“Whatever My Mother Wants”: Barriers to Adequate Pain Management

PubMed Central

Yennurajalingam, Sriram; Bruera, Eduardo

2013-01-01

Abstract Opioids are the preferred medications to treat cancer pain; however, several barriers to cancer pain management exist, including those related to the patient, health care provider, and family caregiver. We describe one such situation in which a family member prevents the patient from receiving adequate pain management at the end of life despite interdepartmental and interdisciplinary efforts. This case highlights the importance of understanding and addressing fears regarding opioid use and implementing an integrated approach including oncologists and palliative care physicians, along with early referrals to palliative care. PMID:22946542

Experiment Needs and Facilities Study Appendix A Transient Reactor Test Facility (TREAT) Upgrade

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

None

The TREAT Upgrade effort is designed to provide significant new capabilities to satisfy experiment requirements associated with key LMFBR Safety Issues. The upgrade consists of reactor-core modifications to supply the physics performance needed for the new experiments, an Advanced TREAT loop with size and thermal-hydraulics capabilities needed for the experiments, associated interface equipment for loop operations and handling, and facility modifications necessary to accommodate operations with the Loop. The costs and schedules of the tasks to be accomplished under the TREAT Upgrade project are summarized. Cost, including contingency, is about 10 million dollars (1976 dollars). A schedule for execution ofmore » 36 months has been established to provide the new capabilities in order to provide timely support of the LMFBR national effort. A key requirement for the facility modifications is that the reactor availability will not be interrupted for more than 12 weeks during the upgrade. The Advanced TREAT loop is the prototype for the STF small-bundle package loop. Modified TREAT fuel elements contain segments of graphite-matrix fuel with graded uranium loadings similar to those of STF. In addition, the TREAT upgrade provides for use of STF-like stainless steel-UO{sub 2} TREAT fuel for tests of fully enriched fuel bundles. This report will introduce the Upgrade study by presenting a brief description of the scope, performance capability, safety considerations, cost schedule, and development requirements. This work is followed by a "Design Description". Because greatly upgraded loop performance is central to the upgrade, a description is given of Advanced TREAT loop requirements prior to description of the loop concept. Performance requirements of the upgraded reactor system are given. An extensive discussion of the reactor physics calculations performed for the Upgrade concept study is provided. Adequate physics performance is essential for performance of experiments with the Advanced TREAT loop, and the stress placed on these calculations reflects this. Additional material on performance and safety is provided. Backup calculations on calculations of plutonium-release limits are described. Cost and schedule information for the Upgrade are presented.« less

United States Army Medical Materiel Development Activity - 1989

DTIC Science & Technology

1990-01-31

physicians to treat diseases such as Korean Hemorrhagic Fever and Lassa Fever. * J-5 Human Monoclonal Antibody is secreted by cultured hybridomas that were...volunteer studies involving a collaborative effort between WRAIR and the Swiss Serum and Vaccine Institute (SSVI). s Lassa Fever Immune Plasma is an...immune globulin used to treat Lassa fever infections. The collection of human immune plasma in Africa is an ongoing contract effort. USANRIID performs

Inhalation delivery of protein therapeutics.

PubMed

Kane, Colleen; O'Neil, Karyn; Conk, Michelle; Picha, Kristen

2013-04-01

Inhaled therapeutics are used routinely to treat a variety of pulmonary diseases including asthma, COPD and cystic fibrosis. In addition, biological therapies represent the fastest growing segment of approved pharmaceuticals. However, despite the increased availability of biological therapies, nearly all inhaled therapeutics are small molecule drugs with only a single inhaled protein therapeutic approved. There remains a significant unmet need for therapeutics in pulmonary diseases, and biological therapies with potential to alter disease progression represent a significant opportunity to treat these challenging diseases. This review provides a background into efforts to develop inhaled biological therapies and highlights some of the associated challenges. In addition, we speculate on the ideal properties of a biologic therapy for inhaled delivery.

Multi-Family Group Intervention for OEF/OIF Traumatic Brain Injury Survivors and Their Families

DTIC Science & Technology

2010-10-01

information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden...considerable layer of complexity to recruitment, especially as the PI and study clinicians were based in psychiatry. It has taken many months to develop...coordination or recruitment efforts by psychiatry with the services diagnosing and treating the vets is complex and time-consuming. In New Jersey

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

Luther, Erik Paul; Leckie, Rafael M.; Dombrowski, David E.

This supplemental report describes fuel fabrication efforts conducted for the Idaho National Laboratory Trade Study for the TREAT Conversion project that is exploring the replacement of the HEU (Highly Enriched Uranium) fuel core of the TREAT reactor with LEU (Low Enriched Uranium) fuel. Previous reports have documented fabrication of fuel by the “upgrade” process developed at Los Alamos National Laboratory. These experiments supplement an earlier report that describes efforts to increase the graphite content of extruded fuel and minimize cracking.

Transient Testing of Nuclear Fuels and Materials in the United States

NASA Astrophysics Data System (ADS)

Wachs, Daniel M.

2012-12-01

The United States has established that transient irradiation testing is needed to support advanced light water reactors fuel development. The U.S. Department of Energy (DOE) has initiated an effort to reestablish this capability. Restart of the Transient Testing Reactor (TREAT) facility located at the Idaho National Laboratory (INL) is being considered for this purpose. This effort would also include the development of specialized test vehicles to support stagnant capsule and flowing loop tests as well as the enhancement of postirradiation examination capabilities and remote device assembly capabilities at the Hot Fuel Examination Facility. It is anticipated that the capability will be available to support testing by 2018, as required to meet the DOE goals for the development of accident-tolerant LWR fuel designs.

Polyamine pathway inhibition as a novel therapeutic approach to treating neuroblastoma

PubMed Central

Gamble, Laura D.; Hogarty, Michael D.; Liu, Xueyuan; Ziegler, David S.; Marshall, Glenn; Norris, Murray D.; Haber, Michelle

2012-01-01

Polyamines are highly regulated essential cations that are elevated in rapidly proliferating tissues, including diverse cancers. Expression analyses in neuroblastomas suggest that up-regulation of polyamine pro-synthetic enzymes and down-regulation of catabolic enzymes is associated with poor prognosis. Polyamine sufficiency may be required for MYCN oncogenicity in MYCN amplified neuroblastoma, and targeting polyamine homeostasis may therefore provide an attractive therapeutic approach. ODC1, an oncogenic MYCN target, is rate-limiting for polyamine synthesis, and is overexpressed in many cancers including neuroblastoma. Inhibition of ODC1 by difluoromethylornithine (DFMO) decreased tumor penetrance in TH-MYCN mice treated pre-emptively, and extended survival and synergized with chemotherapy in treating established tumors in both TH-MYCN and xenograft models. Efforts to augment DFMO activity, or otherwise maximally reduce polyamine levels, are focused on antagonizing polyamine uptake or augmenting polyamine export or catabolism. Since polyamine inhibition appears to be clinically well tolerated, these approaches, particularly when combined with chemotherapy, have great potential for improving neuroblastoma outcome in both MYCN amplified and non-MYCN amplified neuroblastomas. PMID:23181218

Use of atypical antipsychotics for treatment-resistant major depressive disorder.

PubMed

Papakostas, George I; Shelton, Richard C

2008-12-01

Despite the progressive increase in the number of pharmacologic agents with potential antidepressant activity, many patients suffering from major depressive disorder (MDD) continue to be symptomatic. Clearly, an urgent need exists to develop safer, better tolerated, and more effective treatments for MDD. Use of atypical antipsychotic agents as adjunctive treatment for treatment-resistant MDD (TRD) represents one such effort toward novel pharmacotherapy development. Atypical antipsychotic agents have been hypothesized to be beneficial in treating mood disorders, including TRD, as a result of their complex mechanisms of action. After an initial series of positive case reports, series, and small clinical trials, subsequent larger-scale projects have yielded conflicting results. However, more recently, larger-scale clinical trials have supported the effectiveness of at least some of these medications. This review summarizes the existing data regarding the effectiveness of these medications in treating TRD, including biochemical rationale and clinical data.

Immunology proves a great success for treating systemic autoimmune diseases - a perspective on immunopharmacology: IUPHAR Review 23.

PubMed

Ishii, Masaru

2017-07-01

Recent advances in the bioengineering of monoclonal antibodies (mAbs) have revolutionized the treatment of several immunological and rheumatic diseases. mAbs exhibit high specificity and affinity, and are very effective targeting agents, associated with minimal off-target adverse effects. Of several relevant immunological diseases, rheumatoid arthritis was the condition initially treated with mAbs, with great success. Currently, many immunological disorders are targeted and successfully treated using such novel approaches; these include inflammatory bowel diseases, multiple sclerosis, lupus and psoriasis. Today, the efforts of researchers in basic immunology (with a long history) have borne fruit; bioengineered mAbs are employed in clinical practice. In this brief review, I will describe the current and emerging therapeutic mAbs and molecular targeted agents, and discuss the future of the field, especially from the viewpoint of pharmacology. © 2017 The British Pharmacological Society.

Depression and kidney transplantation.

PubMed

Chilcot, Joseph; Spencer, Benjamin Walter Jack; Maple, Hannah; Mamode, Nizam

2014-04-15

While kidney transplantation offers several advantages in terms of improved clinical outcomes and quality of life compared to dialysis modalities, depressive symptoms are still present in approximately 25% of patients, rates comparable to that of the hemodialysis population. Correlates of depressive symptoms include marital status, income, kidney function, history of affective illness, malnutrition, and inflammation. Depressive symptoms are also associated with poor outcomes following kidney transplantation including nonadherence to immunosuppressant medication, graft failure, and all-cause mortality. Efforts to detect and treat depression should be a priority if one is to improve treatment adherence, quality of life, and outcomes in transplant recipients.

How do robots take two parts apart

NASA Technical Reports Server (NTRS)

Bajcsy, Ruzena K.; Tsikos, Constantine J.

1989-01-01

This research is a natural progression of efforts which begun with the introduction of a new research paradigm in machine perception, called Active Perception. There it was stated that Active Perception is a problem of intelligent control strategies applied to data acquisition processes which will depend on the current state of the data interpretation, including recognition. The disassembly/assembly problem is treated as an Active Perception problem, and a method for autonomous disassembly based on this framework is presented.

Pattern of Disabilities among Leprosy Patients in Abia State, Nigeria - a Retrospective Review.

PubMed

Onyeonoro, U U; Aguocha, G U; Madukwe, S O; Nwokeukwu, H I; Nwamoh, U N; Aguocha, B U

2016-01-01

Early case detection and prompt treatment have been identified as key strategies for effective control and elimination of leprosy disease. Hence, control efforts should include among others treatment of the disease and disability prevention. This study is aimed at determining prevalence and pattern of disability among leprosy patients treated in a Leprosy Center in Abia State, Nigeria. Records of 287 leprosy patients treated in Uzoakoli Leprosy Center, Abia State between 2002 and 2006 were reviewed and analysed. Findings showed 23 (9.9%) with childhood leprosy, 206 (83.7%) multi-bacillary type and 64 (28.4%) with grade 2 disability among the leprosy cases.Four children (15.4%) presented with grade 2 disability at diagnosis. Prior to treatment 80 (27.9%) had grade 2 disability, while 11 (6.6%) at the end of the treatment.,Based on EHF score 85 patients (50.9%) out 167 patients who completed treatment had impairment before treatment; on completion of treatment 133 (89.9%) of them improved, while 5 (3.4%) deteriorated. The lower limb (92.6%) was the most affected site in the leprosy patients,, while the eye (3.4%) was the leastaffected. The current leprosy control efforts should be intensified to ensure early case detection and prompt treatment in order to reduce the leprosy burden, including disabilities in individuals and community at large.

The ethics of improving African traditional medical practice: scientific or African traditional research methods?

PubMed

Nyika, Aceme

2009-11-01

The disease burden in Africa, which is relatively very large compared with developed countries, has been attributed to various factors that include poverty, food shortages, inadequate access to health care and unaffordability of Western medicines to the majority of African populations. Although for 'old diseases' knowledge about the right African traditional medicines to treat or cure the diseases has been passed from generation to generation, knowledge about traditional medicines to treat newly emerging diseases has to be generated in one way or another. In addition, the existing traditional medicines have to be continuously improved, which is also the case with Western scientific medicines. Whereas one school of thought supports the idea of improving medicines, be they traditional or Western, through scientific research, an opposing school of thought argues that subjecting African traditional medicines to scientific research would be tantamount to some form of colonization and imperialism. This paper argues that continuing to use African traditional medicines for old and new diseases without making concerted efforts to improve their efficacy and safety is unethical since the disease burden affecting Africa may continue to rise in spite of the availability and accessibility of the traditional medicines. Most importantly, the paper commends efforts being made in some African countries to improve African traditional medicine through a combination of different mechanisms that include the controversial approach of scientific research on traditional medicines.

Oral carcinogenesis is not achieved in different carcinogen-treated PAI-1 transgenic and wild-type mouse models.

PubMed

Avgoustidis, Dimitris; Nisyrios, Themistoklis; Nkenke, Emeka; Lijnen, Roger; Ragos, Vassilis; Perrea, Despina; Donta, Ismini; Vaena, Apostolia; Yapijakis, Christos; Vairaktaris, Eleftherios

2012-01-01

In an effort to assess the role of plasminogen activator inhibitor-1 (PAI-1) in oral squamous cancer development and progression, two different carcinogen treatment protocols were conducted. Protocol I included mice from a PAI-1 transgenic (Tg) breed (n=56) and their wild-type (WT) counterparts (n=56), divided into one control group and two main experimental groups, treated with 7,12-dimethylbenz[a]anthracene (DMBA) for 8 and 16 weeks, respectively. Protocol II included the same number and types of animals and groups, which were similarly treated with 4-Nitroquinoline 1-oxide (4-NQO) in drinking water. Two drugs that affect plasma PAI-1 levels, enalapril and pravastatin, were administered to certain subgroups of animals in both protocols. None of the animals developed macroscopically-visible oral cancer lesions. Eleven animals under Protocol I and 52 animals under Protocol II died. Skin lesions were noted only in DMBA-treated animals (n=9). Almost all animals administered with 4-NQO developed alopecia and lost weight, while two of them developed stomach tumours, and one female mouse developed a large ovarian cyst. Transgenic mice may respond differently when used in well-established carcinogen models and oral carcinogenesis is hard to achieve in these rodents.

AMPA RECEPTOR POTENTIATORS: FROM DRUG DESIGN TO COGNITIVE ENHANCEMENT

PubMed Central

PARTIN, KATHRYN M.

2014-01-01

Positive allosteric modulators of ionotropic glutamate receptors have emerged as a target for treating cognitive impairment and neurodegeneration, but also mental illnesses such as major depressive disorder. The possibility of creating a new class of pharmaceutical agent to treat refractive mental health issues has compelled researchers to redouble their efforts to develop a safe, effective treatment for memory and cognition impairments. Coupled with the more robust research methodologies that have emerged, including more sophisticated high-throughput-screens, higher resolution structural biology techniques, and more focused assessment on pharmacokinetics, the development of positive modulators of AMPA receptors holds great promise. We describe recent approaches that improve our understanding of the basic physiology underlying memory and cognition, and their application towards promoting human health. PMID:25462292

Protecting the Rights of School Children with Diabetes

PubMed Central

Wood, James M.

2013-01-01

School children with diabetes are facing increasing difficulties in receiving care during the school day. Despite theexistence of federal statutes ensuring their rights to a free, appropriate public education, many school districts throughout the country do little, if anything, to ensure that their condition is treated throughout the school day. The chronic shortage of school nurses has resulted in hardships on families, relatives, and friends to ensure that care, including insulin, is timely and appropriately provided. While many states have taken measures to provide care by unlicensed trained volunteers, efforts to accomplish this in California have resulted in prolonged litigation. A variety of nursing organizations oppose all efforts to train unlicensed volunteers, arguing that such is not permitted by California law. The issue is unresolved and currently pending in the California Supreme Court. PMID:23566990

Ebola Virus Epidemic in West Africa: Global Health Economic Challenges, Lessons Learned, and Policy Recommendations.

PubMed

Elmahdawy, Mahmoud; Elsisi, Gihan H; Carapinha, Joao; Lamorde, Mohamed; Habib, Abdulrazaq; Agyie-Baffour, Peter; Soualmi, Redouane; Ragab, Samah; Udezi, Anthony W; Usifoh, Cyril; Usifoh, Stella

2017-09-01

The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics. Copyright © 2017. Published by Elsevier Inc.

Anabolic-androgenic steroids and decision making: Probability and effort discounting in male rats.

PubMed

Wallin, Kathryn G; Alves, Jasmin M; Wood, Ruth I

2015-07-01

Anabolic-androgenic steroid (AAS) abuse is implicated in maladaptive behaviors such as increased aggression and risk taking. Impaired judgment due to changes in the mesocorticolimbic dopamine system may contribute to these behavioral changes. While AAS are known to influence dopamine function in mesocorticolimbic circuitry, the effects on decision making are unknown. This was the focus of the present study. Adolescent male Long-Evans rats were treated chronically with high-dose testosterone (7.5 mg/kg) or vehicle (13% cyclodextrin in water), and tested for cost/benefit decision making in two discounting paradigms. Rats chose between a small reward (1 sugar pellet) and a large discounted reward (3 or 4 pellets). Probability discounting (PD) measures sensitivity to reward uncertainty by decreasing the probability (100, 75, 50, 25, 0%) of receiving the large reward in successive blocks of each daily session. Effort discounting (ED) measures sensitivity to a work cost by increasing the lever presses required to earn the large reward (1, 2, 5, 10, 15 presses). In PD, testosterone-treated rats selected the large/uncertain reward significantly less than vehicle-treated controls. However, during ED, testosterone-treated rats selected the large/high effort reward significantly more than controls. These studies show that testosterone has divergent effects on different aspects of decision making. Specifically, testosterone increases aversion to uncertainty but decreases sensitivity to the output of effort for reward. These results have implications for understanding maladaptive behavioral changes in human AAS users. Copyright © 2015 Elsevier Ltd. All rights reserved.

Endoscopic management of benign bile duct strictures.

PubMed

Baron, Todd H; Davee, Tomas

2013-04-01

The use of endoscopic retrograde cholangiopancreatography for treating benign biliary strictures has become the standard of practice, with surgery and percutaneous therapy reserved for selected patients. The gold-standard endoscopic therapy is dilation of the stricture followed by placing and exchanging progressively larger and more numerable plastic stents over a 1-year period. Newer modalities, including the use of fully covered metal stents, are currently under investigation in an effort to improve the treatment of benign biliary strictures. Copyright © 2013 Elsevier Inc. All rights reserved.

Aquaculture as yet another environmental gateway to the development and globalisation of antimicrobial resistance.

PubMed

Cabello, Felipe C; Godfrey, Henry P; Buschmann, Alejandro H; Dölz, Humberto J

2016-07-01

Aquaculture uses hundreds of tonnes of antimicrobials annually to prevent and treat bacterial infection. The passage of these antimicrobials into the aquatic environment selects for resistant bacteria and resistance genes and stimulates bacterial mutation, recombination, and horizontal gene transfer. The potential bridging of aquatic and human pathogen resistomes leads to emergence of new antimicrobial-resistant bacteria and global dissemination of them and their antimicrobial resistance genes into animal and human populations. Efforts to prevent antimicrobial overuse in aquaculture must include education of all stakeholders about its detrimental effects on the health of fish, human beings, and the aquatic ecosystem (the notion of One Health), and encouragement of environmentally friendly measures of disease prevention, including vaccines, probiotics, and bacteriophages. Adoption of these measures is a crucial supplement to efforts dealing with antimicrobial resistance by developing new therapeutic agents, if headway is to be made against the increasing problem of antimicrobial resistance in human and veterinary medicine. Copyright © 2016 Elsevier Ltd. All rights reserved.

Major Adverse Cardiovascular Events in Treated Periodontitis: A Population-Based Follow-Up Study from Taiwan

PubMed Central

Chou, Shing-Hsien; Tung, Ying-Chang; Lin, Yu-Sheng; Wu, Lung-Sheng; Lin, Chia-Pin; Liou, Eric Jein-Wein; Chang, Chee-Jen; Kung, Suefang; Chu, Pao-Hsien

2015-01-01

Background The aim of the present study was to identify the long-term major adverse cardiovascular events (MACE) in treated periodontitis patients in Taiwan. Methods From the National Health Insurance Research Database (2001-2010), adult patients (≥ 18 years) with treated periodontitis were identified. Comparison was made between patients with mild form and severe form of treated periodontitis after propensity score matching. The primary end point was the incidence of MACE. Results A total of 32,504 adult patients with treated periodontitis were identified between 2001 and 2010. After propensity score matching, 27,146 patients were preserved for comparison, including 13,573 patients with mild form and 13,573 patients with severe form of treated periodontitis. During follow-up, 728 individuals in mild treated periodontitis group and 1,206 individuals in severe treated periodontitis group had at least 1 MACE event. After adjustment for gender, hyperlipidemia, hypertension and diabetes mellitus, severe treated periodontitis was associated with a mildly but significantly increased risk of MACE among older patients > 60 years of age (incidence rate ratio, 1.26; 95% confidence interval, 1.08–1.46). No association was found among younger patients ≤ 60 years of age. Conclusions Severe form of treated periodontitis was associated with an increased risk of MACE among older Taiwanese patients, but not among younger Taiwanese patients. We should put more efforts on the improvement of periodontal health to prevent further MACE. PMID:26114433

Research update for the treated wood reusing program at the Calhoun Research Station

Treesearch

Cheng Piao; Todd F. Shupe; Leslie Groom; W. Allen Nipper

2009-01-01

The reusability of decommissioned treated wood is primarily dependent on residual preservative retention and residual strength of the wood after service. Therefore, determining the residual preservative retention, bonding performance, and residual strength of spent treated wood can provide vital information to further recycling efforts. This report summarizes the...

Why do these issues constitute problems? Pathogen indicators

EPA Science Inventory

The Water Environment Research Foundation funded a collaborative effort designed to better understand the factors affecting regrowth, odors and the sudden increase of bacterial indicators in heat treated biosolids. As part of this effort the Principal Investigators developed a w...

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia.

PubMed

Kim, Won Young; Giberson, Tyler A; Uber, Amy; Berg, Katherine; Cocchi, Michael N; Donnino, Michael W

2014-08-01

Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3)min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10min, 11-20min, 21-30min, >30min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20min. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

PubMed Central

Kim, Won Young; Giberson, Tyler A.; Uber, Amy; Berg, Katherine; Cocchi, Michael N.; Donnino, Michael W.

2014-01-01

Background Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. Methods This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. Results 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0–32.3) minutes and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10 min, 11-20 min, 21-30 min, > 30 min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20 minutes, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Conclusions Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime > 20 minutes. PMID:24746783

Use of insecticide-treated house screens to reduce infestations of dengue virus vectors, Mexico.

PubMed

Manrique-Saide, Pablo; Che-Mendoza, Azael; Barrera-Perez, Mario; Guillermo-May, Guillermo; Herrera-Bojorquez, Josue; Dzul-Manzanilla, Felipe; Gutierrez-Castro, Cipriano; Lenhart, Audrey; Vazquez-Prokopec, Gonzalo; Sommerfeld, Johannes; McCall, Philip J; Kroeger, Axel; Arredondo-Jimenez, Juan I

2015-02-01

Dengue prevention efforts rely on control of virus vectors. We investigated use of insecticide-treated screens permanently affixed to windows and doors in Mexico and found that the screens significantly reduced infestations of Aedes aegypti mosquitoes in treated houses. Our findings demonstrate the value of this method for dengue virus vector control.

Use of treated woods in roof assembly.

PubMed

Edlich, Richard F; Winters, Kathryne L; Long, William B; Gubler, K Dean; Britt, L D

2005-01-01

On February 12, 2002, the US Environmental Protection Agency (EPA) announced a voluntary decision by industry to move consumer use of treated lumber products away from a variety of pressure-treated wood that contains Arsenate (As) by December 31, 2003, in favor of new alternative wood preservatives. It is the purpose of this report to outline legislative efforts to ban the use of chromated copper arsenate (CCA)-treated wood for residential roofing in the State of Oregon. At the time that the legislation was introduced, it was coincidental that the National Roofing Contractors Association (NRCA) recommended that CCA-treated wood should not be used in residential roofing. A summary of the report is included in this review. Finally, we discuss some of the potentially harmful environmental hazards of wood preservatives on the environment. In addition to the toxicity of pressure-treated wood on our environment, we point out that wood as well as pressure-treated wood assemblies are highly flammable. Consequently, we recommend the use of residential roofing systems that have Class A fire protection for the homeowner. Because residential roof fires remain a life-threatening danger to residential homeowners in the United States, we describe a national fire prevention program for reducing residential roof fires by use of an Underwriters Laboratories Inc. (UL) and National Fire Protection Association Class A fire-rated roof system.

Protecting the rights of school children with diabetes.

PubMed

Wood, James M

2013-03-01

School children with diabetes are facing increasing difficulties in receiving care during the school day. Despite theexistence of federal statutes ensuring their rights to a free, appropriate public education, many school districts throughout the country do little, if anything, to ensure that their condition is treated throughout the school day. The chronic shortage of school nurses has resulted in hardships on families, relatives, and friends to ensure that care, including insulin, is timely and appropriately provided. While many states have taken measures to provide care by unlicensed trained volunteers, efforts to accomplish this in California have resulted in prolonged litigation. A variety of nursing organizations oppose all efforts to train unlicensed volunteers, arguing that such is not permitted by California law. The issue is unresolved and currently pending in the California Supreme Court. © 2013 Diabetes Technology Society.

Burden of illness of rheumatoid arthritis in Latin America: a regional perspective.

PubMed

Ramírez, L A; Rodríguez, C; Cardiel, M H

2015-03-01

Rheumatoid arthritis (RA) is one of the most important rheumatic diseases. Its prevalence varies among ethnic groups. Genetic and environmental factors influence its incidence and prevalence. This chronic disease will increase its frequency in the future due to population aging. The personal impact of this disease on many relevant areas of an individual requires special efforts to prevent and treat it properly. Adequate advice on several recently described risk factors such as tobacco and alcohol exposure, infections, obesity, and physical exercise should be part of every medical consultation. This knowledge should be incorporated to improve health care prevention programs. Patients and clinicians must work together through better communication skills to finally improve outcomes. Including RA in priority health care lists will need special effort from rheumatology societies and better communication with policy makers.

The veterinary medicine industry in Britain in the twentieth century.

PubMed

Corley, T A B; Godley, Andrew

2011-01-01

Economic historians have focused research effort on accounting for the growth and significance of Britain's pharmaceutical industry, but little effort has so far been directed at the veterinary medicine industry, which formed an important part of the wider sector. This article addresses that gap. Factors responsible for that sector's relative insignificance until the 1950s included a general tendency to slaughter rather than to treat sick animals, the absence of advanced medicines until the innovation of sulpha drugs and antibiotics, and difficult relations with the wider pharmaceutical industry. Thereafter output of veterinary medicines increased dramatically, arising from an exponential growth in the demand for intensively farmed poultry meat. Since the 1980s a decline in the use of drugs in agriculture has caused the industry to concentrate on the health needs of domestic animals rather than those of livestock.

Model-based software for simulating ultrasonic pulse/echo inspections of metal components

NASA Astrophysics Data System (ADS)

Chiou, Chien-Ping; Margetan, Frank J.; Taylor, Jared L.; McKillip, Matthew; Engle, Brady J.; Roberts, Ronald A.; Barnard, Daniel J.

2017-02-01

Under the sponsorship of the National Science Foundation's Industry/University Cooperative Research Center at Iowa State University, an effort was initiated in 2015 to repackage existing research-grade software into user friendly tools for the rapid estimation of signal-to-noise ratio (S/N) for ultrasonic inspections of metals. The software combines: (1) a Python-based graphical user interface for specifying an inspection scenario and displaying results; and (2) a Fortran-based engine for computing defect signals and backscattered grain noise characteristics. The later makes use the Thompson-Gray Model for the response from an internal defect and the Independent Scatterer Model for backscattered grain noise. This paper provides an overview of the ongoing modeling effort with emphasis on recent developments. These include: treatment of angle-beam inspections, implementation of distance-amplitude corrections, changes in the generation of "invented" calibration signals, efforts to simulate ultrasonic C-scans; and experimental testing of model predictions. The simulation software can now treat both normal and oblique-incidence immersion inspections of curved metal components having equiaxed microstructures in which the grain size varies with depth. Both longitudinal and shear-wave inspections are treated. The model transducer can either be planar, spherically-focused, or bi-cylindrically-focused. A calibration (or reference) signal is required and is used to deduce the measurement system efficiency function. This can be "invented" by the software using center frequency and bandwidth information specified by the user, or, alternatively, a measured calibration signal can be used. Defect types include flat-bottomed-hole reference reflectors, and spherical pores and inclusions. Simulation outputs include estimated defect signal amplitudes, root-mean-squared grain noise amplitudes, and S/N as functions of the depth of the defect within the metal component. At any particular depth, the user can view a simulated A-scan displaying the superimposed defect and grain-noise waveforms. The realistic grain noise signals used in the A-scans are generated from a set of measured "universal" noise signals whose strengths and spectral characteristics are altered to match predicted noise characteristics for the simulation at hand. We present simulation examples demonstrating recent developments, and discuss plans to improve simulator capabilities.

Programming with process groups: Group and multicast semantics

NASA Technical Reports Server (NTRS)

Birman, Kenneth P.; Cooper, Robert; Gleeson, Barry

1991-01-01

Process groups are a natural tool for distributed programming and are increasingly important in distributed computing environments. Discussed here is a new architecture that arose from an effort to simplify Isis process group semantics. The findings include a refined notion of how the clients of a group should be treated, what the properties of a multicast primitive should be when systems contain large numbers of overlapping groups, and a new construct called the causality domain. A system based on this architecture is now being implemented in collaboration with the Chorus and Mach projects.

Regulation of appetite to treat obesity

PubMed Central

Kim, Gilbert W; Lin, Jieru E; Valentino, Michael A; Colon-Gonzalez, Francheska; Waldman, Scott A

2011-01-01

Obesity has escalated into a pandemic over the past few decades. In turn, research efforts have sought to elucidate the molecular mechanisms underlying the regulation of energy balance. A host of endogenous mediators regulate appetite and metabolism, and thereby control both short- and long-term energy balance. These mediators, which include gut, pancreatic and adipose neuropeptides, have been targeted in the development of anti-obesity pharmacotherapy, with the goal of amplifying anorexigenic and lipolytic signaling or blocking orexigenic and lipogenic signaling. This article presents the efficacy and safety of these anti-obesity drugs. PMID:21666781

BP America Treating Site #9 Compressor Station... Status of PSD and Title V permits following decommissioning of site

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Beyond negative valence: 2-week administration of a serotonergic antidepressant enhances both reward and effort learning signals.

PubMed

Scholl, Jacqueline; Kolling, Nils; Nelissen, Natalie; Browning, Michael; Rushworth, Matthew F S; Harmer, Catherine J

2017-02-01

To make good decisions, humans need to learn about and integrate different sources of appetitive and aversive information. While serotonin has been linked to value-based decision-making, its role in learning is less clear, with acute manipulations often producing inconsistent results. Here, we show that when the effects of a selective serotonin reuptake inhibitor (SSRI, citalopram) are studied over longer timescales, learning is robustly improved. We measured brain activity with functional magnetic resonance imaging (fMRI) in volunteers as they performed a concurrent appetitive (money) and aversive (effort) learning task. We found that 2 weeks of citalopram enhanced reward and effort learning signals in a widespread network of brain regions, including ventromedial prefrontal and anterior cingulate cortex. At a behavioral level, this was accompanied by more robust reward learning. This suggests that serotonin can modulate the ability to learn via a mechanism that is independent of stimulus valence. Such effects may partly underlie SSRIs' impact in treating psychological illnesses. Our results highlight both a specific function in learning for serotonin and the importance of studying its role across longer timescales.

Critical evaluation of the cancer risk of dibromochloropropane (DBCP).

PubMed

Clark, Heather A; Snedeker, Suzanne M

2005-01-01

Dibromochloropropane (1,2-dibromo-3-chloropropane, DBCP), a pesticide used widely for over 20 years to control nematodes on crops, turf and in nurseries, was banned by the United States Environmental Protection Agency (US EPA) in 1977 because of evidence of infertility in men and induction of a variety of tumors in laboratory animals. Despite the ban on the use of DBCP, this pesticide remains persistent in soil and continues to be detected as a groundwater contaminant in areas of past high use, in particular California's Central Valley. In this review, we present a critical evaluation of the available scientific literature on the potential for DBCP to affect cancer risk, including the results of animal cancer bioassays, human epidemiological studies and in vitro and in vivo genotoxicity studies. In addition, we provide updated information on DBCP chemistry and metabolism, production and past use, current regulations, its environmental fate, potential for human exposure and current remediation efforts. Results from long-term cancer bioassays in rodents show a statistically significant increase in the incidence of malignant and benign mammary gland tumors in female rats treated orally with DBCP compared to controls and some evidence of increased incidence of mammary fibroadenomas in DBCP low-dose treated female rats exposed by inhalation. Significantly increased incidence of tumors of the forestomach occurred in both sexes of rats and mice treated orally. Rats exposed to DBCP by inhalation showed significant increases in tumors of the tunica vaginalis in males; tumors of the pharynx and adrenal gland in females; and tumors of the tongue, nasal turbinate and nasal cavity in both sexes compared to controls. Male and female mice exposed to DBCP by inhalation experienced increased tumor incidence in the lungs and nasal cavity compared to controls. Significant increases in tumors of the lung and forestomach have also been reported in female mice treated by a dermal route. Although high mortality rates in both rat and mouse bioassays limited the ability to detect tumors late in life, the induction of a variety of tumors by multiple routes of exposure in two rodent species provides clear evidence of a DBCP tumorigenic response. In vitro, in vivo and human genotoxicity studies indicate that DBCP is capable of acting as a mutagen and clastogen. Few studies have been conducted to assess whether DBCP workplace or drinking water exposures affect cancer risk in humans. While case-control, cohort and ecological epidemiology studies have not found significant, positive associations between DBCP exposure and cancer in exposed populations, these studies have numerous limitations including small numbers of participants, a lack of control for confounding factors, lack of exposure information on DBCP and other chemicals and short follow-up times. Given the persistent nature of DBCP contamination in areas of past use, efforts should be made to continue remediation efforts and follow previously exposed populations for development of certain human cancers, including breast, ovarian, stomach, respiratory, oral and nasal cancers, among others.

Case series: evaluation of a liquid silicone gel on scar appearance following excisional surgery--a pilot study.

PubMed

Spencer, James M

2010-07-01

Efforts to improve the size and appearance of scars have included therapies as varied as laser treatments and onion extract gels. Silicone gel sheeting is well know to improve the appearance of hypertrophic scars, and may have a role in the management of routine surgical and traumatic scars. By varying the degree of cross linking, silicone elastomer can be a solid sheet or a liquid gel. In this pilot series, seven patients applied a liquid silicone gel twice a day to one half of a new surgical scar for three months. At the end of this time, the treated side was noticeably better in appearance in five of seven patients while two of seven had no difference. In no patient was the silicone treated side worse in appearance.

Advances in model-based software for simulating ultrasonic immersion inspections of metal components

NASA Astrophysics Data System (ADS)

Chiou, Chien-Ping; Margetan, Frank J.; Taylor, Jared L.; Engle, Brady J.; Roberts, Ronald A.

2018-04-01

Under the sponsorship of the National Science Foundation's Industry/University Cooperative Research Center at ISU, an effort was initiated in 2015 to repackage existing research-grade software into user-friendly tools for the rapid estimation of signal-to-noise ratio (SNR) for ultrasonic inspections of metals. The software combines: (1) a Python-based graphical user interface for specifying an inspection scenario and displaying results; and (2) a Fortran-based engine for computing defect signals and backscattered grain noise characteristics. The later makes use the Thompson-Gray measurement model for the response from an internal defect, and the Thompson-Margetan independent scatterer model for backscattered grain noise. This paper, the third in the series [1-2], provides an overview of the ongoing modeling effort with emphasis on recent developments. These include the ability to: (1) treat microstructures where grain size, shape and tilt relative to the incident sound direction can all vary with depth; and (2) simulate C-scans of defect signals in the presence of backscattered grain noise. The simulation software can now treat both normal and oblique-incidence immersion inspections of curved metal components. Both longitudinal and shear-wave inspections are treated. The model transducer can either be planar, spherically-focused, or bi-cylindrically-focused. A calibration (or reference) signal is required and is used to deduce the measurement system efficiency function. This can be "invented" by the software using center frequency and bandwidth information specified by the user, or, alternatively, a measured calibration signal can be used. Defect types include flat-bottomed-hole reference reflectors, and spherical pores and inclusions. Simulation outputs include estimated defect signal amplitudes, root-mean-square values of grain noise amplitudes, and SNR as functions of the depth of the defect within the metal component. At any particular depth, the user can view a simulated A-, B-, and C-scans displaying the superimposed defect and grain-noise waveforms. The realistic grain noise signals used in the A-scans are generated from a set of measured "universal" noise signals whose strengths and spectral characteristics are altered to match predicted noise characteristics for the simulation at hand.

Toward a Mechanistic Source Term in Advanced Reactors: A Review of Past U.S. SFR Incidents, Experiments, and Analyses

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

Bucknor, Matthew; Brunett, Acacia J.; Grabaskas, David

In 2015, as part of a Regulatory Technology Development Plan (RTDP) effort for sodium-cooled fast reactors (SFRs), Argonne National Laboratory investigated the current state of knowledge of source term development for a metal-fueled, pool-type SFR. This paper provides a summary of past domestic metal-fueled SFR incidents and experiments and highlights information relevant to source term estimations that were gathered as part of the RTDP effort. The incidents described in this paper include fuel pin failures at the Sodium Reactor Experiment (SRE) facility in July of 1959, the Fermi I meltdown that occurred in October of 1966, and the repeated meltingmore » of a fuel element within an experimental capsule at the Experimental Breeder Reactor II (EBR-II) from November 1967 to May 1968. The experiments described in this paper include the Run-Beyond-Cladding-Breach tests that were performed at EBR-II in 1985 and a series of severe transient overpower tests conducted at the Transient Reactor Test Facility (TREAT) in the mid-1980s.« less

Issues and developments related to assessing function in serious mental illness.

PubMed

Brown, Matt A; Velligan, Dawn I

2016-06-01

Serious mental illness (SMI) results in functional disability that imposes a significant burden on individuals, caregivers, and society. Development of novel treatments is under way in an effort to improve the illness domains of cognitive impairment and negative symptoms and subsequently to improve functional outcomes. The assessment of functional outcomes in SMI faces a number of challenges, including the proliferation of assessment instruments and the differential prioritization of functional goals among stakeholder groups. Functional assessments relying on self- and informant report present a number of limitations. Identifying alternative strategies to assess functioning that are reliable, valid, and sensitive to change is necessary for use in clinical trials. Measures of functional capacity have been proposed for clinical trials investigating compounds to treat cognitive impairment in schizophrenia. Alternative approaches employing effort-based decision making or daily activity recording using instruments such as the Daily Activity Report may be more appropriate for studies focused on improving negative symptoms.

Therapeutic vaccines for leishmaniasis.

PubMed

Khamesipour, Ali

2014-11-01

Numerous therapeutic strategies are used to treat leishmaniasis. The treatment of cutaneous leishmaniasis (CL) is solely depends on antimonate derivatives with safety issues and questionable efficacy and there is no fully effective modality to treat CL caused by Leishmania tropica and Leishmania braziliensis. There is no prophylactic vaccine available against any form of leishmaniasis. Immunotherapy for CL has a long history; immunotherapy trials of first and second generation vaccines showed promising results. The current article briefly covers the prophylactic vaccines and explains different immunotherapy strategies that have been used to treat leishmaniasis. This paper does not include experimental vaccines and only lays emphasis on human trials and those vaccines which reached human trials. Immunotherapy is currently used to successfully treat several disorders; Low cost, limited side effects and no possibility to develop resistance make immunotherapy a valuable choice especially for infectious disease with chemotherapy problems. Efforts are needed to explore the immunological surrogate marker(s) of cure and protection in leishmaniasis and overcome the difficulties in standardization of crude Leishmania vaccines. One of the reasons for anti-leishmaniasis vaccine failure is lack of an appropriate adjuvant. So far, not enough attention has been paid to develop vaccines for immunotherapy of leishmaniasis.

First characterization of a microsporidial triosephosphate isomerase and the biochemical mechanisms of its inactivation to propose a new druggable target.

PubMed

García-Torres, Itzhel; De la Mora-De la Mora, Ignacio; Hernández-Alcántara, Gloria; Molina-Ortiz, Dora; Caballero-Salazar, Silvia; Olivos-García, Alfonso; Nava, Gabriela; López-Velázquez, Gabriel; Enríquez-Flores, Sergio

2018-06-05

The microsporidia are a large group of intracellular parasites with a broad range of hosts, including humans. Encephalitozoon intestinalis is the second microsporidia species most frequently associated with gastrointestinal disease in humans, especially immunocompromised or immunosuppressed individuals, including children and the elderly. The prevalence reported worldwide in these groups ranges from 0 to 60%. Currently, albendazole is most commonly used to treat microsporidiosis caused by Encephalitozoon species. However, the results of treatment are variable, and relapse can occur. Consequently, efforts are being directed toward identifying more effective drugs for treating microsporidiosis, and the study of new molecular targets appears promising. These parasites lack mitochondria, and oxidative phosphorylation therefore does not occur, which suggests the enzymes involved in glycolysis as potential drug targets. Here, we have for the first time characterized the glycolytic enzyme triosephosphate isomerase of E. intestinalis at the functional and structural levels. Our results demonstrate the mechanisms of inactivation of this enzyme by thiol-reactive compounds. The most striking result of this study is the demonstration that established safe drugs such as omeprazole, rabeprazole and sulbutiamine can effectively inactivate this microsporidial enzyme and might be considered as potential drugs for treating this important disease.

Follow-Up Review to Determine the Extent to Which the Department of Health and Human Services has Implemented the Recommendations in Our Report: ’Increased Federal Efforts Needed to Better Identify, Treat, and Prevent Child Abuse and Neglect’.

DTIC Science & Technology

1981-09-18

34Increased Federal Efforts Needed to Better Identify, Treat, and Prevent Child Abuse and Neglect7 ’(HRD-80-66, Apr. 29, 1980) (HRD-81-153) On December 2...and 4, 1980, the Subcommittee held oversight hearings on title I of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978. That...legislation amended and extended the provisions of the Child Abuse and Treatment Act of 1974. The 1974 act established the National Center on Child

Suicide attempts within 12 months of treatment for substance use disorders.

PubMed

Britton, Peter C; Conner, Kenneth R

2010-02-01

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.

Nandrolone decanoate and physical effort: histological and morphometrical assessment in adult rat uterus.

PubMed

de Almeida Chuffa, Luiz Gustavo; de Souza, Roberta Barreiros; Frei, Fernando; de Fátima Paccola Mesquita, Suzana; Camargo, Isabel Cristina Cherici

2011-02-01

In the past decades, the therapeutic use of anabolic androgenic steroids (AAS) has been overshadowed by illicit abuse of these drugs by athletes and non-athletes. Since that AAS can affect the reproductive tract, resulting in reproduction and fertilization damages, the purpose of this study was to investigate the nandrolone decanoate (ND) effects, associated or not with physical effort, on the uterine histomorphometric parameters. Female Wistar rats, sedentary or not, were exposed to treatment with ND by intraperitoneal injection (5 mg/kg/day, once a week) during four consecutive weeks. Control animals, sedentary or not, received vehicle alone (propylene glycol) in the same manner. The physical activity was forced swimming (20 min/day). During the experiment, all animals were monitored by daily vaginal smears. After 30 days of treatment, the females were sacrificed and their uteri collected and examined under light microscopy techniques. The ND-treated females showed estrus acyclicity and decreased thickness of both the epithelium and endometrial stroma. A reduction in the number and size of blood vessels was also found in ND-treated rats submitted to physical effort when compared to ND sedentary rats. ND-treated rats, regardless of exercise, exhibited stromal fibrosis and reduced gland ducts that displayed high mitotic activity. A remarkable widespread presence of leukocytes occurred in rats receiving ND and submitted to exercise. These results suggest that ND associated or not with physical effort causes histomorphometric changes to the rat uterus. 2010 Wiley-Liss, Inc.

The Challenging Pupil in the Classroom: Child Effects on Teachers

PubMed Central

Houts, Renate M.; Caspi, Avshalom; Pianta, Robert C.; Arseneault, Louise; Moffitt, Terrie E.

