was presented by the author at the Democratic Opinion Forum on Health Teaching and Research, organized by Mexico's National Health Institutes Coordinating Office, at National Cardiology Institute "Ignacio Chavez", where he presented a critical review of the conventional classification of basic and applied science, as well as his personal view on health science teaching and research. According to the author, "well-conducted science" is that "generating reality-checked knowledge" and "mis-conducted science" is that "unproductive or producing 'just lies' and 'non-fundable'. To support his views, the author reviews utilitarian and pejorative definitions of science, as well as those of committed and pure science, useful and useless science, and practical and esoterical science, as synonyms of applied and basic science. He also asserts that, in Mexico, "this classification has been used in the past to justify federal funding cutbacks to basic science, allegedly because it is not targeted at solving 'national problems' or because it was not relevant to priorities set in a given six-year political administration period". Regarding health education and research, the author asserts that the current academic programs are inefficient and ineffective; his proposal to tackle these problems is to carry out a solid scientific study, conducted by a multidisciplinary team of experts, "to design the scientific researcher curricula from recruitment of intelligent young people to retirement or death". Performance assessment of researchers would not be restricted to publication of papers, since "the quality of scientific work and contribution to the development of science is not reflected by the number of published papers". The English version of this paper is available at: http://www.insp.mx/salud/index.html

  6. Clinical Trials

    MedlinePlus

    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers scientific ... screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  7. Strategies for Successful Clinical Teaching.

    PubMed

    Koharchik, Linda; Redding, Sharon R

    2016-07-01

    This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes teaching strategies as well as the importance of the learning environment.

  8. Communities of clinical practice: the social organization of clinical learning.

    PubMed

    Egan, Tony; Jaye, Chrystal

    2009-01-01

    The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.

  9. Data compression applied to HHVT

    NASA Technical Reports Server (NTRS)

    Thompson, William K.

    1990-01-01

    A task order was written by the High Resolution, High Frame Rate Video Technology (HHVT) project engineers to study data compression techniques that could be applied to the HHVT system. Specifically, the goals of the HHVT data compression study are to accomplish the following: (1) Determine the downlink capabilities of the Space Shuttle and Space Station Freedom to support HHVT data (i.e., determine the maximum data rates and link availability); (2) Determine current and projected capabilities of high speed storage media to support HHVT data by determining their maximum data acquisition/transmission rates and volumes; (3) Identify which experiment in the HHVT Users' Requirement data base need data compression, based on the experiments' imaging requirements; (4) Select the best data compression technique for each of these users by identifying a technique that provides compression but minimizes distortion; and (5) Investigate state-of-the-art technologies for possible implementation of selected data compression techniques. Data compression will be needed because of the high data rates and larger volumes of data that will result from the use of digitized video onboard the Space Shuttle and Space Station Freedom.

  10. Modeling Applied to Problem Solving

    NASA Astrophysics Data System (ADS)

    Pawl, Andrew; Barrantes, Analia; Pritchard, David E.

    2009-11-01

    We describe a modeling approach to help students learn expert problem solving. Models are used to present and hierarchically organize the syllabus content and apply it to problem solving, but students do not develop and validate their own Models through guided discovery. Instead, students classify problems under the appropriate instructor-generated Model by selecting a system to consider and describing the interactions that are relevant to that system. We believe that this explicit System, Interactions and Model (S.I.M.) problem modeling strategy represents a key simplification and clarification of the widely disseminated modeling approach originated by Hestenes and collaborators. Our narrower focus allows modeling physics to be integrated into (as opposed to replacing) a typical introductory college mechanics course, while preserving the emphasis on understanding systems and interactions that is the essence of modeling. We have employed the approach in a three-week review course for MIT freshmen who received a D in the fall mechanics course with very encouraging results.