2012-01-01

Teaching children requires effort and some children naturally require more effort than others. This study tests whether teacher effort devoted to individual children varies as a function of children’s personal characteristics. Using a nation-wide longitudinal study of twins followed between ages 5-12 years, we asked teachers about the effort they invested in each child enrolled in our study. We found that teacher effort was a function of heritable child characteristics; that children’s challenging behavior assessed at age 5 predicted teacher effort at age 12; and that challenging child behavior and teacher effort share common etiology in children’s genes. While child effects accounted for a significant proportion of variance in teacher effort, we also found variation that could not be attributed to children’s behavior. Treating children with challenging behavior and enhancing teachers’ skills in behavior management could increase the time and energy teachers have to deliver curriculum in their classrooms. PMID:21078897

A streamlined failure mode and effects analysis.

PubMed

Ford, Eric C; Smith, Koren; Terezakis, Stephanie; Croog, Victoria; Gollamudi, Smitha; Gage, Irene; Keck, Jordie; DeWeese, Theodore; Sibley, Greg

2014-06-01

Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and used to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes had RPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.

"Nanoantibiotics": a new paradigm for treating infectious diseases using nanomaterials in the antibiotics resistant era.

PubMed

Huh, Ae Jung; Kwon, Young Jik

2011-12-10

Despite the fact that we live in an era of advanced and innovative technologies for elucidating underlying mechanisms of diseases and molecularly designing new drugs, infectious diseases continue to be one of the greatest health challenges worldwide. The main drawbacks for conventional antimicrobial agents are the development of multiple drug resistance and adverse side effects. Drug resistance enforces high dose administration of antibiotics, often generating intolerable toxicity, development of new antibiotics, and requests for significant economic, labor, and time investments. Recently, nontraditional antibiotic agents have been of tremendous interest in overcoming resistance that is developed by several pathogenic microorganisms against most of the commonly used antibiotics. Especially, several classes of antimicrobial nanoparticles (NPs) and nanosized carriers for antibiotics delivery have proven their effectiveness for treating infectious diseases, including antibiotics resistant ones, in vitro as well as in animal models. This review summarizes emerging efforts in combating against infectious diseases, particularly using antimicrobial NPs and antibiotics delivery systems as new tools to tackle the current challenges in treating infectious diseases. Copyright © 2011 Elsevier B.V. All rights reserved.

Management of Depression in Patients with Coronary Heart Disease: Association, Mechanisms, and Treatment Implications for Depressed Cardiac Patients

PubMed Central

Wang, Jenny T.; Hoffman, Benson; Blumenthal, James A.

2010-01-01

Importance of the field Coronary heart disease (CHD) and depression are two leading causes of death and disability in the United States and worldwide. Depression is especially common in cardiac patients, and there is growing evidence that depression is a risk factor for fatal and non-fatal events in CHD patients. Areas covered in this review This paper reviews current literature of depression as a risk factor for CHD along with pharmacologic and non-pharmacologic treatments for depression in cardiac patients. What the reader will gain Readers will gain knowledge about the importance of depression as a CHD risk factor and learn the results of efforts to treat depressed CHD patients. Take home message Although randomized clinical trials (RCTs) of medication and non-pharmacologic therapies have not demonstrated that treating depression improves survival, there is evidence that treating depressed patients can reduce depressive symptoms and improve quality of life. Additional RCTs are needed, including evaluation of non-pharmacologic therapies such as exercise, to examine the effects of treatment of depression on medical and psychosocial outcomes. PMID:20715885

The Next Wave of Influenza Drugs.

PubMed

Shaw, Megan L

2017-10-13

Options for influenza therapy are currently limited to one class of drug, the neuraminidase inhibitors. Amidst concerns about drug resistance, much effort has been placed on the discovery of new drugs with distinct targets and mechanisms of action, with great success. There are now several candidates in late stage development which include small molecules targeting the three subunits of the viral polymerase complex and monoclonal antibodies targeting the hemagglutinin, as well as host-directed therapies. The availability of drugs with diverse mechanisms now opens the door to exploring combination therapies for influenza, and the range of administration routes presents more opportunities for treating hospitalized patients.

Recent developments in the surgical management of perianal fistula for Crohn’s disease

PubMed Central

Geltzeiler, Cristina B.; Wieghard, Nicole; Tsikitis, Vassiliki L.

2014-01-01

Perianal manifestations of Crohn’s disease (CD) are common and, of them, fistulas are the most common. Perianal fistulas can be extremely debilitating for patients and are often very challenging for clinicians to treat. CD perianal fistulas usually require multidisciplinary and multimodality treatment, including both medical and surgical approaches. The majority of patients require multiple surgical interventions. CD patients with perianal fistulas have a high rate of primary non-healing, surgical morbidity, and high recurrence rates. This has led to constant efforts to improve surgical management of this disease process. PMID:25331917

HIV-associated malignancies in sub-Saharan Africa: progress, challenges, and opportunities.

PubMed

Chinula, Lameck; Moses, Agnes; Gopal, Satish

2017-01-01

To summarize recent developments for HIV-associated malignancies (HIVAM) in low-income and middle-income countries (LMIC) with particular focus on sub-Saharan Africa (SSA). Antiretroviral therapy (ART) scale-up is leading to epidemiologic transitions in LMIC similar to high-income countries, with aging and growth of HIV-infected populations, declining infectious deaths, increasing cancer deaths, and transitions from AIDS-defining cancers to non-AIDS defining cancers. Despite ART scale-up, the HIVAM burden remains high including an enormous AIDS-defining cancers burden in SSA. For Kaposi sarcoma, patients treated with ART and chemotherapy can experience good outcomes even in rural SSA, but Kaposi sarcoma heterogeneity remains insufficiently understood including virologic, immunologic, and inflammatory features that may be unique to LMIC. For cervical cancer, scale-up of prevention efforts including vaccination and screening is underway, with benefits already apparent despite continuing high disease burden. For non-Hodgkin lymphoma, curative treatment is possible in the ART era even in SSA, and multifaceted approaches can improve outcomes further. For many other prevalent HIVAM, care and research efforts are being established to guide treatment and prevention specifically in LMIC. Sustained investment for HIVAM in LMIC can help catalyze a cancer care and research agenda that benefits HIV-positive and HIV-negative patients worldwide.

Beyond negative valence: 2-week administration of a serotonergic antidepressant enhances both reward and effort learning signals

PubMed Central

Kolling, Nils; Nelissen, Natalie; Browning, Michael; Rushworth, Matthew F. S.; Harmer, Catherine J.

2017-01-01

To make good decisions, humans need to learn about and integrate different sources of appetitive and aversive information. While serotonin has been linked to value-based decision-making, its role in learning is less clear, with acute manipulations often producing inconsistent results. Here, we show that when the effects of a selective serotonin reuptake inhibitor (SSRI, citalopram) are studied over longer timescales, learning is robustly improved. We measured brain activity with functional magnetic resonance imaging (fMRI) in volunteers as they performed a concurrent appetitive (money) and aversive (effort) learning task. We found that 2 weeks of citalopram enhanced reward and effort learning signals in a widespread network of brain regions, including ventromedial prefrontal and anterior cingulate cortex. At a behavioral level, this was accompanied by more robust reward learning. This suggests that serotonin can modulate the ability to learn via a mechanism that is independent of stimulus valence. Such effects may partly underlie SSRIs’ impact in treating psychological illnesses. Our results highlight both a specific function in learning for serotonin and the importance of studying its role across longer timescales. PMID:28207733

Clinical Teaching of Prosthodontics in Undergraduate Courses in a German Dental School: Patients, Visits, Efforts, and Incentives.

PubMed

Huettig, Fabian; Behrend, Florian

2016-01-01

It is unknown what disadvantages are faced by patients deciding for a prosthodontic treatment by inexperienced students. Commonly, the related extra effort and time are compensated by cost reduction of treatment fees. Thereby, the dental schools subsidize treatments to teach clinical prosthodontics. The aim of this study was to clarify the benefits to patients as well as the efforts of the dental school. Data collected from three courses in a dental school in Germany were patient gender, age, occupation, zip code, number of visits, scope of treatment including costs, financial discount, and remaining copayment. Travel costs were calculated based on zip code. Balance of travel costs and treatment discount was defined as financial benefit. The results showed that 185 patients (95 male) aged 32 to 82 years (median=58) were treated with fixed restorations (FR, n=110), telescopic dentures (TD, n=87), complete dentures (CD, n=17), or other (RD, n=3). The mean number of visits was 11 for FR, 12 for TD, and 9 for CD. Single distance to the clinic ranged from 0.6 to 65 miles (median=12). Total costs of prosthodontics were reduced by 19% on average. The mean financial benefit was 429 USD (median=298, min=-482, max=4025). The financial benefits were found to differ widely, including additional expenditures of patients. Participation, travel burden, and copayment did not depend on age, gender, or occupation. The financial benefit was relativized because students needed at least twice the sessions of a dentist. As a result, the financial efforts of dental schools are significant and compromise a cost-covering education.

Overview of rehabilitative efforts in understanding and managing sexually coercive behaviors.

PubMed

Schwartz, Barbara K

2003-06-01

In reviewing approaches to rehabilitative efforts in understanding and managing sexually coercive behaviors within the past two decades, one is struck by the development of two totally divergent paths. In 1971, there were a few civil commitment programs operated by mental health departments-most notably were the Sexual Psychopath Program at Western State Hospital in Fort Steilacoom, Washington, and the Massachusetts Treatment Center for Sexually Dangerous Persons. There were a few programs in prisons started by therapists who were interested in this population but given little recognition and even fewer resources. Additionally there were a handful of community-based programs including the J.J. Peters Institute in Philadelphia and PASO (Positive Approaches to Sex Offenders) in Albuquerque, New Mexico. Today there are thousands of specialized sexual offender treatment programs treating sexual abusers of every age, gender, ethnicity, and with a wide range of comorbid conditions. They are treated in the community, prisons, mental hospitals, residential facilities, and private practices. There is an international organization, a specialized research journal, and a specialized branch of the Department of Justice, the Center for Sex Offender Management. This chapter will provide an overview of the developments in the field, primarily covering the last 25 years. It will look at the evolution of theoretical approaches, the development of specialized approaches for subpopulations, significant landmarks, and possible future trends.

Professional tools and a personal touch - experiences of physical therapy of persons with migraine.

PubMed

Rutberg, Stina; Kostenius, Catrine; Öhrling, Kerstin

2013-09-01

The aim was to explore the lived experience of physical therapy of persons with migraine. Data were collected by conducting narrative interviews with 11 persons with migraine. Inspired by van Manen, a hermeneutic phenomenological method was used to analyse the experiences of physical therapy which these persons had. Physical therapy for persons with migraine meant making an effort in terms of time and energy to improve their health by meeting a person who was utilising his or her knowledge and skill to help. Being respected and treated as an individual and having confidence in the physical therapist were highlighted aspects. The analysis revealed a main theme, "meeting a physical therapist with professional tools and a personal touch". The main theme included four sub-themes, "investing time and energy to feel better", "relying on the competence of the physical therapist", "wanting to be treated and to become involved as an individual" and "being respected in a trustful relationship". The therapeutic relationship with the physical therapist is important and the findings of this study can increase awareness about relational aspects of physical therapy and encourage thoughtfulness among physical therapists and other healthcare professionals interacting with persons with migraine. Physical therapists use both professional tools and a personal touch in their interaction with persons with migraine and this article can increase physical therapists' awareness and encourage thoughtfulness in their professional practice. Being respected and treated as an individual and having confidence in the physical therapist are important aspects of the therapeutic relationship and indicate a need for patient-centred care. By making the effort of spending the time and energy required, physical therapy could be a complement or an alternative to medication to ease the consequences of migraine.

Cutaneous Leishmaniasis in Saudi Arabia: A Comprehensive Overview

PubMed Central

Abdoon, Abdalmohsin M.; Aldahan, Mohamed A.; Alzahrani, Abdullah G.; Alhakeem, Raaft F.; Asiri, Abdullah M.; Alzahrani, Mohamed H.; Memish, Ziad A.

2017-01-01

Abstract Despite the great efforts by health authorities in Kingdom of Saudi Arabia (KSA), Cutaneous leishmaniasis (CL) continues to be a major public health problem in the country. Many risk factors make KSA prone to outbreaks and epidemics; among these, rapid urbanization and the huge population movement are the most important. The disease is endemic in many parts of KSA, with the majority of cases concentrated in six regions, including Al-Qaseem, Riyadh, Al-Hassa, Aseer, Ha'il, and Al-Madinah. Leishmania major (L. major) and Leishmania tropica (L. tropica) are the main dermotropic species, and Phlebotomus papatasi (vector of L. major) and Phlebotomus sergenti (vector of L. tropica) are the proved vectors of the disease. Psammomys obesus and Meriones libycus have been defined as the principal reservoir hosts of zoonotic CL in Al-Hassa oasis, Al-Madinah, and Al-Qaseem provinces. Clinically, males are affected more than females, and there is no variation between the Saudis and expatriates in terms of number of reported cases, but the disease tends to run a more severe course among non-Saudis. Face is the most commonly affected site, and ulcerative pattern accounts for 90% of lesions. Despite local and international recommendations of using laboratory diagnostics to confirm CL cases, most cases in KSA are diagnosed and treated on clinical grounds and local epidemiology. However, systemic parenteral sodium stibogluconate (SSG) is the first line of therapy and used to treat all CL patients irrespective of their clinical presentation or the incriminated species. In brief, more efforts are needed to combat this disease. Several aspects of the disease require more evaluation through encouragement of national and regional studies. Development of evidence based national diagnostic and management guidelines, as well as algorithms, is urgently needed to improve the practice of diagnosing and treating CL in KSA. PMID:28806141

Spinal and Paraspinal Ewing Tumors

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

Indelicato, Daniel J., E-mail: dindelicato@floridaproton.or; University of Florida Proton Therapy Institute, Jacksonville, FL; Keole, Sameer R.

Purpose: To perform a review of the 40-year University of Florida experience treating spinal and paraspinal Ewing tumors. Patients and Methods: A total of 27 patients were treated between 1965 and 2007. For local management, 21 patients were treated with radiotherapy (RT) alone and 6 with surgery plus RT. All patients with metastatic disease were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 17 years, and the most frequent subsite was the sacral spine (n = 9). The median potential follow-up was 16 years. Results: The 5-year actuarial overall survival, cause-specificmore » survival, and local control rate was 62%, 62%, and 90%, respectively. For the nonmetastatic subset (n = 22), the 5-year overall survival, cause-specific survival, and local control rate was 71%, 71%, and 89%, respectively. The local control rate was 84% for patients treated with RT alone vs. 100% for those treated with surgery plus RT. Patients who were >14 years old and those who were treated with intensive therapy demonstrated superior local control. Of 9 patients in our series with Frankel C or greater neurologic deficits at presentation, 7 experienced a full recovery with treatment. Of the 27 patients, 37% experienced Common Toxicity Criteria Grade 3 or greater toxicity, including 2 deaths from sepsis. Conclusion: Aggressive management of spinal and paraspinal Ewing tumors with RT with or without surgery results in high toxicity but excellent local control and neurologic outcomes. Efforts should be focused on identifying disease amenable to combined modality local therapy and improving RT techniques.« less

A Military-Centered Approach to Neuroprotection for Traumatic Brain Injury

PubMed Central

Shear, Deborah A.; Tortella, Frank C.

2013-01-01

Studies in animals show that many compounds and therapeutics have the potential to greatly reduce the morbidity and post-injury clinical sequela for soldiers experiencing TBI. However, to date there are no FDA approved drugs for the treatment of TBI. In fact, expert opinion suggests that combination therapies will be necessary to treat any stage of TBI recovery. Our approach to this research effort is to conduct comprehensive pre-clinical neuroprotection studies in military-relevant animal models of TBI using the most promising neuroprotective agents. In addition, emerging efforts incorporating novel treatment strategies such as stem cell based therapies and alternative therapeutic approaches will be discussed. The development of a non-surgical, non-invasive brain injury therapeutic clearly addresses a major, unresolved medical problem for the Combat Casualty Care Research Program. Since drug discovery is too expensive to be pursued by DOD in the TBI arena, this effort capitalizes on partnerships with the Private Sector (Pharmaceutical Companies) and academic collaborations (Operation Brain Trauma Therapy Consortium) to study therapies already under advanced development. Candidate therapies selected for research include drugs that are aimed at reducing the acute and delayed effects of the traumatic incident, stem cell therapies aimed at brain repair, and selective brain cooling to stabilize cerebral metabolism. Each of these efforts can also focus on combination therapies targeting multiple mechanisms of neuronal injury. PMID:23781213

Nonthermal plasma technology for organic destruction

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

Heath, W.O.; Birmingham, J.G.

1995-06-01

Pacific Northwest Laboratory (PNL) is investigating the use of nonthermal, electrically driven plasmas for destroying organic contaminants near ambient temperatures and pressures. Three different plasma systems have been developed to treat organics in air, water, and soil. These systems are the Gas-Phase Corona Reactor (GPCR)III for treating air, the Liquid-Phase Corona Reactor for treating water, and In Situ Corona for treating soils. This presentation focuses on recent technical developments, commercial status, and project costs of OPCR as a cost-effective alternative to other air-purification technologies that are now in use to treat off-gases from site-remediation efforts as well as industrial emissions.

Abnormal neural activation patterns underlying working memory impairment in chronic phencyclidine-treated mice.

PubMed

Arime, Yosefu; Akiyama, Kazufumi

2017-01-01

Working memory impairment is a hallmark feature of schizophrenia and is thought be caused by dysfunctions in the prefrontal cortex (PFC) and associated brain regions. However, the neural circuit anomalies underlying this impairment are poorly understood. The aim of this study is to assess working memory performance in the chronic phencyclidine (PCP) mouse model of schizophrenia, and to identify the neural substrates of working memory. To address this issue, we conducted the following experiments for mice after withdrawal from chronic administration (14 days) of either saline or PCP (10 mg/kg): (1) a discrete paired-trial variable-delay task in T-maze to assess working memory, and (2) brain-wide c-Fos mapping to identify activated brain regions relevant to this task performance either 90 min or 0 min after the completion of the task, with each time point examined under working memory effort and basal conditions. Correct responses in the test phase of the task were significantly reduced across delays (5, 15, and 30 s) in chronic PCP-treated mice compared with chronic saline-treated controls, suggesting delay-independent impairments in working memory in the PCP group. In layer 2-3 of the prelimbic cortex, the number of working memory effort-elicited c-Fos+ cells was significantly higher in the chronic PCP group than in the chronic saline group. The main effect of working memory effort relative to basal conditions was to induce significantly increased c-Fos+ cells in the other layers of prelimbic cortex and the anterior cingulate and infralimbic cortex regardless of the different chronic regimens. Conversely, this working memory effort had a negative effect (fewer c-Fos+ cells) in the ventral hippocampus. These results shed light on some putative neural networks relevant to working memory impairments in mice chronically treated with PCP, and emphasize the importance of the layer 2-3 of the prelimbic cortex of the PFC.

Abnormal neural activation patterns underlying working memory impairment in chronic phencyclidine-treated mice

PubMed Central

Akiyama, Kazufumi

2017-01-01

Working memory impairment is a hallmark feature of schizophrenia and is thought be caused by dysfunctions in the prefrontal cortex (PFC) and associated brain regions. However, the neural circuit anomalies underlying this impairment are poorly understood. The aim of this study is to assess working memory performance in the chronic phencyclidine (PCP) mouse model of schizophrenia, and to identify the neural substrates of working memory. To address this issue, we conducted the following experiments for mice after withdrawal from chronic administration (14 days) of either saline or PCP (10 mg/kg): (1) a discrete paired-trial variable-delay task in T-maze to assess working memory, and (2) brain-wide c-Fos mapping to identify activated brain regions relevant to this task performance either 90 min or 0 min after the completion of the task, with each time point examined under working memory effort and basal conditions. Correct responses in the test phase of the task were significantly reduced across delays (5, 15, and 30 s) in chronic PCP-treated mice compared with chronic saline-treated controls, suggesting delay-independent impairments in working memory in the PCP group. In layer 2–3 of the prelimbic cortex, the number of working memory effort-elicited c-Fos+ cells was significantly higher in the chronic PCP group than in the chronic saline group. The main effect of working memory effort relative to basal conditions was to induce significantly increased c-Fos+ cells in the other layers of prelimbic cortex and the anterior cingulate and infralimbic cortex regardless of the different chronic regimens. Conversely, this working memory effort had a negative effect (fewer c-Fos+ cells) in the ventral hippocampus. These results shed light on some putative neural networks relevant to working memory impairments in mice chronically treated with PCP, and emphasize the importance of the layer 2–3 of the prelimbic cortex of the PFC. PMID:29253020

Prospective Clinical Study of 551 Cases of Liposuction and Abdominoplasty Performed Individually and in Combination

PubMed Central

2013-01-01

Background: Despite the popularity of these procedures, there are limited published prospective studies evaluating liposuction and abdominoplasty. Lipoabdominoplasty is a subject of recent attention. Several investigators have recommended alternative techniques that preserve the Scarpa fascia in an effort to reduce complications, particularly the risk of seromas. Methods: Over a 5-year period, 551 consecutive patients were treated with ultrasonic liposuction alone (n = 384), liposuction/abdominoplasty (n = 150), or abdominoplasty alone (n = 17). In lipoabdominoplasties, the abdomen and flanks were first treated with liposuction. A traditional flap dissection was used for all abdominoplasties. Scalpel dissection was used rather than electrodissection. A supine “jackknife” position was used in surgery to provide maximum hip flexion, allowing a secure deep fascial repair. Results: The complication rate after liposuction was 4.2% vs 50% for patients treated with an abdominoplasty. Approximately half of the abdominoplasty complications were minor scar deformities, including widened umbilical scars (17.3%) that were revised. The seroma rate after abdominoplasties was 5.4%; there were no seromas after liposuction alone. Conclusions: Lipoabdominoplasty may be performed safely, so that patients may benefit from both modalities. The seroma rate is reduced by avoiding electrodissection, making Scarpa fascia preservation a moot point. A deep fascial repair keeps the abdominoplasty scar within the bikini line. Deep venous thrombosis and other complications may be minimized with precautions that do not include anticoagulation. PMID:25289226

Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology.

PubMed

Zesiewicz, T A; Sullivan, K L; Arnulf, I; Chaudhuri, K R; Morgan, J C; Gronseth, G S; Miyasaki, J; Iverson, D J; Weiner, W J

2010-03-16

Nonmotor symptoms (sleep dysfunction, sensory symptoms, autonomic dysfunction, mood disorders, and cognitive abnormalities) in Parkinson disease (PD) are a major cause of morbidity, yet are often underrecognized. This evidence-based practice parameter evaluates treatment options for the nonmotor symptoms of PD. Articles pertaining to cognitive and mood dysfunction in PD, as well as treatment of sialorrhea with botulinum toxin, were previously reviewed as part of American Academy of Neurology practice parameters and were not included here. A literature search of MEDLINE, EMBASE, and Science Citation Index was performed to identify clinical trials in patients with nonmotor symptoms of PD published between 1966 and August 2008. Articles were classified according to a 4-tiered level of evidence scheme and recommendations were based on the level of evidence. Sildenafil citrate (50 mg) may be considered to treat erectile dysfunction in patients with Parkinson disease (PD) (Level C). Macrogol (polyethylene glycol) may be considered to treat constipation in patients with PD (Level C). The use of levodopa/carbidopa probably decreases the frequency of spontaneous nighttime leg movements, and should be considered to treat periodic limb movements of sleep in patients with PD (Level B). There is insufficient evidence to support or refute specific treatments for urinary incontinence, orthostatic hypotension, and anxiety (Level U). Future research should include concerted and interdisciplinary efforts toward finding treatments for nonmotor symptoms of PD.

Abuse-resistant drug delivery.

PubMed

DuPont, Robert L; Bensinger, Peter B

2006-08-01

In attempting to reduce the nonmedical use of controlled substances, a reasonable step is to educate the physicians prescribing controlled substances, including the prescription stimulants used to treat ADHD, as well as patients and family members, about the risks of nonmedical use and the dangers of giving or selling these medicines to persons for whom they were not prescribed. Patients who find benefits in the use of such medicines have a significant interest in protecting their continued access to them. Such access is potentially threatened by concerns about widespread nonmedical use. Physicians can help protect the appropriate medical use of prescription stimulants by considering the abuse potential of various medicines used to treat patients with ADHD, especially when these patients also have a history of nonmedical substance use. In addition, we suggest that today there is an opportunity to add a new and perhaps more hopeful paradigm: the wider use of drug delivery systems that make products less attractive to drug abusers. This new drug abuse prevention paradigm holds great promise for efforts to reduce the nonmedical use of prescription controlled substances, including the prescription stimulants used to treat ADHD. To achieve the full potential of this new paradigm to reduce prescription drug abuse, it will be necessary to develop standards to assess the relative abuse resistance of various drug formulations and delivery systems, as well as meaningful incentives to foster the development of these abuse-resistant delivery systems for controlled substances.

[Formula: see text]Working memory and attention in pediatric brain tumor patients treated with and without radiation therapy.

PubMed

Raghubar, Kimberly P; Mahone, E Mark; Yeates, Keith Owen; Cecil, Kim M; Makola, Monwabisi; Ris, M Douglas

2017-08-01

Children are at risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Longitudinal studies have consistently demonstrated declines on measures of intellectual functioning, and recently it has been proposed that specific neurocognitive processes underlie these changes, including working memory, processing speed, and attention. However, a fine-grained examination of the affected neurocognitive processes is required to inform intervention efforts. Radiation therapy (RT) impacts white matter integrity, likely affecting those cognitive processes supported by distributed neural networks. This study examined working memory and attention in children during the early delayed stages of recovery following surgical resection and RT. The participants included 27 children diagnosed with pediatric brain tumor, treated with (n = 12) or without (n = 15) RT, who completed experimental and standardized measures of working memory and attention (n-back and digit span tasks). Children treated with radiation performed less well than those who did not receive radiation on the n-back measure, though performance at the 0-back level was considerably poorer than would be expected for both groups, perhaps suggesting difficulties with more basic processes such as vigilance. Along these lines, marginal differences were noted on digit span forward. The findings are discussed with respect to models of attention and working memory, and the interplay between the two.

Temporal changes in the outcomes of patients with diabetes mellitus undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute dynamic registry.

PubMed

Holper, Elizabeth M; Abbott, J Dawn; Mulukutla, Suresh; Vlachos, Helen; Selzer, Faith; McGuire, Darren; Faxon, David P; Laskey, Warren; Srinivas, Vankeepuram S; Marroquin, Oscar C; Jacobs, Alice K

2011-02-01

Patients with diabetes mellitus (DM) are at higher risk for adverse outcomes following percutaneous coronary intervention (PCI). To determine whether outcomes have improved over time, we analyzed data from 2,838 consecutive patients with medically treated DM, including 1,066 patients (37.6%) treated with insulin, in the National Heart, Lung, and Blood Institute Dynamic Registry undergoing PCI registered in waves 1 (1997-1998), 2 (1999), 3 (2001-2002), 4 (2004), and 5 (2006). We compared baseline demographics and 1-year outcomes in the overall cohort and in analyses stratified by recruitment wave and insulin use. Crude mortality rates by chronological wave were 9.5%, 12.5%, 8.9%, 11.6%, and 6.6% (P value(trend) = .33) among those treated with insulin and, respectively, 9.7%, 6.5%, 4.1%, 5.4%, and 4.7% (P value(trend) = .006) among patients treated with oral agents,. The adjusted hazard ratios of death, myocardial infarction (MI), and overall major adverse cardiovascular events (death, MI, revascularization) in insulin-treated patients with DM in waves 2 to 5 as compared with wave 1 were either higher or the same. In contrast, the similar adjusted hazard ratios for oral agent-treated patients with DM were either similar or lower. Significant improvements over time in adverse events by 1 year were detected in patients with DM treated with oral agents. In insulin-treated diabetic patients, despite lower rates of repeat revascularization over time, death and MI following PCI have not significantly improved. These findings underscore the need for continued efforts at optimizing outcomes among patients with DM undergoing PCI, especially those requiring insulin treatment. Copyright © 2011 Mosby, Inc. All rights reserved.

The Chinese free antiretroviral treatment program: challenges and responses.

PubMed

Zhang, Fujie; Haberer, Jessica E; Wang, Yu; Zhao, Yan; Ma, Ye; Zhao, Decai; Yu, Lan; Goosby, Eric P

2007-12-01

To respond to the HIV/AIDS epidemic in China, the National Center for AIDS/STD Control and Prevention established the Division of Treatment and Care in late 2001. The pilot for the National Free ART Program began in Henan Province in 2002, and the program fully began in 2003. Treatment efforts initially focused on patients infected through illicit blood and plasma donation in the mid-1990s and subsequently expanded to include HIV-infected injection drug users, commercial sex workers, pregnant women, and children. The National Free ART Database was established in late 2004, and includes data on current patients and those treated before 2004. Over 31 000 adult and pediatric patients have been treated thus far. Challenges for the program include integration of drug treatment services with ART, an under-resourced health care system, co-infections, stigma, discrimination, drug resistance, and procurement of second-line ART. The merging of national treatment and care, epidemiologic, and drug resistance databases will be critical for a better understanding of the epidemic, for earlier identification of patients requiring ART, and for improved patient follow-up. The Free ART Program has made considerable progress in providing the necessary care and treatment for HIV-infected people in China and has strong government support for continued improvement and expansion.

The Increasing Interest of ANAMMOX Research in China: Bacteria, Process Development, and Application

PubMed Central

Chai, Li-Yuan; Tang, Chong-Jian; Zheng, Ping; Min, Xiao-Bo; Yang, Zhi-Hui; Song, Yu-Xia

2013-01-01

Nitrogen pollution created severe environmental problems and increasingly has become an important issue in China. Since the first discovery of ANAMMOX in the early 1990s, this related technology has become a promising as well as sustainable bioprocess for treating strong nitrogenous wastewater. Many Chinese research groups have concentrated their efforts on the ANAMMOX research including bacteria, process development, and application during the past 20 years. A series of new and outstanding outcomes including the discovery of new ANAMMOX bacterial species (Brocadia sinica), sulfate-dependent ANAMMOX bacteria (Anammoxoglobus sulfate and Bacillus benzoevorans), and the highest nitrogen removal performance (74.3–76.7 kg-N/m3/d) in lab scale granule-based UASB reactors around the world were achieved. The characteristics, structure, packing pattern and floatation mechanism of the high-rate ANAMMOX granules in ANAMMOX reactors were also carefully illustrated by native researchers. Nowadays, some pilot and full-scale ANAMMOX reactors were constructed to treat different types of ammonium-rich wastewater including monosodium glutamate wastewater, pharmaceutical wastewater, and leachate. The prime objective of the present review is to elucidate the ongoing ANAMMOX research in China from lab scale to full scale applications, comparative analysis, and evaluation of significant findings and to set a design to usher ANAMMOX research in culmination. PMID:24381935

The effectiveness of tobacco control policies on vulnerable populations in the USA: a review.

PubMed

Vijayaraghavan, Maya; Schroeder, Steven A; Kushel, Margot

2016-09-22

Despite population-wide efforts to reduce tobacco use, low-income populations in the USA have much higher rates of tobacco use compared with the general population. The principal components of tobacco control policies in the USA include cigarette taxes, clean indoor air laws and comprehensive interventions to increase access to tobacco cessation services. In this review, we describe the effectiveness of these policies and interventions in reducing tobacco use among vulnerable populations, focusing on persons with mental health disorders and substance use disorders, persons who have experienced incarceration or homelessness, and low-income tenants of public housing. We discuss the challenges that evolving tobacco and nicotine products pose to tobacco control efforts. We conclude by highlighting the clinical implications of treating tobacco dependence in healthcare settings that serve vulnerable populations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

New approaches to structure-based discovery of dengue protease inhibitors.

PubMed

Tomlinson, S M; Malmstrom, R D; Watowich, S J

2009-06-01

Dengue virus (DENV), a member of the family Flaviviridae, presents a tremendous threat to global health since an estimated 2.5 billion people worldwide are at risk for epidemic transmission. DENV infections are primarily restricted to sub-tropical and tropical regions; however, there is concern that the virus will spread into new regions including the United States. There are no approved antiviral drugs or vaccines to combat dengue infection, although DENV vaccines have entered Phase 3 clinical trials. Drug discovery and development efforts against DENV and other viral pathogens must overcome specificity, efficacy, safety, and resistance challenges before the shortage of licensed drugs to treat viral infections can be relieved. Current drug discovery methods are largely inefficient and thus relatively ineffective at tackling the growing threat to public health presented by emerging and remerging viral pathogens. This review discusses current and newly implemented structure-based computational efforts to discover antivirals that target the DENV NS3 protease, although it is clear that these computational tools can be applied to most disease targets.

Development of breeding populations of rhesus macaques (Macaca mulatta) that are specific pathogen-free for rhesus cytomegalovirus.

PubMed

Barry, Peter A; Strelow, Lisa

2008-02-01

Development of breeding colonies of rhesus macaques (Macaca mulatta) that are specific pathogen-free (SPF) for rhesus cytomegalovirus (RhCMV) is relatively straightforward and requires few modifications from current SPF programs. Infants separated from the dam at or within a few days of birth and cohoused with similarly treated animals remain RhCMV seronegative indefinitely, provided they are never directly or indirectly exposed to a RhCMV-infected monkey. By systematically cohousing seronegative animals into larger social cohorts, breeding populations of animals SPF for RhCMV can be established. The additional costs involved in expanding the current definition of SPF status to include RhCMV are incremental compared with the money already being spent on existing SPF efforts. Moreover, the large increase in research opportunities available for RhCMV-free animals arguably would far exceed the development costs. Potential new areas of research and further expansion of existing research efforts involving these newly defined SPF animals would have direct implications for improvements in human health.

A streamlined failure mode and effects analysis

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

Ford, Eric C., E-mail: eford@uw.edu; Smith, Koren; Terezakis, Stephanie

Purpose: Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort. Methods: FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase. A core group of seven people was identified and a facilitator was chosen to lead the effort. Failure modes were identified and scored according to the FMEA formalism. A risk priority number,RPN, was calculated and usedmore » to rank failure modes. Failure modes with RPN > 150 received safety improvement interventions. Staff effort was carefully tracked throughout the project. Results: Fifty-two failure modes were identified, 22 collected during meetings, and 30 from take-home worksheets. The four top-ranked failure modes were: delay in film check, missing pacemaker protocol/consent, critical structures not contoured, and pregnant patient simulated without the team's knowledge of the pregnancy. These four failure modes hadRPN > 150 and received safety interventions. The FMEA was completed in one month in four 1-h meetings. A total of 55 staff hours were required and, additionally, 20 h by the facilitator. Conclusions: Streamlined FMEA provides a means of accomplishing a relatively large-scale analysis with modest effort. One potential value of FMEA is that it potentially provides a means of measuring the impact of quality improvement efforts through a reduction in risk scores. Future study of this possibility is needed.« less

Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches

PubMed Central

Dobke, Marek; Mackert, Gina A.

2017-01-01

The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD) orthopedic and plastic surgery team (2011–2016) and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management. PMID:28220751

Alloy 690 for steam generator tubing applications

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

Gold, R.E.; Harrod, D.L.; Aspden, R.G.

1990-10-01

This report has been prepared to provide background information for Ni-Cr-Fe Alloy 690 which is currently the material of choice for steam generator heat transfer tubing applications. Activities directed toward the qualification of Alloy 690 for these applications are summarized; this includes efforts which focused on optimization of materials procurement specifications. Emphasis is placed on research accomplished primarily in the four year period from June 1985, the time of the first EPRI Workshop on Alloy 690 was held. The topic is treated in a broad sense, and includes review of the physical metallurgy of the alloy, tube manufacturing processes, themore » properties of commercial production tubing, and the corrosion behavior of Alloy 690 in environments appropriate to steam generator service. 12 refs., 7 figs., 8 tabs.« less

Agmatine: clinical applications after 100 years in translation.

PubMed

Piletz, John E; Aricioglu, Feyza; Cheng, Juei-Tang; Fairbanks, Carolyn A; Gilad, Varda H; Haenisch, Britta; Halaris, Angelos; Hong, Samin; Lee, Jong Eun; Li, Jin; Liu, Ping; Molderings, Gerhard J; Rodrigues, Ana Lúcia S; Satriano, Joseph; Seong, Gong Je; Wilcox, George; Wu, Ning; Gilad, Gad M

2013-09-01

Agmatine (decarboxylated arginine) has been known as a natural product for over 100 years, but its biosynthesis in humans was left unexplored owing to long-standing controversy. Only recently has the demonstration of agmatine biosynthesis in mammals revived research, indicating its exceptional modulatory action at multiple molecular targets, including neurotransmitter systems, nitric oxide (NO) synthesis and polyamine metabolism, thus providing bases for broad therapeutic applications. This timely review, a concerted effort by 16 independent research groups, draws attention to the substantial preclinical and initial clinical evidence, and highlights challenges and opportunities, for the use of agmatine in treating a spectrum of complex diseases with unmet therapeutic needs, including diabetes mellitus, neurotrauma and neurodegenerative diseases, opioid addiction, mood disorders, cognitive disorders and cancer. Copyright © 2013 Elsevier Ltd. All rights reserved.

iPSCs-based anti-aging therapies: Recent discoveries and future challenges.

PubMed

Pareja-Galeano, Helios; Sanchis-Gomar, Fabián; Pérez, Laura M; Emanuele, Enzo; Lucia, Alejandro; Gálvez, Beatriz G; Gallardo, María Esther

2016-05-01

The main biological hallmarks of the aging process include stem cell exhaustion and cellular senescence. Consequently, research efforts to treat age-related diseases as well as anti-aging therapies in general have recently focused on potential 'reprogramming' regenerative therapies. These new approaches are based on induced pluripotent stem cells (iPSCs), including potential in vivo reprogramming for tissue repair. Another possibility is targeting pathways of cellular senescence, e.g., through modulation of p16INK4a signaling and especially inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB). Here, we reviewed and discussed these recent developments together with their possible usefulness for future treatments against sarcopenia, a major age-related condition. Copyright © 2016 Elsevier B.V. All rights reserved.

Managing Heteronormativity and Homonegativity in Athletic Training: In and Beyond the Classroom

PubMed Central

Maurer-Starks, Suanne S; Clemons, Heather L; Whalen, Shannon L

2008-01-01

Context: As an allied health professional working in various settings, an athletic trainer (AT) is responsible for the health care of a highly diverse population. More often than not, this diversity is defined by the visible, such as race or sex. However, diversity encompasses many more variables than these observable factors and includes sexual orientation. Efforts have been made to educate ATs about issues related to sex and race; however, sexual orientation typically has not been addressed, although ATs have treated and will continue to treat lesbian, gay, and bisexual (LGB) patients. Objective: To introduce ATs (educators and practicing clinicians) to the concept of heteronormativity, its effect on society, and its influences on the manner in which they teach athletic training students and deliver health care to their patients. Data Collection and Analysis: We searched various databases, including MEDLINE, ERIC, SportDiscus, and CINAHL Information Systems using the terms bisexual, diversity, gay, heteronormativity, homophobia in sport, and lesbian. Pertinent articles were cross-referenced to gain additional information. The literature revealed the historic implications of homonegativity for sport and its effects on those involved in sport culture, including ATs. Conclusions: Future dialogues should focus on innovative strategies for including LGB issues into athletic training curricula and for meeting the needs of students and professionals in addition to patients who identify as LGB. PMID:18523570

The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

ERIC Educational Resources Information Center

Kronenberg, J.; And Others

1994-01-01

Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

Opportunities for woody crop production using treated wastewater in Egypt

Treesearch

S.R. Evett; R.S.  Zalesny; N.F.  Kandil; John Stanturf; C.  Soriano

2011-01-01

An Egyptian national program targets annual reuse of 2.4 billion m3 of treated wastewater (TWW) to irrigate 84,000 ha of manmade forests in areas close to treatment plants and in the desert. To evaluate the feasibility of such afforestation efforts, we describe information about TWW irrigation strategies based on (1) water use of different tree species, (2) weather...

Opportunities for woody crop production using treated wastewater in Egypt. II. Irrigation strategies

Treesearch

Steven R. Evett; Ronald S. Zalesny Jr.; Nabil F. Kandil; John A. Stanturf; Christopher Soriano

2011-01-01

An Egyptian national program targets annual reuse of 2.4 billion m3 of treated wastewater (TWW) to irrigate 84,000 ha of manmade forests in areas close to treatment plants and in the desert. To evaluate the feasibility of such afforestation efforts, we describe information about TWW irrigation strategies based on (1) water use of different tree...

Status of viruses as biocontrol agents for spruce budworms

Treesearch

J. C. Cunningham

1985-01-01

Aerial spray trials with a variety of viruses have been conducted between 1971 and 1983 with 2656 ha (65 plots) treated to control spruce budworm in Ontario and Quebec and 424 ha (6 plots) treated to control western spruce budworm in British Columbia. Generally, results have been inconsistent and less than satisfactory, but research continues in an effort to develop a...

An Improved Radiative Transfer Model for Climate Calculations

NASA Technical Reports Server (NTRS)

Bergstrom, Robert W.; Mlawer, Eli J.; Sokolik, Irina N.; Clough, Shepard A.; Toon, Owen B.

1998-01-01

This paper presents a radiative transfer model that has been developed to accurately predict the atmospheric radiant flux in both the infrared and the solar spectrum with a minimum of computational effort. The model is designed to be included in numerical climate models To assess the accuracy of the model, the results are compared to other more detailed models for several standard cases in the solar and thermal spectrum. As the thermal spectrum has been treated in other publications, we focus here on the solar part of the spectrum. We perform several example calculations focussing on the question of absorption of solar radiation by gases and aerosols.

Three-Dimensional Cell Cultures in Drug Discovery and Development

PubMed Central

Fang, Ye; Eglen, Richard M.

2017-01-01

The past decades have witnessed significant efforts toward the development of three-dimensional (3D) cell cultures as systems that better mimic in vivo physiology. Today, 3D cell cultures are emerging, not only as a new tool in early drug discovery but also as potential therapeutics to treat disease. In this review, we assess leading 3D cell culture technologies and their impact on drug discovery, including spheroids, organoids, scaffolds, hydrogels, organs-on-chips, and 3D bioprinting. We also discuss the implementation of these technologies in compound identification, screening, and development, ranging from disease modeling to assessment of efficacy and safety profiles. PMID:28520521

CARs: Synthetic Immunoreceptors for Cancer Therapy and Beyond

PubMed Central

Chang, ZeNan L.; Chen, Yvonne Y.

2017-01-01

Chimeric antigen receptors (CARs) are versatile synthetic receptors that provide T cells with engineered specificity. Clinical success in treating B-cell malignancies has demonstrated the therapeutic potential of CAR-T cells against cancer, and efforts are underway to expand the use of engineered T cells to the treatment of diverse medical conditions, including infections and autoimmune diseases. Here, we review current understanding of the molecular properties of CARs, how this knowledge informs the rational design and characterization of novel receptors, successes and shortcomings of CAR-T cells in the clinic, and emerging solutions for the continued improvement of CAR-T cell therapy. PMID:28416139

Novel Therapeutics for Therapy-Related Acute Myeloid Leukemia: 2014.

PubMed

Feldman, Eric J

2015-06-01

Effective treatment options for adults with therapy-related AML continues to be an area of unmet need. Genetic and molecular changes within these leukemias confer resistance to standard chemotherapy regimens. Emerging developmental therapeutics in this area has focused on several approaches. These include; novel delivery of chemotherapy as well as newer DNA-damaging agents delivered through antibody-drug conjugates, increased use of hypomethylating agents, and molecularly-directed small molecules against specific mutations commonly occurring in secondary AML. Results of this efforts are encouraging, but to date, no clear improvements have been demonstrated in this most difficult to treat population. Copyright © 2015 Elsevier Inc. All rights reserved.

An Archetype of the Collaborative Efforts of Psychotherapy and Psychopharmacology in Successfully Treating Dissociative Identity Disorder with Comorbid Bipolar Disorder

PubMed Central

Lakshmanan, Manu N.; Meier, Stacey L. Colton; Meier, Robert S.

2010-01-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient’s comorbid bipolar disorder contributed to the patient’s instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method. PMID:20805917

An archetype of the collaborative efforts of psychotherapy and psychopharmacology in successfully treating dissociative identity disorder with comorbid bipolar disorder.

PubMed

Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy

2010-07-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

Solid state SPS microwave generation and transmission study. Volume 1: Phase 2

NASA Technical Reports Server (NTRS)

Maynard, O. E.