  11. Intelligence Applied to Air Vehicles

    NASA Technical Reports Server (NTRS)

    Rosen, Robert; Gross, Anthony R.; Fletcher, L. Skip; Zornetzer, Steven (Technical Monitor)

    2000-01-01

    The exponential growth in information technology has provided the potential for air vehicle capabilities that were previously unavailable to mission and vehicle designers. The increasing capabilities of computer hardware and software, including new developments such as neural networks, provide a new balance of work between humans and machines. This paper will describe several NASA projects, and review results and conclusions from ground and flight investigations where vehicle intelligence was developed and applied to aeronautical and space systems. In the first example, flight results from a neural network flight control demonstration will be reviewed. Using, a highly-modified F-15 aircraft, a NASA/Dryden experimental flight test program has demonstrated how the neural network software can correctly identify and respond to changes in aircraft stability and control characteristics. Using its on-line learning capability, the neural net software would identify that something in the vehicle has changed, then reconfigure the flight control computer system to adapt to those changes. The results of the Remote Agent software project will be presented. This capability will reduce the cost of future spacecraft operations as computers become "thinking" partners along with humans. In addition, the paper will describe the objectives and plans for the autonomous airplane program and the autonomous rotorcraft project. Technologies will also be developed.

  12. Applying adult learning practices in medical education.

    PubMed

    Reed, Suzanne; Shell, Richard; Kassis, Karyn; Tartaglia, Kimberly; Wallihan, Rebecca; Smith, Keely; Hurtubise, Larry; Martin, Bryan; Ledford, Cynthia; Bradbury, Scott; Bernstein, Henry Hank; Mahan, John D

    2014-07-01

    The application of the best practices of teaching adults to the education of adults in medical education settings is important in the process of transforming learners to become and remain effective physicians. Medical education at all levels should be designed to equip physicians with the knowledge, clinical skills, and professionalism that are required to deliver quality patient care. The ultimate outcome is the health of the patient and the health status of the society. In the translational science of medical education, improved patient outcomes linked directly to educational events are the ultimate goal and are best defined by rigorous medical education research efforts. To best develop faculty, the same principles of adult education and teaching adults apply. In a systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education, the use of experiential learning, feedback, effective relationships with peers, and diverse educational methods were found to be most important in the success of these programs. In this article, we present 5 examples of applying the best practices in teaching adults and utilizing the emerging understanding of the neurobiology of learning in teaching students, trainees, and practitioners. These include (1) use of standardized patients to develop communication skills, (2) use of online quizzes to assess knowledge and aid self-directed learning, (3) use of practice sessions and video clips to enhance significant learning of teaching skills, (4) use of case-based discussions to develop professionalism concepts and skills, and (5) use of the American Academy of Pediatrics PediaLink as a model for individualized learner-directed online learning. These examples highlight how experiential leaning, providing valuable feedback, opportunities for practice, and stimulation of self-directed learning can be utilized as medical education continues its dynamic transformation in the years ahead

  13. [Corneal permeability of topically applied pirenzepine solution].

    PubMed

    Wang, Kai-di; Zhang, Jin-song; Yan, Pan-shi

    2006-06-01

    To study the corneal permeability of three different pirenzepine eye-drop solutions and provide reference for further clinical use. Sixty-three New Zealand white rabbits were divided into three groups. Each group of rabbits received 2% pirenzepine (pirenzepine group), 2% pirenzepine with 0.1% hyaluronic acid (hyaluronic acid group), or 2% pirenzepine with 0.1% azone (azone group). One drop eye-drops was applied to conjunctive sac every 5 min for six times. Aqueous samples were obtained from each group at 0.5, 1.0, 2.0, 4.0, 8.0, 12.0, 24.0 h after the last drop, respectively. Concentration of pirenzepine in these samples was determined by the HPLC (high pressure liquid chromatography). Stimulation symptom of rabbit eyes was also observed. The concentrations of pirenzepine in aqueous humor were (0.40 +/- 0.06) microg/ml at 0.5 h, (0.53 +/- 0.03) microg/ml at 1.0 h, (1.52 +/- 0.33) microg/ml at 2.0 h and (0.15 +/- 0.02) microg/ml at 4.0 h in pirenzepine group. Aqueous humor concentration of pirenzepine in both 2% pirenzepine with 0.1% azone and 2% pirenzepine with 0.1% hyaluronic acid were significantly higher than that of single pirenzepine application, and their bioavailability in the groups with combinations of pirenzepine with 0.1% azone or 0.1% hyaluronic acid were 23.0 times and 3.4 times higher than that of single pirenzepine usage. No obvious irritate symptom was found in rabbit of all three groups after eye-drop applying. The combination application of pirenzepine with azone or hyaluronic acid has higher corneal permeability compared with pirenzepine alone. This result indicates that azone and hyaluronic acid could be used in pirenzepine eye-drop solution to increase corneal permeability.