1980-01-01

The solid state sandwich concept for Solar Power Station (SPS) was investigated. The design effort concentrated on the spacetenna, but did include some system analysis for parametric comparison reasons. The study specifically included definition and math modeling of basic solid state microwave devices, an initial conceptual subsystems and system design, sidelobe control and system selection, an assessment of selected system concept and parametric solid state microwave power transmission system data relevant to the SPS concept. Although device efficiency was not a goal, the sensitivities to design of this efficiency were parametrically treated. Sidelobe control consisted of various single step tapers, multistep tapers, and Gaussian tapers. A preliminary assessment of a hybrid concept using tubes and solid state is also included. There is a considerable amount of thermal analysis provided with emphasis on sensitivities to waste heat radiator form factor, emissivity, absorptivity, amplifier efficiency, material and junction temperature.

NASA progress in aircraft noise prediction

NASA Technical Reports Server (NTRS)

Raney, J. P.; Padula, S. L.; Zorumski, W. E.

1981-01-01

Langley Research Center efforts to develop a methodology for predicting the effective perceived noise level (EPNL) produced by jet-powered CTOL aircraft to an accuracy of + or - 1.5 dB are summarized with emphasis on the aircraft noise prediction program (ANOPP) which contains a complete set of prediction methods for CTOL aircraft including propulsion system noise sources, aerodynamic or airframe noise sources, forward speed effects, a layered atmospheric model with molecular absorption, ground impedance effects including excess ground attenuation, and a received noise contouring capability. The present state of ANOPP is described and its accuracy and applicability to the preliminary aircraft design process is assessed. Areas are indicated where further theoretical and experimental research on noise prediction are needed. Topics covered include the elements of the noise prediction problem which are incorporated in ANOPP, results of comparisons of ANOPP calculations with measured noise levels, and progress toward treating noise as a design constraint in aircraft system studies.

Domestic violence in the pregnant patient: obstetric and behavioral interventions.

PubMed

Mayer, L; Liebschutz, J

1998-10-01

Every day, obstetric providers treat patients experiencing domestic violence. Domestic violence can have both dramatic and subtle impacts on maternal and fetal morbidity and mortality. This article enumerates patient risk factors for and obstetric consequences of domestic violence. It describes adaptations to the assessment and treatment of pregnancy complications occurring in the context of domestic violence and presents behavioral interventions that can be performed within existing obstetric care delivery systems. Behavioral interventions include assessments of a patient's readiness for change and her emotional responses to the violence. Obstetric interventions include an assessment of risk of physical harm to a pregnant woman and her fetus from domestic violence. Interviewing techniques include educating the patient about the effects of abuse and, over time, validating a patient's efforts to change. Reliance on a team approach and use of community resources are emphasized. All of these mechanisms enable obstetric providers to assist pregnant women in taking steps to end the abuse.

Effort-Reward Imbalance at Work and the Prevalence of Unsuccessfully Treated Hypertension Among White-Collar Workers.

PubMed

Trudel, Xavier; Milot, Alain; Gilbert-Ouimet, Mahée; Duchaine, Caroline; Guénette, Line; Dalens, Violaine; Brisson, Chantal

2017-08-15

We examined the association between effort-reward imbalance (ERI) exposure at work and unsuccessfully treated hypertension among white-collar workers from a large cohort in Quebec City, Canada. The study used a repeated cross-sectional design involving 3 waves of data collection (2000-2009). The study sample was composed of 474 workers treated for hypertension, accounting for 739 observations. At each observation, ERI was measured using validated scales, and ambulatory blood pressure (BP) was measured every 15 minutes during the working day. Unsuccessfully treated hypertension was defined as daytime ambulatory BP of at least 135/85 mm Hg and was further divided into masked and sustained hypertension. Adjusted prevalence ratios and 95% confidence intervals were estimated. Participants in the highest tertile of ERI exposure had a higher prevalence of unsuccessfully treated hypertension (prevalence ratio = 1.45, 95% confidence interval: 1.16, 1.81) after adjustment for gender, age, education, family history of cardiovascular diseases, body mass index, diabetes, smoking, sedentary behaviors, and alcohol intake. The present study supports the effect of adverse psychosocial work factors from the ERI model on BP control in treated workers. Reducing these frequent exposures at work might lead to substantial benefits on BP control at the population level. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations.

PubMed

Magnani, Barbarajean; Harubin, Beth; Katz, Judith F; Zuckerman, Andrea L; Strohsnitter, William C

2016-12-01

- See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. - To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. - Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. - During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. - In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.

[RABIN MEDICAL CENTER - A TERTIARY CENTER OF EXCELLENCE IN SERVICE, TEACHING AND RESEARCH].

PubMed

Niv, Yaron; Halpern, Eyran

2017-04-01

Rabin Medical Center (RMC) belongs to Clalit Health Services and is a tertiary, academic medical center with all the facilities of modern and advanced medicine. Annually in the RMC, 650,000 patients are treated in the outpatient clinics, and 100,000 patients are hospitalized in the hospital departments. All these patients are treated by 4500 devoted staff members, including 1000 physicians and 2000 nurses. RMC is one of the largest, centrally located medical centers for medical and nursing students' education in Israel, taking place in clinical departments, as well as in basic sciences courses. We also have a nursing school attached to the hospital. Our vision supports excellence in research. We have a special Research Department that supports RMC researchers, with research coordinators, and all the relevant facilities to assist in clinical and basic science studies. We also promote collaboration efforts with many academic centers in Israel and abroad. The scope of RMC research is broad, including 700 new studies every year and 1500 active studies currently. This issue of Harefuah is dedicated to the clinical and basic science research conducted at RMC with original papers presenting research performed by our departments and laboratories.

Streptomyces artemisiae MCCB 248 isolated from Arctic fjord sediments has unique PKS and NRPS biosynthetic genes and produces potential new anticancer natural products.

PubMed

Dhaneesha, M; Benjamin Naman, C; Krishnan, K P; Sinha, Rupesh Kumar; Jayesh, P; Joseph, Valsamma; Bright Singh, I S; Gerwick, William H; Sajeevan, T P

2017-05-01

After screening marine actinomycetes isolated from sediment samples collected from the Arctic fjord Kongsfjorden for potential anticancer activity, an isolate identified as Streptomyces artemisiae MCCB 248 exhibited promising results against the NCI-H460 human lung cancer cell line. H460 cells treated with the ethyl acetate extract of strain MCCB 248 and stained with Hoechst 33342 showed clear signs of apoptosis, including shrinkage of the cell nucleus, DNA fragmentation and chromatin condensation. Further to this treated cells showed indications of early apoptotic cell death, including a significant proportion of Annexin V positive staining and evidence of DNA damage as observed in the TUNEL assay. Amplified PKS 1 and NRPS genes involved in secondary metabolite production showed only 82% similarity to known biosynthetic genes of Streptomyces, indicating the likely production of a novel secondary metabolite in this extract. Additionally, chemical dereplication efforts using LC-MS/MS molecular networking suggested the presence of a series of undescribed tetraene polyols. Taken together, these results revealed that this Arctic S. artemisiae strain MCCB 248 is a promising candidate for natural products drug discovery and genome mining for potential anticancer agents.

Organizational context associated with time spent evaluating language and cognitive-communicative impairments in skilled nursing facilities: Survey results within an implementation science framework.

PubMed

Douglas, Natalie F

2016-01-01

The Consolidated Framework for Implementation Research (CFIR) was developed to merge research and practice in healthcare by accounting for the many elements that influence evidence-based treatment implementation. These include characteristics of the individuals involved, features of the treatment itself, and aspects of the organizational culture where the treatment is being provided. The purpose of this study was to apply the CFIR to a measurement of current practice patterns of speech-language pathologists (SLPs) working in the skilled nursing facility (SNF) environment. In an effort to inform future evidence-based practice implementation interventions, research questions addressed current practice patterns, clinician treatment use and preferences, and perceptions of the organizational context including leadership, resources, and other staff. Surveys were mailed to each SLP working in a SNF in the state of Michigan. Participants (N=77, 19% response rate) completed a survey mapping on to CFIR components impacting evidence-based practice implementation. Quantitative descriptive and nonparametric correlational analyses were completed. Use of evidence-based treatments by SLPs in SNFs was highly variable. Negative correlations between treating speech and voice disorders and treating swallowing disorders (rs=-.35, p<.01), evaluating language and cognitive-communicative disorders and treating swallowing disorders (rs=-.30, p<.01), treating language and cognitive-communicative disorders and treating swallowing disorders (rs=-.67, p<.01), and evaluating swallowing disorders and treating language and cognitive-communicative disorders (rs=-.37, p<.01) were noted. A positive correlation between the SLPs' perception of organizational context and time spent evaluating language and other cognitive-communicative disorders (rs=.27, p<.05) was also present. Associative data suggest that the more an SLP in the SNF evaluates and treats swallowing disorders, the less he or she will evaluate speech, voice, language or other cognitive-communicative disorders. Further, SLPs in this sample spent more time evaluating language and cognitive-communicative impairments if they perceived their organizational context in a more positive way. The CFIR may guide treatment and implementation research to increase the uptake of evidence-based practices for SLPs working in the SNF setting. Copyright © 2015 Elsevier Inc. All rights reserved.

Efforts to support special-needs soldiers serving in the Israeli defense forces.

PubMed

Bodner, Ehud; Iancu, Iulian; Sarel, Amiram; Einat, Haim

2007-11-01

Providing treatment and support to special-needs populations can decrease psychopathology and suicide rates. Because service in the military is an important socializing force in Israeli society and most Israelis serve, the Israeli Defense Forces (IDF) makes special efforts to identify, treat, and support soldiers with emotional, behavioral, and cognitive problems. This column describes the IDF's efforts for three groups of soldiers with special needs, with a focus on those with the most severe problems who receive support throughout their service to address psychopathology and suicidality. Suicide rates for the IDF population and for the three groups are reported.

Mechanical Properties of Heat-treated Carbon Fibers

NASA Technical Reports Server (NTRS)

Effinger, Michael R.; Patel, Bhavesh; Koenig, John; Cuneo, Jaques; Neveux, Michael G.; Demos, Chrystoph G.

2004-01-01

Carbon fibers are selected for ceramic matrix composites (CMC) are based on their as-fabricated properties or on "that is what we have always done" technical culture while citing cost and availability when there are others with similar cost and availability. However, the information is not available for proper selection of carbon fibers since heat-treated properties are not known for the fibers on the market currently. Heat-treating changes the fiber's properties. Therefore, an effort was undertaken to establish fiber properties on 19 different types of fibers from six different manufactures for both PAN and pitch fibers. Heat-treating has been done at three different temperatures.

Not just gRASping at flaws: Finding vulnerabilities to develop novel therapies for treating KRAS mutant cancers

PubMed Central

Ebi, Hiromichi; Faber, Anthony C; Engelman, Jeffrey A; Yano, Seiji

2014-01-01

Mutations in Kirsten rat-sarcoma (KRAS) are well appreciated to be major drivers of human cancers through dysregulation of multiple growth and survival pathways. Similar to many other non-kinase oncogenes and tumor suppressors, efforts to directly target KRAS pharmaceutically have not yet materialized. As a result, there is broad interest in an alternative approach to develop therapies that induce synthetic lethality in cancers with mutant KRAS, therefore exposing the particular vulnerabilities of these cancers. Fueling these efforts is our increased understanding into the biology driving KRAS mutant cancers, in particular the important pathways that mutant KRAS governs to promote survival. In this mini-review, we summarize the latest approaches to treat KRAS mutant cancers and the rationale behind them. PMID:24612015

Modeling Retention at a Large Public University: Can At-Risk Students Be Identified Early Enough to Treat?

ERIC Educational Resources Information Center

Singell, Larry D.; Waddell, Glen R.

2010-01-01

We examine the extent to which readily available data at a large public university can be used to a priori identify at-risk students who may benefit from targeted retention efforts. Although it is possible to identify such students, there remains an inevitable tradeoff in any resource allocation between not treating the students who are likely to…

Investigational drugs to treat methicillin-resistant Staphylococcus aureus

PubMed Central

Vuong, Cuong; Yeh, Anthony J; Cheung, Gordon YC; Otto, Michael

2016-01-01

Introduction Staphylococcus aureus remains one of the leading causes of morbidity and mortality worldwide. This is to a large extent due to antibiotic-resistant strains, in particular methicillin-resistant S. aureus (MRSA). While the toll of invasive MRSA infections appears to decrease in U.S. hospitals, the rate of community-associated MRSA infections remains constant and there is a surge of MRSA in many other countries. This situation calls for continuing if not increased efforts to find novel strategies to combat MRSA infections. Areas covered This review will provide an overview of current investigational antibiotics in clinical development (up to phase II), and of therapeutic antibodies and alternative drugs against S. aureus in preclinical and clinical development, including a short description of the mechanism of action and a presentation of microbiological and clinical data. Expert opinion Increased recent antibiotic development efforts and results from pathogenesis research have led to several new antibiotics and alternative drugs, as well as a more informed selection of targets for vaccination efforts against MRSA. This developing portfolio of novel anti-staphylococcal drugs will hopefully provide us with additional and more efficient ways to combat MRSA infections in the near future and prevent us from running out of treatment options, even if new resistances arise. PMID:26536498

Mevalocidin: a novel, phloem mobile phytotoxin from Fusarium DA056446 and Rosellinia DA092917.

PubMed

Gerwick, B Clifford; Brewster, William K; Deboer, Gerrit J; Fields, Steve C; Graupner, Paul R; Hahn, Donald R; Pearce, Cedric J; Schmitzer, Paul R; Webster, Jeffery D

2013-02-01

A multiyear effort to identify new natural products was built on a hypothesis that both phytotoxins from plant pathogens and antimicrobial compounds might demonstrate herbicidal activity. The discovery of one such compound, mevalocidin, is described in the current report. Mevalocidin was discovered from static cultures of two unrelated fungal isolates designated Rosellinia DA092917 and Fusarium DA056446. The chemical structure was confirmed by independent synthesis. Mevalocidin demonstrated broad spectrum post-emergence activity on grasses and broadleaves and produced a unique set of visual symptoms on treated plants suggesting a novel mode of action. Mevalocidin was rapidly absorbed in a representative grass and broadleaf plant. Translocation occurred from the treated leaf to other plant parts including roots confirming phloem as well as xylem mobility. By 24 hr after application, over 20 % had been redistributed through-out the plant. Mevalocidin is a unique phytotoxin based on its chemistry, with the uncommon attribute of demonstrating both xylem and phloem mobility in grass and broadleaf plants.

Hypothesis: Impregnated school uniforms reduce the incidence of dengue infections in school children.

PubMed

Wilder-Smith, A; Lover, A; Kittayapong, P; Burnham, G

2011-06-01

Dengue infection causes a significant economic, social and medical burden in affected populations in over 100 countries in the tropics and sub-tropics. Current dengue control efforts have generally focused on vector control but have not shown major impact. School-aged children are especially vulnerable to infection, due to sustained human-vector-human transmission in the close proximity environments of schools. Infection in children has a higher rate of complications, including dengue hemorrhagic fever and shock syndromes, than infections in adults. There is an urgent need for integrated and complementary population-based strategies to protect vulnerable children. We hypothesize that insecticide-treated school uniforms will reduce the incidence of dengue in school-aged children. The hypothesis would need to be tested in a community based randomized trial. If proven to be true, insecticide-treated school uniforms would be a cost-effective and scalable community based strategy to reduce the burden of dengue in children. Copyright © 2011 Elsevier Ltd. All rights reserved.

Discovery of the Highly Potent PI3K/mTOR Dual Inhibitor PF-04979064 through Structure-Based Drug Design

PubMed Central

2012-01-01

PI3K, AKT, and mTOR are key kinases from PI3K signaling pathway being extensively pursued to treat a variety of cancers in oncology. To search for a structurally differentiated back-up candidate to PF-04691502, which is currently in phase I/II clinical trials for treating solid tumors, a lead optimization effort was carried out with a tricyclic imidazo[1,5]naphthyridine series. Integration of structure-based drug design and physical properties-based optimization yielded a potent and selective PI3K/mTOR dual kinase inhibitor PF-04979064. This manuscript discusses the lead optimization for the tricyclic series, which both improved the in vitro potency and addressed a number of ADMET issues including high metabolic clearance mediated by both P450 and aldehyde oxidase (AO), poor permeability, and poor solubility. An empirical scaling tool was developed to predict human clearance from in vitro human liver S9 assay data for tricyclic derivatives that were AO substrates. PMID:24900568

Defining Medical Capabilities for Exploration Missions

NASA Technical Reports Server (NTRS)

Hailey, M.; Antonsen, E.; Blue, R.; Reyes, D.; Mulcahy, R.; Kerstman, E.; Bayuse, T.

2018-01-01

Exploration-class missions to the moon, Mars and beyond will require a significant change in medical capability from today's low earth orbit centric paradigm. Significant increases in autonomy will be required due to differences in duration, distance and orbital mechanics. Aerospace medicine and systems engineering teams are working together within ExMC to meet these challenges. Identifying exploration medical system needs requires accounting for planned and unplanned medical care as defined in the concept of operations. In 2017, the ExMC Clinicians group identified medical capabilities to feed into the Systems Engineering process, including: determining what and how to address planned and preventive medical care; defining an Accepted Medical Condition List (AMCL) of conditions that may occur and a subset of those that can be treated effectively within the exploration environment; and listing the medical capabilities needed to treat those conditions in the AMCL. This presentation will discuss the team's approach to addressing these issues, as well as how the outputs of the clinical process impact the systems engineering effort.

Neurological consequences of vitamin B12 deficiency and its treatment.

PubMed

Chalouhi, Christel; Faesch, Sabine; Anthoine-Milhomme, Marie-Constance; Fulla, Yvonne; Dulac, Olivier; Chéron, Gérard

2008-08-01

In developed countries, the vitamin B12 deficiency usually occurs in children exclusively breast-fed, whose mothers are vegetarians, causing low stores of vitamin B12. Symptoms of vitamin B12 deficiency appear during the second trimester of life and include failure to thrive, lethargy, hypotonia, and arrest or regression of developmental skills. A megaloblastic anemia can be present. One half of the infants exhibit abnormal movements before the start of treatment with intramuscular cobalamin, which disappear 1 or 2 days after. More rarely, movement disorders appear a few days after treatment, whereas neurological symptoms are improving. These abnormal movements can last for 2 to 6 weeks. If not treated, vitamin B12 deficiency can cause lasting neurodisability. Therefore, efforts should be directed to preventing deficiency in pregnant and breast-feeding women on vegan diets and their infants by giving them vitamin B12 supplements. When preventive supplementation has failed, one should recognize and treat quickly an infant presenting with failure to thrive and delayed development.

Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

PubMed

Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A; Williams, Linda S; Bravata, Dawn M; Cheng, Eric M; Bosworth, Hayden B; Homer, Jack B; Matchar, David B

2014-07-01

Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained. © 2014 American Heart Association, Inc.

Determination of fluorotelomer alcohols in selected consumer products and preliminary investigation of their fate in the indoor environment.

PubMed

Liu, Xiaoyu; Guo, Zhishi; Folk, Edgar E; Roache, Nancy F

2015-06-01

The U.S. Environmental Protection Agency (EPA) has established an ongoing effort to identify the major perfluorocarboxylic acid (PFCA) sources in nonoccupational indoor environments and characterize their transport and fate. This study determined the concentrations of fluorotelomer alcohols (FTOHs), which are the precursors to PFCAs, in fifty-four consumer products collected from the U.S. open market in the years of 2011 and 2013. The products included carpet, commercial carpet-care liquids, household carpet/fabric-care liquids, treated apparel, treated home textiles, treated non-woven medical garments, floor waxes, food-contact paper, membranes for apparel, and thread-sealant tapes. The FTOHs quantified were 1H,1H,2H,2H-perfluoro-1-octanol (6:2 FTOH), 1H,1H,2H,2H-perfluoro-1-decanol (8:2 FTOH), and 1H,1H,2H,2H-perfluoro-1-dodecanol (10:2 FTOH). The content of 6:2 FTOH ranged from non-delectable to 331μgg(-1), 8:2 FTOH from non-delectable to 92μgg(-1), and 10:2 FTOH from non-detectable to 24μgg(-1). In addition, two consumer products from the home textile category were tested in the washing-drying process. One product from the treated apparel category and one from the home textile category were tested in the micro-scale chamber under elevated temperatures. The experimental data show that the washing-drying process with one cycle did not significantly reduce the FTOH concentrations in the tested consumer products. FTOH off-gassing was observed under accelerated aging conditions. Future tests should include air sampling to allow determination of the absolute emission rates at different temperatures. The results of this study should be informative to exposure assessment and risk management. Published by Elsevier Ltd.

Outcome of adult horses with botulism treated at a veterinary hospital: 92 cases (1989-2013).

PubMed

Johnson, A L; McAdams-Gallagher, S C; Aceto, H

2015-01-01

There are no studies evaluating a large population of adult horses treated for botulism. Reported survival rates in outbreak situations are low; however, many horses in outbreaks do not receive treatment. That adult horses treated at a veterinary hospital would have improved survival compared to outbreak situations. Additional aims included identification of predictors of nonsurvival. All horses greater than 6 months of age with a final diagnosis of botulism admitted to a veterinary teaching hospital between 1989 and 2013 were included. Retrospective study. Historical, admission, and hospitalization data were retrieved from medical records and associations between variables and nonsurvival were identified using logistic regression. Two multivariable models were developed pertaining to (1) information available at admission and (2) clinical findings during hospitalization. Ninety-two records met inclusion criteria. Retained variables for the two models indicated that higher rectal temperature (OR, 1.94; CI, 1.19-3.17) and dysphagia (OR, 4.04; CI, 1.01-16.17) observed at admission increased the odds of survival, as did treatment with antitoxin (OR, 121.30; CI, 9.94-1,480.65). Horses with abnormal respiratory effort or inability to stand had decreased odds of survival. Overall survival was 48% but was significantly higher (67%, P = .011) for horses that arrived standing, and even higher (95%, P < .001) for horses that remained able to stand throughout hospitalization. Complications occurred in 62% of horses but were not associated with nonsurvival. Horses that lose the ability to stand have a poor chance of survival. Complications are common in treated horses but do not reduce survival. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States

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

Rutter, Charles E., E-mail: charles.rutter@yale.edu; Yale Cancer Center, New Haven, Connecticut; Yu, James B.

2015-03-01

Purpose: To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions. Patients and Methods: The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details. Results: Wemore » included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05). Conclusions: Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.« less

Applying procedural justice theory to law enforcement's response to persons with mental illness.

PubMed

Watson, Amy C; Angell, Beth

2007-06-01

Procedural justice provides a framework for considering how persons with mental illness experience interactions with the police and how officer behaviors may shape cooperation or resistance. The procedural justice perspective holds that the fairness with which people are treated in an encounter with authority figures (such as the police) influences whether they cooperate or resist authority. Key components of a procedural justice framework include participation (having a voice), which involves having the opportunity to present one's own side of the dispute and be heard by the decision maker; dignity, which includes being treated with respect and politeness and having one's rights acknowledged; and trust that the authority is concerned with one's welfare. Procedural justice has its greatest impact early in the encounter, suggesting that how officers initially approach someone is extremely important. Persons with mental illness may be particularly attentive to how they are treated by police. According to this framework, people who are uncertain about their status (such as members of stigmatized groups) will respond most strongly to the fairness by which police exercise their authority. This article reviews the literature on police response to persons with mental illness. Procedural justice theory as it has been applied to mental health and justice system contexts is examined. Its application to encounters between police and persons with mental illness is discussed. Implications and cautions for efforts to improve police response to persons with mental illness and future research also are examined.

Phencyclidine increased while isolation rearing did not affect progressive ratio responding in rats: Investigating potential models of amotivation in schizophrenia.

PubMed

Amitai, Nurith; Powell, Susan B; Young, Jared W

2017-11-22

Schizophrenia is a debilitating neurodevelopmental disorder affecting 1% of the global population with heterogeneous symptoms including positive, negative, and cognitive. While treatment for positive symptoms exists, none have been developed to treat negative symptoms. Animal models of schizophrenia are required to test targeted treatments and since patients exhibit reduced effort (breakpoints) for reward in a progressive ratio (PR) task, we examined the PR breakpoints of rats treated with the NMDA receptor antagonist phencyclidine or those reared in isolation - two common manipulations used to induce schizophrenia-relevant behaviors in rodents. In two cohorts, the PR breakpoint for a palatable food reward was examined in Long Evans rats after: 1) a repeated phencyclidine regimen; 2) A subchronic phencyclidine regimen followed by drug washout; and 3) post-weaning social isolation. Rats treated with repeated phencyclidine and those following washout from phencyclidine exhibited higher PR breakpoints than vehicle-treated rats. The breakpoint of isolation reared rats did not differ from those socially reared, despite abnormalities of these rats in other schizophrenia-relevant behaviors. Despite their common use for modeling other schizophrenia-relevant behaviors neither phencyclidine treatment nor isolation rearing recreated the motivational deficits observed in patients with schizophrenia, as measured by PR breakpoint. Other manipulations, and negative symptom-relevant behaviors, require investigation prior to testing putative therapeutics. Copyright © 2017 Elsevier B.V. All rights reserved.

Combining group-based exposure therapy with prolonged exposure to treat U.S. Vietnam veterans with PTSD: a case study.

PubMed

Ready, David J; Vega, Edward M; Worley, Virginia; Bradley, Bekh

2012-10-01

Group-based exposure therapy (GBET) of 16-week duration was developed to treat combat-related posttraumatic stress disorder (PTSD) and decreased PTSD symptoms in 3 noncontrolled open trials with low attrition (0%-5%). Group-based exposure therapy has not produced as much PTSD symptom reduction as Prolonged Exposure (PE) within a U.S. Veterans Affairs PTSD treatment program, although PE had more dropouts (20%). This pilot study was of a model that combined key elements of GBET with components of PE in an effort to increase the effectiveness of a group-based treatment while reducing its length and maintaining low attrition. Twice per week, 8 Vietnam combat veterans with PTSD were treated for 12 weeks, with an intervention that included 2 within-group war trauma presentations per participant, 6 PE style individual imaginal exposure (IE) sessions per participant, daily listening to recorded IE sessions, and daily in vivo exposure exercises. All completed treatment and showed Significant reductions on all measures of PTSD with large effect sizes; 7 participants no longer met PTSD criteria on treating clinician administered interviews and a self-report measure at posttreatment. Significant reductions in depression with large effect sizes and moderate reductions in PTSD-related cognitions were also found. Most gains were maintained 6 months posttreatment. Published 2012. This article is a US Government work and is in the public domain in the USA.

Solid state SPS microwave generation and transmission study. Volume 2, phase 2: Appendices

NASA Technical Reports Server (NTRS)

Maynard, O. E.

1980-01-01

The solid state sandwich concept for SPS was further defined. The design effort concentrated on the spacetenna, but did include some system analysis for parametric comparison reasons. Basic solid state microwave devices were defined and modeled. An initial conceptual subsystems and system design was performed as well as sidelobe control and system selection. The selected system concept and parametric solid state microwave power transmission system data were assessed relevant to the SPS concept. Although device efficiency was not a goal, the sensitivities to design of this efficiency were parametrically treated. Sidelobe control consisted of various single step tapers, multistep tapers and Gaussian tapers. A hybrid concept using tubes and solid state was evaluated. Thermal analyses are included with emphasis on sensitivities to waste heat radiator form factor, emissivity, absorptivity, amplifier efficiency, material and junction temperature.

Clinically Available Medicines Demonstrating Anti-Toxoplasma Activity

PubMed Central

Neville, Andrew J.; Zach, Sydney J.; Wang, Xiaofang; Larson, Joshua J.; Judge, Abigail K.; Davis, Lisa A.; Vennerstrom, Jonathan L.

2015-01-01

Toxoplasma gondii is an apicomplexan parasite of humans and other mammals, including livestock and companion animals. While chemotherapeutic regimens, including pyrimethamine and sulfadiazine regimens, ameliorate acute or recrudescent disease such as toxoplasmic encephalitis or ocular toxoplasmosis, these drugs are often toxic to the host. Moreover, no approved options are available to treat infected women who are pregnant. Lastly, no drug regimen has shown the ability to eradicate the chronic stage of infection, which is characterized by chemoresistant intracellular cysts that persist for the life of the host. In an effort to promote additional chemotherapeutic options, we now evaluate clinically available drugs that have shown efficacy in disease models but which lack clinical case reports. Ideally, less-toxic treatments for the acute disease can be identified and developed, with an additional goal of cyst clearance from human and animal hosts. PMID:26392504

Reducing Cancer Health Disparities in the US-associated Pacific

PubMed Central

Tsark, JoAnn U.; Braun, Kathryn L.

2010-01-01

Purpose To assess cancer prevention and control capacity in the US-associated Pacific Islands (USAPI, including American Samoa, Northern Mariana Islands, Micronesia, Guam, Marshall Islands, and Palau) and to support indigenous leadership in reducing cancer health disparities. Methods Jurisdiction-specific needs assessments were conducted to assess cancer prevention and control capacity and challenges, The Cancer Council of the Pacific islands (CCPI), an indigenous health leadership team from public health and medicine, was supported to review assessment findings, develop priorities, and build capacity to address recommendations. Results Capacity varied across jurisdictions, but generally there is limited ability to measure cancer burden and a lack of programs, equipment, and trained personnel to detect and treat cancer. Most cancers are diagnosed in late stages when survival is compromised and care is most costly. Jurisdictions also are challenged by geographic, social, and political constraints and multiple in-country demands for funding. Based on findings, strategies were developed by the CCPI to guide efforts, including fund seeking, to expand cancer prevention and control capacity in regionally appropriate ways. Conclusions Concerted planning, training, and funding efforts are needed to overcome challenges and upgrade capacity in cancer education, prevention, detection, and treatment in the USAPI. Indigenous leadership and local capacity building are essential to this process. PMID:17149100

Exploration Laboratory Analysis FY13

NASA Technical Reports Server (NTRS)

Krihak, Michael; Perusek, Gail P.; Fung, Paul P.; Shaw, Tianna, L.

2013-01-01

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, which is stated as the Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL), and to perform human research studies on the International Space Station (ISS) that are supported by the Human Health and Countermeasures (HHC) element. Since there are significant similarities in the research and medical operational requirements, ELA hardware development has emerged as a joint effort between ExMC and HHC. In 2012, four significant accomplishments were achieved towards the development of exploration laboratory analysis for medical diagnostics. These achievements included (i) the development of high priority analytes for research and medical operations, (ii) the development of Level 1 functional requirements and concept of operations documentation, (iii) the selection and head-to-head competition of in-flight laboratory analysis instrumentation, and (iv) the phase one completion of the Small Business Innovation Research (SBIR) projects under the topic Smart Phone Driven Blood-Based Diagnostics. To utilize resources efficiently, the associated documentation and advanced technologies were integrated into a single ELA plan that encompasses ExMC and HHC development efforts. The requirements and high priority analytes was used in the selection of the four in-flight laboratory analysis performers. Based upon the competition results, a down select process will be performed in the upcoming year. Looking ahead, this unified effort has positioned each element for an in-flight lab analysis demonstration of select diagnostics measurements in the 2015 timeframe.

Drug discovery for alopecia: gone today, hair tomorrow.

PubMed

Santos, Zenildo; Avci, Pinar; Hamblin, Michael R

2015-03-01

Hair loss or alopecia affects the majority of the population at some time in their life, and increasingly, sufferers are demanding treatment. Three main types of alopecia (androgenic [AGA], areata [AA] and chemotherapy-induced [CIA]) are very different, and have their own laboratory models and separate drug-discovery efforts. In this article, the authors review the biology of hair, hair follicle (HF) cycling, stem cells and signaling pathways. AGA, due to dihydrotesterone, is treated by 5-α reductase inhibitors, androgen receptor blockers and ATP-sensitive potassium channel-openers. AA, which involves attack by CD8(+)NK group 2D-positive (NKG2D(+)) T cells, is treated with immunosuppressives, biologics and JAK inhibitors. Meanwhile, CIA is treated by apoptosis inhibitors, cytokines and topical immunotherapy. The desire to treat alopecia with an easy topical preparation is expected to grow with time, particularly with an increasing aging population. The discovery of epidermal stem cells in the HF has given new life to the search for a cure for baldness. Drug discovery efforts are being increasingly centered on these stem cells, boosting the hair cycle and reversing miniaturization of HF. Better understanding of the molecular mechanisms underlying the immune attack in AA will yield new drugs. New discoveries in HF neogenesis and low-level light therapy will undoubtedly have a role to play.

Factors accounting for the rise in health-care spending in the United States: the role of rising disease prevalence and treatment intensity.

PubMed

Thorpe, Kenneth E

2006-11-01

To examine the factors responsible for the rise in health- care spending in the United States over the past 15 years. Nationally representative survey data from 1987 and 2003 were used to examine the top medical conditions accounting for the rise in spending. I also estimate how much of the rise is traced to rising treated disease prevalence and rising spending per case. The study finds most of the rise in spending is linked to rising rates of treated disease prevalence. The rise in prevalence is associated with the doubling of obesity in the US and changes in clinical thresholds for treating asymptomatic patients with certain cardiovascular risk factors. Most of the policy solutions offered in the US to slow the growth in spending do not address the fundamental factors accounting for spending growth. More aggressive efforts for slowing the growth in obesity among adults and children should be centre-stage in the efforts to slow the rise in health-care spending.

Improvement and Application of Atmospheric Radiative Transfer Models for Prediction of the Climatic Effects of Aerosol

NASA Technical Reports Server (NTRS)

Bergstrom, Robert W.; Mlawer, Eli J.; Sokolik, Irina N.; Clough, Shepard A.; Toon, Owen B.

1998-01-01

This paper presents a radiative transfer model that has been developed to accurately predict the atmospheric radiant flux in both the infrared and the solar spectrum with a minimum of computational effort. The model is designed to be included in numerical climate models. To assess the accuracy of the model, the results are compared to other more detailed models for several standard cases in the solar and thermal spectrum. As the thermal spectrum has been treated in other publications, we focus here on the solar part of the spectrum. We perform several example calculations focussing on the question of absorption of solar radiation by gases and aerosols.

Improvement and Application of Atmospheric Radiative Transfer Models for Prediction of the Climatic Effects of Aerosol

NASA Technical Reports Server (NTRS)

Bergstrom, Robert W.

1998-01-01

This paper presents a radiative transfer model that has been developed to accurately predict the atmospheric radiant flux in both the infrared and the solar spectrum with a minimum of computational effort. The model is designed to be included in numerical climate models. To assess the accuracy of the model, the results are compared to other more detailed models for several standard cases in the solar and thermal spectrum. As the thermal spectrum has been treated in other publications we focus here on the solar part of the spectrum. We perform several example calculations focussing on the question of absorption of solar radiation by gases and aerosols.

In vivo screening and discovery of novel candidate thalidomide analogs in the zebrafish embryo and chicken embryo model systems

PubMed Central

Beedie, Shaunna L.; Rore, Holly M.; Barnett, Shelby; Chau, Cindy H.; Luo, Weiming; Greig, Nigel H.; Figg, William D.; Vargesson, Neil

2016-01-01

Thalidomide, a drug known for its teratogenic side-effects, is used successfully to treat a variety of clinical conditions including leprosy and multiple myeloma. Intense efforts are underway to synthesize and identify safer, clinically relevant analogs. Here, we conduct a preliminary in vivo screen of a library of new thalidomide analogs to determine which agents demonstrate activity, and describe a cohort of compounds with anti-angiogenic properties, anti-inflammatory properties and some compounds which exhibited both. The combination of the in vivo zebrafish and chicken embryo model systems allows for the accelerated discovery of new, potential therapies for cancerous and inflammatory conditions. PMID:27120781

Dysphagia Management in Acute and Sub-acute Stroke

PubMed Central

Vose, Alicia; Nonnenmacher, Jodi; Singer, Michele L.; González-Fernández, Marlís

2014-01-01

Swallowing dysfunction is common after stroke. More than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months. The physiologic impairments that result in post-stroke dysphagia are varied. This review focuses primarily on well-established dysphagia treatments in the context of the physiologic impairments they treat. Traditional dysphagia therapies including volume and texture modifications, strategies such as chin tuck, head tilt, head turn, effortful swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver and exercises such as the Shaker exercise and Masako (tongue hold) maneuver are discussed. Other more recent treatment interventions are discussed in the context of the evidence available. PMID:26484001

Moving towards a latex-free environment: advice from experiences in US dentistry.

PubMed

Palenik, C J; Miller, C H

1999-12-01

Most dental practitioners now routinely wear gloves while treating patients. The most commonly used types of gloves contain latex. Latex is also present in other personal protective equipment, such as masks, eyewear and clinic gowns. Increased use of such items, unfortunately, has been linked to adverse skin and mucous membrane reactions. Latex proteins and chemicals associated with the material's production have been implicated. Exposure to such chemicals has also resulted in allergic responses in dental patients. There is a strong movement in the USA to limit exposure to latex in healthcare environments, including dentistry. The aim of this article is to describe past, present and future efforts to create low-latex or latex-free environments.

Synthesis, Characterization, and Handling of Eu(II)-Containing Complexes for Molecular Imaging Applications

NASA Astrophysics Data System (ADS)

Basal, Lina A.; Allen, Matthew J.

2018-03-01

Considerable research effort has focused on the in vivo use of responsive imaging probes that change imaging properties upon reacting with oxygen because hypoxia is relevant to diagnosing, treating, and monitoring diseases. One promising class of compounds for oxygen-responsive imaging is Eu(II)-containing complexes because the Eu(II/III) redox couple enables imaging with multiple modalities including magnetic resonance and photoacoustic imaging. The use of Eu(II) requires care in handling to avoid unintended oxidation during synthesis and characterization. This review describes recent advances in the field of imaging agents based on discrete Eu(II)-containing complexes with specific focus on the synthesis, characterization, and handling of aqueous Eu(II)-containing complexes.

NASA/Drexel program. [research effort in large-scale technical programs management for application to urban problems

NASA Technical Reports Server (NTRS)

1973-01-01

The results are reported of the NASA/Drexel research effort which was conducted in two separate phases. The initial phase stressed exploration of the problem from the point of view of three primary research areas and the building of a multidisciplinary team. The final phase consisted of a clinical demonstration program in which the research associates consulted with the County Executive of New Castle County, Delaware, to aid in solving actual problems confronting the County Government. The three primary research areas of the initial phase are identified as technology, management science, and behavioral science. Five specific projects which made up the research effort are treated separately. A final section contains the conclusions drawn from total research effort as well as from the specific projects.

Understanding, treating and avoiding hematological disease: Better medicine through mathematics?

PubMed Central

Dale, David C.; Mackey, Michael C.

2014-01-01

This paper traces the experimental, clinical and mathematical modeling efforts to understand a periodic hematological disease–cyclical neutropenia. It is primarily a highly personal account by two scientists from quite different backgrounds of the interactions over almost 40 years and their attempts to understand this intriguing disease. It’s also a story of their efforts to offer effective treatments for the patients who suffer from cyclic neutropenia and other conditions causing neutropenia and infections. PMID:25213154

Disease control in hatchery fish

USGS Publications Warehouse

Fish, F.F.

1947-01-01

The method described herein has been extensively tested, both in the laboratory and at the producing hatchery, over a period of several years. Once familiarity with the details of application have been mastered, th8 reduction in effort required to treat fish is amazing. For example, two men have treated 20 large ponds containing several million fish, in one morning with no significant increase in mortality of the fish, whereas a crew of eight men required a full day to treat a single similar pond by hand dipping the fish with a subsequent loss approximating 50 percent of the stock.

Practices and outcomes of self-treatment with helminths based on physicians' observations.

PubMed

Liu, J; Morey, R A; Wilson, J K; Parker, W

2017-05-01

The successful use of helminths as therapeutic agents to resolve inflammatory disease was first recorded 40 years ago. Subsequent work in animal models and in humans has demonstrated that the organisms might effectively treat a wide range of inflammatory diseases, including allergies, autoimmune disorders and inflammation-associated neuropsychiatric disorders. However, available information regarding the therapeutic uses and effects of helminths in humans is limited. This study probes the practices and experiences of individuals 'self-treating' with helminths through the eyes of their physicians. Five physicians monitoring more than 700 self-treating patients were interviewed. The results strongly support previous indications that helminth therapy can effectively treat a wide range of allergies, autoimmune conditions and neuropsychiatric disorders, such as major depression and anxiety disorders. Approximately 57% of the self-treating patients observed by physicians in the study had autism. Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis. However, approximately 1% of paediatric patients experienced severe gastrointestinal pains with the use of H. diminuta, although the symptoms were resolved with an anti-helminthic drug. Further, exposure to helminths apparently did not affect the impaired comprehension of social situations that is the hallmark of autism. These observations point toward potential starting points for clinical trials, and provide further support for the importance of such trials and for concerted efforts aimed at probing the potential of helminths, and perhaps other biologicals, for therapeutic use.

Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection.

PubMed

Schooley, Robert T; Biswas, Biswajit; Gill, Jason J; Hernandez-Morales, Adriana; Lancaster, Jacob; Lessor, Lauren; Barr, Jeremy J; Reed, Sharon L; Rohwer, Forest; Benler, Sean; Segall, Anca M; Taplitz, Randy; Smith, Davey M; Kerr, Kim; Kumaraswamy, Monika; Nizet, Victor; Lin, Leo; McCauley, Melanie D; Strathdee, Steffanie A; Benson, Constance A; Pope, Robert K; Leroux, Brian M; Picel, Andrew C; Mateczun, Alfred J; Cilwa, Katherine E; Regeimbal, James M; Estrella, Luis A; Wolfe, David M; Henry, Matthew S; Quinones, Javier; Salka, Scott; Bishop-Lilly, Kimberly A; Young, Ry; Hamilton, Theron

2017-10-01

Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.

What Changes in Cognitive Therapy for Depression? An Examination of Cognitive Therapy Skills and Maladaptive Beliefs

PubMed Central

Adler, Abby D.; Strunk, Daniel R.; Fazio, Russell H.

2015-01-01

This study examined effortful cognitive skills and underlying maladaptive beliefs among patients treated with Cognitive Therapy for depression (CT). Depressed patients (n = 44) completed cognitive measures before and after 16 weeks of CT. Measures included: an assessment of CT skills (Ways of Responding Scale, WOR), an implicit test of maladaptive beliefs (Implicit Association Test, IAT), and a self-report questionnaire of maladaptive beliefs (Dysfunctional Attitude Scale, DAS). A matched sample of never-depressed participants (n = 44) also completed study measures. Prior to treatment, depressed patients endorsed significantly more undesirable cognitions on the WOR, IAT, and DAS compared to never-depressed participants. Patients displayed improvement on the WOR and DAS over the course of treatment, but showed no change on the IAT. Additionally, improvements on the WOR and DAS were each related to greater reductions in depressive symptoms. Results suggest that the degree of symptom reduction among patients participating in CT is related to changes in patients’ acquisition of coping skills requiring deliberate efforts and reflective thought, but not related to reduced endorsement of implicitly-assessed maladaptive beliefs. PMID:25526838

Atomic resolution mechanistic studies of ribocil: A highly selective unnatural ligand mimic of the E. coli FMN riboswitch

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

Howe, John A.; Xiao, Li; Fischmann, Thierry O.

2016-08-02

Bacterial riboswitches are non-coding RNA structural elements that direct gene expression in numerous metabolic pathways. The key regulatory roles of riboswitches, and the urgent need for new classes of antibiotics to treat multi-drug resistant bacteria, has led to efforts to develop small-molecules that mimic natural riboswitch ligands to inhibit metabolic pathways and bacterial growth. Recently, we reported the results of a phenotypic screen targeting the riboflavin biosynthesis pathway in the Gram-negative bacteria Escherichia coli that led to the identification of ribocil, a small molecule inhibitor of the flavin mononucleotide (FMN) riboswitch controlling expression of this biosynthetic pathway. Although ribocil ismore » structurally distinct from FMN, ribocil functions as a potent and highly selective synthetic mimic of the natural ligand to repress riboswitch-mediated ribB gene expression and inhibit bacterial growth both in vitro and in vivo. Herein, we expand our analysis of ribocil; including mode of binding in the FMN binding pocket of the riboswitch, mechanisms of resistance and structure-activity relationship guided efforts to generate more potent analogs.« less

Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection

PubMed Central

Biswas, Biswajit; Gill, Jason J.; Hernandez-Morales, Adriana; Lancaster, Jacob; Lessor, Lauren; Barr, Jeremy J.; Reed, Sharon L.; Rohwer, Forest; Benler, Sean; Segall, Anca M.; Taplitz, Randy; Smith, Davey M.; Kerr, Kim; Kumaraswamy, Monika; Nizet, Victor; Lin, Leo; McCauley, Melanie D.; Strathdee, Steffanie A.; Benson, Constance A.; Pope, Robert K.; Leroux, Brian M.; Picel, Andrew C.; Mateczun, Alfred J.; Cilwa, Katherine E.; Regeimbal, James M.; Estrella, Luis A.; Wolfe, David M.; Henry, Matthew S.; Quinones, Javier; Salka, Scott; Bishop-Lilly, Kimberly A.; Young, Ry; Hamilton, Theron

2017-01-01

ABSTRACT Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii. We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted. PMID:28807909

The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies?

PubMed

Campbell, Norm R C; Sheldon, Tobe

2010-07-01

To indicate the key elements of current Canadian programs to treat and control hypertension. In the early 1990s Canada had a hypertension treatment and control rate of 13%. A Canadian strategy to prevent and control hypertension was developed and a coalition of national organizations and volunteers formed to develop increasingly extensive programs. The Canadian effort was largely based on annually updated hypertension management recommendations, an integrated and extensive hypertension knowledge translation program and an increasingly comprehensive outcomes assessment program. After the start of the annual process in 1999, there were very large increases in diagnosis and hypertension treatment coupled with dropping rates of cardiovascular disease. More recent initiatives include an extensive education program for the public and people with hypertension, a program to reduce dietary salt and a funded leadership position. The treatment and control rate increased to 66% when last assessed (2007-2009). The study describes important aspects of the Canadian hypertension management programs to aid those wishing to develop similar programs. Many of the programs could be fully or partially implemented by other countries.

21st century pharmacovigilance: efforts, roles, and responsibilities.

PubMed

Pitts, Peter J; Louet, Hervé Le; Moride, Yola; Conti, Rena M

2016-11-01

In an era when the number of expedited and conditional review pathways for newly available brand-name drugs and biosimilar medicines to treat serious and life-threatening diseases is increasing, defining pharmacovigilance has never been more crucial. 21st century pharmacovigilance is not merely about uncovering, reporting, and addressing adverse events associated with already approved and marketed agents, but can be described as the systematic monitoring of the process of pre-market review and post-market surveillance, which includes the use of medicines in everyday practice. Pharmacovigilance identifies previously unrecognised adverse events or changes in the patterns of these effects, the quality and adequacy of drug supply, and should ensure effective communication with the public, health-care professionals, and patients about the optimum safety and effective use of medicines. In this paper, the first in a Series of three about drug safety in oncology, we discuss evolving challenges in the purview, roles, and responsibilities of the US Food and Drug Administration and the European Medicines Agency with respect to pharmacovigilance efforts, with a special emphasis on oncology treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders

PubMed Central

Das, Smita; Prochaska, Judith J.

2018-01-01

Introduction Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically under-prioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential. PMID:28756728

Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders.

PubMed

Das, Smita; Prochaska, Judith J

2017-10-01

Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.

Implementing standardized performance indicators to improve hypertension control at both the population and healthcare organization levels

PubMed Central

Campbell, Norm; Ordunez, Pedro; Jafe, Marc G.; Orias, Marcelo; DiPete, Donald J.; Patel, Pragna; Khan, Nadia; Onuma, Oyere; Lackland, Daniel T.

2017-01-01

The ability to reliably evaluate the impact of interventions and changes in hypertension prevalence and control is critical if the burden of hypertension-related disease is to be reduced. Previously, a World Hypertension League Expert Committee made recommendations to standardize the reporting of population blood pressure surveys. We have added to those recommendations and also provide modified recommendations from a Pan American Health Organization expert meeting for “performance indicators” to be used to evaluate clinical practices. Core indicators for population surveys are recommended to include: (1) mean systolic blood pressure and (2) mean diastolic blood pressure, and the prevalences of: (3) hypertension, (4) awareness of hypertension, (5) drug-treated hypertension, and (6) drug-treated and controlled hypertension. Core indicators for clinical registries are recommended to include: (1) the prevalence of diagnosed hypertension and (2) the ratio of diagnosed hypertension to that expected by population surveys, and the prevalences of: (3) controlled hypertension, (4) lack of blood pressure measurement within a year in people diagnosed with hypertension, and (5) missed visits by people with hypertension. Definitions and additional indicators are provided. Widespread adoption of standardized population and clinical hypertension performance indicators could represent a major step forward in the effort to control hypertension. PMID:28191704

A review and update on orphan drugs for the treatment of noninfectious uveitis

PubMed Central

You, Caiyun; Sahawneh, Haitham F; Ma, Lina; Kubaisi, Buraa; Schmidt, Alexander; Foster, C Stephen

2017-01-01

Introduction Uveitis, a leading cause of preventable blindness around the world, is a critically underserved disease in regard to the medications approved for use. Multiple immunomodulatory therapy (IMT) drugs are appropriate for uveitis therapy but are still off-label. These IMT agents, including antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents, have been designated as “orphan drugs” and are widely used for systemic autoimmune diseases or organ transplantation. Area covered The purpose of this paper is to comprehensively review and summarize the approved orphan drugs and biologics that are being used to treat systemic diseases and to discuss drugs that have not yet received approval as an “orphan drug for treating uveitis” by the US Food and Drug Administration (FDA). Our perspective IMT, as a steroid-sparing agent for uveitis patients, has shown promising clinical results. Refractory and recurrent uveitis requires combination IMT agents. IMT is continued for a period of 2 years while the patient is in remission before considering tapering medication. Our current goals include developing further assessments regarding the efficacy, optimal dose, and safety in efforts to achieve FDA approval for “on-label” use of current IMT agents and biologics more quickly and to facilitate insurance coverage and expand access to the products for this orphan disease. PMID:28203051

End-to-end imaging information rate advantages of various alternative communication systems

NASA Technical Reports Server (NTRS)

Rice, R. F.

1982-01-01

The efficiency of various deep space communication systems which are required to transmit both imaging and a typically error sensitive class of data called general science and engineering (gse) are compared. The approach jointly treats the imaging and gse transmission problems, allowing comparisons of systems which include various channel coding and data compression alternatives. Actual system comparisons include an advanced imaging communication system (AICS) which exhibits the rather significant advantages of sophisticated data compression coupled with powerful yet practical channel coding. For example, under certain conditions the improved AICS efficiency could provide as much as two orders of magnitude increase in imaging information rate compared to a single channel uncoded, uncompressed system while maintaining the same gse data rate in both systems. Additional details describing AICS compression and coding concepts as well as efforts to apply them are provided in support of the system analysis.

Emerging and recurrent issues in drug development.

PubMed

Anello, C

This paper reviews several emerging and recurrent issues relating to the drug development process. These emerging issues include changes to the FDA regulatory environment, internationalization of drug development, advances in computer technology and visualization tools, and efforts to incorporate meta-analysis methodology. Recurrent issues include: renewed interest in statistical methods for handling subgroups in the design and analysis of clinical trials; renewed interest in alternatives to the 'intention-to-treat' analysis in the presence of non-compliance in randomized clinical trials; renewed interest in methodology to address the multiplicities resulting from a variety of sources inherent in the drug development process, and renewed interest in methods to assure data integrity. These emerging and recurrent issues provide a continuing challenge to the international community of statisticians involved in drug development. Moreover, the involvement of statisticians with different perspectives continues to enrich the field and contributes to improvement in the public health.

Community health workers provide integrated community case management using malaria rapid diagnostic test kits.

PubMed

Orji, Bright C; Rao, Namratha; Thompson, Elizabeth; Brieger, William R; 'Dipo Otolorin, Emmanuel

Throughout Nigeria malaria is an endemic disease. Efforts to treat malaria can also be combined with other illnesses including pneumonia and diarrhea, which are killing children under five years of age. The use of Rapid Diagnostic Test (RDT) aids early diagnosis of malaria and informs when other illnesses should be considered. Those with positive RDT results should be treated with Artemisinin-based Combination Therapy (ACTs), while those with negative RDTs results are further investigated for pneumonia and diarrhea. Critical health systems challenges such as human resource constraints mean that community case management (CCM) and community health workers such as volunteers called Community Directed Distributors (CDDs) can therefore play an important role in diagnosing and treating malaria. This repost described an effort to monitor and document the performance of trained CDDs in providing quality management of febrile illnesses including the use of RDTs. The program trained one hundred and fifty-two (152) CDDs on the use of RDTs to test for malaria and give ACTs for positive RDTs results, cotrimoxazole for the treatment of pneumonia and Oral rehydration solution and zinc for diarrhea They were also taught to counsel on compliance medicine, identify adverse reactions, and keep accurate records. The CDDs worked for 12 Calendar months. Their registers were retrieved and audited using a checklist to document client complaints, tests done, test results and treatment provided. No client identifying information was collected. There were 32 (21%) male CDDs and 120 (79%) females. The overall mean age of the CDDs was 36.8 (±8.7) years old. 89% of the male CDDs provided correct treatment based on RDT results compared to 97.6% of the female CDDs, a statistically significant difference. Likewise CDDs younger than 36 years of age provided 92.7% correct case management compared to those 36 years and older (98.4%). The difference between the age groups was also significant. There was a strong association between CDDs dispensing ACTs with positive RDT results. In RDT negative cases, the most common course of action was dispensing antibiotics (43.2%), followed by referring the patients (30.34%) and the providing ORS (24.1%). Volunteer CDDs who are community members can adhere to treatment protocols and guidelines and comply with performance standards. The next step is scaling this approach to a state-wide level. Copyright © 2016 Elsevier Inc. All rights reserved.

Vocational rehabilitation considerations for people with reflex sympathetic dystrophy.

PubMed

Smith, T S; Genoff, M C

1997-01-01

Reflex sympathetic dystrophy (RSD) is identified by the existence of pain, trophic changes, vasomotor instability, limited range of motion and swelling of an extremity. RSD is difficult to treat and prognosis is often poor. Although widely noted in the medical literature, the vocational rehabilitation literature has failed to address the potential role of vocational rehabilitation professionals in the social and economic employment outcome for people with RSD. Vocational rehabilitation professionals are defined as those performing vocational assessments, assessing transferable skills, determining adaptive skills, certifying residual work-related capacities, conducting vocational interest testing, coordinating efforts with pre-injury employers to assist in work reentry efforts, or performing other activities to assist in the placement or retraining of individuals with RSD. The sources used for this article include a review of the literature and observations of the authors. A vocational rehabilitation primer is provided. The following topics are addressed: the anatomical and physiological basis of RSD, treatment protocols, difficulties in accurately diagnosing RSD, influence of litigation, job placement considerations and vocational planning. As the vocational rehabilitation counsellor faces a greater number of people either diagnosed with RSD, or exhibiting RSD symptoms, he/she will be challenged to: (1) increase one's knowledge base about the etiology and treatment of RSD; (2) coordinate personal efforts with other professionals; and (3) provide personal counselling to address lifestyle and motivational factors.

Craters on Mars: Global Geometric Properties from Gridded MOLA Topography

NASA Technical Reports Server (NTRS)

Garvin, J. B.; Sakimoto, S. E. H.; Frawley, J. J.

2003-01-01

Impact craters serve as natural probes of the target properties of planetary crusts and the tremendous diversity of morphological expressions of such features on Mars attests to their importance for deciphering the history of crustal assembly, modification, and erosion. This paper summarizes the key findings associated with a five year long survey of the three-dimensional properties of approx. 6000 martian impact craters using finely gridded MOLA topography. Previous efforts have treated representative subpopulations, but this effort treats global properties from the largest survey of impact features from the perspective of their topography ever assimilated. With the Viking missions of the mid-1970 s, the most intensive and comprehensive robotic expeditions to any Deep Space location in the history of humanity were achieved, with scientifically stunning results associated with the morphology of impact craters. The relationships illustrated and suggest that martian impact features are remarkably sensitive to target properties and to the local depositional processes.

Shock-treated Lunar Soil Simulant: Preliminary Assessment as a Construction Material

NASA Technical Reports Server (NTRS)

Boslough, Mark B.; Bernold, Leonhard E.; Horie, Yasuyuki

1992-01-01

In an effort to examine the feasibility of applying dynamic compaction techniques to fabricate construction materials from lunar regolith, preliminary explosive shock-loading experiments on lunar soil simulants were carried out. Analysis of our shock-treated samples suggests that binding additives, such as metallic aluminum powder, may provide the necessary characteristics to fabricate a strong and durable building material (lunar adobe) that takes advantage of a cheap base material available in abundance: lunar regolith.

[A sense of responsibility in health personnel as a cause of work-related stress].

PubMed

Nedić, Olesja; Jocić, Neda; Filipović, Danka; Solak, Zdravko

2002-01-01

Job stress is a great problem in developed countries of the world, but in Yugoslavia, it is increased due to additional reasons associated with economic crisis in the society. Health services and health workers are in particularly difficult conditions. The aim of this paper was to examine sources and causes of job stress in health workers. The research was undertaken among health workers treated at Health Centre "Hospital" in Novi Sad. The study group included health workers--doctors, nurses and laboratory workers, and the control group included the rest of non-medical staff. Adapted Siegrist questionnaire was used. Three factors were examined: extrinsic efforts (disturbances at work, sense of great job responsibility and the need for overtime work); intrinsinc efforts (major criticism, thinking about the job from the early morning, getting nervous because of minor problems, discontentment because of unsolved problems at work, relaxation at home and so on), and low reward (respect from the superiors and colleagues, support and security at workplace). Answers were scored indicating intensity (high, moderate, low, not at all). Statistic analysis included testing the level of significance in health workers in relation to non-medical staff (t test and Fisher's exact test). Applying the scoring system it has been established that health workers are exposed to greater job stress, great sense of very high job responsibility and frequent overtime work (p < 0.001) than the control group. In regard to answers from the second group--intrinsic effort and low reward, there was no statistiscal significance between the study and control group. Generally, high level of risk factors was established, especially presence of one or more risk factors. Job stress increases absenteeism, reduces work productivity, causes higher expenses of medical treatment, rehabilitation and staff retraining. It is of great importance to identify factors which cause job dissatisfaction in order to decrease them to the lowest level. High sense of responsibility in health workers is a course of job stress.

Drug discovery for alopecia: gone today, hair tomorrow

PubMed Central

Santos, Zenildo; Avci, Pinar; Hamblin, Michael R

2015-01-01

Introduction Hair loss or alopecia affects the majority of the population at some time in their life, and increasingly, sufferers are demanding treatment. Three main types of alopecia (androgenic [AGA], areata [AA] and chemotherapy-induced [CIA]) are very different, and have their own laboratory models and separate drug-discovery efforts. Areas covered In this article, the authors review the biology of hair, hair follicle (HF) cycling, stem cells and signaling pathways. AGA, due to dihydrotesterone, is treated by 5-α reductase inhibitors, androgen receptor blockers and ATP-sensitive potassium channel-openers. AA, which involves attack by CD8+NK group 2D-positive (NKG2D+) T cells, is treated with immunosuppressives, biologics and JAK inhibitors. Meanwhile, CIA is treated by apoptosis inhibitors, cytokines and topical immunotherapy. Expert opinion The desire to treat alopecia with an easy topical preparation is expected to grow with time, particularly with an increasing aging population. The discovery of epidermal stem cells in the HF has given new life to the search for a cure for baldness. Drug discovery efforts are being increasingly centered on these stem cells, boosting the hair cycle and reversing miniaturization of HF. Better understanding of the molecular mechanisms underlying the immune attack in AA will yield new drugs. New discoveries in HF neogenesis and low-level light therapy will undoubtedly have a role to play. PMID:25662177

Evaluating immunocontraception for managing suburban white-tailed deer in Irondequoit, New York

USGS Publications Warehouse

Rudolph, B.A.; Porter, W.F.; Underwood, H.B.

2000-01-01

Immunocontraception is frequently proposed as an alternative to lethal removal of females for deer management. However, little information is available for evaluating the potential of applying immunocontraceptives to free-ranging populations. Our objectives were to estimate effort required to apply porcine zona pellucida (PZP) to individual deer and assess the utility of using immunocontraception to control growth of deer populations. The study was conducted in a 43-km2 suburban community with about 400 deer. Effort per deer was measured as time required to capture and mark deer, and then to apply booster immunocontraceptive treatments by remote injection. Estimates of numbers of females to treat to control population growth were based on the generalized sustained-yield (SY) model adapted for contraception of females. The SY curve was calibrated using data on deer abundance acquired from aerial population surveys and nutritional condition of females removed by a concurrent culling program. Effort was influenced by 4 factors: deer population density, approachability of individual deer, access to private and public land, and efficacy of the contraceptive treatment. Effort and deer density were inversely related. Cumulative effort for treatment increased exponentially because some deer were more difficult to approach than others. Potential of using immunocontraception at low deer population densities (<25% ecological carrying capacity) is limited by the interaction of the proportion of breeding-age females in the population and treatment efficacy, as well as encounter rates. Immunocontraception has the best potential for holding suburban deer populations between 30 and 70% of ecological carrying capacity, but is likely to be useful only in localized populations when the number of females to be treated is small (e.g., <200 deer).

Pre-conceptual Development and characterization of an extruded graphite composite fuel for the TREAT Reactor

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

Luther, Erik; Rooyen, Isabella van; Leckie, Rafael

2015-03-01

In an effort to explore fuel systems that are more robust under accident scenarios, the DOE-NE has identified the need to resume transient testing. The Transient Reactor Test (TREAT) facility has been identified as the preferred option for the resumption of transient testing of nuclear fuel in the United States. In parallel, NNSA’s Global Threat Reduction Initiative (GTRI) Convert program is exploring the needs to replace the existing highly enriched uranium (HEU) core with low enriched uranium (LEU) core. In order to construct a new LEU core, materials and fabrication processes similar to those used in the initial core fabricationmore » must be identified, developed and characterized. In this research, graphite matrix fuel blocks were extruded and materials properties of were measured. Initially the extrusion process followed the historic route; however, the project was expanded to explore methods to increase the graphite content of the fuel blocks and explore modern resins. Materials properties relevant to fuel performance including density, heat capacity and thermal diffusivity were measured. The relationship between process defects and materials properties will be discussed.« less

Ethiopia Schistosomiasis and Soil-Transmitted Helminthes Control Programme: Progress and Prospects.

PubMed

Negussu, Nebiyu; Mengistu, Birhan; Kebede, Biruck; Deribe, Kebede; Ejigu, Ephrem; Tadesse, Gemechu; Mekete, Kalkidan; Sileshi, Mesfin

2017-01-01

Schistosomiasis and soil-transmitted helminthes are among seventeen WHO prioritized neglected tropical diseases that infect humans. These parasitic infections can be treated using single-dose and safe drugs. Ethiopia successfully mapped the distribution of these infections nationwide. According to the mapping there are an estimated 37.3 million people living in schistosomiasis endemic areas, and 79 million in schistosomiasis and soil-transmitted helminthes endemic areas. The Federal Ministry of Health successfully scaled up Schistosomiasis and schistosomiasis and soil-transmitted helminthes intervention in endemic areas and treated over 19 million individuals in 2015. The Ministry of Health has made a huge effort to establish neglected tropical diseases, including schistosomiasis and soil-transmitted helminthes program in the health system which helped to map majority of the woredas and initiate nationwide intervention. The National control programme is designed to achieve elimination for those diseases as a major public health problem by 2020 and aim to attain transmission break by 2025. The programme focuses on reaching those school-aged children who are not attending school, integration between neglected tropical diseases programme, and further collaboration with the WASH actors.

Cross-Cultural Approaches to Addict Families.

ERIC Educational Resources Information Center

Coleman, Sandra B.

1979-01-01

From a national survey of family therapy and drug abuse treatment, diverse methods of treating families from varying ethnic/minority backgrounds have been derived in an effort to integrate both family and environmental systems theory--an "ecological" family therapy approach. (Author)

Synthesis study on transverse variable asphalt application rates for seal coats.

DOT National Transportation Integrated Search

2009-06-01

This report documents a cooperative effort to collect, process, and make available information about successful methods of varying seal coat asphalt application rates across treated roadways to optimize aggregate retention and avoid wheel path flushi...

Interventional Application of Shape Memory Polymer Foam Final Report CRADA No. TC-02067-03

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

Maitland, D.; Metzger, M. F.

This was a collaborative effort between The Regents of the University of California, Lawrence Livermore National Laboratory (LLNL) and Sierra Interventions, LLC, to develop shape memory polymer foam devices for treating hemorrhagic stroke.

Treating the America's Cup Sailors.

PubMed

Miller, C

1987-01-01

Some physicians are taking part in efforts to win the America's Cup races, now taking place off the west coast of Australia, near Fremantle. But although 12-Meter yacht racing can be intense, sailors most often need treatment for minor injuries.

Quantitative Assessment of Commutability for Clinical Viral Load Testing Using a Digital PCR-Based Reference Standard

PubMed Central

Tang, L.; Sun, Y.; Buelow, D.; Gu, Z.; Caliendo, A. M.; Pounds, S.

2016-01-01

Given recent advances in the development of quantitative standards, particularly WHO international standards, efforts to better understand the commutability of reference materials have been made. Existing approaches in evaluating commutability include prediction intervals and correspondence analysis; however, the results obtained from existing approaches may be ambiguous. We have developed a “deviation-from-ideal” (DFI) approach to evaluate commutability of standards and applied it to the assessment of Epstein-Bar virus (EBV) load testing in four quantitative PCR assays, treating digital PCR as a reference assay. We then discuss advantages and limitations of the DFI approach as well as experimental design to best evaluate the commutability of an assay in practice. PMID:27076654

Preventing and treating biologic-associated opportunistic infections.

PubMed

Winthrop, Kevin L; Chiller, Tom

2009-07-01

A variety of opportunistic pathogens have been reported to infect patients receiving tumor necrosis factor (TNF) antagonists for the treatment of autoimmune diseases. These pathogens are numerous, and include coccidioides, histoplasma, nontuberculous mycobacteria, Mycobacteria tuberculosis, and others of public health concern. Accordingly, TNF antagonists should be used with caution in patients at risk for tuberculosis, and screening for latent tuberculosis infection should be undertaken before anti-TNF therapy is initiated. Although screening and prevention efforts have decreased the risk of tuberculosis in this setting, optimal screening methods represent an area of evolving controversy. This article discusses the latest developments in screening methodologies for latent tuberculosis infection, as well as potential preventive and therapeutic considerations for opportunistic infections associated with anti-TNF agents and other biologic therapies.

Out of the shadows? The inclusion of men and boys in conceptualisations of wartime sexual violence.

PubMed

Touquet, Heleen; Gorris, Ellen

2016-05-01

Researchers increasingly acknowledge that men and boys are frequent victims of sexual violence in conflict alongside women and girls, who remain the group that is disproportionately affected. This increasing awareness has contributed to significant efforts to include men and boys in conceptualisations of conflict-related sexual violence in policy as well as in international criminal law. This article analyses the changes that have occurred in these two fields in recent years. We argue that while a major shift towards including male victims in international policy on wartime sexual violence took place in 2013-2014, this development has yet to be consolidated in salient policy guidelines and handbooks. While men and boys' potential victimisation is frequently recognised, most policy documents do not treat the topic of male victimisation in depth. International criminal law on the other hand has pioneered gender-neutral and inclusive definitions. However, the interpretation and application of the gender-inclusive approach is often left to the discretion of judges and the prosecution who at times fail to take the experience of males fully into account, signalling the continuing influence of gender stereotypes and deeply held cultural myths. A renewed effort to fully integrate male victims into conceptualisations of conflict-related sexual violence in both policy and law is therefore advised. Copyright © 2016 Elsevier Inc. All rights reserved.

Changes in stigma and barriers to care over time in U.K. Armed Forces deployed to Afghanistan and Iraq between 2008 and 2011.

PubMed

Osório, Carlos; Jones, Norman; Fertout, Mohammed; Greenberg, Neil

2013-08-01

Stigmatizing beliefs about seeking help for mental health conditions and perceived barriers to care (BTC) may influence the decision to seek support and treatment in U.K. military personnel. Many coalition partners, including the U.K. Armed Forces (UKAF), have made considerable efforts to reduce stigma/BTC although the impact of these efforts over time has not been assessed. We surveyed a total of 23,101 UKAF personnel who deployed to Afghanistan and Iraq between 2008 and 2011 and examined whether stigma/BTC levels changed during this time. The results suggested that stigma, including the fear of being treated differently by commanders and loss of trust among peers, was greater than perceived BTC. The likelihood of reporting stigma/BTC, although significantly greater during deployment than postdeployment, reduced significantly over the survey period. A similar reduction was less apparent during postdeployment phase. These findings support the notion that UKAF's anti-stigma campaigns may have had some positive effects, particularly among deployed personnel. However, we suggest that stigma still plays a part in inhibiting help-seeking, particularly during deployment when stigma rates are higher, and that a careful balance must be struck between encouraging help-seeking and maintaining the operational effectiveness of deployed personnel. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Assessing the Impact of Source-Zone Remediation Efforts at the Contaminant-Plume Scale Through Analysis of Contaminant Mass Discharge

PubMed Central

Brusseau, M. L.; Hatton, J.; DiGuiseppi, W.

2011-01-01

The long-term impact of source-zone remediation efforts was assessed for a large site contaminated by trichloroethene. The impact of the remediation efforts (soil vapor extraction and in-situ chemical oxidation) was assessed through analysis of plume-scale contaminant mass discharge, which was measured using a high-resolution data set obtained from 23 years of operation of a large pump-and-treat system. The initial contaminant mass discharge peaked at approximately 7 kg/d, and then declined to approximately 2 kg/d. This latter value was sustained for several years prior to the initiation of source-zone remediation efforts. The contaminant mass discharge in 2010, measured several years after completion of the two source-zone remediation actions, was approximately 0.2 kg/d, which is ten times lower than the value prior to source-zone remediation. The time-continuous contaminant mass discharge data can be used to evaluate the impact of the source-zone remediation efforts on reducing the time required to operate the pump-and-treat system, and to estimate the cost savings associated with the decreased operational period. While significant reductions have been achieved, it is evident that the remediation efforts have not completely eliminated contaminant mass discharge and associated risk. Remaining contaminant mass contributing to the current mass discharge is hypothesized to comprise poorly-accessible mass in the source zones, as well as aqueous (and sorbed) mass present in the extensive lower-permeability units located within and adjacent to the contaminant plume. The fate of these sources is an issue of critical import to the remediation of chlorinated-solvent contaminated sites, and development of methods to address these sources will be required to achieve successful long-term management of such sites and to ultimately transition them to closure. PMID:22115080

Patient-centered care coordination in hematopoietic cell transplantation

PubMed Central

Martin, Patricia; Edsall, Kristen; Bonagura, Anthony; Burns, Linda J.; Juckett, Mark; King, Olivia; LeMaistre, C. Frederick; Majhail, Navneet S.

2017-01-01

Hematopoietic cell transplantation (HCT) is an expensive, resource-intensive, and medically complicated modality for treatment of many hematologic disorders. A well-defined care coordination model through the continuum can help improve health care delivery for this high-cost, high-risk medical technology. In addition to the patients and their families, key stakeholders include not only the transplantation physicians and care teams (including subspecialists), but also hematologists/oncologists in private and academic-affiliated practices. Initial diagnosis and care, education regarding treatment options including HCT, timely referral to the transplantation center, and management of relapse and late medical or psychosocial complications after HCT are areas where the referring hematologists/oncologists play a significant role. Payers and advocacy and community organizations are additional stakeholders in this complex care continuum. In this article, we describe a care coordination framework for patients treated with HCT within the context of coordination issues in care delivery and stakeholders involved. We outline the challenges in implementing such a model and describe a simplified approach at the level of the individual practice or center. This article also highlights ongoing efforts from physicians, medical directors, payer representatives, and patient advocates to help raise awareness of and develop access to adequate tools and resources for the oncology community to deliver well-coordinated care to patients treated with HCT. Lastly, we set the stage for policy changes around appropriate reimbursement to cover all aspects of care coordination and generate successful buy-in from all stakeholders. PMID:29296802

[Treatment of gamma-hydroxybutyrate withdrawal].

PubMed

Strand, Niels August Willer; Petersen, Tonny Studsgaard; Nielsen, Lars Martin; Boegevig, Soren

2017-12-11

Gamma-hydroxybutyrate (GHB) is a drug of abuse, for which physical addiction develops quickly. GHB withdrawal can develop into a life-threatening condition and has previously been treated mainly with benzodiazepines. These have not always proven effective, leading to long hospitalizations in intensive care units. Based on successful Dutch treatment results for using GHB to treat GHB withdrawal symptoms, we propose to implement a similar method in Denmark. The method requires an interdisciplinary effort for which The Danish Poison Information Centre should be consulted for expertise.

Injuries from paintball game related activities in the United States, 1997–2001

PubMed Central

Conn, J; Annest, J; Gilchrist, J; Ryan, G

2004-01-01

Objective: To quantify and characterize injuries resulting from paintball game related activities among persons ⩾7 years in the United States. Setting: Hospitals included in the National Electronic Injury Surveillance System (NEISS); these are composed of a stratified probability sample of all hospitals in the United States with emergency departments. Methods: Using NEISS, non-fatal injury data for paintball game related injury cases from 1997–2001 were obtained from emergency department records. Participation estimates used to calculate injury rates were obtained from a yearly survey funded by the National Sporting Goods Association. Results: An estimated 11 998 persons ⩾7 years with paintball game related injuries were treated in emergency departments from 1997–2001, with an annual average rate of 4.5 per 10 000 participants (95% confidence interval 3.3 to 5.7). The paintball game related injury rate was highest for 18–24 year olds (4.9 per 10 000 participants) and most injuries (94.0%) occurred among males. Almost 60% of all injured persons ⩾7 years were treated for paintball pellet wounds of which most were to the eye. While 76.9% of injured persons ages 7–17 years were treated for paintball pellet wounds, almost 40% of those ⩾18 years were treated for injuries resulting from overexertion or a fall. Lower extremity injuries were also common (23.0%), mostly from overexertion. Most injured persons (95.5%) were treated and released. Conclusions: As paintball games become more popular, efforts are needed to increase training, enforce rules, and educate participants about how to stay safe, such as wearing protective eye gear, when engaged in paintball games at home, in a public area, or in a sports field. PMID:15178668

Maintenance and sustained use of insecticide-treated bednets and curtains three years after a controlled trial in western Kenya.

PubMed

Kachur, S P; Phillips-Howard, P A; Odhacha, A M; Ruebush, T K; Oloo, A J; Nahlen, B L

1999-11-01

In large experimental trials throughout Africa, insecticide-treated bednets and curtains have reduced child mortality in malaria-endemic communities by 15%-30%. While few questions remain about the efficacy of this intervention, operational issues around how to implement and sustain insecticide-treated materials (ITM) projects need attention. We revisited the site of a small-scale ITM intervention trial, 3 years after the project ended, to assess how local attitudes and practices had changed. Qualitative and quantitative methods, including 16 focus group discussions and a household survey (n = 60), were employed to assess use, maintenance, retreatment and perceptions of ITM and the insecticide in former study communities. Families that had been issued bednets were more likely to have kept and maintained them and valued bednets more highly than those who had been issued curtains. While most households retained their original bednets, none had treated them with insecticide since the intervention trial was completed 3 years earlier. Most of those who had been issued bednets repaired them, but none acquired new or replacement nets. In contrast, households that had been issued insecticide-treated curtains often removed them. Three (15%) of the households issued curtains had purchased one or more bednets since the study ended. In households where bednets had been issued, children 10 years of age and younger were a third as likely to sleep under a net as were adults (relative risk (RR) = 0. 32; 95% confidence interval (95%CI) = 0.19, 0.53). Understanding how and why optimal ITM use declined following this small-scale intervention trial can suggest measures that may improve the sustainability of current and future ITM efforts.

CDC Vital Signs: Making Health Care Safer -- Stop Infections from Lethal CRE Germs Now

MedlinePlus

... recommendations when treating patients with CRE. Dedicate rooms, staff, and equipment to patients with CRE. Prescribe antibiotics ... coordinated, and consistent effort by doctors, nurses, lab staff, medical facility leadership, health departments/states, policy makers, ...

A specific role for serotonin in overcoming effort cost.

PubMed

Meyniel, Florent; Goodwin, Guy M; Deakin, Jf William; Klinge, Corinna; MacFadyen, Christine; Milligan, Holly; Mullings, Emma; Pessiglione, Mathias; Gaillard, Raphaël

2016-11-08

Serotonin is implicated in many aspects of behavioral regulation. Theoretical attempts to unify the multiple roles assigned to serotonin proposed that it regulates the impact of costs, such as delay or punishment, on action selection. Here, we show that serotonin also regulates other types of action costs such as effort. We compared behavioral performance in 58 healthy humans treated during 8 weeks with either placebo or the selective serotonin reuptake inhibitor escitalopram. The task involved trading handgrip force production against monetary benefits. Participants in the escitalopram group produced more effort and thereby achieved a higher payoff. Crucially, our computational analysis showed that this effect was underpinned by a specific reduction of effort cost, and not by any change in the weight of monetary incentives. This specific computational effect sheds new light on the physiological role of serotonin in behavioral regulation and on the clinical effect of drugs for depression. ISRCTN75872983.

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

Brunett, A. J.; Fei, T.; Strons, P. S.

The Transient Reactor Test Facility (TREAT), located at Idaho National Laboratory (INL), is a test facility designed to evaluate the performance of reactor fuels and materials under transient accident conditions. The facility, an air-cooled, graphite-moderated reactor designed to utilize fuel containing high-enriched uranium (HEU), has been in non-operational standby status since 1994. Currently, in support of the missions of the Department of Energy (DOE) National Nuclear Security Administration (NNSA) Material Management and Minimization (M3) Reactor Conversion Program, a new core design is being developed for TREAT that will utilize low-enriched uranium (LEU). The primary objective of this conversion effort ismore » to design an LEU core that is capable of meeting the performance characteristics of the existing HEU core. Minimal, if any, changes are anticipated for the supporting systems (e.g. reactor trip system, filtration/cooling system, etc.); therefore, the LEU core must also be able to function with the existing supporting systems, and must also satisfy acceptable safety limits. In support of the LEU conversion effort, a range of ancillary safety analyses are required to evaluate the LEU core operation relative to that of the existing facility. These analyses cover neutronics, shielding, and thermal hydraulic topics that have been identified as having the potential to have reduced safety margins due to conversion to LEU fuel, or are required to support the required safety analyses documentation. The majority of these ancillary tasks have been identified in [1] and [2]. The purpose of this report is to document the ancillary safety analyses that have been performed at Argonne National Laboratory during the early stages of the LEU design effort, and to describe ongoing and anticipated analyses. For all analyses presented in this report, methodologies are utilized that are consistent with, or improved from, those used in analyses for the HEU Final Safety Analysis Report (FSAR) [3]. Depending on the availability of historical data derived from HEU TREAT operation, results calculated for the LEU core are compared to measurements obtained from HEU TREAT operation. While all analyses in this report are largely considered complete and have been reviewed for technical content, it is important to note that all topics will be revisited once the LEU design approaches its final stages of maturity. For most safety significant issues, it is expected that the analyses presented here will be bounding, but additional calculations will be performed as necessary to support safety analyses and safety documentation. It should also be noted that these analyses were completed as the LEU design evolved, and therefore utilized different LEU reference designs. Preliminary shielding, neutronic, and thermal hydraulic analyses have been completed and have generally demonstrated that the various LEU core designs will satisfy existing safety limits and standards also satisfied by the existing HEU core. These analyses include the assessment of the dose rate in the hodoscope room, near a loaded fuel transfer cask, above the fuel storage area, and near the HEPA filters. The potential change in the concentration of tramp uranium and change in neutron flux reaching instrumentation has also been assessed. Safety-significant thermal hydraulic items addressed in this report include thermally-induced mechanical distortion of the grid plate, and heating in the radial reflector.« less

Competing Principles for Allocating Health Care Resources.

PubMed

Carter, Drew; Gordon, Jason; Watt, Amber M

2016-10-01

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to "need" and "the capacity to benefit" (CTB). Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person's initial health state and a person's CTB per resource unit expended: (1) allocate resources so as to most closely equalize final health states and (2) allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person's initial health state and a person's CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit's thought on Prioritarianism (a prioritizing of the worst off). Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention.

PubMed

Anestis, Michael D; Law, Keyne C; Jin, Hyejin; Houtsma, Claire; Khazem, Lauren R; Assavedo, Brittney L

2017-10-01

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt. © 2016 The American Association of Suicidology.

Chronic co-administration of the cannabinoid receptor agonist WIN55,212-2 during puberty or adulthood reverses 3,4 methylenedioxymetamphetamine (MDMA)-induced deficits in recognition memory but not in effort-based decision making.

PubMed

Schulz, Sybille; Becker, Thorsten; Nagel, Ulrich; von Ameln-Mayerhofer, Andreas; Koch, Michael

2013-05-01

Cannabis and 3,4 methylenedioxymetamphetamine (MDMA, "ecstasy") are the most frequently combined illegal drugs among young adults in western societies. This study examined the effects of chronic co-administration of the cannabinoid receptor agonist WIN55,212-2 (WIN) and MDMA on working memory and effort-based decision making in rats. Treatment consisted of MDMA (7.5 mg/kg), WIN (1.2 mg/kg), a combination of these substances (MDMA+WIN) or vehicle over a period of 25 days during puberty (PD40-65) or adulthood (PD80-105). Ten days after the last treatment, WIN reversed MDMA-induced working memory deficits in the object recognition test in animals treated during adulthood or puberty, but had no influence on impairment of adult rats in the effort-based T-maze task. No differences were observed between groups of pubertally treated rats in the decision making task. During a subsequent acute drug challenge MDMA and MDMA+WIN decreased high reward choices in both age groups, indicating MDMA-induced cost-aversive choice. Differential long-term interactions on the neuronal level in the hippocampus and MDMA-induced disturbances in cortico-limbic connections are suggested. Copyright © 2013 Elsevier Inc. All rights reserved.

THE IMPACT OF PARTIAL DNAPL SOURCE ZONE REMEDIATION

EPA Science Inventory

Dense non-aqueous phase liquids (DNAPL) constitute a long-term source of groundwater contamination and a significant effort is usually required to treat these contaminated waters and bring them back to maximum contaminant level (MCL) required by the regulatory authorities.
Fi...

Injuries to seat occupants of light airplanes.

DOT National Transportation Integrated Search

1989-02-01

A series of 55 light-airplane accidents was examined in an effort to demonstrate the role of seats in the genesis of injury in seat occupants. Good engineering, design of airplane seats is an important related issue which is not treated in this study...

Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review.

PubMed

Gunda, Resign; Chimbari, Moses John

2017-01-01

Malaria continues to be a public health problem despite past and on-going control efforts. For sustenance of control efforts to achieve the malaria elimination goal, it is important that the most cost-effective interventions are employed. This paper reviews studies on cost-effectiveness of malaria interventions using disability-adjusted life years. A review of literature was conducted through a literature search of international peer-reviewed journals as well as grey literature. Searches were conducted through Medline (PubMed), EMBASE and Google Scholar search engines. The searches included articles published in English for the period from 1996 to 2016. The inclusion criteria for the study were type of malaria intervention, year of publication and cost-effectiveness ratio in terms of cost per DALY averted. We included 40 studies which specifically used the DALY metric in cost-effectiveness analysis (CEA) of malaria interventions. The majority of the reviewed studies (75%) were done using data from African settings with the majority of the interventions (60.0%) targeting all age categories. Interventions included case treatment, prophylaxis, vector control, insecticide treated nets, early detection, environmental management, diagnosis and educational programmes. Sulfadoxine-pyrimethamine was the most common drug of choice in malaria prophylaxis, while artemisinin-based combination therapies were the most common drugs for case treatment. Based on guidelines for CEA, most interventions proved cost-effective in terms of cost per DALYs averted for each intervention. The DALY metric is a useful tool for determining the cost-effectiveness of malaria interventions. This paper demonstrates the importance of CEA in informing decisions made by policy makers.

Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Towards pathogen inactivation of red blood cells and whole blood targeting viral DNA/RNA: design, technologies, and future prospects for developing countries.

PubMed

Drew, Victor J; Barro, Lassina; Seghatchian, Jerard; Burnouf, Thierry

2017-10-01

Over 110 million units of blood are collected yearly. The need for blood products is greater in developing countries, but so is the risk of contracting a transfusion-transmitted infection. Without efficient donor screening/viral testing and validated pathogen inactivation technology, the risk of transfusion-transmitted infections correlates with the infection rate of the donor population. The World Health Organization has published guidelines on good manufacturing practices in an effort to ensure a strong global standard of transfusion and blood product safety. Sub-Saharan Africa is a high-risk region for malaria, human immunodeficiency virus (HIV), hepatitis B virus and syphilis. Southeast Asia experiences high rates of hepatitis C virus. Areas with a tropical climate have an increased risk of Zika virus, Dengue virus, West Nile virus and Chikungunya, and impoverished countries face economical limitations which hinder efforts to acquire the most modern pathogen inactivation technology. These systems include Mirasol ® Pathogen Reduction Technology, INTERCEPT ® , and THERAFLEX ® . Their procedures use a chemical and ultraviolet or visible light for pathogen inactivation and significantly decrease the threat of pathogen transmission in plasma and platelets. They are licensed for use in Europe and are used in several other countries. The current interest in the blood industry is the development of pathogen inactivation technologies that can treat whole blood (WB) and red blood cell (RBC). The Mirasol system has recently undergone phase III clinical trials for treating WB in Ghana and has demonstrated some efficacy toward malaria inactivation and low risk of adverse effects. A 2 nd -generation of the INTERCEPT ® S-303 system for WB is currently undergoing a phase III clinical trial. Both methodologies are applicable for WB and components derived from virally reduced WB or RBC.

Towards pathogen inactivation of red blood cells and whole blood targeting viral DNA/RNA: design, technologies, and future prospects for developing countries

PubMed Central

Drew, Victor J.; Barro, Lassina; Seghatchian, Jerard; Burnouf, Thierry

2017-01-01

Over 110 million units of blood are collected yearly. The need for blood products is greater in developing countries, but so is the risk of contracting a transfusion-transmitted infection. Without efficient donor screening/viral testing and validated pathogen inactivation technology, the risk of transfusion-transmitted infections correlates with the infection rate of the donor population. The World Health Organization has published guidelines on good manufacturing practices in an effort to ensure a strong global standard of transfusion and blood product safety. Sub-Saharan Africa is a high-risk region for malaria, human immunodeficiency virus (HIV), hepatitis B virus and syphilis. Southeast Asia experiences high rates of hepatitis C virus. Areas with a tropical climate have an increased risk of Zika virus, Dengue virus, West Nile virus and Chikungunya, and impoverished countries face economical limitations which hinder efforts to acquire the most modern pathogen inactivation technology. These systems include Mirasol® Pathogen Reduction Technology, INTERCEPT®, and THERAFLEX®. Their procedures use a chemical and ultraviolet or visible light for pathogen inactivation and significantly decrease the threat of pathogen transmission in plasma and platelets. They are licensed for use in Europe and are used in several other countries. The current interest in the blood industry is the development of pathogen inactivation technologies that can treat whole blood (WB) and red blood cell (RBC). The Mirasol system has recently undergone phase III clinical trials for treating WB in Ghana and has demonstrated some efficacy toward malaria inactivation and low risk of adverse effects. A 2nd-generation of the INTERCEPT® S-303 system for WB is currently undergoing a phase III clinical trial. Both methodologies are applicable for WB and components derived from virally reduced WB or RBC. PMID:28488960

The Prediction of Drug-Disease Correlation Based on Gene Expression Data.

PubMed

Cui, Hui; Zhang, Menghuan; Yang, Qingmin; Li, Xiangyi; Liebman, Michael; Yu, Ying; Xie, Lu

2018-01-01

The explosive growth of high-throughput experimental methods and resulting data yields both opportunity and challenge for selecting the correct drug to treat both a specific patient and their individual disease. Ideally, it would be useful and efficient if computational approaches could be applied to help achieve optimal drug-patient-disease matching but current efforts have met with limited success. Current approaches have primarily utilized the measureable effect of a specific drug on target tissue or cell lines to identify the potential biological effect of such treatment. While these efforts have met with some level of success, there exists much opportunity for improvement. This specifically follows the observation that, for many diseases in light of actual patient response, there is increasing need for treatment with combinations of drugs rather than single drug therapies. Only a few previous studies have yielded computational approaches for predicting the synergy of drug combinations by analyzing high-throughput molecular datasets. However, these computational approaches focused on the characteristics of the drug itself, without fully accounting for disease factors. Here, we propose an algorithm to specifically predict synergistic effects of drug combinations on various diseases, by integrating the data characteristics of disease-related gene expression profiles with drug-treated gene expression profiles. We have demonstrated utility through its application to transcriptome data, including microarray and RNASeq data, and the drug-disease prediction results were validated using existing publications and drug databases. It is also applicable to other quantitative profiling data such as proteomics data. We also provide an interactive web interface to allow our Prediction of Drug-Disease method to be readily applied to user data. While our studies represent a preliminary exploration of this critical problem, we believe that the algorithm can provide the basis for further refinement towards addressing a large clinical need.