  14. Exercise, muscle, and the applied load-bone strength balance.

    PubMed

    Giangregorio, L; El-Kotob, R

    2017-01-01

    A fracture occurs when the applied load is greater than the bone can withstand. Clinical practice guidelines for the management of osteoporosis include recommendations for exercise; one of the few therapies where the proposed anti-fracture mechanisms that include effects on both bone strength and applied loads, where applied loads can come in the form of a fall, externally applied loads, body weight, or muscle forces. The aim of this review is to provide an overview of the clinical evidence pertaining to the potential efficacy of exercise for preventing fractures in older adults, including its direct effects on outcomes along the causal pathway to fractures (e.g., falls, posture, bone strength) and the indirect effects on muscle or the muscle-bone relationship. The evidence is examined as it pertains to application in clinical practice. Considerations for future research are discussed, such as the need for trials in individuals with low bone mass or students that evaluate whether changes in muscle mediate changes in bone. Future trials should also consider adequacy of calorie or protein intake, the confounding effect of exercise-induced weight loss, or the most appropriate therapeutic goal (e.g., strength, weight bearing, or hypertrophy) and outcome measures (e.g., fracture, disability, cost-effectiveness).

  15. A Multiple Approach to Evaluating Applied Academics.

    ERIC Educational Resources Information Center

    Wang, Changhua; Owens, Thomas

    The Boeing Company is involved in partnerships with Washington state schools in the area of applied academics. Over the past 3 years, Boeing offered grants to 57 high schools to implement applied mathematics, applied communication, and principles of technology courses. Part 1 of this paper gives an overview of applied academics by examining what…

  16. Sorption of cadmium and copper ions on natural and synthetic hydroxylapatite particles

    SciTech Connect

    Fernane, F.; Mecherri, M.O.; Sharrock, P. Hadioui, M.; Lounici, H.; Fedoroff, M.

    2008-05-15

    The sorption of divalent cadmium and copper ions from aqueous solutions on natural and synthetic hydroxyapatite was investigated by the batch method and under dynamic conditions in columns at 22 deg. C and pH 5. The effect of cadmium and copper concentration on sorption was studied. Both types of apatites are efficient, despite their different composition and morphology. The sorption mechanism involves an ion exchange for Cd(II), while Cu(II) leads to precipitation of a newly formed solid. Thus, the sorption efficiency depends on the experimental conditions and the specific physicochemical properties of the apatites used. The sorption isotherms were fitted to the Langmuir equation.

  17. Morphometrics applied to medical entomology.

    PubMed

    Dujardin, Jean-Pierre

    2008-12-01

    Morphometrics underwent a revolution more than one decade ago. In the modern morphometrics, the estimate of size is now contained in a single variable reflecting variation in many directions, as many as there are landmarks under study, and shape is defined as their relative positions after correcting for size, position and orientation. With these informative data, and the corresponding software freely available to conduct complex analyses, significant biological and epidemiological features can be quantified more accurately. We discuss the evolutionary significance of the environmental impact on metric variability, mentioning the importance of concepts like genetic assimilation, genetic accommodation, and epigenetics. We provide examples of measuring the effect of selection on metric variation by comparing (unpublished) Qst values with corresponding (published) Fst. The primary needs of medical entomologists are to distinguish species, especially cryptic species, and to detect them where they are not expected. We explain how geometric morphometrics could apply to these questions, and where there are deficiencies preventing the approach from being utilized at its maximum potential. Medical entomologists in connection with control programs aim to identify isolated populations where the risk of reinfestation after treatment would be low ("biogeographical islands"). Identifying them can be obtained from estimating the number of migrants per generation. Direct assessment of movement remains the most valid approach, but it scores active movement only. Genetic methods estimating gene flow levels among interbreeding populations are commonly used, but gene flow does not necessarily mean the current flow of migrants. Methods using the morphometric variation are neither suited to evaluate gene flow, nor are they adapted to estimate the flow of migrants. They may provide, however, the information needed to create a preliminary map pointing to relevant areas where one could

  18. Five practices of efficient factories applied to dental education.

    PubMed

    Nalliah, Romesh P

    2015-05-01

    Efficient factories, such as dental school clinics (DSC), are trying to improve the quality of their product by reducing inefficiencies, error rates, and wastage. Dental education is an expensive business for the student and the institution. Dental materials and equipment are costly, and students are novice providers who work slowly and inefficiently compared to an experienced dentist; this is not a good business model. The objective of this article was to present and apply five practices of efficient factories that could be applied to the DSC setting. I propose that this will lead to improved educational outcomes and improved patient outcomes in DSC. © 2015 Wiley Publishing Asia Pty Ltd.

  19. Applying research to practice: exploring the barriers.

    PubMed

    Hewitt-Taylor, Jaqui; Heaslip, Vanessa; Rowe, Nicholas E

    Nurses are not averse to applying research findings to their clinical practice; however, there appears to be a number of barriers to achieving this. Generally, barriers include lack of time and the need to provide more education surrounding the use of research. While these are both valid points, the authors suggest that perhaps the solution to the problem is looking at how research is 'sold' to practitioners. For example, the use of jargon in research is off-putting to many practitioners, which creates an impression that research is associated with academia, rather than a tool for practitioners. Also, there may be an unrealistic expectation of what 'using research' might mean. Research is seen as the pinnacle of evidence, and not a part of evidence-based practice. In this article, the authors propose that teaching and expectations of research should focus on the application of research to practice. Reviewing and critiquing of research should serve the purpose of helping to make decisions about its practical applications, rather than for academic use.

  20. [Damage control applied to severe maxillofacial trauma].

    PubMed

    Laversanne, S; Pierrou, C; Haen, P; Brignol, L; Thiéry, G

    2014-02-01

    Damage control is defined by the extreme emergency implementation of a first resuscitation and surgical step, during which there is no attempt at repairing lesions but only at restoring adequate physiological function. In recent years, "damage control" has considerably improved the management of polytrauma patients, especially in war surgery. Respiratory distress or hemorrhagic shock requirements are critical maxillofacial emergencies. We present the specificities of "damage control" management for patients with severe maxillofacial trauma. Some clinical and biological criteria have been defined to choose "damage control" strategy, in patients presenting with life-threatening facial hemorrhage after facial trauma. A rapid initial stage restores vital functions. Airways are maintained and secured: oro-tracheal intubation, cricothyroidotomy, surgical tracheotomy. Facial bleeding is controlled with various means: oronasal packing, angiographic embolization, selective ligation then external carotid artery if necessary. The resuscitation step stabilizes the lethal triad: hypothermia, coagulopathy, metabolic acidosis. The second step that comes in later is a surgical repair of facial injuries. "Damage control" can be adequately applied to the management of patients with severe maxillofacial trauma. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. REGENERATIVE MEDICINE AS APPLIED TO GENERAL SURGERY