Occurrence and Speciation of Polymeric Chromium(III), Monomeric Chromium(III) and Chromium(VI) in Environmental Samples

PubMed Central

HU, LIGANG; CAI, YONG; JIANG, GUIBIN

2016-01-01

Laboratory experiments suggest that polymeric Cr(III) could exist in aqueous solution for a relative long period of time. However, the occurrence of polymeric Cr(III) has not been reported in environmental media due partially to the lack of method for speciating polymeric Cr. We observed an unknown Cr species during the course of study on speciation of Cr in the leachates of chromated-copper-arsenate (CCA)-treated wood. Efforts were made to identify structure of the unknown Cr species. Considering the forms of Cr existed in the CCA-treated woods, we mainly focused our efforts to determine if the unknown species were polymeric Cr(III), complex of Cr/As or complex of Cr with dissolved organic matter (DOM). In order to evaluate whether polymeric Cr(III) largely exist in wood leachates, high performance liquid chromatography coupled with inductively coupled mass spectrometry (HPLC-ICPMS was used) for simultaneous speciation of monomeric Cr(III), polymeric Cr(III), and Cr(VI). In addition to wood leachates where polymeric Cr (III) ranged from 39.1 to 67.4 %, occurrence of the unknown Cr species in other environmental matrices, including surface waters, tap and waste waters, was also investigated. It was found that polymeric Cr(III) could exist in environmental samples containing μg/L level of Cr, at a level up to 60% of total Cr, suggesting that polymeric Cr(III) could significantly exist in natural environments. Failure in quantifying polymeric Cr(III) would lead to the underestimation of total Cr and bias in Cr speciation. The environmental implication of the presence of polymeric Cr(III) species in the environment deserves further study. PMID:27156211

Neonatal abstinence syndrome: Historical perspective, current focus, future directions.

PubMed

Jones, Hendrée E; Fielder, Andrea

2015-11-01

Neonatal abstinence syndrome (NAS) occurs following prenatal opioid exposure. It is characterized by signs and symptoms indicating central nervous system hyperirritability and autonomic nervous system, gastrointestinal tract, and respiratory system dysfunction. This article: (1) briefly reviews NAS history, including initial identification, assessment, and treatment efforts; (2) summarizes the current status of and current issues surrounding recent NAS assessment and treatment, and (3) details future directions in NAS conceptualization, measurement, and treatment. Mortality rate estimates in neonates treated for NAS exceeded 33%, and surpassed 90% for un-treated infants during the late-1800s until the mid-1900s. The focus of both assessment and treatment over the past 50years is predominantly due to two forces. First, methadone pharmacotherapy for "heroin addiction" led to women in methadone maintenance programs who were, or became pregnant. The second was defining NAS and developing a measure of neonatal withdrawal, the Neonatal Abstinence Scoring System (NASS). Various NAS treatment protocols were based on the NASS as well as other NAS measures. Future research must focus on psychometrically sound screening and assessment measures of neonatal opioid withdrawal for premature, term and older infants, measuring and treating possible withdrawal from non-opioids, particularly benzodiazepines, integrated non-pharmacological treatment of NAS, weight-based versus symptom-based treatment of NAS, and second-line treatment for NAS. Copyright © 2015 Elsevier Inc. All rights reserved.

What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs.

PubMed

Adler, Abby D; Strunk, Daniel R; Fazio, Russell H

2015-01-01

This study examined effortful cognitive skills and underlying maladaptive beliefs among patients treated with cognitive therapy (CT) for depression. Depressed patients (n=44) completed cognitive measures before and after 16 weeks of CT. Measures included an assessment of CT skills (Ways of Responding Scale; WOR), an implicit test of maladaptive beliefs (Implicit Association Test; IAT), and a self-report questionnaire of maladaptive beliefs (Dysfunctional Attitude Scale; DAS). A matched sample of never-depressed participants (n=44) also completed study measures. Prior to treatment, depressed patients endorsed significantly more undesirable cognitions on the WOR, IAT, and DAS compared with never-depressed participants. Patients displayed improvement on the WOR and DAS over the course of treatment, but showed no change on the IAT. Additionally, improvements on the WOR and DAS were each related to greater reductions in depressive symptoms. Results suggest that the degree of symptom reduction among patients participating in CT is related to changes in patients' acquisition of coping skills requiring deliberate efforts and reflective thought, but not related to reduced endorsement of implicitly assessed maladaptive beliefs. Copyright © 2014. Published by Elsevier Ltd.

Strategic Planning to Reduce the Burden of Stroke among Veterans: Using Simulation Modeling to Inform Decision Making

PubMed Central

Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A.; Williams, Linda S.; Bravata, Dawn M.; Cheng, Eric M.; Bosworth, Hayden B.; Homer, Jack B.; Matchar, David B.

2014-01-01

Background and Purpose Reducing the burden of stroke is a priority for the Veterans Affairs (VA) Health System, reflected by the creation of the VA Stroke Quality Enhancement Research Initiative (QUERI). To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the United States Veteran population to inform policy and practice. Methods A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20-year) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented and the number-needed-to-treat (NNT) per QALY gained. Results At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Conclusions Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of NNT per QALY gained. PMID:24923722

Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned.

PubMed

Bilski, Tracy R; Baker, Bruce C; Grove, Jay R; Hinks, Robert P; Harrison, Michael J; Sabra, John P; Temerlin, Steven M; Rhee, Peter

2003-05-01

Operation Enduring Freedom is an effort to combat terrorism after an attack on the United States. The first large-scale troop movement (> 1,300) was made by the U.S. Marines into the country of Afghanistan by establishing Camp Rhino. Data were entered into a personal computer at Camp Rhino, using combat casualty collecting software. Surgical support at Camp Rhino consisted of two surgical teams (12 personnel each), who set up two operating tables in one tent. During the 6-week period, a total of 46 casualties were treated, and all were a result of blast or blunt injury. One casualty required immediate surgery, two required thoracostomy tube, and the remainder received fracture stabilization or wound care before being transported out of Afghanistan. The casualties received 6 major surgical procedures and 11 minor procedures, which included fracture fixations. There was one killed in action and one expectant patient. The major problem faced was long delay in access to initial surgical care, which was more than 5 hours and 2 hours for two of the casualties. Smaller, more mobile surgical teams will be needed more frequently in future military operations because of inability to set up current larger surgical facilities, and major problems will include long transport times. Future improvements to the system should emphasize casualty evacuation, en-route care, and joint operations planning between services.

Metastatic prostate cancer in the modern era of PSA screening

PubMed Central

Fontenot, Philip A.; Nehra, Avinash; Parker, William; Wyre, Hadley; Mirza, Moben; Duchene, David A.; Holzbeierlein, Jeffrey; Thrasher, James Brantley; Veldhuizen, Peter Van; Lee, Eugene K.

2017-01-01

ABSTRACT Introduction To characterize initial presentation and PSA screening status in a contemporary cohort of men treated for metastatic prostate cancer at our institution. Materials and methods We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respectively, and developed metastases. Groups 3 and 4 had asymptomatic and symptomatic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening. Results Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis. Conclusion Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after definitive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screening at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened. PMID:28338310

Neuroblastoma: treatment outcome after incomplete resection of primary tumors.

PubMed

Moon, Suk-Bae; Park, Kwi-Won; Jung, Sung-Eun; Youn, Woong-Jae

2009-09-01

For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection. The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group. Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive. For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents.

The Emergence of Ebola as a Global Health Security Threat: From ‘Lessons Learned’ to Coordinated Multilateral Containment Efforts

PubMed Central

Kalra, Sarathi; Kelkar, Dhanashree; Galwankar, Sagar C.; Papadimos, Thomas J.; Stawicki, Stanislaw P.; Arquilla, Bonnie; Hoey, Brian A.; Sharpe, Richard P.; Sabol, Donna; Jahre, Jeffrey A.

2014-01-01

First reported in remote villages of Africa in the 1970s, the Ebolavirus was originally believed to be transmitted to people from wild animals. Ebolavirus (EBOV) causes a severe, frequently fatal hemorrhagic syndrome in humans. Each outbreak of the Ebolavirus over the last three decades has perpetuated fear and economic turmoil among the local and regional populations in Africa. Until now it has been considered a tragic malady confined largely to the isolated regions of the African continent, but it is no longer so. The frequency of outbreaks has increased since the 1970s. The 2014 Ebola outbreak in Western Africa has been the most severe in history and was declared a public health emergency by the World Health Organization. Given the widespread use of modern transportation and global travel, the EBOV is now a risk to the entire Global Village, with intercontinental transmission only an airplane flight away. Clinically, symptoms typically appear after an incubation period of approximately 11 days. A flu-like syndrome can progress to full hemorrhagic fever with multiorgan failure, and frequently, death. Diagnosis is confirmed by detection of viral antigens or Ribonucleic acid (RNA) in the blood or other body fluids. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. The treatment involves early, aggressive supportive care with rehydration. Core interventions, including contact tracing, preventive initiatives, active surveillance, effective isolation and quarantine procedures, and timely response to patients, are essential for a successful outbreak control. These measures, combined with public health education, point-of-care diagnostics, promising new vaccine and pharmaceutical efforts, and coordinated efforts of the international community, give new hope to the Global effort to eliminate Ebola as a public health threat. Here we present a review of EBOV infection in an effort to further educate medical and political communities on what the Ebolavirus disease entails, and what efforts are recommended to treat, isolate, and eventually eliminate it. PMID:25538455

The emergence of ebola as a global health security threat: from 'lessons learned' to coordinated multilateral containment efforts.

PubMed

Kalra, Sarathi; Kelkar, Dhanashree; Galwankar, Sagar C; Papadimos, Thomas J; Stawicki, Stanislaw P; Arquilla, Bonnie; Hoey, Brian A; Sharpe, Richard P; Sabol, Donna; Jahre, Jeffrey A

2014-10-01

First reported in remote villages of Africa in the 1970s, the Ebolavirus was originally believed to be transmitted to people from wild animals. Ebolavirus (EBOV) causes a severe, frequently fatal hemorrhagic syndrome in humans. Each outbreak of the Ebolavirus over the last three decades has perpetuated fear and economic turmoil among the local and regional populations in Africa. Until now it has been considered a tragic malady confined largely to the isolated regions of the African continent, but it is no longer so. The frequency of outbreaks has increased since the 1970s. The 2014 Ebola outbreak in Western Africa has been the most severe in history and was declared a public health emergency by the World Health Organization. Given the widespread use of modern transportation and global travel, the EBOV is now a risk to the entire Global Village, with intercontinental transmission only an airplane flight away. Clinically, symptoms typically appear after an incubation period of approximately 11 days. A flu-like syndrome can progress to full hemorrhagic fever with multiorgan failure, and frequently, death. Diagnosis is confirmed by detection of viral antigens or Ribonucleic acid (RNA) in the blood or other body fluids. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. The treatment involves early, aggressive supportive care with rehydration. Core interventions, including contact tracing, preventive initiatives, active surveillance, effective isolation and quarantine procedures, and timely response to patients, are essential for a successful outbreak control. These measures, combined with public health education, point-of-care diagnostics, promising new vaccine and pharmaceutical efforts, and coordinated efforts of the international community, give new hope to the Global effort to eliminate Ebola as a public health threat. Here we present a review of EBOV infection in an effort to further educate medical and political communities on what the Ebolavirus disease entails, and what efforts are recommended to treat, isolate, and eventually eliminate it.

Off-the-Shelf Virus-Specific T Cells to Treat BK Virus, Human Herpesvirus 6, Cytomegalovirus, Epstein-Barr Virus, and Adenovirus Infections After Allogeneic Hematopoietic Stem-Cell Transplantation.

PubMed

Tzannou, Ifigeneia; Papadopoulou, Anastasia; Naik, Swati; Leung, Kathryn; Martinez, Caridad A; Ramos, Carlos A; Carrum, George; Sasa, Ghadir; Lulla, Premal; Watanabe, Ayumi; Kuvalekar, Manik; Gee, Adrian P; Wu, Meng-Fen; Liu, Hao; Grilley, Bambi J; Krance, Robert A; Gottschalk, Stephen; Brenner, Malcolm K; Rooney, Cliona M; Heslop, Helen E; Leen, Ann M; Omer, Bilal

2017-11-01

Purpose Improvement of cure rates for patients treated with allogeneic hematopoietic stem-cell transplantation (HSCT) will require efforts to decrease treatment-related mortality from severe viral infections. Adoptively transferred virus-specific T cells (VSTs) generated from eligible, third-party donors could provide broad antiviral protection to recipients of HSCT as an immediately available off-the-shelf product. Patient and Methods We generated a bank of VSTs that recognized five common viral pathogens: Epstein-Barr virus (EBV), adenovirus (AdV), cytomegalovirus (CMV), BK virus (BKV), and human herpesvirus 6 (HHV-6). The VSTs were administered to 38 patients with 45 infections in a phase II clinical trial. Results A single infusion produced a cumulative complete or partial response rate of 92% (95% CI, 78.1% to 98.3%) overall and the following rates by virus: 100% for BKV (n = 16), 94% for CMV (n = 17), 71% for AdV (n = 7), 100% for EBV (n = 2), and 67% for HHV-6 (n = 3). Clinical benefit was achieved in 31 patients treated for one infection and in seven patients treated for multiple coincident infections. Thirteen of 14 patients treated for BKV-associated hemorrhagic cystitis experienced complete resolution of gross hematuria by week 6. Infusions were safe, and only two occurrences of de novo graft-versus host disease (grade 1) were observed. VST tracking by epitope profiling revealed persistence of functional VSTs of third-party origin for up to 12 weeks. Conclusion The use of banked VSTs is a feasible, safe, and effective approach to treat severe and drug-refractory infections after HSCT, including infections from two viruses (BKV and HHV-6) that had never been targeted previously with an off-the-shelf product. Furthermore, the multispecificity of the VSTs ensures extensive antiviral coverage, which facilitates the treatment of patients with multiple infections.

Predictors of change in depressive symptoms from preschool to first grade.

PubMed

Reinfjell, Trude; Kårstad, Silja Berg; Berg-Nielsen, Turid Suzanne; Luby, Joan L; Wichstrøm, Lars

2016-11-01

Children's depressive symptoms in the transition from preschool to school are rarely investigated. We therefore tested whether children's temperament (effortful control and negative affect), social skills, child psychopathology, environmental stressors (life events), parental accuracy of predicting their child's emotion understanding (parental accuracy), parental emotional availability, and parental depression predict changes in depressive symptoms from preschool to first grade. Parents of a community sample of 995 4-year-olds were interviewed using the Preschool Age Psychiatric Assessment. The children and parents were reassessed when the children started first grade (n = 795). The results showed that DSM-5 defined depressive symptoms increased. Child temperamental negative affect and parental depression predicted increased, whereas social skills predicted decreased, depressive symptoms. However, such social skills were only protective among children with low and medium effortful control. Further, high parental accuracy proved protective among children with low effortful control and high negative affect. Thus, interventions that treat parental depression may be important for young children. Children with low effortful control and high negative affect may especially benefit from having parents who accurately perceive their emotional understanding. Efforts to enhance social skills may prove particularly important for children with low or medium effortful control.

A Concentrated Effort

ERIC Educational Resources Information Center

Lum, Lydia

2010-01-01

For years, New York health-care providers have treated Asian-Americans afflicted by serious, even life-threatening illnesses with ever-increasing frequency. Many doctors in the nation's largest city agreed that Asians seemed particularly at risk for specific health problems, but there was neither research nor statistics supporting physician…

Transferring Minority Employees: Are They Being Treated Fairly?

ERIC Educational Resources Information Center

Moore, John M.

1975-01-01

As corporations try to relocate and hire minority group members in all categories of employment, they may be ignoring a very basic problem, their housing needs. Discriminatory home pricing and financing policies may severely restrict a company's efforts to remain an equal opportunity employer. (Author)

Teaching Russian Civilization.

ERIC Educational Resources Information Center

Vakar, Nicholas

1949-01-01

Prior to World War Two, Slavic studies in America treated history, literature, and language as isolated disciplines and often neglected the study of Russian literature written after 1917. The pragmatic necessities of the war questioned the relevance of this traditional approach and specialists appeared, concentrating their efforts on the recent…

Two stage surgical procedure for root coverage

PubMed Central

George, Anjana Mary; Rajesh, K. S.; Hegde, Shashikanth; Kumar, Arun

2012-01-01

Gingival recession may present problems that include root sensitivity, esthetic concern, and predilection to root caries, cervical abrasion and compromising of a restorative effort. When marginal tissue health cannot be maintained and recession is deep, the need for treatment arises. This literature has documented that recession can be successfully treated by means of a two stage surgical approach, the first stage consisting of creation of attached gingiva by means of free gingival graft, and in the second stage, a lateral sliding flap of grafted tissue to cover the recession. This indirect technique ensures development of an adequate width of attached gingiva. The outcome of this technique suggests that two stage surgical procedures are highly predictable for root coverage in case of isolated deep recession and lack of attached gingiva. PMID:23162343

Sexually transmitted diseases in women--something can be done!

PubMed

Felman, Y M

1981-03-01

Women with sexually transmitted diseases (STDs) are largely asymptomatic, and even in the presence of symptoms are frequently misdiagnosed. The "stigma of VD" perpetuates this problem, such that both patient and physician are too embarrassed to suggest appropriate STD diagnostic tests. Imperatives for the reduction of STDs include increasing federal appropriations for STD control, improving STD training for health professionals, openly advertising condoms, and equipping clinical facilities likely to see women harboring STDs with the means to diagnose and treat. The development of serologic tests and vaccines against gonorrhea, chlamydia and herpes is an additional objective that would benefit women. A multifaceted approach combining the efforts of women's groups, family physicians, gynecologists, nurse practitioners and public health educators will be required to effectively handle the problem of STDs in women.

An update on vinpocetine: New discoveries and clinical implications.

PubMed

Zhang, Yi-Shuai; Li, Jian-Dong; Yan, Chen

2018-01-15

Vinpocetine, a derivative of the alkaloid vincamine, has been clinically used in many countries for treatment of cerebrovascular disorders such as stroke and dementia for more than 30 years. Currently, vinpocetine is also available in the market as a dietary supplement to enhance cognition and memory. Due to its excellent safety profile, increasing efforts have been put into exploring the novel therapeutic effects and mechanism of actions of vinpocetine in various cell types and disease models. Recent studies have revealed a number of novel functions of vinpocetine, including anti-inflammation, antagonizing injury-induced vascular remodeling and high-fat-diet-induced atherosclerosis, as well as attenuating pathological cardiac remodeling. These novel findings may facilitate the repositioning of vinpocetine for preventing or treating relevant disorders in humans. Copyright © 2017 Elsevier B.V. All rights reserved.

Pharmacogenomics of Cisplatin Sensitivity in Non-small Cell Lung Cancer

PubMed Central

Rose, Maimon C.; Kostyanovskaya, Elina; Huang, R. Stephanie

2014-01-01

Cisplatin, a platinum-based chemotherapeutic drug, has been used for over 30 years in a wide variety of cancers with varying degrees of success. In particular, cisplatin has been used to treat late stage non-small cell lung cancer (NSCLC) as the standard of care. However, therapeutic outcomes vary from patient to patient. Considerable efforts have been invested to identify biomarkers that can be used to predict cisplatin sensitivity in NSCLC. Here we reviewed current evidence for cisplatin sensitivity biomarkers in NSCLC. We focused on several key pathways, including nucleotide excision repair, drug transport and metabolism. Both expression and germline DNA variation were evaluated in these key pathways. Current evidence suggests that cisplatin-based treatment could be improved by the use of these biomarkers. PMID:25449594

PROCEEDINGS: EIGHTH SYMPOSIUM ON THE TRANSFER AND UTILIZATION OF PARTICULATE CONTROL TECHNOLOGY - VOLUME 1. ELECTROSTATIC PRECIPITATORS

EPA Science Inventory

The two-volume proceedings describe the latest research and development efforts to improve particulate control devices, while treating traditional concerns of operational cost and compliance. Overall, particulate control remains a key issue in the cost and applicability of furnac...

Hormones that Stimulate the Growth of Blood Cells.

ERIC Educational Resources Information Center

Golde, David W.; Gasson, Judith C.

1988-01-01

Describes the nature and action of hematopoietic proteins which regulate the production of specific sets of blood cells. Discusses the production of these hematopoietins by recombinant-DNA methods in an effort to enable physicians to treat patients by eliciting production of specific types of blood cells. (CW)

REDUCTION OF NITROSOBENZENES AND N-HYDROXYLANILINES BY FE (II) SPECIES: ELUCIDATION OF REACTION MECHANISM

EPA Science Inventory

There has been a substantial effort toward understanding the reduction of nitroaromatics in Fe(II)-treated ferric oxide systems, little has been done to gain insight into the factors controlling the transformation of their reaction intermediates, nitrosobenzenes and N-hydroxylani...

Microgravity

NASA Image and Video Library

2004-04-15

Biomedical research offers hope for a variety of medical problems, from diabetes to the replacement of damaged bone and tissues. Bioreactors, which are used to grow cells and tissue cultures, play a major role in such research and production efforts. Cell culturing, such as this bone cell culture, is an important part of biomedical research. The BioDyn payload includes a tissue engineering investigation. The commercial affiliate, Millenium Biologix, Inc., has been conducting bone implant experiments to better understand how synthetic bone can be used to treat bone-related illnesses and bone damaged in accidents. On STS-95, the BioDyn payload will include a bone cell culture aimed to help develop this commercial synthetic bone product. Millenium Biologix, Inc., is exploring the potential for making human bone implantable materials by seeding its proprietary artificial scaffold material with human bone cells. The product of this tissue engineering experiment using the Bioprocessing Modules (BPMs) on STS-95 is space-grown bone implants, which could have potential for dental implants, long bone grafts, and coating for orthopedic implants such as hip replacements.

Microgravity

NASA Image and Video Library

2004-04-15

Biomedical research offers hope for a variety of medical problems, from diabetes to the replacement of damaged bone and tissues. Bioreactors, which are used to grow cells and tissue cultures, play a major role in such research and production efforts. Cell culturing, such as this bone cell culture, is an important part of biomedical research. The BioDyn payload includes a tissue engineering investigation. The commercial affiliate, Millenium Biologix, Inc. has been conducting bone implant experiments to better understand how synthetic bone can be used to treat bone-related illnesses and bone damaged in accidents. On STS-95, the BioDyn payload will include a bone cell culture aimed to help develop this commercial synthetic bone product. Millenium Biologix, Inc. is exploring the potential for making human bone implantable materials by seeding its proprietary artificial scaffold material with human bone cells. The product of this tissue engineering experiment using the Bioprocessing Modules (BPMs) on STS-95 is space-grown bone implants, which could have potential for dental implants, long bone grafts, and coating for orthopedic implants such as hip replacements.

Distinct cellular properties of oncogenic KIT receptor tyrosine kinase mutants enable alternative courses of cancer cell inhibition

PubMed Central

Shi, Xiarong; Sousa, Leiliane P.; Mandel-Bausch, Elizabeth M.; Tome, Francisco; Reshetnyak, Andrey V.; Hadari, Yaron; Schlessinger, Joseph; Lax, Irit

2016-01-01

Large genomic sequencing analysis as part of precision medicine efforts revealed numerous activating mutations in receptor tyrosine kinases, including KIT. Unfortunately, a single approach is not effective for inhibiting cancer cells or treating cancers driven by all known oncogenic KIT mutants. Here, we show that each of the six major KIT oncogenic mutants exhibits different enzymatic, cellular, and dynamic properties and responds distinctly to different KIT inhibitors. One class of KIT mutants responded well to anti-KIT antibody treatment alone or in combination with a low dose of tyrosine kinase inhibitors (TKIs). A second class of KIT mutants, including a mutant resistant to imatinib treatment, responded well to a combination of TKI with anti-KIT antibodies or to anti-KIT toxin conjugates, respectively. We conclude that the preferred choice of precision medicine treatments for cancers driven by activated KIT and other RTKs may rely on clear understanding of the dynamic properties of oncogenic mutants. PMID:27482095

Development of a System to Assess Biofilm Formation in the International Space Station

NASA Technical Reports Server (NTRS)

Martin Charles, E.; Summers, Silvia M.; Roman, Monserrate C.

1998-01-01

The design requirements for the water treatment systems aboard the International Space Station (ISS) include and require recycling as much water as possible and to treat the water for intentional contamination (hygiene, urine distillate, condensate, etc.) and unintentional contamination in the form of biofilm and microorganisms. As part of an effort to address the latter issue, a biofilm system was developed by Marshall Space Flight Center (MSFC) to simulate the conditions aboard ISS with respect to materials, flow rates, water conditions, water content, and handling. The tubing, connectors, sensors, and fabricated parts included in the system were chosen for specific attributes as applicable to emulate an orbital water treatment system. This paper addresses the design and development process of the system, as well as the configuration, operation, and system procedures for maintenance to assure that the simulation is valid for the representative data as it applies to water degradation and biofilm/microbial growth. Preliminary biofilm/microbial results are also presented.

Lessons from a national audit of acute pancreatitis: A summary of the NCEPOD report 'Treat the Cause'.

PubMed

O'Reilly, D A; McPherson, S J; Sinclair, M T; Smith, N

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is an independent organisation whose remit is to review the quality of medical and surgical care provided in the United Kingdom. We undertook a review into the care provided to patients treated for acute pancreatitis during a 6 month study period between 1st January and 30th June 2014. This included assessment of care at an organisational level, clinical level within hospitals and external peer review. From a random sample, 712 patients underwent hospital clinician review and 418 patients had external peer review. Overall, we found that there was room for improvement in care in over 50% of patients with acute pancreatitis. Case reviewers felt that efforts to prevent recurrent episodes due to gallstones and alcohol were inadequate as 21% of patients in the study had one or more previous episodes of acute pancreatitis. Aspects of general care where improvements could be made include better antibiotic stewardship; as 1/5 of patients were considered to have been given antibiotics unnecessarily. Overall management of the patients' nutrition was considered adequate by the case reviewers in only 85% of cases. The use of an early warning score was omitted in 31% of emergency department admissions. Recommendations include standardised early warning scoring systems to be used throughout the hospital and commenced in the emergency department. The development of better networking arrangements and regional pancreatitis units, with shared management guidelines, is also essential to improve the coordination of care. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Liquid secondary waste: Waste form formulation and qualification

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

Cozzi, A. D.; Dixon, K. L.; Hill, K. A.

The Hanford Site Effluent Treatment Facility (ETF) currently treats aqueous waste streams generated during site cleanup activities. When the Hanford Tank Waste Treatment and Immobilization Plant (WTP) begins operations, including Direct Feed Low Activity Waste (DFLAW) vitrification, a liquid secondary waste (LSW) stream from the WTP will need to be treated. The volume of effluent for treatment at the ETF will increase significantly. The powdered salt waste form produced by the ETF will be replaced by a stabilized solidified waste form for disposal in Hanford’s Integrated Disposal Facility (IDF). Washington River Protection Solutions is implementing a Secondary Liquid Waste Immobilizationmore » Technology Development Plan to address the technology needs for a waste form and solidification process to treat the increased volume of waste planned for disposal at the IDF. Waste form testing to support this plan is composed of work in the near term to provide data as input to a performance assessment (PA) for Hanford’s IDF. In 2015, three Hanford Liquid Secondary Waste simulants were developed based on existing and projected waste streams. Using these waste simulants, fourteen mixes of Hanford Liquid Secondary Waste were prepared and tested varying the waste simulant, the water-to-dry materials ratio, and the dry materials blend composition.1 In FY16, testing was performed using a simulant of the EMF process condensate blended with the caustic scrubber—from the Low Activity Waste (LAW) melter—, processed through the ETF. The initial EMF-16 simulant will be based on modeling efforts performed to determine the mass balance of the ETF for the DFLAW.2 The compressive strength of all of the mixes exceeded the target of 3.4 MPa (500 psi) to meet the requirements identified as potential IDF Waste Acceptance Criteria in Table 1 of the Secondary Liquid Waste Immobilization Technology Development Plan.3 The hydraulic properties of the waste forms tested (hydraulic conductivity and water characteristic curves) were comparable to the properties measured on the Savannah River Site (SRS) Saltstone waste form. Future testing should include efforts to first; 1) determine the rate and amount of ammonia released during each unit operation of the treatment process to determine if additional ammonia management is required, then; 2) reduce the ammonia content of the ETF concentrated brine prior to solidification, making the waste more amenable to grouting, or 3) manage the release of ammonia during production and ongoing release during storage of the waste form, or 4) develop a lower pH process/waste form thereby precluding ammonia release.« less

Gas Sensors Based on Coated and Doped Carbon Nanotubes

NASA Technical Reports Server (NTRS)

Li, Jing; Meyyappan, Meyya

2008-01-01

Efforts are underway to develop inexpensive, low-power electronic sensors, based on single-walled carbon nanotubes (SWCNTs), for measuring part-per-million and part-per-billion of selected gases (small molecules) at room temperature. Chemically unmodified SWCNTs are mostly unresponsive to typical gases that one might wish to detect. However, the electrical resistances of SWCNTs can be made to vary with concentrations of gases of interest by coating or doping the SWCNTs with suitable materials. Accordingly, the basic idea of the present development efforts is to incorporate thus-treated SWCNTs into electronic devices that measure their electrical resistances.

Stem Cell Therapies for Treating Diabetes: Progress and Remaining Challenges.

PubMed

Sneddon, Julie B; Tang, Qizhi; Stock, Peter; Bluestone, Jeffrey A; Roy, Shuvo; Desai, Tejal; Hebrok, Matthias

2018-06-01

Restoration of insulin independence and normoglycemia has been the overarching goal in diabetes research and therapy. While whole-organ and islet transplantation have become gold-standard procedures in achieving glucose control in diabetic patients, the profound lack of suitable donor tissues severely hampers the broad application of these therapies. Here, we describe current efforts aimed at generating a sustainable source of functional human stem cell-derived insulin-producing islet cells for cell transplantation and present state-of-the-art efforts to protect such cells via immune modulation and encapsulation strategies. Copyright © 2018. Published by Elsevier Inc.

Neurological Surgery at the National Institutes of Health

PubMed Central

Mehta, Gautam U.; Heiss, John D.; Park, John K.; Asthagiri, Ashok R.; Lonser, Russell R.

2010-01-01

The Surgical Neurology Branch (SNB) in the intramural program of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health has been a unique setting for academic neurosurgery for nearly 60 years. Every patient evaluated and treated in the SNB is enrolled in a clinical research protocol, which underscores a singular focus on advancing neurosurgical research and patient care. Since the inception of the SNB, this research effort has been driven by dedicated clinician-investigators and basic scientists including Maitland Baldwin, Igor Klatzo, John M. Van Buren, Ayub K. Ommaya, Richard J. Youle and Edward H. Oldfield. These and other SNB investigators have studied and advanced treatment of a number of neuropathologic processes including delineation of differences between cytotoxic and vasogenic edema, head injury, Cushing’s disease, the effects of vascular endothelial growth factor in nervous system tissues, tumor suppressor syndromes, the pathophysiology of syringomyelia, mechanisms underlying cerebral vasospasm after subarachnoid hemorrhage, spinal arteriovenous malformations, mechanisms of cell death and drug delivery. Currently, SNB efforts are focused on central nervous system drug-delivery, the natural history of familial tumor syndromes, functional neurosurgery, epilepsy, vasospasm and development of chemotherapeutics for malignant glioma. Throughout its history, the SNB has also been dedicated to training neurosurgeon clinician-investigators; 22 previous fellows/staff have become Chairs of their respective neurosurgical departments. Recently, the commitment to training future neurosurgeon clinician-investigators has been further defined with the development of a residency-training program in neurological surgery approved in 2010. PMID:21278842

Effortful Control, Explicit Processing, and the Regulation of Human Evolved Predispositions

ERIC Educational Resources Information Center

MacDonald, Kevin B.

2008-01-01

This article analyzes the effortful control of automatic processing related to social and emotional behavior, including control over evolved modules designed to solve problems of survival and reproduction that were recurrent over evolutionary time. The inputs to effortful control mechanisms include a wide range of nonrecurrent…

Integrated processes for desalination and salt production: A mini-review

NASA Astrophysics Data System (ADS)

Wenten, I. Gede; Ariono, Danu; Purwasasmita, Mubiar; Khoirudin

2017-03-01

The scarcity of fresh water due to the rapid growth of population and industrial activities has increased attention on desalination process as an alternative freshwater supply. In desalination process, a large volume of saline water is treated to produce freshwater while a concentrated brine is discharged back into the environment. The concentrated brine contains a high concentration of salt and also chemicals used during desalination operations. Due to environmental impacts arising from improper treatment of the brine and more rigorous regulations of the pollution control, many efforts have been devoted to minimize, treat, or reuse the rejected brine. One of the most promising alternatives for brine handling is reusing the brine which can reduce pollution, minimize waste volume, and recover valuable salt. Integration of desalination and salt production can be implemented to reuse the brine by recovering water and the valuable salts. The integrated processes can achieve zero liquid discharge, increase water recovery, and produce the profitable salt which can reduce the overall desalination cost. This paper gives an overview of desalination processes and the brine impacts. The integrated processes, including their progress and advantages in dual-purpose desalination and salt production are discussed.

Wholesomeness of irradiated food

NASA Astrophysics Data System (ADS)

Ehlermann, Dieter A. E.

2016-12-01

Just with the emergence of the idea to treat food by ionizing radiation, the concerns were voiced whether it would be safe to consume such food. Now, we look back on more than hundred years of research into the 'wholesomeness', a terminology developed during those efforts. This review will cover the many questions which had been raised, explaining the most relevant ones in some detail; it will also give place to the concerns and elucidate their scientific relevance and background. There has never been any other method of food processing studied in such depth and in such detail as food irradiation. The conclusion based on science is: Consumption of any food treated at any high dose is safe, as long as the food remains palatable. This conclusion has been adopted by WHO, also by international and national bodies. Finally, this finding has also been adopted by Codex Alimentarius in 2003, the international standard for food. However, this conclusion has not been adopted and included at its full extent in most national regulations. As the literature about wholesomeness of irradiated food is abundant, this review will use only a few, most relevant references, which will guide the reader to further reading.

Influence of manual therapy on functional mobility after joint injury in a rat model.

PubMed

Ruhlen, Rachel L; Snider, Eric J; Sargentini, Neil J; Worthington, Bart D; Singh, Vineet K; Pazdernik, Vanessa K; Johnson, Jane C; Degenhardt, Brian F

2013-10-01

Animal models can be used to investigate manual therapy mechanisms, but testing manipulation in animal models is problematic because animals cannot directly report their pain. To develop a rat model of inflammatory joint injury to test the efficacy of manual therapy in reducing nociception and restoring function. The authors induced acute inflammatory joint injury in rats by injecting carrageenan into the ankle and then measured voluntary running wheel activity in treated and untreated rats. Treatments included manual therapy applied to the ankle and knee of the injured limb and several analgesic medications (eg, morphine, ketorolac, prednisone). Intra-articular injection of carrageenan to the ankle produced significant swelling (diameter of the ankle increased by 64% after injection; P=.004) and a robust reduction in voluntary running wheel activity (running distance reduced by 91% compared with controls; P<.001). Injured rats gradually returned to running levels equal to controls over 10 days. Neither manual therapy nor analgesic medications increased running wheel activity relative to untreated rats. Voluntary running wheel activity appears to be an appropriate functional measure to evaluate the impact of an acute inflammatory joint injury. However, efforts to treat the injury did not restore running relative to untreated rats.

[Limitations and Problems with Treatment of Eating Disorders in a Psychiatric Hospital].

PubMed

Amayasu, Hideaki; Okubo, Momoe; Itai, Takahiro

2015-01-01

Treating patients who have eating disorders in psychiatric hospitals is difficult for several reasons. The first reason is that there is a shortage of qualified psychiatrists. For each psychiatrist, there are approximately thirty hospitalized patients. In addition to this limited number of psychiatrists, funding in psychiatric hospitals only provides for a limited number of other medical staff when compared with funding available for general hospitals. The second reason is that there is a problem with the national medical treatment fee system. Specifically, in the current system, patients are not permitted to stay in hospitals long-term; outpatient treatment is preferred. The third reason is that psychiatric hospitals are not equipped to deal with patients who have physical illnesses. The following two case studies highlight the problems and limitations associated with treating patients who have eating disorders. Ways in which psychiatric hospitals can collaborate with other organizations, including low enforcement officials, are also considered. Although it is clear that an integrated and collaborative approach is necessary, implementation of such a system is still a long way from being realized, and greater effort is needed to provide patients suffering from eating disorders with the best possible treatment.

Using opioids to treat dyspnea in advanced COPD

PubMed Central

Young, Joanne; Donahue, Margaret; Farquhar, Morag; Simpson, Cathy; Rocker, Graeme

2012-01-01

Abstract Objective To explore the experiences of family physicians and respiratory therapists in treating advanced chronic obstructive pulmonary disease (COPD) and their attitudes to the use of opioids for dyspnea in this context. Design Qualitative methodology using one-on-one semistructured interviews. Setting Southern New Brunswick (St Stephen to Sussex). Participants Ten family physicians and 8 respiratory therapists who worked in primary care settings. Methods Participant interviews were audiorecorded, transcribed verbatim, coded conceptually, and thematically analyzed using interpretive description. Main findings Participants reported that patients with advanced COPD often suffered from inadequate control of their dyspnea in advanced stages and that they saw the potential value of opioids in this context; however, family physicians described discomfort prescribing opioids. Barriers included insufficient knowledge, lack of education and guidelines, and fear of censure. Those with palliative care experience tended to be more comfortable with opioid prescribing. Conclusion Findings suggest an important need to address barriers related to more effective treatment of refractory dyspnea in advanced COPD. Further, findings indicate these efforts should focus on effective palliation and innovative educational initiatives, as well as the development, promotion, and uptake of evidence-based practice guidelines related to prescribing opioids for these patients. PMID:22798476

Identification and Quantification of Carbon Phases in Conversion Fuel for the Transient Reactor Test Facility

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

Steele, Robert; Mata, Angelica; Dunzik-Gougar, Mary Lou

2016-06-01

As part of an overall effort to convert US research reactors to low-enriched uranium (LEU) fuel use, a LEU conversion fuel is being designed for the Transient Reactor Test Facility (TREAT) at the Idaho National Laboratory. TREAT fuel compacts are comprised of UO2 fuel particles in a graphitic matrix material. In order to refine heat transfer modeling, as well as determine other physical and nuclear characteristics of the fuel, the amount and type of graphite and non-graphite phases within the fuel matrix must be known. In this study, we performed a series of complementary analyses, designed to allow detailed characterizationmore » of the graphite and phenolic resin based fuel matrix. Methods included Scanning Electron and Transmission Electron Microscopies, Raman spectroscopy, X-ray Diffraction, and Dual-Beam Focused Ion Beam Tomography. Our results indicate that no single characterization technique will yield all of the desired information; however, through the use of statistical and empirical data analysis, such as curve fitting, partial least squares regression, volume extrapolation and spectra peak ratios, a degree of certainty for the quantity of each phase can be obtained.« less

The politics of participation in watershed modeling.

PubMed

Korfmacher, K S

2001-02-01

While researchers and decision-makers increasingly recognize the importance of public participation in environmental decision-making, there is less agreement about how to involve the public. One of the most controversial issues is how to involve citizens in producing scientific information. Although this question is relevant to many areas of environmental policy, it has come to the fore in watershed management. Increasingly, the public is becoming involved in the sophisticated computer modeling efforts that have been developed to inform watershed management decisions. These models typically have been treated as technical inputs to the policy process. However, model-building itself involves numerous assumptions, judgments, and decisions that are relevant to the public. This paper examines the politics of public involvement in watershed modeling efforts and proposes five guidelines for good practice for such efforts. Using these guidelines, I analyze four cases in which different approaches to public involvement in the modeling process have been attempted and make recommendations for future efforts to involve communities in watershed modeling. Copyright 2001 Springer-Verlag

A bias for the natural? Children's beliefs about traits acquired through effort, bribes, or medicine.

PubMed

Lockhart, Kristi L; Keil, Frank C; Aw, Justine

2013-09-01

Three studies compared beliefs about natural and late blooming positive traits with those acquired through personal effort, extrinsic rewards or medicine. Young children (5-6 years), older children (8-13 years), and adults all showed a strong bias for natural and late blooming traits over acquired traits. All age groups, except 8- to 10-year-olds, treated natural and late-blooming traits as fixed essences that would persist over time and under challenging conditions. Older children and adults viewed traits acquired by intrinsic effort as more similar to natural and late-blooming traits than those acquired through bribes or medicine, suggesting that intrinsic effort itself comes to be seen as a more natural mechanism of change. A bias for the natural may therefore be an early emerging way of evaluating others that is reinforced by the ambient culture and becomes stronger with increasing age. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Student Unions: The Implications for Colleges and Universities

ERIC Educational Resources Information Center

Felper, David; Dragga, Anthony

2015-01-01

Efforts to unionize students at private universities are gaining momentum. The National Labor Relations Board (NLRB) has agreed to reconsider whether graduate students at private nonprofit colleges and universities should be treated as employees under the National Labor Relations Act. The case, "New School", Case No. 02- RC-143009,…

The Missed Promotion: An Exercise Demonstrating the Importance of Organizational Justice

ERIC Educational Resources Information Center

Caza, Arran; Caza, Brianna Barker; Lind, E. Allan

2011-01-01

Treating employees fairly produces many positive outcomes, but evidence suggests that managers' efforts to be fair are often unsuccessful because they emphasize the wrong aspects of justice. Managers tend to emphasize distributive justice, though employees may be most concerned with procedural and interactional justice. Organizational justice…

The Molecular Biology of Nitroamine Degradation in Soils

DTIC Science & Technology

2015-07-26

analysis and activity assays .............................................................................. 28 Determination of a putative...81 Figure 52: Specific XplA activity in cells treated with different nitrogen sources. .......... 83 Figure 53: Effect of... activity . Our efforts to develop a functional screen for genes from the soil metagenome were unsuccessful. We developed efficient methods of

Treatment for Drug Abusing Offenders during Correctional Supervision: A Nationwide Overview.

ERIC Educational Resources Information Center

Lipton, Douglas S.

1998-01-01

Discusses problems associated with the increasing number of drug offenders in U.S. correctional institutions. Explores the relationship between drugs and crime, the history of treating drug-using offenders, and efforts afoot in the Federal Correctional Options Program and the Bureau of Prisons to rehabilitate these prisoners. (MKA)

Field testing of a low-cost retrofit filter berm to treat stormwater runoff contaminants.

DOT National Transportation Integrated Search

2008-09-01

The goal of this cooperative effort between MaineDOT and the University of New Hampshire was to test a low-cost : retrofit filter berm that would reduce non-point pollution from highway runoff. The retrofit berm would be easy to : construct using rea...

Interventions to Improve Neuropsychological Functioning in Childhood Cancer Survivors

ERIC Educational Resources Information Center

Butler, Robert W.; Sahler, Olle Jane Z.; Askins, Martha A.; Alderfer, Melissa A.; Katz, Ernest R.; Phipps, Sean; Noll, Robert B.

2008-01-01

A very brief historical review on the identification of neurocognitive deficits in patients treated for a pediatric malignancy that involved CNS disease, treatment, or a combination is provided. This review is particularly directed toward providing a foundation upon which the introduction of specific brain injury rehabilitation efforts and…

Separation of Church and State? Remarks on "Rosenberger v. University of Virginia".

ERIC Educational Resources Information Center

Morris, Arval A.

1996-01-01

"Rosenberger" revises Establishment Clause jurisprudence in several aspects: (1) ends "Lemon versus Kurtzman" as a main precedent; (2) alters First Amendment law by holding that government efforts to treat religious speech differently amounts to discrimination against people based on their "viewpoint"; and (3)…

Treating Gulf War Illness with Novel Anti-Inflammatories: A Screening of Botanical Microglia Modulators

DTIC Science & Technology

2017-10-01

at several local Disabled American Veterans chapters to let local veterans know about the opportunity to participate. Every effort is being made to...screens and consult with Emily on potential participant eligibility and inclusion criteria as well as other project questions during a weekly meeting

Design criteria monograph for pressure regulators, relief valves, check valves, burst disks, and explosive valves

NASA Technical Reports Server (NTRS)

1974-01-01

Monograph reviews and assesses current design practices, and from them establishes firm guidance for achieving greater consistency in design, increased reliability in end product, and greater efficiency in design effort. Five devices are treated separately. Guides to aid in configuration selection are outlined.