    PubMed Central

    Orlando, Giuseppe; Wood, Kathryn J; De Coppi, Paolo; Baptista, Pedro M; Binder, Kyle W; Bitar, Khalil N; Breuer, Christopher; Burnett, Luke; Christ, George; Farney, Alan; Figliuzzi, Marina; Holmes, James H; Koch, Kenneth; Macchiarini, Paolo; Sani, Sayed-Hadi Mirmalek; Opara, Emmanuel; Remuzzi, Andrea; Rogers, Jeffrey; Saul, Justin M; Seliktar, Dror; Shapira-Schweitzer, Keren; Smith, Tom; Solomon, Daniel; Van Dyke, Mark; Yoo, James J; Zhang, Yuanyuan; Atala, Anthony; Stratta, Robert J; Soker, Shay

    2012-01-01

    The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues or organs in order to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate. PMID:22330032

  2. Blood viscometer applying electromagnetically spinning method.

    PubMed

    Fukunaga, Kazuyoshi; Onuki, Masaya; Ohtsuka, Yoshinori; Hirano, Taichi; Sakai, Keiji; Ohgoe, Yasuharu; Katoh, Ayako; Yaguchi, Toshiyuki; Funakubo, Akio; Fukui, Yasuhiro

    2013-09-01

    Viscosity is an important parameter which affects hemodynamics during extracorporeal circulation and long-term cardiac support. In this study, we have aimed to develop a novel viscometer with which we can easily measure blood viscosity by applying the electromagnetically spinning (EMS) method. In the EMS method, we can rotate an aluminum ball 2 mm in diameter indirectly in a test tube with 0.3 ml sample of a liquid by utilizing the moment caused by the Lorentz force as well as separate the test tube from the viscometer body. First, we calibrated the EMS viscometer by means of liquid samples with known viscosities and computational fluid dynamics. Then, when we measured the viscosity of 9.4 mPa s silicone oil in order to evaluate the performance of the EMS viscometer, the mean viscosity was found to be 9.55 ± 0.10 mPa s at available shear rates from 10 to 240 s(-1). Finally, we measured the viscosity of bovine blood. We prepared four blood samples whose hematocrit levels were adjusted to 23, 45, 50, and 70% and a plasma sample without hemocyte components. As a result, the measurements of blood viscosities showed obedience to Casson's equation. We found that the viscosity was approximately constant in Newtonian silicone oil, whereas the viscosity decreased with increasing shear rate in non-Newtonian bovine blood. These results suggest that the EMS viscometer will be useful to measure blood viscosity at the clinical site.

  3. Regenerative medicine as applied to general surgery.

    PubMed

    Orlando, Giuseppe; Wood, Kathryn J; De Coppi, Paolo; Baptista, Pedro M; Binder, Kyle W; Bitar, Khalil N; Breuer, Christopher; Burnett, Luke; Christ, George; Farney, Alan; Figliuzzi, Marina; Holmes, James H; Koch, Kenneth; Macchiarini, Paolo; Mirmalek Sani, Sayed-Hadi; Opara, Emmanuel; Remuzzi, Andrea; Rogers, Jeffrey; Saul, Justin M; Seliktar, Dror; Shapira-Schweitzer, Keren; Smith, Tom; Solomon, Daniel; Van Dyke, Mark; Yoo, James J; Zhang, Yuanyuan; Atala, Anthony; Stratta, Robert J; Soker, Shay

    2012-05-01

    The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues, or organs to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues, and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.

  4. Clinical Challenge.

    PubMed

    2017-09-01

    Questions for this month's clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated four Category 2 points (Activity ID: 109894). Answers to this clinical challenge are available immediately following successful completion online at http://gplearning.racgp.org.au. Clinical challenge quizzes may be completed at any time throughout the 2017-19 triennium; therefore, the previous months' answers are not published. Each of the questions or incomplete statements below is followed by four suggested answers or completions. Select the most appropriate statement as your answer.