2013 NCI Alliance for Nanotechnology in Cancer Annual Bulletin

Cancer.gov

The NCI Alliance for Nanotechnology in Cancer Bulletin is a resource that serves to connect Alliance participants, partners, and affiliates by highlighting the innovative work of the Alliance members in their efforts to harness the power of nanotechnology to radically change the way we diagnose, treat, and prevent cancer.

White-tailed Deer Visitation Rates at Medicated Bait Sites in Southern Texas

USDA-ARS?s Scientific Manuscript database

The cattle fever tick, Rhipicephalus (Boophilus) microplus, has been found on white-tailed deer (Odocoileus virginianus) complicating eradication efforts of the USDA’s Cattle Fever Tick Eradication Program. Our objective was to assess patterns of deer visitation to medicated bait sites used to treat...

Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED.

PubMed

Zhang, Xi; Rowan, Nicole; Pflugeisen, Bethann Mangel; Alajbegovic, Sanjin

2017-04-01

Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED. This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression. Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR=4.5, 95% CI: 1.2-17.2; p=0.03) or nitrites (OR=10.8, 95% CI: 1.7-68.1; p=0.01) in the urine and age≥75 (OR=3.5, 95% CI: 1.2-9.6, p=0.02). Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

It takes 2: partner attributes associated with sexually transmitted infections among adolescents.

PubMed

Swartzendruber, Andrea; Zenilman, Jonathan M; Niccolai, Linda M; Kershaw, Trace S; Brown, Jennifer L; Diclemente, Ralph J; Sales, Jessica M

2013-05-01

The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. The design of this study was systematic review. We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.

Safely Converting an Entire Academic Medical Center From Sliding Scale to Basal Bolus Insulin via Implementation of the eGlycemic Management System.

PubMed

Newsom, Rosalina; Patty, Christopher; Camarena, Emma; Sawyer, Regina; McFarland, Raymie; Gray, Thomas; Mabrey, Melanie

2018-01-01

Hyperglycemia is common in the inpatient setting and providers frequently rely on sliding scale insulin. This case study reviews the experience of one hospital moving from high utilization of sliding scale to basal bolus insulin therapy. This Retrospective Quality Improvement Study describes the journey of clinicians at a 580-bed hospital to convert from high usage of SSI to BBI. Hyperglycemic adult patients prescribed insulin, with/without a diagnosis of diabetes, were included. Data over the first year showed that patients treated with Glucommander (GM) spent more time in the target range of 70-180 mg/dL than patients treated with non-Glucommander (non-GM), with 2,434 fewer hypoglycemic events and 40,589 fewer hyperglycemic events. Prior to implementation of GM, SSI was close to 95%, BBI at 5%. Within the first month of use, 96% usage of BBI was achieved. Reduction of hypoglycemic events (% of BG < 70 mg/dL) by 21% with 2.16% non-GM compared to GM at 1.74% and severe Hypoglycemia (% of BG < 50 mg/dL) by 50% in the ICU 3% non-GM compared to GM at 1.5%. In addition, patients treated with GM had a shorter LOS than patients treated with non-GM by 3.18 days and used 47.4% less point of care tests per patient. Glycemic management improved with use of eGMS. The conversion from SSI to BBI enhanced overall patient safety, eliminated the time and effort otherwise required when manually titrating insulin and reduced overall cost of care for patients on insulin therapy.

Healthcare Utilisation and Drug Treatment in a Large Cohort of Patients with Inflammatory Bowel Disease

PubMed Central

Wettermark, Björn; Löfberg, Robert; Eriksson, Irene; Sundström, Johan; Lördal, Mikael

2016-01-01

Background and Aims: Crohn’s disease [CD] and ulcerative colitis [UC] are chronic diseases associated with a substantial utilisation of healthcare resources. We aimed to estimate the prevalence of inflammatory bowel disease [IBD], CD, and UC and to describe and compare healthcare utilisation and drug treatment in CD and UC patients. Methods: This was a cross-sectional study of all patients with a recorded IBD diagnosis in Stockholm County, Sweden. Data on outpatient visits, hospitalisations, surgeries, and drug treatment during 2013 were analysed. Results: A total of 13 916 patients with IBD were identified, corresponding to an overall IBD prevalence of 0.65% [CD 0.27%, UC 0.35%, inflammatory bowel disease unclassified 0.04%]; 49% of all IBD patients were treated with IBD-related drugs. Only 3.6% of the patients received high-dose corticosteroids, whereas 32.4% were treated with aminosalicylates [CD 21.2%, UC 41.0%, p < 0.0001]. More CD patients were treated with biologicals compared with UC patients [CD 9.6%, UC 2.9%, p < 0.0001] and surgery was significantly more common among CD patients [CD 3.0%, UC 0.8%, p < 0.0001]. Conclusions: This study indicates that patients with CD are the group with the highest medical needs. Patients with CD utilised significantly more healthcare resources [including outpatient visits, hospitalisations, and surgeries] than UC patients. Twice as many CD patients received immunomodulators compared with UC patients and CD patients were treated with biologicals three times more often. These results highlight that CD remains a challenge and further efforts are needed to improve care in these patients. PMID:26733406

The effects of reduced dopamine transporter function and chronic lithium on motivation, probabilistic learning, and neurochemistry in mice: Modeling bipolar mania.

PubMed

Milienne-Petiot, Morgane; Kesby, James P; Graves, Mary; van Enkhuizen, Jordy; Semenova, Svetlana; Minassian, Arpi; Markou, Athina; Geyer, Mark A; Young, Jared W

2017-02-01

Bipolar disorder (BD) mania patients exhibit poor cognition and reward-seeking/hypermotivation, negatively impacting a patient's quality of life. Current treatments (e.g., lithium), do not treat such deficits. Treatment development has been limited due to a poor understanding of the neural mechanisms underlying these behaviors. Here, we investigated putative mechanisms underlying cognition and reward-seeking/motivational changes relevant to BD mania patients using two validated mouse models and neurochemical analyses. The effects of reducing dopamine transporter (DAT) functioning via genetic (knockdown vs. wild-type littermates), or pharmacological (GBR12909- vs. vehicle-treated C57BL/6J mice) means were assessed in the probabilistic reversal learning task (PRLT), and progressive ratio breakpoint (PRB) test, during either water or chronic lithium treatment. These tasks quantify reward learning and effortful motivation, respectively. Neurochemistry was performed on brain samples of DAT mutants ± chronic lithium using high performance liquid chromatography. Reduced DAT functioning increased reversals in the PRLT, an effect partially attenuated by chronic lithium. Chronic lithium alone slowed PRLT acquisition. Reduced DAT functioning increased motivation (PRB), an effect attenuated by lithium in GBR12909-treated mice. Neurochemical analyses revealed that DAT knockdown mice exhibited elevated homovanillic acid levels, but that lithium had no effect on these elevated levels. Reducing DAT functioning recreates many aspects of BD mania including hypermotivation and improved reversal learning (switching), as well as elevated homovanillic acid levels. Chronic lithium only exerted main effects, impairing learning and elevating norepinephrine and serotonin levels of mice, not specifically treating the underlying mechanisms identified in these models. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-management of buprenorphine/naloxone among online discussion board users.

PubMed

Brown, Shan-Estelle; Altice, Frederick L

2014-06-01

Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. To identify facilitators of self-treatment by online buprenorphine/naloxone users. A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a "bad-tasting" medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely "substance-free." The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. CONCLUSIONS/IMPORTANCE: The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.

Treatment Options for Infections Caused by Carbapenem-resistant Enterobacteriaceae: Can We Apply “Precision Medicine” to Antimicrobial Chemotherapy?

PubMed Central

Perez, Federico; El Chakhtoura, Nadim G.; Papp-Wallace, Krisztina; Wilson, Brigid M; Bonomo, Robert A.

2016-01-01

Introduction For the past three decades, carbapenems played a central role in our antibiotic armamentarium, trusted to effectively treat infections caused by drug-resistant bacteria. The utility of this class of antibiotics has been compromised by the emergence of resistance especially among Enterobacteriaceae. Areas covered We review the current mainstays of pharmacotherapy against infections caused by carbapenem-resistant Enterobacteriaceae (CRE) including tigecycline, aminoglycosides, and rediscovered 'old' antibiotics such as fosfomycin and polymyxins, and discuss their efficacy and potential toxicity. We also summarize the clinical experience treating CRE infections with antibiotic combination therapy. Finally, we review ceftazidime/avibactam and imipenem/relebactam, a new generation of beta-lactamase inhibitors, which may offer alternatives to treat CRE infections. We critically evaluate the published literature, identify relevant clinical trials and review documents submitted to the United States Food and Drug Administration. Expert Opinion It is essential to define the molecular mechanisms of resistance and to apply insights about pharmacodynamic and pharmacokinetic properties of antibiotics, in order to maximize the impact of old and new therapeutic approaches against infections caused by CRE. A concerted effort is needed to carry out high-quality clinical trials that: i) establish the superiority of combination therapy vs. monotherapy; ii) confirm the role of novel beta-lactam/beta-lactamase inhibitor combinations as therapy against KPC- and OXA-48 producing Enterobacteriaceae; and, iii) evaluate new antibiotics active against CRE as they are introduced into the clinic. PMID:26799840

Low Treatment Adherence in Pubertal Children Treated with Thyroxin or Growth Hormone.

PubMed

Lass, Nina; Reinehr, Thomas

2015-01-01

Treatment outcome depends largely on treatment adherence (TA). However, studies analyzing TA in chronic endocrine diseases are scarce and controversial in childhood. We studied TA in 103 children treated subcutaneously with growth hormone (GH) and 97 children treated orally with thyroxin. TA was calculated based on the prescription refill rates. The number of GH injections was recorded by an autoinjector device in 23 children treated with GH. The correlation between recorded TA and calculated TA based on prescription refill rates was very good (p < 0.001, r = 0.83). TA was lower (p < 0.01) in pubertal children compared to prepubertal children and in children self-administering their medication compared to those whose drug was administered by their parents, both in GH- and thyroxin-treated children. Overall, 67% of the pubertal children treated with GH and 58% of the pubertal children treated with thyroxin missed at least 1 dose per week. TA was higher (p < 0.001) in children with thyroxin treatment compared to children treated with recombinant human GH (8 vs. 26% missed >3 doses/week). Puberty and self-administration of drugs were negative predictors of TA. Therefore, in puberty, prevention and treatment efforts should be undertaken to improve TA, especially when adolescents administer their drugs themselves. © 2015 S. Karger AG, Basel.

Introduction to the special issue: 50th anniversary of APA Division 28: The past, present, and future of psychopharmacology and substance abuse.

PubMed

Stoops, William W; Sigmon, Stacey C; Evans, Suzette M

2016-08-01

This is an introduction to the special issue "50th Anniversary of APA Division 28: The Past, Present, and Future of Psychopharmacology and Substance Abuse." Taken together, the scholarly contributions included in this special issue serve as a testament to the important work conducted by our colleagues over the past five decades. Division 28 and its members have advanced and disseminated knowledge on the behavioral effects of drugs, informed efforts to prevent and treat substance abuse, and influenced education and policy issues more generally. As past and current leaders of the division, we are excited to celebrate 50 years of Division 28 and look forward to many more successful decades for our division and its members. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Characteristics of Project Managers: An Exploration of Complex Projects in the National Aeronautics and Space Administration

NASA Technical Reports Server (NTRS)

Mulenburg, Gerald M.

2000-01-01

Study of characteristics and relationships of project managers of complex projects in the National Aeronautics and Space Administration. Study is based on Research Design, Data Collection, Interviews, Case Studies, and Data Analysis across varying disciplines such as biological research, space research, advanced aeronautical test facilities, aeronautic flight demonstrations, and projects at different NASA centers to ensure that findings were not endemic to one type of project management, or to one Center's management philosophies. Each project is treated as a separate case with the primary data collected during semi-structured interviews with the project manager responsible for the overall project. Results of the various efforts show some definite similarities of characteristics and relationships among the project managers in the study. A model for how the project managers formulated and managed their projects is included.

Recycle of radioactive scrap metal from the Oak Ridge Gaseous Diffusion Plant (K-25 Site)

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

Meehan, R.W.

1997-02-01

The scale of the metal available for reuse at the plant includes 22 million pounds of Ni, 17 million pounds of Al, 47 million pounds of copper, and 835 million pounds of steels. In addition there is a wide range of industrial equipment and other items of value. The author describes small bench scale and pilot plant scale efforts made at treating metal for decontamination and fabrication into cast stock or specialized containers for reuse within the DOE complex or release. These projects show that much of the material can be cleaned or chemically decontaminated to a level where itmore » can be free released to various markets. Of the remaining metals, much of it can be cast into products which can be absorbed within the DOE complex.« less

Delbruck Prize Award: Insights into HIV Dynamics and Cure

NASA Astrophysics Data System (ADS)

Perelson, Alan S.

A large effort is being made to find a means to cure HIV infection. I will present a dynamical model of a phenomenon called post-treatment control (PTC) or functional cure of HIV-infection in which some patients treated with suppressive antiviral therapy have been taken off of therapy and then spontaneously control HIV infection. The model relies on an immune response and bistability to explain PTC. I will then generalize the model to explicitly include immunotherapy with monoclonal antibodies approved for use in cancer to show that one can induce PTC with a limited number of antibody infusions and compare model predictions with experiments in SIV infected macaques given immunotherapy. Lastly, I will argue that quantitative insights derived from models of HIV infection have and will continue to play an important role in medicine.

A note on the history of the Norwegian Psychoanalytic Society from 1933 to 1945.

PubMed

Anthi, Per; Haugsgjerd, Svein

2013-08-01

The Norwegian analysts, who were trained in Berlin before 1933, were drawn into a struggle against fascism, informed by politically leftist analysts who worked at the Berlin Institute. The Norwegian group, including the analysts Wilhelm Reich and Otto Fenichel, were committed to Marxist or social democratic ideologies in order to fight down fascism and Nazism. They were a source of inspiration but also of conflict. After the war the leadership of the IPA was sceptical about the Norwegian group because of its former connections with Die Linke, as well as its relations with Wilhelm Reich. This paper in part considers the courageous efforts of Nic Waal, whom Ernest Jones used as a delegate and courier to solve problems for the IPA and who was unjustly treated after the war. Copyright © 2013 Institute of Psychoanalysis.

NASA evolution of exploration architectures

NASA Technical Reports Server (NTRS)

Roberts, Barney B.

1991-01-01

A series of charts and diagrams is used to provide a detailed overview of the evolution of NASA space exploration architectures. The pre-Apollo programs including the Werner von Braun feasibility study are discussed and the evolution of the Apollo program itself is treated in detail. The post-Apollo era is reviewed and attention is given to the resurgence of strategic planning exemplified by both ad hoc and formal efforts at planning. Results of NASA's study of the main elements of the Space Exploration Initiative which examined technical scenarios, science opportunities, required technologies, international considerations, institutional strengths and needs, and resource estimates are presented. The 90-day study concludes that, among other things, major investments in challenging technologies are required, the scientific opportunities provided by the program are considerable, current launch capabilities are inadequate, and Space Station Freedom is essential.

Stretch-sensitive paresis and effort perception in hemiparesis.

PubMed

Vinti, Maria; Bayle, Nicolas; Hutin, Emilie; Burke, David; Gracies, Jean-Michel

2015-08-01

In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p < 0.01) in healthy subjects (not on gastrocnemius medialis co-contraction) while it depended on both tibialis anterior agonist recruitment (βARI(TA) = 0.41, p < 0.001) and gastrocnemius medialis co-contraction (βCCI(MG) = 0.43, p < 0.001) in hemiparetic subjects. In hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.

Lytic activity of the staphylolytic Twort phage endolysin CHAP domain is enhanced by the SH3b cell wall binding domain

USDA-ARS?s Scientific Manuscript database

Increases in the prevalence of antibiotic resistant strains of Staphylococcus (S.) aureus have elicited efforts to develop novel antimicrobials to treat these drug-resistant pathogens. One potential treatment repurposes the lytic enzymes produced by bacteriophages as antimicrobials. The phage Twor...

Winning with Green Remediation Practices at the Former McClellan AFB, Sacramento CA

DTIC Science & Technology

2011-05-12

PCE)  Metals (lead, cadmium, chromium)  Fuels (gas and diesel )  Radiological (Radium 226)  Largest cleanup effort in the Air Force  318 sites...Existing pump and treat system replaced with sustainable in-situ bioremediation (passive vegetable oil injection)  Cost to complete reduced by $15,000,000

PROCEEDINGS: EIGHTH SYMPOSIUM ON THE TRANSFER AND UTILIZATION OF PARTICULATE CONTROL TECHNOLOGY - VOLUME 2. BAGHOUSES AND PARTICULATE CONTROL FOR NEW APPLICATIONS

EPA Science Inventory

The two-volume proceedings describe the latest research and development efforts to improve particulate control devices, while treating traditional concerns of operational cost and compliance. Overall, particulate control remains a key issue in the cost and applicability of furnac...

MIGRANT FARM LABOR IN NEW YORK STATE.

ERIC Educational Resources Information Center

New York State Interdepartmental Committee on Farm and Food Processing Labor, Albany.

SEVEN NEW YORK STATE DEPARTMENTS WORK TOGETHER TO SEE THAT THE MIGRANT IS TREATED FAIRLY AND HUMANELY IN THE AREAS OF HEALTH, HOUSING, CHILD CARE, EDUCATION, LABOR CONDITIONS, SAFETY, AND EMPLOYER-EMPLOYEE RELATIONS. AN INTERDEPARTMENTAL COMMITTEE GUIDES THE EFFORTS OF THE DEPARTMENTS. THE AGENCIES WORK WITH A BODY OF STATE LAW WHICH IS UPDATED…

American Association of Poison Control Centers

Science.gov Websites

centers in their efforts to prevent and treat poison exposures. Poison centers offer free, confidential ۼ Over-the-Counter Medicine Safety Over-the-Counter Medicine Safety is a 100% free, evidence-based after the close of the data year in the journal Clinical Toxicology and is available for download free

Integrating stand density management with fuel reduction

Treesearch

Joseph W. Sherlock

2007-01-01

The widespread effort to reduce fuel hazards in western forested ecosystems places significant emphasis on surface and small ladder fuels. Changes in canopy density, for purposes of either reducing potential crown fire impacts or insect/pathogen-related mortality, are less frequently considered. Providing a sound basis for treating more than surface and small ladder...

Combat or Cooperation?

ERIC Educational Resources Information Center

Tate, Thomas F.; Copas, Randall L.

2010-01-01

The best intentioned efforts of adults are often sabotaged by coercive climates of bullying among peers and conflict with adults. The solution is to create cultures where youth cooperate with authority and treat one another with respect. In this article, the authors stress the task of the staff to create a condition in which students see more…

Opening remarks

Treesearch

Denver P. Burns

1985-01-01

Thank you, Dave (Grimble). Let me begin by saying that it is particularly fitting that this group meet at this point in time. First, it a fair guess that in the 1984 field season more forest acreage will be treated with microbial insecticides than in any previous year. Second, the research effort devoted to all phases of microbial insecticide formulation and...

What Is Your Body Mass Index?

ERIC Educational Resources Information Center

Yanik, H. Bahadir; Memis, Yasin

2016-01-01

Billions of dollars are spent each year in efforts to prevent and treat diseases caused by unhealthy eating habits. Promoting awareness among young children regarding the importance of achieving and maintaining a healthy weight is crucial for preparing them to sustain healthy lives as adults. This article aims to highlight ways to help students…

Language in the Marketplace.

ERIC Educational Resources Information Center

Galloway, Vicki

These materials were developed by the South Carolina Department of Education for use in a public relations (PR) workshop for foreign language teachers. They deal with a grassroots PR campaign in terms of program planning to bridge the gap from present actuality to future possibilities. They also treat the means by which these efforts may be…

Targeting Political Communications: A Problem in Market Segmentation.

ERIC Educational Resources Information Center

Markwart, Richard I.

Political campaigns are major, high-budget marketing efforts, but because they are usually managed by people with little training in either marketing or communications, they fail to persuade voters to vote in the desired way. Political targeting can be treated as a segmentation problem, one of identifying and responding to the specific qualities…

The Mexican-American and the United States.

ERIC Educational Resources Information Center

Bustamante, Charles J.; Bustamante, Patricia L.

The historical study of the plight of Mexican Americans is divided into 3 sections. Part I relates the beginnings of Mexico, from Spanish injustices to the Indians to how the Indians felt about Black men. Various historical facts are briefly presented. Part II treats Mexico's efforts to become a republic, various aspects of the wars between…

Using Test Scores from Students with Disabilities in Teacher Evaluation

ERIC Educational Resources Information Center

Buzick, Heather M.; Jones, Nathan D.

2015-01-01

Much of the recent focus of educational policymakers has been on improving the measurement of teacher effectiveness. Linking student growth to teacher effects has been a large part of reform efforts. To date, neither researchers nor practitioners have arrived at a consensus on how to treat test scores from students with disabilities in…

[Motivation for weight loss among weight loss treatment participants].

PubMed

Czeglédi, Edit

2017-12-01

Unrealistic expectations about weight goal and about weight loss-related benefits can hinder the effort for a successful long-term weight control. To explore weight loss-related goals and their background among overweight/obese patients. Study sample consisted of patients who participated in the inpatient weight loss treatment in the Lipidological Department of Szent Imre Hospital (n = 339, 19% men). Mean age: 50.2 years (SD = 13.47 years), mean BMI: 38.6 (SD = 7.58). self-reported anthropometric data, type and number of treated illnesses, Goals and Relative Weights Questionnaire, Motivations for Weight Loss Scale, Body Shape Questionnaire. Participants would feel disappointed with a possible 10% weight loss in a half-year time span. The acceptable weight loss percentage was higher among women, younger participants and among those who had more excess weight. Motivation regarding the increase in social desirability by weight loss is in association with body dissatisfaction, health related motivation is in association with the number of treated illnesses. Our results are contributing to the understanding of motivational factors behind weight reduction efforts, considering these can improve treatment success rates. Orv Hetil. 2017; 158(49): 1960-1967.

Lessening the Effects of Projection for Line-of-Sight Magnetic Field Data

NASA Astrophysics Data System (ADS)

Leka, K. D.; Barnes, Graham; Wagner, Eric

2016-05-01

A method for treating line-of-sight magnetic field data (Blos) is developed for the goal of reconstructing the radially-directed component (Br) of the solar photospheric magnetic field. The latter is generally the desired quantity for use as a boundary for modeling efforts and observational interpretation of the surface field, but the two are only equivalent where the viewing angle is exactly zero (μ=1.0). A common approximation known as the "μ-correction", which assumes all photospheric field to be radial, is compared to a method which invokes a potential field constructed to match the observed Blos (Alissandrakis 1981; Sakurai 1982), from which the potential field radial field component (Brpot) is recovered.We compare this treatment of Blos data to the radial component derived from SDO/HMI full-disk vector magnetograms as the "ground truth", and discuss the implications for data analysis and modeling efforts. In regions that are truly dominated by radial field, the μ-correction performs acceptably if not better than the potential-field approach. However, for any solar structure which includes horizontal fields, i.e. active regions, the potential-field method better recovers magnetic neutral line location and the inferred strength of the radial field.This work was made possible through contracts with NASA, NSF, and NOAA/SBIR.

An overview of antiretroviral pre-exposure prophylaxis of HIV infection.

PubMed

McGowan, Ian

2014-06-01

Despite improvements in access to antiretroviral therapy and the use of simplified dosing regimens, HIV infection is still an important global public health problem. As a consequence, significant research efforts have been focused on the development of strategies to prevent the acquisition of HIV infection. These efforts have begun to produce results. The HPTN-052 study demonstrated the effectiveness of treating infected individuals as a means to prevent onward transmission of HIV infection. In addition, Phase 2B/3 studies have shown that the use of oral and topical antiretroviral pre-exposure prophylaxis (PrEP) can significantly reduce the acquisition of HIV infection in serodiscordant couples, young women in sub-Saharan Africa, men who have sex with men, and intravenous drug users. Despite these successes, challenges remain. Adherence to daily PrEP is variable, and some large studies have failed to demonstrate the effectiveness of PrEP in reducing HIV acquisition. Novel PrEP technologies, including sustained delivery intravaginal rings and long-acting injectable products, are being developed to try and circumvent adherence problems associated with daily PrEP regimens. The purpose of this article is to briefly summarize recent progress in the development of antiretroviral PrEP. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Thiadiazolidinones: A New Class of Alanine Racemase Inhibitors with Antimicrobial Activity against Methicillin- Resistant S. aureus

PubMed Central

Ciustea, Mihai; Mootien, Sara; Rosato, Adriana E.; Perez, Oriana; Cirillo, Pier; Yeung, Kacheong R.; Ledizet, Michel; Cynamon, Michael H.; Aristoff, Paul A.; Koski, Raymond A.; Kaplan, Paul A.; Anthony, Karen G.

2012-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) is a human pathogen and a major cause of hospital-acquired infections. New antibacterial agents that have not been compromised by bacterial resistance are needed to treat MRSA-related infections. We chose the S. aureus cell wall synthesis enzyme, alanine racemase (Alr) as the target for a high-throughput screening effort to obtain novel enzyme inhibitors, which inhibit bacterial growth. Among the ‘hits’ identified was a thiadiazolidinone with chemical properties attractive for lead development. This study evaluated the mode of action, antimicrobial activities, and mammalian cell cytotoxicity of the thiadiazolidinone family in order to assess its potential for development as a therapeutic agent against MRSA. The thiadiazolidones inhibited Alr activity with 50% inhibitory concentrations (IC50) ranging from 0. 36 – 6. 4 μM, and they appear to inhibit the enzyme irreversibly. The series inhibited the growth of S. aureus, including MRSA strains, with minimal inhibitory concentrations (MICs) ranging from 6. 25–100 μg/mL. The antimicrobial activity showed selectivity against Gram-positive bacteria and fungi, but not Gram-negative bacteria. The series inhibited human HeLa cell proliferation. Lead development centering on the thiadiazolidinone series would require additional medicinal chemistry efforts to enhance the antibacterial activity and minimize mammalian cell toxicity. PMID:22146584

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa.

PubMed

Yé, Yazoume; Eisele, Thomas P; Eckert, Erin; Korenromp, Eline; Shah, Jui A; Hershey, Christine L; Ivanovich, Elizabeth; Newby, Holly; Carvajal-Velez, Liliana; Lynch, Michael; Komatsu, Ryuichi; Cibulskis, Richard E; Moore, Zhuzhi; Bhattarai, Achuyt

2017-09-01

Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.

Cryogenic Treatment of Al-Li Alloys for Improved Weldability, Repairability, and Reduction of Residual Stresses

NASA Technical Reports Server (NTRS)

Malone, Tina W.; Graham, Benny F.; Gentz, Steven J. (Technical Monitor)

2001-01-01

Service performance has shown that cryogenic treatment of some metals provides improved strength, fatigue life, and wear resistance to the processed material. Effects such as these were initially discovered by NASA engineers while evaluating spacecraft that had returned from the cold vacuum of space. Factors such as high cost, poor repairability, and poor machinability are currently prohibitive for wide range use of some aerospace aluminum alloys. Application of a cryogenic treatment process to these alloys is expected provide improvements in weldability and weld properties coupled with a reduction in repairs resulting in a significant reduction in the cost to manufacture and life cycle cost of aerospace hardware. The primary purpose of this effort was to evaluate the effects of deep cryogenic treatment of some aluminum alloy plate products, welds, and weld repairs, and optimize a process for the treatment of these materials. The optimized process is being evaluated for improvements in properties of plate and welds, improvements in weldability and repairability of treated materials, and as an alternative technique for the reduction of residual stresses in repaired welds. This paper will present the results of testing and evaluation conducted in this effort. These results will include assessments of changes in strength, toughness, stress corrosion susceptability, weldability, repairability, and reduction in residual stresses of repaired welds.

Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?

PubMed Central

Mishra, Bal Krishna; Moonan, Patrick K.; Nair, Sreenivas A.; Kumar, Ajay M. V.; Gandhi, Mohit P.; Mannan, Shamim

2016-01-01

Introduction Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). Aim To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP). Materials and Methods A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July–December 2012. Results Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilograms—the current weight requirement for receiving drugs under RNTCP. Conclusion ICF approaches are feasible at NRCs; however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilograms. PMID:27066518

Psychosocial facets of resilience: implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience.

PubMed

Iacoviello, Brian M; Charney, Dennis S

2014-01-01

There is a range of potential responses to stress and trauma. Whereas, on one extreme, some respond to stress and trauma by developing psychiatric disorders (e.g., posttraumatic stress disorder, PTSD), on the other extreme are the ones who exhibit resilience. Resilience is broadly defined as adaptive characteristics of an individual to cope with and recover from adversity. Understanding of the factors that promote resilience is warranted and can be obtained by interviewing and learning from particularly resilient individuals as well as empirical research. In this paper, we discuss a constellation of factors comprising cognitive, behavioral, and existential elements that have been identified as contributing to resilience in response to stress or trauma. The psychosocial factors associated with resilience include optimism, cognitive flexibility, active coping skills, maintaining a supportive social network, attending to one's physical well-being, and embracing a personal moral compass. These factors can be cultivated even before exposure to traumatic events, or they can be targeted in interventions for individuals recovering from trauma exposure. Currently available interventions for PTSD could be expanded to further address these psychosocial factors in an effort to promote resilience. The cognitive, behavioral, and existential components of psychosocial factors that promote individual resilience can also inform efforts to promote resilience to disaster at the community level.

Evaluating Water Supply and Water Quality Management Options for Las Vegas Valley

NASA Astrophysics Data System (ADS)

Ahmad, S.

2007-05-01

The ever increasing population in Las Vegas is generating huge demand for water supply on one hand and need for infrastructure to collect and treat the wastewater on the other hand. Current plans to address water demand include importing water from Muddy and Virgin Rivers and northern counties, desalination of seawater with trade- payoff in California, water banking in Arizona and California, and more intense water conservation efforts in the Las Vegas Valley (LVV). Water and wastewater in the LVV are intrinsically related because treated wastewater effluent is returned back to Lake Mead, the drinking water source for the Valley, to get a return credit thereby augmenting Nevada's water allocation from the Colorado River. The return of treated wastewater however, is a major contributor of nutrients and other yet unregulated pollutants to Lake Mead. Parameters that influence the quantity of water include growth of permanent and transient population (i.e., tourists), indoor and outdoor water use, wastewater generation, wastewater reuse, water conservation, and return flow credits. The water quality of Lake Mead and the Colorado River is affected by the level of treatment of wastewater, urban runoff, groundwater seepage, and a few industrial inputs. We developed an integrated simulation model, using system dynamics modeling approach, to account for both water quantity and quality in the LVV. The model captures the interrelationships among many variables that influence both, water quantity and water quality. The model provides a valuable tool for understanding past, present and future pathways of water and its constituents in the LVV. The model is calibrated and validated using the available data on water quantity (flows at water and wastewater treatment facilities and return water credit flow rates) and water quality parameters (TDS and phosphorus concentrations). We used the model to explore important questions: a)What would be the effect of the water transported from the northern counties on the water supply and water quality of Lake Mead? b)What would be the impact of increased reuse of wastewater on return credits? c)What would be the effect of treating runoff water on the load of nutrients to Lake Mead?

When to Suspect Sleep Apnea and What to Do About It.

PubMed

Kimoff, R John

2015-07-01

Obstructive sleep apnea (OSA), which is characterized by recurrent upper airway obstruction during sleep with resultant hypoxia-reoxygenation and sleep fragmentation, is prevalent among patients with cardiovascular disease. Refractory hypertension, nocturnal angina or arrhythmias, and stroke in particular should prompt consideration of OSA. The symptoms of OSA include snoring and excessive daytime sleepiness; risk factors include obesity and reduced upper airway dimensions. Up to 50% of patients with congestive heart failure (CHF) may manifest OSA, central sleep apnea-Cheyne-Stokes respiration (CSA-CSR), or both. Patients with CSA-CSR may present with fatigue, disrupted sleep, and paroxysmal nocturnal dyspnea. Objective sleep recording is required to document the nature and severity of sleep apnea. The gold standard is in-laboratory overnight polysomnography (PSG), including monitoring of electroencephalography and other signals to determine sleep-wake state, and recording of body position, airflow, respiratory effort, and pulse oximetry. Portable cardiorespiratory recorders are now approved for diagnosis in patients without comorbidities. Full PSG is recommended for diagnosis in all other cases, although OSA and CSA-CSR can be identified from portable recorders in some patients with CHF and other conditions. The objectives of treatment are to improve symptoms, quality of life, and cardiovascular outcomes. The mainstay of treatment for moderate-to-severe OSA is positive airway pressure (PAP). Automated PAP devices may be used in uncomplicated OSA, whereas continuous fixed PAP is the treatment of choice for other patients with OSA, and may also treat a proportion of patients with CSA-CSR. A form of bi-level PAP known as adaptive servoventilation is effective in treating a majority of patients with CSA-CSR. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Modeled Effectiveness of Ventilation with Contaminant Control Devices on Indoor Air Quality in a Swine Farrowing Facility

PubMed Central

Anthony, T. Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M.

2016-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5°C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s−1 (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures. PMID:24433305

Modeled effectiveness of ventilation with contaminant control devices on indoor air quality in a swine farrowing facility.

PubMed

Anthony, T Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M

2014-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5 °C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s(-1) (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures.

Improving condition severity classification with an efficient active learning based framework

PubMed Central

Nissim, Nir; Boland, Mary Regina; Tatonetti, Nicholas P.; Elovici, Yuval; Hripcsak, George; Shahar, Yuval; Moskovitch, Robert

2017-01-01

Classification of condition severity can be useful for discriminating among sets of conditions or phenotypes, for example when prioritizing patient care or for other healthcare purposes. Electronic Health Records (EHRs) represent a rich source of labeled information that can be harnessed for severity classification. The labeling of EHRs is expensive and in many cases requires employing professionals with high level of expertise. In this study, we demonstrate the use of Active Learning (AL) techniques to decrease expert labeling efforts. We employ three AL methods and demonstrate their ability to reduce labeling efforts while effectively discriminating condition severity. We incorporate three AL methods into a new framework based on the original CAESAR (Classification Approach for Extracting Severity Automatically from Electronic Health Records) framework to create the Active Learning Enhancement framework (CAESAR-ALE). We applied CAESAR-ALE to a dataset containing 516 conditions of varying severity levels that were manually labeled by seven experts. Our dataset, called the “CAESAR dataset,” was created from the medical records of 1.9 million patients treated at Columbia University Medical Center (CUMC). All three AL methods decreased labelers’ efforts compared to the learning methods applied by the original CAESER framework in which the classifier was trained on the entire set of conditions; depending on the AL strategy used in the current study, the reduction ranged from 48% to 64% that can result in significant savings, both in time and money. As for the PPV (precision) measure, CAESAR-ALE achieved more than 13% absolute improvement in the predictive capabilities of the framework when classifying conditions as severe. These results demonstrate the potential of AL methods to decrease the labeling efforts of medical experts, while increasing accuracy given the same (or even a smaller) number of acquired conditions. We also demonstrated that the methods included in the CAESAR-ALE framework (Exploitation and Combination_XA) are more robust to the use of human labelers with different levels of professional expertise. PMID:27016383

Improving condition severity classification with an efficient active learning based framework.

PubMed

Nissim, Nir; Boland, Mary Regina; Tatonetti, Nicholas P; Elovici, Yuval; Hripcsak, George; Shahar, Yuval; Moskovitch, Robert

2016-06-01

Classification of condition severity can be useful for discriminating among sets of conditions or phenotypes, for example when prioritizing patient care or for other healthcare purposes. Electronic Health Records (EHRs) represent a rich source of labeled information that can be harnessed for severity classification. The labeling of EHRs is expensive and in many cases requires employing professionals with high level of expertise. In this study, we demonstrate the use of Active Learning (AL) techniques to decrease expert labeling efforts. We employ three AL methods and demonstrate their ability to reduce labeling efforts while effectively discriminating condition severity. We incorporate three AL methods into a new framework based on the original CAESAR (Classification Approach for Extracting Severity Automatically from Electronic Health Records) framework to create the Active Learning Enhancement framework (CAESAR-ALE). We applied CAESAR-ALE to a dataset containing 516 conditions of varying severity levels that were manually labeled by seven experts. Our dataset, called the "CAESAR dataset," was created from the medical records of 1.9 million patients treated at Columbia University Medical Center (CUMC). All three AL methods decreased labelers' efforts compared to the learning methods applied by the original CAESER framework in which the classifier was trained on the entire set of conditions; depending on the AL strategy used in the current study, the reduction ranged from 48% to 64% that can result in significant savings, both in time and money. As for the PPV (precision) measure, CAESAR-ALE achieved more than 13% absolute improvement in the predictive capabilities of the framework when classifying conditions as severe. These results demonstrate the potential of AL methods to decrease the labeling efforts of medical experts, while increasing accuracy given the same (or even a smaller) number of acquired conditions. We also demonstrated that the methods included in the CAESAR-ALE framework (Exploitation and Combination_XA) are more robust to the use of human labelers with different levels of professional expertise. Copyright © 2016 Elsevier Inc. All rights reserved.

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential.

PubMed

Perlman, David C; Jordan, Ashly E; Uuskula, Anneli; Huong, Duong Thi; Masson, Carmen L; Schackman, Bruce R; Des Jarlais, Don C

2015-11-01

People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries-the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include (1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, (2) inconsistent use of OST as a platform for HCV services, (3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and (4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: (1) maintaining current HIV prevention efforts, (2) expanding efforts to reduce the stigmatization of drug use, (3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, (4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV. Copyright © 2015 Elsevier B.V. All rights reserved.

Broken promise? Taxes and tariffs on insecticide treated mosquito nets.

PubMed

Alilio, Martin; Mwenesi, Halima; Barat, Lawrence M; Payes, Roshelle M; Prysor-Jones, Suzanne; Diara, Malick; McGuire, David; Shaw, Willard

2007-12-01

Seven years ago, the removal of taxes and tariffs on insecticide treated nets (ITNs) was considered one of the easiest resolutions for most countries to implement among the targets agreed upon at the African Summit on Roll Back Malaria in Abuja, Nigeria, on April 25, 2000. However, seven years later, 24 of the 39 Abuja signatories continue to impose taxes and tariffs on this life-saving tool. Taxes and tariffs significantly increase the price of an insecticide treated net, reduce affordability, and discourage the commercial sector from importing insecticide treated net products. Consequently, Roll Back Malaria partners are engaged in advocacy efforts to remove taxes and tariffs on insecticide treated nets in malaria-endemic countries of Africa. This viewpoint summarizes key obstacles to the removal of taxes and tariffs that have been identified through a review of country situations. To achieve the goal of producing and supplying more than 160 million insecticide treated nets needed to reach the revised Roll Back Malaria Partnership targets by 2010, tax and tariff reforms are urgently needed. Such reforms must be accompanied by country-specific systems to protect the poor (e.g., through voucher systems for vulnerable groups and other forms of targeted subsidies).

A review of chamber experiments for determining specific emission rates and investigating migration pathways of flame retardants

NASA Astrophysics Data System (ADS)

Rauert, Cassandra; Lazarov, Borislav; Harrad, Stuart; Covaci, Adrian; Stranger, Marianne

2014-01-01

The widespread use of flame retardants (FRs) in indoor products has led to their ubiquitous distribution within indoor microenvironments with many studies reporting concentrations in indoor air and dust. Little information is available however on emission of these compounds to air, particularly the measurement of specific emission rates (SERs), or the migration pathways leading to dust contamination. Such knowledge gaps hamper efforts to develop understanding of human exposure. This review summarizes published data on SERs of the following FRs released from treated products: polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDs), tetrabromobisphenol-A (TBBPA), novel brominated flame retardants (NBFRs) and organophosphate flame retardants (PFRs), including a brief discussion of the methods used to derive these SERs. Also reviewed are published studies that utilize emission chambers for investigations/measurements of mass transfer of FRs to dust, discussing the chamber configurations and methods used for these experiments. A brief review of studies investigating correlations between concentrations detected in indoor air/dust and possible sources in the microenvironment is included along with efforts to model contamination of indoor environments. Critical analysis of the literature reveals that the major limitations with utilizing chambers to derive SERs for FRs arise due to the physicochemical properties of FRs. In particular, increased partitioning to chamber surfaces, airborne particles and dust, causes loss through “sink” effects and results in long times to reach steady state conditions inside the chamber. The limitations of chamber experiments are discussed as well as their potential for filling gaps in knowledge in this area.

Bisphosphonate ISS Flight Experiment

NASA Technical Reports Server (NTRS)

LeBlanc, Adrian; Matsumoto, Toshio; Jones, Jeffrey; Shapiro, Jay; Lang, Thomas; Shackleford, Linda; Smith, Scott M.; Evans, Harlan; Spector, Elizabeth; Ploutz-Snyder, Robert;

Critical features and challenges associated with imaging in patients undergoing cancer immunotherapy.

PubMed

Solinas, Cinzia; Porcu, Michele; Hlavata, Zuzana; De Silva, Pushpamali; Puzzoni, Marco; Willard-Gallo, Karen; Scartozzi, Mario; Saba, Luca

2017-12-01

Manipulating an individual's immune system through immune checkpoint blockade is revolutionizing the paradigms of cancer treatment. Peculiar patterns and kinetics of response have been observed with these new drugs, rendering the assessment of tumor burden particularly challenging in cancer immunotherapy. The mechanisms of action for immune checkpoint blockade, based upon engagement of the adaptive immune system, can generate unusual response patterns, including pseudoprogression, hyperprogression, atypical and delayed responses. In patients treated with immune checkpoint blockade and radiotherapy, a reduction in tumor burden at metastatic sites distant from the irradiation field (abscopal effect) has been observed, with synergistic systemic immune effects provoked by this combination. New toxicities have also been observed, due to excessive immune activity in several organs, including lung, colon, liver and endocrine glands. Efforts to standardize assessment of cancer immunotherapy responses include novel consensus guidelines derived by modifying World Health Organization (WHO) and Response Evaluation Criteria In Solid Tumors (RECIST) criteria. The aim of this review is to evaluate imaging techniques currently used routinely in the clinic and those being used as investigational tools in immunotherapy clinical trials. Copyright © 2017 Elsevier B.V. All rights reserved.

Resource letter SH-1: superfluid helium

NASA Astrophysics Data System (ADS)

Hallock, Robert B.

1982-03-01

The resource letter covers the general subject of superfluid helium and treats 3He and 3He-4He mixtures as well as 4He. No effort has been made to include the fascinating experiments on either solid helium or the equally fascinating work on adsorbed helium where the helium coverage is below that necessary for superfluidity. An earlier resource letter by C. T. Lane [Am. J. Phys. 35, 367 (1967)] may be consulted for additional comments on some of the cited earlier manuscripts, but the present work is self-contained and may be used independently. Many high-quality research reports have not been cited here. Rather, the author has tried in most cases to include works particularly readable or relevant. There is a relatively heavy emphasis on experimental references. The primary reason is that these works tend to be more generally readable. No doubt some works that might have been included, have not, and for this the author takes responsibility with apology. Articles selected for incorporation in a reprint volume (to be published separately by the American Association of Physics Teachers) are marked with an asterisk(*). Following each referenced work the general level of difficulty is indicated by E, I, or A for elementary, intermediate, or advanced.

The quest to make fully functional human pancreatic beta cells from embryonic stem cells: climbing a mountain in the clouds.

PubMed

Johnson, James D

2016-10-01

The production of fully functional insulin-secreting cells to treat diabetes is a major goal of regenerative medicine. In this article, I review progress towards this goal over the last 15 years from the perspective of a beta cell biologist. I describe the current state-of-the-art, and speculate on the general approaches that will be required to identify and achieve our ultimate goal of producing functional beta cells. The need for deeper phenotyping of heterogeneous cultures of stem cell derived islet-like cells in parallel with a better understanding of the heterogeneity of the target cell type(s) is emphasised. This deep phenotyping should include high-throughput single-cell analysis, as well as comprehensive 'omics technologies to provide unbiased characterisation of cell products and human beta cells. There are justified calls for more detailed and well-powered studies of primary human pancreatic beta cell physiology, and I propose online databases of standardised human beta cell responses to physiological stimuli, including both functional and metabolomic/proteomic/transcriptomic profiles. With a concerted, community-wide effort, including both basic and applied scientists, beta cell replacement will become a clinical reality for patients with diabetes.