  5. Clinical Challenge.

    PubMed

    2016-12-01

    Questions for this month's clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated four Category 2 points (Activity ID: 69787). Answers to this clinical challenge are available immediately following successful completion online at http://gplearning.racgp.org.au. Clinical challenge quizzes may be completed at any time throughout the 2014-16 triennium; therefore, the previous months' answers are not published. Each of the questions or incomplete statements below is followed by four or five suggested answers or completions. Select the most appropriate statement as your answer.

  6. Data Assimilation for Applied Meteorology

    NASA Astrophysics Data System (ADS)

    Haupt, S. E.

    2012-12-01

    Although atmospheric models provide a best estimate of the future state of the atmosphere, due to sensitivity to initial condition, it is difficult to predict the precise future state. For applied problems, however, users often depend on having accurate knowledge of that future state. To improve prediction of a particular realization of an evolving flow field requires knowledge of the current state of that field and assimilation of local observations into the model. This talk will consider how dynamic assimilation can help address the concerns of users of atmospheric forecasts. First, we will look at the value of assimilation for the renewable energy industry. If the industry decision makers can have confidence in the wind and solar power forecasts, they can build their power allocations around the expected renewable resource, saving money for the ratepayers as well as reducing carbon emissions. We will assess the value to that industry of assimilating local real-time observations into the model forecasts and the value that is provided. The value of the forecasts with assimilation is important on both short (several hour) to medium range (within two days). A second application will be atmospheric transport and dispersion problems. In particular, we will look at assimilation of concentration data into a prediction model. An interesting aspect of this problem is that the dynamics are a one-way coupled system, with the fluid dynamic equations affecting the concentration equation, but not vice versa. So when the observations are of the concentration, one must infer the fluid dynamics. This one-way coupled system presents a challenge: one must first infer the changes in the flow field from observations of the contaminant, then assimilate that to recover both the advecting flow and information on the subgrid processes that provide the mixing. To accomplish such assimilation requires a robust method to match the observed contaminant field to that modeled. One approach is

  7. Clinical research: regulatory issues.

    PubMed

    Wermeling, D P

    1999-02-01

    The regulatory issues faced by institutions performing clinical research are described. Many institutions do not have on staff an expert who understands the regulatory issues involved in managing investigational new drug research and who knows the institution's obligations under the federal rules. Because pharmacists understand the FDA regulations that apply to the management of drugs in clinical research, institutions are asking pharmacists to expand their role and manage clinical research offices. Many authorities govern various aspects of investigational drug research. FDA has published regulations for good clinical practice (GCP), and the International Conference on Harmonisation is developing an international standard for the proper management of clinical trials. The guidelines published by the Joint Commission on Accreditation of Healthcare Organizations aim to protect patients who are in the institution to receive health care and also participate in clinical trials. The Social Security Administration Acts specifically state that only items and services that are reasonable and necessary for the diagnosis and treatment of injury or disease can be billed to the government; research-related billings are excluded from coverage. Proper management of drug research is crucial to the success of a research program that is integrated with patient care.

  8. Applied Psycholinguistics--Amphibian or Phantom?

    ERIC Educational Resources Information Center

    Titone, Renzo

    1975-01-01

    A tentative classification of internal departments of psycholinguistics is suggested and a list of applied fields is presented. Applied psycholinguistics is not seen here to have a right to scientific independence. (SCC)

  9. Applied Psycholinguistics--Amphibian or Phantom?

    ERIC Educational Resources Information Center

    Titone, Renzo

    1975-01-01

    A tentative classification of internal departments of psycholinguistics is suggested and a list of applied fields is presented. Applied psycholinguistics is not seen here to have a right to scientific independence. (SCC)

  10. Applied technology section. Monthly report, December 1993

    SciTech Connect

    Buckner, M.R.

    1994-01-28

    This monthly report contains abstracts of the progress made in various projects from the applied technology section at the Savannah River Plant. Research areas include engineering modeling and simulation, applied physics, experimental thermal hydraulics, and packaging and transportation.

  11. Implementing Peer Evaluation of Clinical Teaching

    ERIC Educational Resources Information Center

    Laske, Rita Ann

    2013-01-01

    Clinical education provides the nursing student opportunities to learn the practice of nursing. In the clinical setting, the nursing student applies classroom knowledge to the real patient care situation. The clinical instructor facilitates this important process by assisting students to integrate knowledge into their practice, improve their…

  12. Implementing Peer Evaluation of Clinical Teaching

    ERIC Educational Resources Information Center

    Laske, Rita Ann

    2013-01-01

    Clinical education provides the nursing student opportunities to learn the practice of nursing. In the clinical setting, the nursing student applies classroom knowledge to the real patient care situation. The clinical instructor facilitates this important process by assisting students to integrate knowledge into their practice, improve their…

  13. Applied Magnetic Field Enhances Arc Vapor Deposition

    NASA Technical Reports Server (NTRS)

    Miller, T. A.; Loutfy, R. O.; Withers, J. C.

    1993-01-01

    Applied magnetic field enhances performance of vaporization part of arc vapor deposition apparatus. When no magnetic field applied by external means, arc wonders semirandomly over cathode, with net motion toward electrical feedthrough. When magnetic field applied arc moves circumferentially around cathode, and downward motion suppressed.

  14. Critical and Alternative Directions in Applied Linguistics

    ERIC Educational Resources Information Center

    Pennycook, Alastair

    2010-01-01

    Critical directions in applied linguistics can be understood in various ways. The term "critical" as it has been used in "critical applied linguistics," "critical discourse analysis," "critical literacy" and so forth, is now embedded as part of applied linguistic work, adding an overt focus on questions of power and inequality to discourse…

  15. Western Perspectives in Applied Linguistics in Africa

    ERIC Educational Resources Information Center

    Makoni, Sinfree; Meinhof, Ulrike H.

    2004-01-01

    The aim of this article is to analyze the nature of the historical and contemporary social contexts within which applied linguistics in Africa emerged, and is currently practiced. The article examines the challenges "local" applied Linguistics in Africa is confronted with as it tries to amplify applied linguistic programs emanating from…

  16. Critical and Alternative Directions in Applied Linguistics

    ERIC Educational Resources Information Center

    Pennycook, Alastair

    2010-01-01

    Critical directions in applied linguistics can be understood in various ways. The term "critical" as it has been used in "critical applied linguistics," "critical discourse analysis," "critical literacy" and so forth, is now embedded as part of applied linguistic work, adding an overt focus on questions of power and inequality to discourse…

  17. Enhancing international medical graduates' communication: the contribution of applied linguistics.

    PubMed

    Dahm, Maria R; Yates, Lynda; Ogden, Kathryn; Rooney, Kim; Sheldon, Brooke

    2015-08-01

    International medical graduates (IMGs) make up one-third of the Australian medical workforce. Those from non-English-language backgrounds can face cultural and communication barriers, yet linguistic support is variable and medical educators are often required to provide feedback on both medical and communication issues. However, some communication difficulties may be very specific to the experiences of IMGs as second language users. This interdisciplinary study combines perspectives from applied linguistics experts and clinical educators to address IMGs' difficulties from multiple dimensions and to enhance feedback quality. Five video-recorded patient encounters with five IMGs were collected at Launceston General Hospital. Three clinical educators gave quantitative and qualitative feedback using the Rating Instrument for Clinical Consulting Skills, and two applied linguistics experts analysed the data for language, pragmatic and communication difficulties. The comparison of the educators' language-related feedback with linguistic analyses of the same interactions facilitated the exploration of differences in the difficulties identified by the two expert groups. Although the clinical educators were able to use their tacit intuitive understanding of communication issues to identify IMG difficulties, they less frequently addressed the underlying issues or suggested specific remedies in their feedback. This pilot study illustrates the effectiveness of interdisciplinary collaboration in highlighting the specific discourse features contributing to IMG communication difficulties and thus assists educators in deconstructing their intuitive knowledge. The authors suggest that linguistic insights can therefore improve communications training by assisting educators to provide more targeted feedback. © 2015 John Wiley & Sons Ltd.