Expert opinion on emerging drugs: chronic low back pain.

PubMed

Hsu, Eugene; Murphy, Sunberri; Chang, David; Cohen, Steven P

2015-03-01

It is difficult to overestimate the personal and socioeconomic impact of chronic low back pain (CLBP). It is the leading cause of years lost to disability and poses the highest economic toll among chronic illnesses. Despite the strong need for extensive research efforts, few drugs have consistently demonstrated effectiveness for this condition. In this review, the epidemiology, rationale for mechanism-based treatment, competitive environment and market trends, and the preclinical and clinical evidence supporting over 15 different classes of analgesic medications studied for CLBP or related pain conditions are discussed. Treatments are divided by drug category, type of CLBP they are likely to treat (e.g., neuropathic or mechanical), and whether they are new formulations of existing treatments, new indications for existing treatments or represent novel mechanisms of action. Databases searched included MEDLINE, Embase, Pharmaprojects and various clinical trial registries. Many barriers exist for the development of medications for CLBP including difficulties in identifying pathophysiological mechanisms, biologic resiliency secondary to multiple concurrent pain pathways and off-target and sometimes serious side effects. Nevertheless, the volume and diversity of novel molecular entities has continued to surge and includes possible disease-modifying therapies such as gene and stem cell therapy.

Towards a Predictive Thermodynamic Model of Oxidation States of Uranium Incorporated in Fe (hydr) oxides

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

Bagus, Paul S.

The theoretical research in this project has been directed toward the interpretation of core-level spectroscopies for systems relevant to the project. For the initial efforts, the focus of our theoretical simulations has been the interpretation of laboratory and synchrotron X-Ray Photoemission Spectra, XPS. In more recent efforts, an increasing emphasis has been placed on developing transparent understandings of X-Ray Adsorption Spectra, XAS . For the XAS, the principal concern is for the near-edge features, either just below or just above, an ionization limit or edge, which are described as Near-Edge X-Ray Adsorption Fine Structure, NEXAFS. In particular, a priority hasmore » involved the analysis and interpretation of XPS and NEXAFS spectra, especially of Fe and U systems, as measured by our PNNL collaborators. The overall objective of our theoretical studies is to establish connections between features of the spectra and their origin in the electronic structure of the materials. The efforts for the analysis of XPS have been reviewed in a paper by the PI, C. J. Nelin, and E. S. Ilton from PNNL on “The interpretation of XPS spectra: Insights into materials properties”, Surf. Sci. Reports, 68, 273 (2013). Two materials properties of special interest have been the degree of ionicity and the character of the covalent bonding in a range of oxides formed with transition metal, lanthanide, and actinide cations. Since the systems treated have electrons in open shells, it has been necessary to determine the energetics and the character of the angular momentum coupling of the open shell electrons. In particular, we have established methods for the treatment of the “intermediate coupling” which arises when the system is between the limit of Russell-Saunders multiplets, and the limit of j-j coupling where the spin-orbit splittings of single electrons dominate. A recent paper by the PI, and M. J. Sassi, and K. M. Rosso, (both at PNNL) “Intermediate Coupling For Core-Level Excited States: Consequences For X-Ray Absorption Spectroscopy”, J. Elec. Spectros. and Related Phenom., 200, 174 (2015) describes our first application of these methods. As well as applications to problems and materials of direct interest for our PNNL colleagues, we have pursued applications of fundamental theoretical significance for the analysis and interpretation of XPS and XAS spectra. These studies are important for the development of the fields of core-level spectroscopies as well as to advance our capabilities for applications of interest to our PNNL colleagues. An excellent example is our study of the surface core-level shifts, SCLS, for the surface and bulk atoms of an oxide that provides a new approach to understanding how the surface electronic of oxides differs from that in the bulk of the material. This work has the potential to lead to a new key to understanding the reactivity of oxide surfaces. Our theoretical studies use cluster models with finite numbers of atoms to describe the properties of condensed phases and crystals. This approach has allowed us to focus on the local atomistic, chemical interactions. For these clusters, we obtain orbitals and spinors through the solution of the Hartree-Fock, HF, and the fully relativistic Dirac HF equations. These orbitals are used to form configuration mixing wavefunctions which treat the many-body effects responsible for the open shell angular momentum coupling and for the satellites of the core-level spectra. Our efforts have been in two complementary directions. As well as the applications described above, we have placed major emphasis on the enhancement and extension of our theoretical and computational capabilities so that we can treat complex systems with a greater range of many-body effects. Noteworthy accomplishments in terms of method development and enhancement have included: (1) An improvement in our treatment of the large matrices that must be handled when many-body effects are treated. (2) Improvements and extensions of our capabilities for the calculation of the intensities of XPS and XAS transitions. And (3) ongoing development of flexible programs for the visualization of the theoretical spectra so that they can be compared with experiment. Our efforts on applications and methodology for these and related topics will continue under a sub-contract to PNNL.« less

Quorum Sensing and Phytochemicals

PubMed Central

Nazzaro, Filomena; Fratianni, Florinda; Coppola, Raffaele

2013-01-01

Most infectious diseases are caused by bacteria, which proliferate within quorum sensing (QS)-mediated biofilms. Efforts to block QS in bacteria and disrupt biofilms have enabled the identification of bioactive molecules that are also produced by plants. This mini review primarily focuses on natural QS inhibitors, which display potential for treating bacterial infections and also enhance the safety of food supply. PMID:23774835

Assisting Wine Growers

NASA Technical Reports Server (NTRS)

1993-01-01

This video documents efforts at NASA Ames Research Center to assist wine growers in the Napa valley in their fight against a root parasite which is destroying millions of dollars worth of grape crops. NASA researchers are using airborne scanners and remote sensing equipment to detect the parasite before it becomes entrenched, so that growers can treat the harvest to resist infestation.

Do Motives Matter?: Nonmedical Use of Prescription Medications among Adolescents

ERIC Educational Resources Information Center

McCabe, Sean Esteban; Boyd, Carol J.

2012-01-01

Adolescents' motives for engaging in nonmedical prescription drug use is somewhat different than their reasons for using other drugs, such as marijuana. For some youth, nonmedical prescription drug use is an attempt to self-treat a medical condition, for others it is an effort to get high, and some youth misuse prescription drugs for both reasons.…

Anti-Drug Abuse Strategy Report. State of New York. 1993 Update.

ERIC Educational Resources Information Center

New York Governor's Office, Albany. Statewide Anti-Drug Abuse Council.

Research shows a clear link between drug and alcohol use and crime and violence. This report describes progress made in 1993 as a result of New York State's anti-drug abuse agenda and priorities for 1994. Efforts exist in three complementary areas: prevention (preventing people from being involved in substance abuse); treatment (treating those who…

A GREENER BUTTE! REVEGETATION THROUGH IRRIGATION USING TREATED MINE WATER FROM THE BELMONT MINE'S FLOODED UNDERGROUND WORKINGS

EPA Science Inventory

Historic mining activities in Butte, Montana have degraded much of the local landscape and vegetation. During the last 5 years, mine tailings located near the Belmont Mine have been successfully capped and reseeded in an effort to “green” and spark development in the area. The B...

Factors affecting the use of increment cores to assess fixation

Treesearch

Stan T. Lebow

2001-01-01

As part of an effort to ensure that treated wood products have minimal environmental and handling concerns, an American Wood Preservers Association task force is considering the development of a test to assess the degree of fixation of Waterborne wood preservatives. The proposed test involves removal and leaching of increment cores. This paper describes a laboratory...

Initiative for Future Agricultural Food Systems (IFAFS) Healthy Lifestyles Focus of Obesity Prevention Program

ERIC Educational Resources Information Center

Kish, Stacy

2008-01-01

Obesity among children and adults has reached epidemic proportions in the United States. This condition has proven difficult to treat effectively, especially in terms of sustainable weight loss. The project described in this report embarked on multidimensional, community-based efforts to prompt a national discussion of the obesity issue and the…

Alleviating Mathematics Anxiety of Elementary School Students: A Situated Perspective

ERIC Educational Resources Information Center

Sharma, Yogesh

2016-01-01

The present study investigates the effects of the situated learning and effortful control on mathematics anxiety of school students. Participants were 99 seventh graders who studied in two schools. Students in one of these were given instruction through the situated learning model, and the students of other school were treated as a control group.…

Activation of the cannabinoid system in the nucleus accumbens affects effort-based decision making.

PubMed

Fatahi, Zahra; Haghparast, Abbas

2018-02-01

Effort-based decision making addresses how we make an action choice based on an integration of action and goal values. The nucleus accumbens (NAc) is implicated in allowing an animal to overcome effort constraints to obtain greater benefits, and it has been previously shown that cannabis derivatives may affect such processes. Therefore, in this study, we intend to evaluate the involvement of the cannabinoid system in the entire NAc on effort-based decision making. Rats were trained in a T-maze cost-benefit decision making the task in which they could choose either to climb a barrier to obtain a large reward in one arm or run into the other arm without a barrier to obtaining a small reward. Following training, the animals were bilaterally implanted with guide cannulae in the NAc. On test day, rats received cannabinoid agonist (Win 55,212-2; 2, 10 and 50μM) and/or antagonist (AM251; 45μM), afterward percentage of large reward choice and latency of reward attainment were investigated. Results revealed that the administration of cannabinoid agonist led to decrease of large reward choice percentage such that the animals preferred to receive a small reward with low effort instead of receiving a large reward with high effort. The administration of antagonist solely did not affect effort-based decision making, but did attenuate the Win 55,212-2-induced impairments in effort allocation. In agonist-treated animals, the latency of reward collection increased. Moreover, when the effort was equated on both arms, the animals returned to choosing large reward showing that obtained results were not caused by spatial memory impairment. Our finding suggested that activation of the cannabinoid system in the NAc impaired effort-based decision making and led to rats were less willing to invest the physical effort to gain large reward. Copyright © 2017 Elsevier Inc. All rights reserved.

TCGA's Pan-Cancer Efforts and Expansion to Include Whole Genome Sequence - TCGA

Cancer.gov

Carolyn Hutter, Ph.D., Program Director of NHGRI's Division of Genomic Medicine, discusses the expansion of TCGA's Pan-Cancer efforts to include the Pan-Cancer Analysis of Whole Genomes (PAWG) project.

Patient-Reported Roles, Preferences, and Expectations Regarding Treatment of Stage I Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium.

PubMed

Tyler Ellis, C; Charlton, Mary E; Stitzenberg, Karyn B

2016-10-01

Historically, stage I rectal cancer was treated with total mesorectal excision. However, there has been growing use of local excision, with and without adjuvant therapy, to treat these early rectal cancers. Little is known about how patients and providers choose among the various treatment approaches. The purpose of this study was to identify patient roles, preferences, and expectations as they relate to treatment decision making for patients with stage I rectal cancer. This is a population-based study. The study included a geographically diverse population and health-system-based cohort. A total of 154 adults with newly diagnosed and surgically treated stage I rectal cancer between 2003 and 2005 were included. We compared patients by surgical treatment groups, including total mesorectal excision and local excision. Clinical, sociodemographic, and health-system factors were assessed for association with patient decision-making preferences and expectations. A total of 80% of patients who underwent total mesorectal excision versus 63% of patients who underwent local excision expected that surgery would be curative (p = 0.04). The total mesorectal excision group was less likely to report that radiation would cure their cancer compared with the local excision group (27% vs 63%; p = 0.004). When asked about their preferred role in decision making, 28% of patients who underwent total mesorectal excision preferred patient-controlled decision making compared with 48% of patients who underwent local excision (p = 0.046). However, with regard to the treatment actually received, 38% of the total mesorectal excision group reported making their own surgical decision compared with 25% of the local excision group (p = 0.18). The study was limited by its sample size. The preferred decision-making role for patients did not match the actual decision-making process. Future efforts should focus on bridging the gap between the decision-making process and patient preferences regarding various treatment approaches. This will be particularly important as newer innovative procedures play a more prominent role in the rectal cancer treatment paradigm.

Decontamination of produced water containing petroleum hydrocarbons by electrochemical methods: a minireview.

PubMed

dos Santos, Elisama Vieira; Bezerra Rocha, Jessica Horacina; de Araújo, Danyelle Medeiros; de Moura, Dayanne Chianca; Martínez-Huitle, Carlos Alberto

2014-01-01

Produced water (PW) is the largest waste stream generated in oil and gas industries. The drilling and extraction operations that are aimed to maximize the production of oil may be counterbalanced by the huge production of contaminated water (called PW) with pollutants, such as heavy metals, dissolved/suspended solids, and organic compounds. PW is conventionally treated through different physical, chemical, and biological methods. In offshore platforms, because of space constraints, compact physical and chemical systems are used. However, major research efforts are being developed with innovative technologies for treating PW in order to comply with reuse and discharge limits. Among them, electrochemical technologies have been proposed as a promising alternative for the treatment of this kind of wastewaters. Then, this paper presents a minireview of efficient electrochemical technologies used until now for treating PW generated by petrochemical industry.

Perspectives on the management of coronary artery disease in India

PubMed Central

Karthikeyan, Ganesan; Xavier, Denis; Prabhakaran, Doriaraj; Pais, Prem

2007-01-01

The most striking feature of the management of patients with cardiovascular disease (CVD) in India, is its heterogeneity: from patients treated at tertiary and teaching hospitals, who receive the best possible evidence‐based care, to patients who have poor or, even no, access to specialist care and whose condition, therefore, is poorly treated. The challenge for Indian healthcare lies in righting this imbalance. One step in this direction would be to document practice patterns in representative treating hospitals in different regions of the country, to identify the strengths and weaknesses of the system. Resource‐sensitive guidelines incorporating evidence‐based, cost‐effective treatments should be widely disseminated. Large‐scale efforts to improve general awareness about CVD and its risk factors, and to promote healthy lifestyles, should be undertaken, and the consumption of tobacco products and unhealthy foods discouraged. PMID:17933988

The use of diet in the treatment of epilepsy.

PubMed

Bailey, Elizabeth E; Pfeifer, Heidi H; Thiele, Elizabeth A

2005-02-01

Fasting and other dietary regimens have been used to treat epilepsy since biblical times. The ketogenic diet, which mimics the metabolism of fasting, was used by modern physicians to treat intractable epilepsy beginning in the 1920s. With the rising popularity of drug treatments however, the ketogenic diet lost its previous status and was used in only a handful of clinics for most of the 20th century. The diet regained widespread recognition as a viable treatment option beginning in 1992 due to the efforts of parent advocate groups. Despite challenges to implementation of the treatment, the ketogenic diet has significant potential as a powerful tool for fighting epilepsy.

Field-incidence transmission of treated orthotropic and laminated composite panels

NASA Technical Reports Server (NTRS)

Koval, L. R.

1983-01-01

In an effort to improve understanding of the phenomenon of noise transmission through the sidewalls of an aircraft fuselage, an analytical model was developed for the field incidence transmission loss of an orthotropic or laminated composite infinite panel with layers of various noise insulation treatments. The model allows for four types of treatments, impervious limp septa, orthotropic trim panels, porous blankets, and air spaces, while it also takes into account the effects of forward speed. Agreement between the model and transmission loss data for treated panels is seen to be fairly good overall. In comparison with transmission loss data for untreated composite panels, excellent agreement occurred.

Men "missing" from population-based HIV testing: insights from qualitative research.

PubMed

Camlin, Carol S; Ssemmondo, Emmanuel; Chamie, Gabriel; El Ayadi, Alison M; Kwarisiima, Dalsone; Sang, Norton; Kabami, Jane; Charlebois, Edwin; Petersen, Maya; Clark, Tamara D; Bukusi, Elizabeth A; Cohen, Craig R; R Kamya, Moses; Havlir, Diane

2016-01-01

Men's uptake of HIV testing is critical to the success of "test and treat" strategies in generalized epidemics. This study sought to identify cultural factors and community processes that influence men's HIV testing uptake in the baseline year of an ongoing test-and-treat trial among 334,479 persons in eastern Africa (SEARCH, NCT#01864603). Data were collected using participant observation at mobile community health campaigns (CHCs) (n = 28); focus group discussions (n = 8 groups) with CHC participants; and in-depth interviews with care providers (n = 50), leaders (n = 32), and members (n = 112) of eight communities in Kenya and Uganda. An 8-person research team defined analytical codes and iteratively refined them during data collection using grounded theoretical approaches, and textual data were coded using Atlas.ti software. Structural and cultural barriers, including men's mobility and gender norms valorizing risk-taking and discouraging health-seeking behavior, were observed, and contributed to men's lower participation in HIV testing relative to women. Men's labor opportunities often require extended absences from households: during planting season, men guarded fields from monkeys from dawn until nightfall; lake fishermen traveled long distances and circulated between beaches. Men often tested "by proxy", believing their wives' HIV test results to be their status. Debates about HIV risks were vigorous, with many men questioning "traditional" masculine gender norms that enhanced risks. The promise of antiretroviral therapy (ART) to prolong health was a motivating factor for many men to participate in testing. Flexibility in operating hours of HIV testing including late evening and weekend times along with multiple convenient locations that moved were cited as facilitating factors enhancing male participating in HIV testing. Mobile testing reduced but did not eliminate barriers to men's participation in a large-scale "test & treat" effort. However, transformations in gender norms related to HIV testing and care-seeking are underway in eastern Africa and should be supported.

Engineering and Evolution of Molecular Chaperones and Protein Disaggregases with Enhanced Activity

PubMed Central

Mack, Korrie L.; Shorter, James

2016-01-01

Cells have evolved a sophisticated proteostasis network to ensure that proteins acquire and retain their native structure and function. Critical components of this network include molecular chaperones and protein disaggregases, which function to prevent and reverse deleterious protein misfolding. Nevertheless, proteostasis networks have limits, which when exceeded can have fatal consequences as in various neurodegenerative disorders, including Parkinson's disease and amyotrophic lateral sclerosis. A promising strategy is to engineer proteostasis networks to counter challenges presented by specific diseases or specific proteins. Here, we review efforts to enhance the activity of individual molecular chaperones or protein disaggregases via engineering and directed evolution. Remarkably, enhanced global activity or altered substrate specificity of various molecular chaperones, including GroEL, Hsp70, ClpX, and Spy, can be achieved by minor changes in primary sequence and often a single missense mutation. Likewise, small changes in the primary sequence of Hsp104 yield potentiated protein disaggregases that reverse the aggregation and buffer toxicity of various neurodegenerative disease proteins, including α-synuclein, TDP-43, and FUS. Collectively, these advances have revealed key mechanistic and functional insights into chaperone and disaggregase biology. They also suggest that enhanced chaperones and disaggregases could have important applications in treating human disease as well as in the purification of valuable proteins in the pharmaceutical sector. PMID:27014702

Outcome methods used in clinical studies of Chiari malformation Type I: a systematic review.

PubMed

Greenberg, Jacob K; Milner, Eric; Yarbrough, Chester K; Lipsey, Kim; Piccirillo, Jay F; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

2015-02-01

Chiari malformation Type I (CM-I) is a common and often debilitating neurological disease. Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes. To understand current approaches and lay a foundation for future research, the authors conducted a systematic review of the methods used in original published research articles to evaluate clinical outcomes in patients treated for CM-I. The authors searched PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov , and Cochrane databases to identify publications between January 2003 and August 2013 that met the following criteria: 1) reported clinical outcomes in patients treated for CM-I; 2) were original research articles; 3) included at least 10 patients or, if a comparative study, at least 5 patients per group; and 4) were restricted to patients with CM-I. Among the 74 papers meeting inclusion criteria, there was wide variation in the outcome methods used. However, all approaches were broadly grouped into 3 categories: 1) "gestalt" impression of overall symptomatic improvement (n=45 papers); 2) postoperative change in specific signs or symptoms (n=20); or 3) results of various standardized assessment scales (n=22). Among standardized scales, 11 general function measures were used, compared with 6 disease-specific tools. Only 3 papers used scales validated in patients with CM-I. To facilitate a uniform comparison of these heterogeneous approaches, the authors appraised articles in multiple domains defined a priori as integral to reporting clinical outcomes in CM-I. Notably, only 7 articles incorporated patient-response instruments when reporting outcome, and only 22 articles explicitly assessed quality of life. The methods used to evaluate clinical outcomes in CM-I are inconsistent and frequently not comparable, complicating efforts to analyze results across studies. Development, validation, and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients.

Antimicrobial drug use in veterinary medicine.

PubMed

Morley, Paul S; Apley, Michael D; Besser, Thomas E; Burney, Derek P; Fedorka-Cray, Paula J; Papich, Mark G; Traub-Dargatz, Josie L; Weese, J Scott

2005-01-01

Recognizing the importance of antimicrobial resistance and the need for veterinarians to aid in efforts for maintaining the usefulness of antimicrobial drugs in animals and humans, the Board of Regents of the American College of Veterinary Internal Medicine charged a special committee with responsibility for drafting this position statement regarding antimicrobial drug use in veterinary medicine. The Committee believes that veterinarians are obligated to balance the well-being of animals under their care with the protection of other animals and public health. Therefore, if an animal's medical condition can be reasonably expected to improve as a result of treatment with antimicrobial drugs, and the animal is under a veterinarian's care with an appropriate veterinarian-client-patient relationship, veterinarians have an obligation to offer antimicrobial treatment as a therapeutic option. Veterinarians also have an obligation to actively promote disease prevention efforts, to treat as conservatively as possible, and to explain the potential consequences associated with antimicrobial treatment to animal owners and managers, including the possibility of promoting selection of resistant bacteria. However, the consequences of losing usefulness of an antimicrobial drug that is used as a last resort in humans or animals with resistant bacterial infections might be unacceptable from a public or population health perspective. Veterinarians could therefore face the difficult choice of treating animals with a drug that is less likely to be successful, possibly resulting in prolonged or exacerbated morbidity, to protect the good of society. The Committee recommends that voluntary actions be taken by the veterinary profession to promote conservative use of antimicrobial drugs to minimize the potential adverse effects on animal or human health. The veterinary profession must work to educate all veterinarians about issues related to conservative antimicrobial drug use and antimicrobial resistance so that each individual is better able to balance ethical obligations regarding the perceived benefit to their patients versus the perceived risk to public health. Specific means by which the veterinary profession can promote stewardship of this valuable resource are presented and discussed in this document.

Sub-lethal effects of dietary neonicotinoid insecticide exposure on honey bee queen fecundity and colony development

NASA Astrophysics Data System (ADS)

Wu-Smart, Judy; Spivak, Marla

2016-08-01

Many factors can negatively affect honey bee (Apis mellifera L.) health including the pervasive use of systemic neonicotinoid insecticides. Through direct consumption of contaminated nectar and pollen from treated plants, neonicotinoids can affect foraging, learning, and memory in worker bees. Less well studied are the potential effects of neonicotinoids on queen bees, which may be exposed indirectly through trophallaxis, or food-sharing. To assess effects on queen productivity, small colonies of different sizes (1500, 3000, and 7000 bees) were fed imidacloprid (0, 10, 20, 50, and 100 ppb) in syrup for three weeks. We found adverse effects of imidacloprid on queens (egg-laying and locomotor activity), worker bees (foraging and hygienic activities), and colony development (brood production and pollen stores) in all treated colonies. Some effects were less evident as colony size increased, suggesting that larger colony populations may act as a buffer to pesticide exposure. This study is the first to show adverse effects of imidacloprid on queen bee fecundity and behavior and improves our understanding of how neonicotinoids may impair short-term colony functioning. These data indicate that risk-mitigation efforts should focus on reducing neonicotinoid exposure in the early spring when colonies are smallest and queens are most vulnerable to exposure.

Sub-lethal effects of dietary neonicotinoid insecticide exposure on honey bee queen fecundity and colony development

PubMed Central

Wu-Smart, Judy; Spivak, Marla

2016-01-01

Many factors can negatively affect honey bee (Apis mellifera L.) health including the pervasive use of systemic neonicotinoid insecticides. Through direct consumption of contaminated nectar and pollen from treated plants, neonicotinoids can affect foraging, learning, and memory in worker bees. Less well studied are the potential effects of neonicotinoids on queen bees, which may be exposed indirectly through trophallaxis, or food-sharing. To assess effects on queen productivity, small colonies of different sizes (1500, 3000, and 7000 bees) were fed imidacloprid (0, 10, 20, 50, and 100 ppb) in syrup for three weeks. We found adverse effects of imidacloprid on queens (egg-laying and locomotor activity), worker bees (foraging and hygienic activities), and colony development (brood production and pollen stores) in all treated colonies. Some effects were less evident as colony size increased, suggesting that larger colony populations may act as a buffer to pesticide exposure. This study is the first to show adverse effects of imidacloprid on queen bee fecundity and behavior and improves our understanding of how neonicotinoids may impair short-term colony functioning. These data indicate that risk-mitigation efforts should focus on reducing neonicotinoid exposure in the early spring when colonies are smallest and queens are most vulnerable to exposure. PMID:27562025

Professional tools and a personal touch – experiences of physical therapy of persons with migraine

PubMed Central

Kostenius, Catrine; Öhrling, Kerstin

2013-01-01

Purpose: The aim was to explore the lived experience of physical therapy of persons with migraine. Method: Data were collected by conducting narrative interviews with 11 persons with migraine. Inspired by van Manen, a hermeneutic phenomenological method was used to analyse the experiences of physical therapy which these persons had. Results: Physical therapy for persons with migraine meant making an effort in terms of time and energy to improve their health by meeting a person who was utilising his or her knowledge and skill to help. Being respected and treated as an individual and having confidence in the physical therapist were highlighted aspects. The analysis revealed a main theme, “meeting a physical therapist with professional tools and a personal touch”. The main theme included four sub-themes, “investing time and energy to feel better”, “relying on the competence of the physical therapist”, “wanting to be treated and to become involved as an individual” and “being respected in a trustful relationship”. Conclusions: The therapeutic relationship with the physical therapist is important and the findings of this study can increase awareness about relational aspects of physical therapy and encourage thoughtfulness among physical therapists and other healthcare professionals interacting with persons with migraine. PMID:23311671

Maggot therapy for wound care in Iran: a case series of the first 28 patients.

PubMed

Mirabzadeh, A; Ladani, M J; Imani, B; Rosen, S A B; Sherman, R A

2017-03-02

The need for improved wound care is receiving considerable attention in the Islamic Republic of Iran. Beginning in 2003, maggot therapy (MT) became part of Iran's effort to advance its wound care technology. The first cohort of patients treated with MT was analysed to evaluate the use of this treatment. Patients treated with MT at three hospitals in Tehran were analysed retrospectively. Primary outcomes were time to wound debridement and time to wound healing. Factors potentially influencing primary outcomes were also recorded, including demographic factors (such as age, race, gender), wound characteristics, underlying medical illnesses, and treatment attitudes. We analysed 28 patients with 29 wounds. Most (55%) of the wounds were ischaemic, neuropathic or mixed-pathology foot ulcers in patients with diabetes. Half were considered unsalvageable. All were completely debrided and subsequently healed with MT, without amputation, grafts, or advanced interventions. Osteomyelitis was present in all cases before MT, but appeared to have been eradicated, without recurrence during at least three years' follow-up. The most common adverse events were malodour, with wound pain reported in two patients. All patients and therapists were pleased with their overall experience. Maggot therapy can provide advanced wound care even in resource-limited areas. Maggot therapy was very acceptable to the patients and their therapists.

[School accidents--an epidemiological assessment of injury types and treatment effort].

PubMed

Kraus, R; Heiss, C; Alt, V; Schnettler, R

2006-10-01

Children and adolescents spend up to 50% of their time at school. The purpose of this study was to assess injury patterns with their treatment of school accidents in a Trauma Service of a German University Hospital and to compare these data to the literature. All school accidents from 01.07.1999 to 30.06.2004 were statistically analysed in a retrospective manner by chart review. There were 1399 school accidents treated in our department. Average age of the injured children was 11.8 years with a boy:girl ratio of 3:2. Almost 40% of the injuries occurred during school sport. The most frequently injured region was the upper extremity including the hand (36.8%). Distortion and contusion were the most frequent diagnoses of all injuries. 16% of the cases had to be treated surgically and/or under general anaesthesia and also a total of 16% of the patients had to be admitted to the hospital. It can be concluded for school facilities that special attention has to be paid during school sports activity and breaks because they account for most accidents. Traffic education may reduce severe injuries. For diagnosis and treatment of school accidents specific knowledge of the growing longbones of the upper extremity and the hand is important.

Predictors of Radiation Therapy Noncompliance in an Urban Academic Cancer Center

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

Ohri, Nitin; Rapkin, Bruce D.; Guha, Debayan

Purpose: To quantify the frequency of patient noncompliance in an urban radiation oncology department and identify predictors of noncompliance. Methods and Materials: We identified patients treated with external beam radiation therapy (RT) with curative intent in our department from 2007 to 2012 for 1 of 7 commonly treated malignancies. Patients who missed 2 or more scheduled RT appointments were deemed “noncompliant.” An institutional database was referenced to obtain clinical and demographic information for each patient, as well as a quantitative estimate of each patient's socioeconomic status. Logistic regression was used to identify factors associated with RT noncompliance. Results: A total ofmore » 2184 patients met eligibility criteria. Of these, 442 (20.2%) were deemed “noncompliant.” On multivariate analysis, statistically significant predictors of noncompliance included diagnosis of head-and-neck, cervical, or uterine cancer, treatment during winter months, low socioeconomic status, and use of a long treatment course (all P<.05). Conclusion: This is the first large effort examining patient noncompliance with daily RT. We have identified demographic, clinical, and treatment-related factors that can be used to identify patients at high risk for noncompliance. These findings may inform future strategies to improve adherence to prescribed therapy.« less

Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

PubMed Central

Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

2011-01-01

The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172

Therapeutic potential of helminths in autoimmune diseases: helminth-derived immune-regulators and immune balance.

PubMed

Wang, Meng; Wu, Linxiang; Weng, Rennan; Zheng, Weihong; Wu, Zhongdao; Lv, Zhiyue

2017-08-01

Helminths have accompanied human throughout history by releasing immune-evasion molecules that could counteract an aberrant immune response within the host. In the past decades, helminth infections are becoming less prevalent possibly due to the developed sanitation. Meanwhile, the incidence of autoimmune diseases is increasing, which cannot be exclusively explained by the changes of susceptibility genes. While the hygiene hypothesis casts light on the problem. The infections of helminths are believed to interact with and regulate human immunity with the byproduct of suppressing the autoimmune diseases. Thus, helminths are potential to treat or cure the autoimmune diseases. The therapeutic progresses and possible immune suppression mechanisms are illustrated in the review. The helminths that are studied most intensively include Heligmosomoides polygyrus, Hymenolepis diminuta, Schistosoma mansoni, Trichinella spiralis, and Trichuris suis. Special attentions are paid on the booming animal models and clinical trials that are to detect the efficiency of immune-modulating helminth-derived molecules on autoimmune diseases. These trials provide us with a prosperous clinical perspective, but the precise mechanism of the down-regulatory immune response remains to be clarified. More efforts are needed to be dedicated until these parasite-derived immune modulators could be used in clinic to treat or cure the autoimmune diseases under a standard management.

Targeting Hsp90 and its co-chaperones to treat Alzheimer’s disease

PubMed Central

Blair, Laura J.; Sabbagh, Jonathan J.; Dickey, Chad A.

2015-01-01

Introduction Alzheimer’s disease (AD), characterized by the accumulation of hyperphosphorylated tau and beta amyloid (Aβ), currently lacks effective treatment. Chaperone proteins, such as the heat shock protein (Hsp) 90, form macromolecular complexes with co-chaperones, which can regulate tau metabolism and Aβ processing. While small molecule inhibitors of Hsp90 have been successful at ameliorating tau and Aβ burden, their development into drugs to treat disease has been slow due to the off- and on-target effects of this approach as well as challenges with the pharmacology of current scaffolds. Thus, other approaches are being developed to improve these compounds and to target co-chaperones of Hsp90 in an effort to limit these liabilities. Areas Covered This article discusses the most current developments in Hsp90 inhibitors including advances in blood-brain barrier permeability, decreased toxicity, and homolog-specific small molecule inhibitors. In addition, we discuss current strategies targeting Hsp90 co-chaperones rather than Hsp90 itself to reduce off-target effects. Expert Opinion While Hsp90 inhibitors have proven their efficacy at reducing tau pathology, they have yet to meet with success in the clinic. The development of Hsp90/tau complex specific inhibitors and further development of Hsp90 co-chaperone specific drugs should yield more potent, less toxic therapeutics. PMID:25069659

Sub-lethal effects of dietary neonicotinoid insecticide exposure on honey bee queen fecundity and colony development.

PubMed

Wu-Smart, Judy; Spivak, Marla

2016-08-26

Many factors can negatively affect honey bee (Apis mellifera L.) health including the pervasive use of systemic neonicotinoid insecticides. Through direct consumption of contaminated nectar and pollen from treated plants, neonicotinoids can affect foraging, learning, and memory in worker bees. Less well studied are the potential effects of neonicotinoids on queen bees, which may be exposed indirectly through trophallaxis, or food-sharing. To assess effects on queen productivity, small colonies of different sizes (1500, 3000, and 7000 bees) were fed imidacloprid (0, 10, 20, 50, and 100 ppb) in syrup for three weeks. We found adverse effects of imidacloprid on queens (egg-laying and locomotor activity), worker bees (foraging and hygienic activities), and colony development (brood production and pollen stores) in all treated colonies. Some effects were less evident as colony size increased, suggesting that larger colony populations may act as a buffer to pesticide exposure. This study is the first to show adverse effects of imidacloprid on queen bee fecundity and behavior and improves our understanding of how neonicotinoids may impair short-term colony functioning. These data indicate that risk-mitigation efforts should focus on reducing neonicotinoid exposure in the early spring when colonies are smallest and queens are most vulnerable to exposure.

Multiple-scale structures: from Faraday waves to soft-matter quasicrystals.

PubMed

Savitz, Samuel; Babadi, Mehrtash; Lifshitz, Ron

2018-05-01

For many years, quasicrystals were observed only as solid-state metallic alloys, yet current research is now actively exploring their formation in a variety of soft materials, including systems of macromolecules, nanoparticles and colloids. Much effort is being invested in understanding the thermodynamic properties of these soft-matter quasicrystals in order to predict and possibly control the structures that form, and hopefully to shed light on the broader yet unresolved general questions of quasicrystal formation and stability. Moreover, the ability to control the self-assembly of soft quasicrystals may contribute to the development of novel photonics or other applications based on self-assembled metamaterials. Here a path is followed, leading to quantitative stability predictions, that starts with a model developed two decades ago to treat the formation of multiple-scale quasiperiodic Faraday waves (standing wave patterns in vibrating fluid surfaces) and which was later mapped onto systems of soft particles, interacting via multiple-scale pair potentials. The article reviews, and substantially expands, the quantitative predictions of these models, while correcting a few discrepancies in earlier calculations, and presents new analytical methods for treating the models. In so doing, a number of new stable quasicrystalline structures are found with octagonal, octadecagonal and higher-order symmetries, some of which may, it is hoped, be observed in future experiments.

Sequential analysis applied to clinical trials in dentistry: a systematic review.

PubMed

Bogowicz, P; Flores-Mir, C; Major, P W; Heo, G

2008-01-01

Clinical trials employ sequential analysis for the ethical and economic benefits it brings. In dentistry, as in other fields, resources are scarce and efforts are made to ensure that patients are treated ethically. The objective of this systematic review was to characterise the use of sequential analysis for clinical trials in dentistry. We searched various databases from 1900 through to January 2008. Articles were selected for review if they were clinical trials in the field of dentistry that had applied some form of sequential analysis. Selection was carried out independently by two of the authors. We included 18 trials from various specialties, which involved many different interventions. We conclude that sequential analysis seems to be underused in this field but that there are sufficient methodological resources in place for future applications.Evidence-Based Dentistry (2008) 9, 55-62. doi:10.1038/sj.ebd.6400587.

Targets for Drug Therapy for Autism Spectrum Disorder: Challenges and Future Directions.

PubMed

Lacivita, Enza; Perrone, Roberto; Margari, Lucia; Leopoldo, Marcello

2017-11-22

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction and restricted, repetitive patterns of behavior, interests, and activities. Various factors are involved in the etiopathogenesis of ASD, including genetic factors, environmental toxins and stressors, impaired immune responses, mitochondrial dysfunction, and neuroinflammation. The heterogeneity in the phenotype among ASD patients and the complex etiology of the condition have long impeded the advancement of the development of pharmacological therapies. In the recent years, the integration of findings from mouse models to human genetics resulted in considerable progress toward the understanding of ASD pathophysiology. Currently, strategies to treat core symptoms of ASD are directed to correct synaptic dysfunctions, abnormalities in central oxytocin, vasopressin, and serotonin neurotransmission, and neuroinflammation. Here, we present a survey of the studies that have suggested molecular targets for drug development for ASD and the state-of-the-art of medicinal chemistry efforts in related areas.

How molecular epidemiology studies can support the National Malaria Control Program in Papua New Guinea.

PubMed

Koepfli, Cristian; Barry, Alyssa; Javati, Sarah; Timinao, Lincoln; Nate, Elma; Mueller, Ivo; Barnadas, Celine

2014-01-01

Papua New Guinea (PNG) is undertaking intensified efforts to control malaria. The National Malaria Control Program aims to reduce the burden of disease by large-scale distribution of insecticide-treated bednets, improved diagnosis and implementation of new treatments. A scientific program monitoring the effect of these interventions, including molecular epidemiology studies, closely accompanies the program. Laboratory assays have been developed in (or transferred to) PNG to measure prevalence of infection and intensity of transmission as well as potential resistance to currently used drugs. These assays help to assess the impact of the National Malaria Control Program, and they reveal a much clearer picture of malaria epidemiology in PNG. In addition, analysis of the geographical clustering of parasites aids in selecting areas where intensified control will be most successful. This paper gives an overview of current research and recently completed studies in the molecular epidemiology of malaria conducted in Papua New Guinea.

Subcutaneous panniculitic T-cell lymphoma in children: response to combination therapy with cyclosporine and chemotherapy.

PubMed

Shani-Adir, Ayelet; Lucky, Anne W; Prendiville, Julie; Murphy, Sharon; Passo, Murray; Huang, Frederick S; Paller, Amy S

2004-02-01

We describe 2 adolescent boys with facial swelling and/or subcutaneous nodules and fever. Extensive evaluation, including several biopsy specimens, led to a diagnosis of subcutaneous panniculitic T-cell lymphoma, an entity rarely seen in children. Both patients were treated with oral cyclosporine in an effort to suppress the cytokine release from T-cells that has been thought to induce the hemophagocytic syndrome. The patients responded dramatically to cyclosporine treatment with defervescence of the fever and reduction in number and size of the subcutaneous nodules. Subsequent therapy with multidrug chemotherapy achieved complete remission in the first patient. This report suggests the value of cyclosporine as a first-line agent coupled with chemotherapy in the treatment of patients with subcutaneous panniculitic T-cell lymphoma. A clinicopathologic review of 8 described pediatric cases of subcutaneous panniculitic T-cell lymphoma is also presented.

Chimaeric antigen receptor T-cell therapy for tumour immunotherapy

PubMed Central

Sha, Huan-huan; Wang, Dan-dan; Yan, Da-li; Hu, Yong; Yang, Su-jin; Liu, Si-wen

2017-01-01

Chimaeric antigen receptor (CAR) T-cell therapies, as one of the cancer immunotherapies, have heralded a new era of treating cancer. The accumulating data, especially about CAR-modified T cells against CD19 support that CAR T-cell therapy is a highly effective immune therapy for B-cell malignancies. Apart from CD19, there have been many trials of CAR T cells directed other tumour specific or associated antigens (TSAs/TAAs) in haematologic malignancies and solid tumours. This review will briefly summarize basic CAR structure, parts of reported TSAs/TAAs, results of the clinical trials of CAR T-cell therapies as well as two life-threatening side effects. Experiments in vivo or in vitro, ongoing clinical trials and the outlook for CAR T-cell therapies also be included. Our future efforts will focus on identification of more viable cancer targets and more strategies to make CAR T-cell therapy safer. PMID:28053197

Assessment of Hexavalent Chromium Natural Attenuation for the Hanford Site 100 Area

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

Truex, Michael J.; Szecsody, James E.; Qafoku, Nikolla P.

2015-09-01

Hexavalent chromium (Cr(VI)) plumes are present in the 100 Area at the Hanford Site. Remediation efforts are under way with objectives of restoring the groundwater to meet the drinking-water standard (48 µg/L) and protecting the Columbia River by ensuring that discharge of groundwater to the river is below the surface-water quality standard (10 µg/L). Current remedies include application of Pump-and-Treat (P&T) at the 100-D, 100-H, and 100-K Areas and Monitored Natural Attenuation (MNA) at the 100-F/IU Area. Remedy selection is still under way at the other 100 Areas. Additional information about the natural attenuation processes for Cr(VI) is important inmore » all of these cases. In this study, laboratory experiments were conducted to demonstrate and quantify natural attenuation mechanisms using 100 Area sediments and groundwater conditions.« less

Desertification treaty includes key role for scientists

NASA Astrophysics Data System (ADS)

Showstack, Randy

When Lois Barber, executive director of the non-profit group EarthAction, began efforts to press for U.S. Senate ratification of the United Nations Convention to Combat Desertification several years ago, the treaty's purpose tripped up some people, she said. They wondered whether it might be a treaty related to military personnel who had abandoned their service, de-certification of something or other, or even an overabundance of after-dinner treats. While the issue may not yet rate highly on the U.S. radar screen, U.S. Senate ratification of the Convention to Combat Desertification (CCD) on November 17, 2000 and entry into force of the treaty in the United States on February 2, 2001, could bring additional focus on desertification from the scientific community and policy-makers, according to a number of experts involved with the issue. The treaty now has been ratified by 174 countries.

Chief Complaint-Based Performance Measures: A New Focus For Acute Care Quality Measurement

PubMed Central

Griffey, Richard T; Pines, Jesse M.; Farley, Heather L.; Phelan, Michael P; Beach, Christopher; Schuur, Jeremiah D; Venkatesh, Arjun K.

2014-01-01

Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Disease Classification (ICD)-9 codes in administrative claims data. While the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care which involves diagnosing, risk-stratifying, and treating patients’ potentially life-threatening conditions based on symptoms (i.e. chief complaints). In this paper we propose chief complaint-based quality measures as a means to enhance the evaluation of quality and value in emergency care. We discuss the potential benefits of chief-complaint based measures, describe opportunities to mitigate challenges, propose an example measure set, and present several recommendations to advance this paradigm in ED-based performance measurement. PMID:25443989

Long-term efficacy, safety and tolerability of Remoxy for the management of chronic pain.

PubMed

Pergolizzi, Joseph V; Zampogna, Gianpietro; Taylor, Robert; Raffa, Robert B

2015-03-01

Historically, chronic pain generally went under-treated for a variety of objective and subjective reasons, including difficulty to objectively diagnose and manage over a long period of time, potential serious adverse effects of commonly available medications, and patient, healthcare and societal concerns over opioid medications. More recently, in an effort to redress the under-treatment of pain, the number of prescriptions of opioid analgesics has risen dramatically. However, paralleling the increased legitimate use has been a concomitant increase in opioid abuse, misuse and diversion. Pharmaceutical companies have responded by developing a variety of opioid formulations designed to deter abuse by making the products more difficult to tamper with. One such product is Remoxy(®), an extended-release formulation of the strong opioid oxycodone. We review the efficacy, safety and tolerability of this formulation based on the available published literature.

New evaluations of redox regulating system in adipose tissue of obesity.

PubMed

Park, Jiyoung; Chung, Jun-Jae; Kim, Jae Bum

2007-09-01

During the past several decades, the incidence of obesity has significantly increased worldwide. Enormous efforts have been devoted to understanding the molecular mechanisms underlying obesity and its related metabolic disorders such as type 2 diabetes, cardiovascular disease, atherosclerosis, and hypertension. It is now well-established that altered adipocyte metabolism in obese patients is closely associated with the induction of various metabolic stresses including hyperglycemia, hyperlipidemia, hyperinsulinemia, and chronic inflammation. However, the cellular factor(s) which sense metabolic changes and/or initiate the pathological progression of obesity-induced metabolic disorders remain to be elucidated. In this review, we will discuss the possible roles of cellular NADP(+)/NADPH, which function as redox potential regulators, in the induction of obesity-associated oxidative stress, chronic inflammation, and insulin resistance and suggest G6PD, a NADPH-generating enzyme, as a novel target for treating metabolic disorders.

The project office of the Gaia Data Processing and Analysis Consortium

NASA Astrophysics Data System (ADS)

Mercier, E.; Els, S.; Gracia, G.; O'Mullane, W.; Lock, T.; Comoretto, G.