  18. Oklahoma administrators' perceptions of applied science

    NASA Astrophysics Data System (ADS)

    Horn, Stanley James

    1998-12-01

    Scope and method of study. The purpose of this study was to assess the perceptions of Oklahoma Public School Superintendents when applied science courses such as Applied Biology/Chemistry and Applied Physics (Principles of Technology) are compared to traditional science courses such as Biology, Chemistry, and Physics. The study was conducted with a population of 69 Oklahoma comprehensive school superintendents who were under contract during the 1997/98 school year. Each participant was employed by a school district that offered either Applied Biology/Chemistry, Applied Physics (also known as Principles of Technology) or both. All participants completed an 18-question telephone survey. Combined means and percentages of participants responses to the survey were recorded to draw conclusions about the study. Findings and conclusions. Superintendents perceive teachers and students as having good acceptance of applied science courses. Superintendents believe students think of applied science courses as excellent hands-on science, and teachers think of them as acceptable alternative science. Superintendents are somewhat satisfied with applied science courses. They believe it makes no difference if a student is college bound, non-college bound, more motivated or less motivated as to whom benefits from applied science courses. Superintendents feel there is no difference in applied science courses and traditional science courses when teaching science concepts of "PASS Skills," or preparing students for college or work. They perceive the cost of applied science courses to be somewhat greater than traditional science courses. They also think additional training for applied science teachers should be in the form of a seminar. Superintendents feel full credit toward high school graduation and college entrance requirements should be given to the students of applied science courses. Superintendents believe there is no difference as to which course, applied science or traditional

  19. Applying Research Evidence to Optimize Telehomecare

    PubMed Central

    Bowles, Kathryn H.; Baugh, Amy C.

    2010-01-01

    Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist with the care of the growing population of chronically ill adults. This article presents a summary and critique of the published empirical evidence about the effects of telehomecare on older adult patients with chronic illness. The knowledge gained will be applied in a discussion regarding telehomecare optimization and areas for future research. The referenced literature in PubMed, MEDLINE, CDSR, ACP Journal Club, DARE, CCTR, and CINAHL databases was searched for the years 1995–2005 using the keywords “telehomecare” and “telemedicine,” and limited to primary research and studies in English. Approximately 40 articles were reviewed. Articles were selected if telehealth technology with peripheral medical devices was used to deliver home care for adult patients with chronic illness. Studies where the intervention consisted of only telephone calls or did not involve video or in-person nurse contact in the home were excluded. Nineteen studies described the effects of telehomecare on adult patients, chronic illness outcomes, providers, and costs of care. Patients and providers were accepting of the technology and it appears to have positive effects on chronic illness outcomes such as self-management, rehospitalizations, and length of stay. Overall, due to savings from healthcare utilization and travel, telehomecare appears to reduce healthcare costs. Generally, studies have small sample sizes with diverse types and doses of telehomecare intervention for a select few chronic illnesses; most commonly heart failure. Very few published studies have explored the cost or quality implications since the change in home

  20. Clinical photography.

    PubMed

    Jakowenko, Janelle

    2009-01-01

    Digital cameras, when used correctly, can provide the basis for telemedicine services. The increasing sophistication of digital cameras, combined with the improved speed and availability of the Internet, make them an instrument that every health-care professional should be familiar with. Taking satisfactory images of patients requires clinical photography skills. Photographing charts, monitors, X-ray films and specimens also requires expertise. Image capture using digital cameras is often done with insufficient attention, which can lead to inaccurate study results. The procedures in clinical photography should not vary from camera to camera, or from country to country. Taking a photograph should be a standardised process. There are seven main scenarios in clinical photography and health professionals who use cameras should be familiar with all of them. Obtaining informed consent prior to photography should be a normal part of the clinical photography routine.