2010-07-01

Gaia is Europe's future astrometry satellite which is currently under development. The data collected by Gaia will be treated and analyzed by the "Data Processing and Analysis Consortium" (DPAC). DPAC consists of over 400 scientists in more than 22 countries, which are currently developing the required data reduction, analysis and handling algorithms and routines. DPAC is organized in Coordination Units (CU's) and Data Processing Centres (DPCs). Each of these entities is individually responsible for the development of software for the processing of the different data. In 2008, the DPAC Project Office (PO) has been set-up with the task to manage the day-to-day activities of the consortium including implementation, development and operations. This paper describes the tasks DPAC faces and the role of the DPAC PO in the Gaia framework and how it supports the DPAC entities in their effort to fulfill the Gaia promise.

Drug therapy in spinal tuberculosis.

PubMed

Rajasekaran, S; Khandelwal, Gaurav

2013-06-01

Although the discovery of effective anti-tuberculosis drugs has made uncomplicated spinal tuberculosis a medical disease, the advent of multi-drug-resistant Mycobacterium tuberculosis and the co-infection of HIV with tuberculosis have led to a resurgence of the disease recently. The principles of drug treatment of spinal tuberculosis are derived from our experience in treating pulmonary tuberculosis. Spinal tuberculosis is classified to be a severe form of extrapulmonary tuberculosis and hence is included in Category I of the WHO classification. The tuberculosis bacilli isolated from patients are of four different types with different growth kinetics and metabolic characteristics. Hence multiple drugs, which act on the different groups of the mycobacteria, are included in each anti-tuberculosis drug regimen. Prolonged and uninterrupted chemotherapy (which may be 'short course' and 'intermittent' but preferably 'directly observed') is effective in controlling the infection. Spinal Multi-drug-resistant TB and spinal TB in HIV-positive patients present unique problems in management and have much poorer prognosis. Failure of chemotherapy and emergence of drug resistance are frequent due to the failure of compliance hence all efforts must be made to improve patient compliance to the prescribed drug regimen.

Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications.

PubMed

Gawron, Lori M; Watson, Katie

2017-02-01

We explored whether the decision-making process of women aborting a pregnancy for a fetal indication fit common medical ethical frameworks. We applied three ethical frameworks (principlism, care ethics, and narrative ethics) in a secondary analysis of 30 qualitative interviews from women choosing 2nd trimester abortion for fetal indications. All 30 women offered reasoning consistent with one or more ethical frameworks. Principlism themes included avoidance of personal suffering (autonomy), and sparing a child a poor quality of life and painful medical interventions (beneficence/non-maleficence). Care ethics reasoning included relational considerations of family needs and resources, and narrative ethics reasoning contextualized this experience into the patient's life story. This population's universal application of commonly accepted medical ethical frameworks supports the position that patients choosing fetal indication abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures. These findings suggest recent political efforts blocking abortion access should be reframed as attempts to undermine the moral decision-making of women. Published by Elsevier Inc.

Protection of Conductive and Non-conductive Advanced Polymer-based Paints from Highly Aggressive Oxidative Environments

NASA Technical Reports Server (NTRS)

Gudimenko, Y.; Ng, R.; Iskanderova, Z.; Kleiman, J.; Grigorevsky, A.; Kiseleva, L.; Finckenor, M.; Edwards, D.

2005-01-01

Research has been continued to further improve the space durability of conductive and non-conductive polymer-based paints and of conductive thermal control paints for space applications. Efforts have been made to enhance the space durability and stability of functional Characteristics in ground-based space environment imitating conditions, using specially developed surface modification treatment. The results of surface modification of new conductive paints, including the ground-based testing in aggressive oxidative environments, such as atomic oxygen/UV and oxygen plasma, and performance evaluation are presented. Functional properties and performance characteristics, such as thermal optical properties (differential solar absorptance and thermal emittance representing the thermal optical performance of thermal control paints) and surface resistivity characteristics of pristine, surface modified, and tested materials were verified. Extensive surface analysis studies have been performed using complementary surface analyses including SEM/EDS and XPS. Test results revealed that the successfully treated materials exhibit reduced mass loss and no surface morphology change, thus indicating good protection from the severe oxidative environment. It was demonstrated that the developed surface modification treatment could be applied successfully to charge dissipative and conductive paints.

Cell Culturing of Cytoskeleton

NASA Technical Reports Server (NTRS)

2004-01-01

Biomedical research offers hope for a variety of medical problems, from diabetes to the replacement of damaged bone and tissues. Bioreactors, which are used to grow cells and tissue cultures, play a major role in such research and production efforts. Cell culturing, such as this bone cell culture, is an important part of biomedical research. The BioDyn payload includes a tissue engineering investigation. The commercial affiliate, Millenium Biologix, Inc., has been conducting bone implant experiments to better understand how synthetic bone can be used to treat bone-related illnesses and bone damaged in accidents. On STS-95, the BioDyn payload will include a bone cell culture aimed to help develop this commercial synthetic bone product. Millenium Biologix, Inc., is exploring the potential for making human bone implantable materials by seeding its proprietary artificial scaffold material with human bone cells. The product of this tissue engineering experiment using the Bioprocessing Modules (BPMs) on STS-95 is space-grown bone implants, which could have potential for dental implants, long bone grafts, and coating for orthopedic implants such as hip replacements.

Cell Culturing of Cytoskeleton

NASA Technical Reports Server (NTRS)

2004-01-01

Biomedical research offers hope for a variety of medical problems, from diabetes to the replacement of damaged bone and tissues. Bioreactors, which are used to grow cells and tissue cultures, play a major role in such research and production efforts. Cell culturing, such as this bone cell culture, is an important part of biomedical research. The BioDyn payload includes a tissue engineering investigation. The commercial affiliate, Millenium Biologix, Inc. has been conducting bone implant experiments to better understand how synthetic bone can be used to treat bone-related illnesses and bone damaged in accidents. On STS-95, the BioDyn payload will include a bone cell culture aimed to help develop this commercial synthetic bone product. Millenium Biologix, Inc. is exploring the potential for making human bone implantable materials by seeding its proprietary artificial scaffold material with human bone cells. The product of this tissue engineering experiment using the Bioprocessing Modules (BPMs) on STS-95 is space-grown bone implants, which could have potential for dental implants, long bone grafts, and coating for orthopedic implants such as hip replacements.

The NASA Human Research Wiki - An Online Collaboration Tool

NASA Technical Reports Server (NTRS)

Barr, Yael; Rasbury, Jack; Johnson, Jordan; Barstend, Kristina; Saile, Lynn; Watkins, Sharmi

2012-01-01

The Exploration Medical Capability (ExMC) element is one of six elements of the Human Research Program (HRP). ExMC is charged with decreasing the risk of: "Inability to adequately recognize or treat an ill or injured crew member" for exploration-class missions In preparation for exploration-class missions, ExMC has compiled a large evidence base, previously available only to persons within the NASA community. ExMC has developed the "NASA Human Research Wiki" in an effort to make the ExMC information available to the general public and increase collaboration within and outside of NASA. The ExMC evidence base is comprised of several types of data, including: (1)Information on more than 80 medical conditions which could occur during space flight (a)Derived from several sources (b)Including data on incidence and potential outcomes, as captured in the Integrated Medical Model s (IMM) Clinical Finding Forms (CliFFs). (2)Approximately 25 gap reports (a)Identify any "gaps" in knowledge and/or technology that would need to be addressed in order to provide adequate medical support for these novel missions.

From classical to quantum and back: Hamiltonian adaptive resolution path integral, ring polymer, and centroid molecular dynamics

NASA Astrophysics Data System (ADS)

Kreis, Karsten; Kremer, Kurt; Potestio, Raffaello; Tuckerman, Mark E.

2017-12-01

Path integral-based methodologies play a crucial role for the investigation of nuclear quantum effects by means of computer simulations. However, these techniques are significantly more demanding than corresponding classical simulations. To reduce this numerical effort, we recently proposed a method, based on a rigorous Hamiltonian formulation, which restricts the quantum modeling to a small but relevant spatial region within a larger reservoir where particles are treated classically. In this work, we extend this idea and show how it can be implemented along with state-of-the-art path integral simulation techniques, including path-integral molecular dynamics, which allows for the calculation of quantum statistical properties, and ring-polymer and centroid molecular dynamics, which allow the calculation of approximate quantum dynamical properties. To this end, we derive a new integration algorithm that also makes use of multiple time-stepping. The scheme is validated via adaptive classical-path-integral simulations of liquid water. Potential applications of the proposed multiresolution method are diverse and include efficient quantum simulations of interfaces as well as complex biomolecular systems such as membranes and proteins.

An Optimized DNA Analysis Workflow for the Sampling, Extraction, and Concentration of DNA obtained from Archived Latent Fingerprints.

PubMed

Solomon, April D; Hytinen, Madison E; McClain, Aryn M; Miller, Marilyn T; Dawson Cruz, Tracey

2018-01-01

DNA profiles have been obtained from fingerprints, but there is limited knowledge regarding DNA analysis from archived latent fingerprints-touch DNA "sandwiched" between adhesive and paper. Thus, this study sought to comparatively analyze a variety of collection and analytical methods in an effort to seek an optimized workflow for this specific sample type. Untreated and treated archived latent fingerprints were utilized to compare different biological sampling techniques, swab diluents, DNA extraction systems, DNA concentration practices, and post-amplification purification methods. Archived latent fingerprints disassembled and sampled via direct cutting, followed by DNA extracted using the QIAamp® DNA Investigator Kit, and concentration with Centri-Sep™ columns increased the odds of obtaining an STR profile. Using the recommended DNA workflow, 9 of the 10 samples provided STR profiles, which included 7-100% of the expected STR alleles and two full profiles. Thus, with carefully selected procedures, archived latent fingerprints can be a viable DNA source for criminal investigations including cold/postconviction cases. © 2017 American Academy of Forensic Sciences.

Accurately modeling Gaussian beam propagation in the context of Monte Carlo techniques

NASA Astrophysics Data System (ADS)

Hokr, Brett H.; Winblad, Aidan; Bixler, Joel N.; Elpers, Gabriel; Zollars, Byron; Scully, Marlan O.; Yakovlev, Vladislav V.; Thomas, Robert J.

2016-03-01

Monte Carlo simulations are widely considered to be the gold standard for studying the propagation of light in turbid media. However, traditional Monte Carlo methods fail to account for diffraction because they treat light as a particle. This results in converging beams focusing to a point instead of a diffraction limited spot, greatly effecting the accuracy of Monte Carlo simulations near the focal plane. Here, we present a technique capable of simulating a focusing beam in accordance to the rules of Gaussian optics, resulting in a diffraction limited focal spot. This technique can be easily implemented into any traditional Monte Carlo simulation allowing existing models to be converted to include accurate focusing geometries with minimal effort. We will present results for a focusing beam in a layered tissue model, demonstrating that for different scenarios the region of highest intensity, thus the greatest heating, can change from the surface to the focus. The ability to simulate accurate focusing geometries will greatly enhance the usefulness of Monte Carlo for countless applications, including studying laser tissue interactions in medical applications and light propagation through turbid media.

Cell Cycle Inhibition To Treat Sleeping Sickness.

PubMed

Epting, Conrad L; Emmer, Brian T; Du, Nga Y; Taylor, Joann M; Makanji, Ming Y; Olson, Cheryl L; Engman, David M

2017-09-19

African trypanosomiasis is caused by infection with the protozoan parasite Trypanosoma brucei During infection, this pathogen divides rapidly to high density in the bloodstream of its mammalian host in a manner similar to that of leukemia. Like all eukaryotes, T. brucei has a cell cycle involving the de novo synthesis of DNA regulated by ribonucleotide reductase (RNR), which catalyzes the conversion of ribonucleotides into their deoxy form. As an essential enzyme for the cell cycle, RNR is a common target for cancer chemotherapy. We hypothesized that inhibition of RNR by genetic or pharmacological means would impair parasite growth in vitro and prolong the survival of infected animals. Our results demonstrate that RNR inhibition is highly effective in suppressing parasite growth both in vitro and in vivo These results support drug discovery efforts targeting the cell cycle, not only for African trypanosomiasis but possibly also for other infections by eukaryotic pathogens. IMPORTANCE The development of drugs to treat infections with eukaryotic pathogens is challenging because many key virulence factors have closely related homologues in humans. Drug toxicity greatly limits these development efforts. For pathogens that replicate at a high rate, especially in the blood, an alternative approach is to target the cell cycle directly, much as is done to treat some hematologic malignancies. The results presented here indicate that targeting the cell cycle via inhibition of ribonucleotide reductase is effective at killing trypanosomes and prolonging the survival of infected animals. Copyright © 2017 Epting et al.

Actinic Keratosis Pathogenesis Update and New Patents.

PubMed

Cantisani, Carmen; Paolino, Giovanni; Melis, Marcello; Faina, Valentina; Romaniello, Federico; Didona, Dario; Cardone, Michele; Calvieri, Stefano

2016-01-01

Actinic keratosis is a common premalignant skin lesion. Because of its increasing incidence, several efforts have been made to earlier detectection and to improve knowledge on photocarcinogenic pathways of keratinocytes. As a consequence, recently new discoveries have been done in this field. Starting from our previous review on actinic keratosis, we reviewed the literature focusing on pathogenesis and new patents in order to highlight the most recent progresses in diagnosis and therapeutic approach. Although several efforts have been done in the field of photodamaged skin, new upgrades in diagnosis and therapy are needed to detect superficial actinic keratosis earlier, to improve the disease free survival of patient and to better treat the field cancerization.

Building a Sustainable Global Surgery Nonprofit Organization at an Academic Institution.

PubMed

Frisella, Margaret M

Surgical Outreach for the Americas is a 501(c)3 nonprofit organization providing surgical care to those in need in developing countries of the Western Hemisphere. Every year since its inception in 2008, teams of surgeons, nurses, and allied health professionals have traveled to areas of need and performed primarily hernia repair surgeries for those without access to affordable health care. Surgical Outreach for the Americas (SOfA) began as a general concept based on World Health Organization statistics claiming that 11% of the global burden of disease can be resolved via surgery. Armed with this information, a group of compassionate and selfless health care professionals planned the first trip, to the Dominican Republic, in January 2009. Building on what was first just an ambition to help others, we now also train surgeons, surgery residents, and nurses in the countries we serve. To date, SOfA has successfully treated 734 patients, with 899 total surgical procedures performed (693 of these under general anesthesia). These procedures include inguinal hernia, umbilical hernia, testicular masses, orchiectomies, and various general surgical procedures. Through the efforts of a great many talented individuals and robust fundraising efforts, the SOfA message continues to gain momentum. SOfA not only considers the health and well-being of the disadvantaged through capacity-building efforts but strives to educate and improve the skills of health care professionals in the countries we visit. Our goal is to increase the number of missions each year and begin a 2-fold educational program that (a) provides surgical resident education through participation in mission work and (b) provides local surgeon education in the areas served. Copyright © 2016. Published by Elsevier Inc.

Nanoelectric Materials Laboratory Development

NASA Technical Reports Server (NTRS)

Allen, Lee; Hill, Curtis

2015-01-01

The Ultracapacitor Research and Development project is a collaborative effort between the NASA Marshall Space Flight Center's (MSFC's) ES43 Parts, Packaging, and Fabrication Branch and the EM41 Nonmetallic Materials Branch. NASA's Ultracapacitor Research is an effort to develop solid-state energy storage devices through processing of ceramic materials into printable dielectric inks, which can be formed and treated to produce solid state ultracapacitor cells capable of exceeding lithium-ion battery energy density at a fraction of the weight. Research and development efforts into solid state ultracapacitors have highlighted a series of technical challenges such as understanding as-received nature of ceramic powders, treatment and optimization of ceramic powders, dielectric and conductor ink formulation, and firing of printed (green) ultracapacitor cells. Two facilities have been continually developed since project inception: the Additive Electronics Lab in Bldg. 4487 and the Nanoelectric Materials Lab in Bldg. 4602. The Nanoelectric Materials Lab has become a unique facility at MSFC, capable of custom processing a wide range of media for additive electronics. As research has progressed, it was discovered that additional in-house processing was necessary to achieve smaller, more uniform particle diameters. A vibratory mill was obtained that can agitate powder and media in three directions, which has shown to be much more effective than ball milling. However, in order to understand the effects of milling, a particle size analysis system has been installed to characterize as-received and milled materials Continued research into the ultracapacitor technology included advanced milling and optimization of ceramic nanoparticles, fluidized bed treatment of atomic-layer deposition- (ALD-) coated ceramic particles, custom development of dielectric and conductor inks, as well as custom ink precursors such as polyvinylidene diflouride- (PVDF-) loaded vehicles. Experiments with graphene-based inks were also conducted.

Effects of flooding and tamarisk removal on habitat for sensitive fish species in the San Rafael River, Utah: implications for fish habitat enhancement and future restoration efforts.

PubMed

Keller, Daniel L; Laub, Brian G; Birdsey, Paul; Dean, David J

2014-09-01

Tamarisk removal is a widespread restoration practice on rivers in the southwestern USA, but impacts of removal on fish habitat have rarely been investigated. We examined whether tamarisk removal, in combination with a large spring flood, had the potential to improve fish habitat on the San Rafael River in southeastern Utah. We quantified habitat complexity and the distribution of wood accumulation in a tamarisk removal site (treated) and a non-removal site (untreated) in 2010, 1 year prior to a large magnitude and long-duration spring flood. We used aerial imagery to analyze river changes in the treated and untreated sites. Areas of channel movement were significantly larger in the treated site compared to the untreated site, primarily because of geomorphic characteristics of the channel, including higher sinuosity and the presence of an ephemeral tributary. However, results suggest that tamarisk removal on the outside of meander bends, where it grows directly on the channel margins, can promote increased channel movement. Prior to the flood, wood accumulations were concentrated in sections of channel where tamarisk had been removed. Pools, riffles, and backwaters occurred more frequently within 30 m upstream and downstream of wood accumulations compared to areas within 30 m of random points. Pools associated with wood accumulations were also significantly larger and deeper than those associated with random points. These results suggest that the combination of tamarisk removal and wood input can increase the potential for channel movement during spring floods thereby diversifying river habitat and improving conditions for native fish.

Effects of Flooding and Tamarisk Removal on Habitat for Sensitive Fish Species in the San Rafael River, Utah: Implications for Fish Habitat Enhancement and Future Restoration Efforts

NASA Astrophysics Data System (ADS)

Keller, Daniel L.; Laub, Brian G.; Birdsey, Paul; Dean, David J.

2014-09-01

Tamarisk removal is a widespread restoration practice on rivers in the southwestern USA, but impacts of removal on fish habitat have rarely been investigated. We examined whether tamarisk removal, in combination with a large spring flood, had the potential to improve fish habitat on the San Rafael River in southeastern Utah. We quantified habitat complexity and the distribution of wood accumulation in a tamarisk removal site (treated) and a non-removal site (untreated) in 2010, 1 year prior to a large magnitude and long-duration spring flood. We used aerial imagery to analyze river changes in the treated and untreated sites. Areas of channel movement were significantly larger in the treated site compared to the untreated site, primarily because of geomorphic characteristics of the channel, including higher sinuosity and the presence of an ephemeral tributary. However, results suggest that tamarisk removal on the outside of meander bends, where it grows directly on the channel margins, can promote increased channel movement. Prior to the flood, wood accumulations were concentrated in sections of channel where tamarisk had been removed. Pools, riffles, and backwaters occurred more frequently within 30 m upstream and downstream of wood accumulations compared to areas within 30 m of random points. Pools associated with wood accumulations were also significantly larger and deeper than those associated with random points. These results suggest that the combination of tamarisk removal and wood input can increase the potential for channel movement during spring floods thereby diversifying river habitat and improving conditions for native fish.

Violations identified from routine swimming pool inspections--selected states and counties, United States, 2008.

PubMed

2010-05-21

Swimming is the third most popular U.S. sport or exercise activity, with approximately 314 million visits to recreational water venues, including treated venues (e.g., pools), each year. The most frequently reported type of recreational water illness (RWI) outbreak is gastroenteritis, the incidence of which is increasing. During 1997--2006, chlorine- and bromine-susceptible pathogens (e.g., Shigella and norovirus) caused 24 (23%) of 104 treated venue--associated RWI outbreaks of gastroenteritis, indicating lapses in proper operation of pools. Pool inspectors help minimize the risk for RWIs and injuries by enforcing regulations that govern public treated recreational water venues. To assess pool code compliance, CDC analyzed 2008 data from 121,020 routine pool inspections conducted by a convenience sample of 15 state and local agencies. Because pool codes and, therefore, inspection items differed across jurisdictions, reported denominators varied. Of 111,487 inspections, 13,532 (12.1%) resulted in immediate closure because of serious violations (e.g., lack of disinfectant in the water). Of 120,975 inspections, 12,917 (10.7%) identified disinfectant level violations. Although these results likely are not representative of all pools in the United States, they suggest the need for increased public health scrutiny and improved pool operation. The results also demonstrate that pool inspection data can be used as a potential source for surveillance to guide resource allocation and regulatory decision-making. Collecting pool inspection data in a standardized, electronic format can facilitate routine analysis to support efforts to reduce health and safety risks for swimmers.

Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

PubMed Central

Brown, Shan-Estelle; Altice, Frederick L.

2017-01-01

Background Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. Objectives To identify facilitators of self-treatment by online buprenorphine/naloxone users. Methods A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Results Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a “bad-tasting” medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely “substance-free.” The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. Conclusions/Importance The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat. PMID:24779501

Mitigating Abnormal Grain Growth for Friction Stir Welded Al-Li 2195 Spun Formed Domes

NASA Technical Reports Server (NTRS)

Chen, Po-Shou; Russell, Carolyn

2012-01-01

Formability and abnormal grain growth (AGG) are the two major issues that have been encountered for Al alloy spun formed dome development using friction stir welded blanks. Material properties that have significant influence on the formability include forming range and strain hardening exponent. In this study, tensile tests were performed for two 2195 friction stir weld parameter sets at 400 F to study the effects of post weld anneal on the forming range and strain hardening exponent. It was found that the formability can be enhanced by applying a newly developed post weld anneal to heat treat the friction stir welded panels. This new post weld anneal leads to a higher forming range and much improved strain hardening exponent. AGG in the weld nugget is known to cause a significant reduction of ductility and fracture toughness. This study also investigated how AGG may be influenced by the heating rate to the solution heat treatment temperature. After post-weld annealing, friction stir welds were strained to 15% and 39% by compression at 400 F before they were subjected to SHT at 950 F for 1 hour. Salt bath SHT is very effective in reducing the grain size as it helps arrest the onset of AGG and promote normal recrystallization and grain growth. However, heat treating a 18 ft dome using a salt bath is not practical. Efforts are continuing at Marshall Space Flight Center to identify the welding parameters and heat treating parameters that can help mitigate the AGG in the friction stir welds.

Prevalence of drug-resistant tuberculosis in Nigeria: A systematic review and meta-analysis

PubMed Central

Onyedum, Cajetan C.; Alobu, Isaac

2017-01-01

Background Drug-resistant tuberculosis (TB) undermines control efforts and its burden is poorly understood in resource-limited settings. We performed a systematic review and meta-analysis to provide an up-to-date summary of the extent of drug-resistant TB in Nigeria. Methods We searched PubMed, Scopus, Embase, HINARI, AJOL, the Cochrane library, Web of Science, and Google Scholar for reports published before January 31 2017, that included any resistance, mono-resistance or multidrug resistance to anti-TB drugs in Nigeria. Summary estimates were calculated using random effects models. Results We identified 34 anti-TB drug resistance surveys with 8002 adult TB patients consisting of 2982 new and 5020 previously-treated cases. The prevalence rate of any drug resistance among new TB cases was 32.0% (95% CI 24.0–40.0%; 734/2892) and among previously-treated cases, the rate was 53.0% (95% CI 35.0–71.0%; 1467/5020). Furthermore, multidrug resistance among new and previously-treated cases was 6.0% (95% CI 4.0–8.0%;161/2502)and 32.0% (95%CI 20.0–44.0; 357/949), respectively. There was significant heterogeneity between the studies (p<0.001, I2 tests). The prevalence of drug-resistant TB varied according to methods of drug susceptibility testing and geographic region of Nigeria. Conclusion The burden of drug-resistant TB in Nigeria is high. We recommend that a national anti-TB drug resistance survey be carried out, and strategies for case detection and programmatic management of drug-resistant TB in Nigeria need to be strengthened. PMID:28704459

Prevalence of drug-resistant tuberculosis in Nigeria: A systematic review and meta-analysis.

PubMed

Onyedum, Cajetan C; Alobu, Isaac; Ukwaja, Kingsley Nnanna

2017-01-01

Drug-resistant tuberculosis (TB) undermines control efforts and its burden is poorly understood in resource-limited settings. We performed a systematic review and meta-analysis to provide an up-to-date summary of the extent of drug-resistant TB in Nigeria. We searched PubMed, Scopus, Embase, HINARI, AJOL, the Cochrane library, Web of Science, and Google Scholar for reports published before January 31 2017, that included any resistance, mono-resistance or multidrug resistance to anti-TB drugs in Nigeria. Summary estimates were calculated using random effects models. We identified 34 anti-TB drug resistance surveys with 8002 adult TB patients consisting of 2982 new and 5020 previously-treated cases. The prevalence rate of any drug resistance among new TB cases was 32.0% (95% CI 24.0-40.0%; 734/2892) and among previously-treated cases, the rate was 53.0% (95% CI 35.0-71.0%; 1467/5020). Furthermore, multidrug resistance among new and previously-treated cases was 6.0% (95% CI 4.0-8.0%;161/2502)and 32.0% (95%CI 20.0-44.0; 357/949), respectively. There was significant heterogeneity between the studies (p<0.001, I2 tests). The prevalence of drug-resistant TB varied according to methods of drug susceptibility testing and geographic region of Nigeria. The burden of drug-resistant TB in Nigeria is high. We recommend that a national anti-TB drug resistance survey be carried out, and strategies for case detection and programmatic management of drug-resistant TB in Nigeria need to be strengthened.

Review of synthetic approaches toward maoecrystal V.

PubMed

Smith, Brandon R; Njardarson, Jon T

2018-05-18

Synthetic approaches toward the complex natural product diterpenoid maoecrystal V are reviewed, including successful total syntheses, published synthetic efforts, and efforts compiled from dissertations. The review focuses on general synthetic strategies and chronicles efforts toward the molecule since its isolation in 2004, summarizing key contributions of these efforts to the broader synthetic community.

Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates

PubMed Central

Reddy, L. Felice; Barch, Deanna M.; Buchanan, Robert W.; Dunayevich, Eduardo; Gold, James M.; Marder, Steven R.; Wynn, Jonathan K.; Young, Jared W.; Green, Michael F.

2015-01-01

Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. PMID:26209546

Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 1—Psychometric Characteristics of 5 Paradigms

PubMed Central

Reddy, L. Felice; Horan, William P.; Barch, Deanna M.; Buchanan, Robert W.; Dunayevich, Eduardo; Gold, James M.; Lyons, Naomi; Marder, Stephen R.; Treadway, Michael T.; Wynn, Jonathan K.; Young, Jared W.; Green, Michael F.

2015-01-01

Impairments in willingness to exert effort contribute to the motivational deficits characteristic of the negative symptoms of schizophrenia. The current study evaluated the psychometric properties of 5 new or adapted paradigms to determine their suitability for use in clinical trials of schizophrenia. This study included 94 clinically stable participants with schizophrenia and 40 healthy controls. The effort-based decision-making battery was administered twice to the schizophrenia group (baseline, 4-week retest) and once to the control group. The 5 paradigms included 1 that assesses cognitive effort, 1 perceptual effort, and 3 that assess physical effort. Each paradigm was evaluated on (1) patient vs healthy control group differences, (2) test-retest reliability, (3) utility as a repeated measure (ie, practice effects), and (4) tolerability. The 5 paradigms showed varying psychometric strengths and weaknesses. The Effort Expenditure for Rewards Task showed the best reliability and utility as a repeated measure, while the Grip Effort Task had significant patient-control group differences, and superior tolerability and administration duration. The other paradigms showed weaker psychometric characteristics in their current forms. These findings highlight challenges in adapting effort and motivation paradigms for use in clinical trials. PMID:26142081

Triple combination antibiotic therapy for carbapenemase-producing Klebsiella pneumoniae: a systematic review.

PubMed

Jacobs, David M; Safir, M Courtney; Huang, Dennis; Minhaj, Faisal; Parker, Adam; Rao, Gauri G

2017-11-25

The spread of carbapenemase-producing K. pneumoniae (CPKP) has become a significant problem worldwide. Combination therapy for CPKP is encouraging, but polymyxin resistance to many antibiotics is hampering effective treatment. Combination therapy with three or more antibiotics is being increasingly reported, therefore we performed a systematic review of triple combination cases in an effort to evaluate their clinical effectiveness for CPKP infections. The PubMed database was searched to identify all published clinical outcomes of CPKP infections treated with triple combination therapy. Articles were stratified into two tiers depending on the level of clinical detail provided. A tier 1 study included: antibiotic regimen, regimen-specific outcome, patient status at onset of infection, and source of infection. Articles not reaching these criteria were considered tier 2. Thirty-three studies were eligible, 23 tier 1 and ten tier 2. Among tier 1 studies, 53 cases were included in this analysis. The most common infection was pneumonia (31%) followed by primary or catheter-related bacteremia (21%) and urinary tract infection (17%). Different combinations of antibiotic classes were utilized in triple combinations, the most common being a polymyxin (colistin or polymyxin B, 86.8%), tigecycline (73.6%), aminoglycoside (43.4%), or carbapenem (43.4%). Clinical and microbiological failure occurred in 14/39 patients (35.9%) and 22/42 patients (52.4%), respectively. Overall mortality for patients treated with triple combination therapy was 35.8% (19/53 patients). Triple combination therapy is being considered as a treatment option for CPKP. Polymyxin-based therapy is the backbone antibiotic in these regimens, but its effectiveness needs establishing in prospective clinical trials.

Broadening our perspectives on complementary and alternative medicine for menopause: A narrative review.

PubMed

Tonob, Dunia; Melby, Melissa K

2017-05-01

Complementary and alternative medicine (CAM) is widely used for menopause, although not all women disclose use to their healthcare providers. This narrative review aims to expand providers' understanding of cross-cultural approaches to treating and managing menopause by providing an overarching framework and perspective on CAM treatments. Increased provider understanding and awareness may improve not only provider-patient communication but also effectiveness of treatments. The distinction between illness (what patients suffer) and disease (what physicians treat) highlights the gap between what patients seek and doctors provide, and may help clarify why many women seek CAM at menopause. For example, CAM is often sought by women for whom biomedicine has been unsuccessful or inaccessible. We review the relevance to menopause of three CAM categories: natural products, mind-body practices including meditation, and other complementary health approaches including traditional Chinese medicine (TCM) and Japanese Kampo. Assessing the effectiveness of CAM is challenging because of the individualized nature of illness patterns and associated treatments, which complicate the design of randomized controlled trials. Because many women seek CAM due to inefficacy of biomedical treatments, or cultural or economic marginalization, biomedical practitioners who make an effort to learn about CAM and ask patients about their CAM use or interest may dramatically improve the patient-provider relationship and rapport, as well as harnessing the 'meaning response' (Moerman, 2002) imbued in the clinical encounter. By working with women to integrate their CAM-related health-seeking behaviors and treatments, providers may also boost the efficacy of their own biomedical treatments. Copyright © 2017 Elsevier B.V. All rights reserved.

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

PubMed Central

Grosse, Scott D.; Nelson, Richard E.; Nyarko, Kwame A.; Richardson, Lisa C.; Raskob, Gary E.

2015-01-01

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000–23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7–10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups. PMID:26654719

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs.

PubMed

Grosse, Scott D; Nelson, Richard E; Nyarko, Kwame A; Richardson, Lisa C; Raskob, Gary E

2016-01-01

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000-23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7-10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups. Published by Elsevier Ltd.

Evidence gaps in advanced cancer care: community-based clinicians' perspectives and priorities for CER.

PubMed

Lowry, Sarah J; Loggers, Elizabeth T; Bowles, Erin J A; Wagner, Edward H

2012-05-01

Although much effort has focused on identifying national comparative effectiveness research (CER) priorities, little is known about the CER priorities of community-based practitioners treating patients with advanced cancer. CER priorities of managed care-based clinicians may be valuable as reflections of both payer and provider research interests. We conducted mixed methods interviews with 10 clinicians (5 oncologists and 5 pharmacists) at 5 health plans within the Health Maintenance Organization Cancer Research Network. We asked, "What evidence do you most wish you had when treating patients with advanced cancer" and questioned participants on their impressions and knowledge of CER and pragmatic clinical trials (PCTs). We conducted qualitative analyses to identify themes across interviews. Ninety percent of participants had heard of CER, 20% had heard of PCTs, and all rated CER/PCTs as highly relevant to patient and health plan decision making. Each participant offered between 3 and 10 research priorities. Half (49%) involved head-to-head treatment comparisons; another 20% involved comparing different schedules or dosing regimens of the same treatment. The majority included alternative outcomes to survival (eg, toxicity, quality of life, noninferiority). Participants cited several limitations to existing evidence, including lack of generalizability, funding biases, and rapid development of new treatments. Head-to-head treatment comparisons remain a major evidence need among community- based oncology clinicians, and CER/PCTs are highly valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by all stakeholders.

Drug Discovery Using Chemical Systems Biology: Repositioning the Safe Medicine Comtan to Treat Multi-Drug and Extensively Drug Resistant Tuberculosis

PubMed Central

Tonge, Peter J.; Xie, Lei; Bourne, Philip E.

2009-01-01

The rise of multi-drug resistant (MDR) and extensively drug resistant (XDR) tuberculosis around the world, including in industrialized nations, poses a great threat to human health and defines a need to develop new, effective and inexpensive anti-tubercular agents. Previously we developed a chemical systems biology approach to identify off-targets of major pharmaceuticals on a proteome-wide scale. In this paper we further demonstrate the value of this approach through the discovery that existing commercially available drugs, prescribed for the treatment of Parkinson's disease, have the potential to treat MDR and XDR tuberculosis. These drugs, entacapone and tolcapone, are predicted to bind to the enzyme InhA and directly inhibit substrate binding. The prediction is validated by in vitro and InhA kinetic assays using tablets of Comtan, whose active component is entacapone. The minimal inhibition concentration (MIC99) of entacapone for Mycobacterium tuberculosis (M.tuberculosis) is approximately 260.0 µM, well below the toxicity concentration determined by an in vitro cytotoxicity model using a human neuroblastoma cell line. Moreover, kinetic assays indicate that Comtan inhibits InhA activity by 47.0% at an entacapone concentration of approximately 80 µM. Thus the active component in Comtan represents a promising lead compound for developing a new class of anti-tubercular therapeutics with excellent safety profiles. More generally, the protocol described in this paper can be included in a drug discovery pipeline in an effort to discover novel drug leads with desired safety profiles, and therefore accelerate the development of new drugs. PMID:19578428

Statewide CBT Training for Clinicians and Supervisors Treating Youth: The New York State Evidence Based Treatment Dissemination Center

ERIC Educational Resources Information Center

Gleacher, Alissa A.; Nadeem, Erum; Moy, Amanda J.; Whited, Andria L.; Albano, Anne Marie; Radigan, Marleen; Wang, Rui; Chassman, Janet; Myrhol-Clarke, Britt; Hoagwood, Kimberly Eaton

2011-01-01

In recent years, several states have undertaken efforts to disseminate evidence-based treatments to agencies and clinicians in their children's service system. In New York, the Evidence Based Treatment Dissemination Center adopted a unique translation-based training and consultation model in which an initial 3-day training was combined with a year…

Autism in China: From Acupuncture to Applied Behavior Analysis

ERIC Educational Resources Information Center

Clark, Elaine; Zhou, Zheng

2005-01-01

It has been only in the past decade that autism has been widely recognized among Chinese service providers. As a result, there are few professionals who are trained to treat the disorder. Although efforts are currently under way to determine the prevalence of autism in China, to date there are no reliable data that indicate the magnitude of the…

Environmental Quality, the Seventh Annual Report of the Council on Environmental Quality.

ERIC Educational Resources Information Center

Council on Environmental Quality, Washington, DC.

This seventh annual report discusses the state of the environment and new or continuing efforts to improve it. The topics are treated in two parts. The first part discusses events of the past year and cites new legislation, court rulings, and other major developments affecting the environment. Part two focuses on conditions and trends by analyzing…

Physical and Nonphysical Bullying Victimization of Academically Oriented Students: The Role of Gender and School Type

ERIC Educational Resources Information Center

Lehman, Brett

2015-01-01

Although there are many factors associated with being the victim of bullying in school, quantitative studies have not treated academic attitudes, effort, and achievement (or lack thereof) as risk factors. This is true despite many ethnographic accounts of good students being stigmatized and directly bullied on account of their status as good…

State of the Research and Literature Address: ACT with Children, Adolescents and Parents

ERIC Educational Resources Information Center

Murrell, Amy R.; Scherbarth, Andrew J.

2011-01-01

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) has been found effective in treating a wide number of psychological conditions affecting adults. To date, however, little research has been done on the use of ACT with youth and parents. Few efforts have been made at summarizing the literature that does exist. This article,…

Medical management of motor fluctuations.

PubMed

Dewey, Richard B

2008-08-01

Given the magnitude of the problem of motor fluctuations in patients who have Parkinson's disease treated with levodopa, a significant effort has been expended by physicians, researchers, and pharmaceutical manufacturers over the years to find effective treatments. This article briefly reviews the medical options for managing motor fluctuations that are in common use in the United States or that are expected to be available soon.

Restoration of Soldier Spring: an isolated habitat for native Apache trout

Treesearch

Jonathan W. Long; B. Mae Burnette; Alvin L. Medina; Joshua L. Parker

2004-01-01

Degradation of streams is a threat to the recovery of the Apache trout, an endemic fish of the White Mountains of Arizona. Historic efforts to improve trout habitat in the Southwest relied heavily on placement of in-stream log structures. However, the effects of structural interventions on trout habitat and populations have not been adequately evaluated. We treated an...

The Reliability and Criterion Validity of the Diagnostic Infant and Preschool Assessment: A New Diagnostic Instrument for Young Children

ERIC Educational Resources Information Center

Scheeringa, Michael S.; Haslett, Nancy

2010-01-01

The need to assess Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) disorders in children younger than 7 years of age has intensified as clinical efforts to diagnose and treat this population have increased, and clinical research on psychopathology has advanced. A new diagnostic instrument for young children was created, the Diagnostic…

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

PubMed

Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

2017-05-01

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

TRANSURANUS: a fuel rod analysis code ready for use

NASA Astrophysics Data System (ADS)

Lassmann, K.

1992-06-01

TRANSURANUS is a computer program for the thermal and mechanical analysis of fuel rods in nuclear reactors and was developed at the European Institute for Transuranium Elements (TUI). The TRANSURANUS code consists of a clearly defined mechanical-mathematical framework into which physical models can easily be incorporated. Besides its flexibility for different fuel rod designs the TRANSURANUS code can deal with very different situations, as given for instance in an experiment, under normal, off-normal and accident conditions. The time scale of the problems to be treated may range from milliseconds to years. The code has a comprehensive material data bank for oxide, mixed oxide, carbide and nitride fuels, Zircaloy and steel claddings and different coolants. During its development great effort was spent on obtaining an extremely flexible tool which is easy to handle, exhibiting very fast running times. The total development effort is approximately 40 man-years. In recent years the interest to use this code grew and the code is in use in several organisations, both research and private industry. The code is now available to all interested parties. The paper outlines the main features and capabilities of the TRANSURANUS code, its validation and treats also some practical aspects.

Minocycline, but not ascorbic acid, increases motor activity and extends the life span of Drosophila melanogaster.

PubMed

Mora, Marylhi; Medina-Leendertz, Shirley J; Bonilla, Ernesto; Terán, Raikelin E; Paz, Milagros C; Arcaya, José Luis

2013-06-01

In the present study we compared the effects of minocycline and ascorbic acid in the life span, motor activity and lipid peroxidation of Drosophila melanogaster, in an effort to find a substance capable of providing protection against oxidative stress in aging. In the flies treated with minocycline a very significant increase in the life span (101 +/- 1.33 days) was observed when compared to those treated with ascorbic acid and controls (42.3% and 38.4%, respectively). The motor activity of minocycline treated flies also increased significantly with respect to control and ascorbic acid fed flies, from the 3rd to the 9th week of treatment. With regard to lipid peroxidation, it was found that the levels of malondialdehyde (MDA) in flies treated with minocycline showed no statistical differences to the control on the first day of treatment, but a significantly lower content on the day of 50% survival. In contrast, in flies treated with ascorbic acid significantly elevated levels of MDA compared to control and minocycline treated flies were detected throughout. These results suggest a protective effect of minocycline against oxidative stress and aging in D. melanogaster. An inhibitory effect on reactive oxygen species production may be an important contributing factor.

Effort-Reward Imbalance for Learning Is Associated with Fatigue in School Children

ERIC Educational Resources Information Center

Fukuda, Sanae; Yamano, Emi; Joudoi, Takako; Mizuno, Kei; Tanaka, Masaaki; Kawatani, Junko; Takano, Miyuki; Tomoda, Akemi; Imai-Matsumura, Kyoko; Miike, Teruhisa; Watanabe, Yasuyoshi

2010-01-01

We examined relationships among fatigue, sleep quality, and effort-reward imbalance for learning in school children. We developed an effort-reward for learning scale in school students and examined its reliability and validity. Self-administered surveys, including the effort reward for leaning scale and fatigue scale, were completed by 1,023…

The pharmacovigilance program on natalizumab in Italy: 2 years of experience.

PubMed

Tedeschi, G; Amato, M P; D'Alessandro, R; Drago, F; Milanese, C; Popoli, P; Rossi, P; Savettieri, G; Tola, M R; Vanacore, N; Covezzoli, A; De Rosa, M; Comi, G; Pozzilli, Carlo; Bertolotto, Antonio; Marrosu, Maria Giovanna; Grimaldi, Luigi M E; Piccinni, C; Montanaro, N; Periotto, Laura; Iommelli, Rosamaria; Addis, Antonio; Martini, Nello; Provinciali, L; Mancardi, G L

2009-10-01

At the end of 2006 a country-based surveillance program on natalizumab therapy in multiple sclerosis was settled in Italy by a collaborative effort of the Italian Drug Agency (AIFA) and a group of experts and neurologists appointed by the National Society of Neurology (SIN). After 2 years, 1,818 patients are registered in the database. The majority of cases (88.6%) failed the therapy with beta interferon or glatiramer acetate and had relapses or accumulated disability during immunomodulating treatment, while 11.4% of patients enrolled in the surveillance study were not previously treated with immunomodulating therapies and had a rapidly evolving clinical course. Almost 10% of the patients treated with natalizumab interrupted, for various different reasons, the therapy. Treatment was well tolerated and side effects were similar to those reported in the registrative studies. The majority of treated cases are stable or ameliorated.

Transfusions and kids: the deadly HIV link in Africa.

PubMed

1997-12-01

Contaminated blood transfusions are responsible for a large proportion of HIV infections, particularly among children, in developing countries. Little attention or money has been provided to control these easily preventable transmissions. According to the Centers for Disease Control and Prevention (CDC), basic remedies such as improving blood-screening and blood-banking practices, reducing the number of unnecessary transfusions, and treating malaria with different drugs could play a key role in reducing infection. The quality of blood-screening is often variable and inconsistent across a single country, and a study in Congo found that contaminated blood accounted for 42 percent of HIV infections in children older than one year. Blood transfusions are a common treatment in Africa, where they are used to treat malaria-related anemias. Malaria remains a major health threat in much of the world, and efforts to treat it more effectively will help reduce the number of HIV infections that result from contaminated blood sources.

AIDS mortality rates lower at sites with HIV experience.

PubMed

1999-11-01

HIV/AIDS patients are more likely to receive antiretroviral treatment and survive longer if they are treated by providers who have more experience treating the disease. Researchers examined data on more than 7,000 AIDS patients treated in 333 California hospitals to come to that conclusion. Another study discovered that pregnant HIV-infected women were more likely to receive treatment if they were at medical centers which performed HIV clinical trials or at State-funded sites with HIV services for people on Medicaid. Public hospitals had a higher mortality rate than for-profit and nonprofit hospitals. Part of the disparity can be linked to capitation arrangements by insurers that forces physicians to limit the time with HIV patients. In addition, private practice physicians rarely have time to keep up with medical advances related to HIV. HIV/AIDS patients might receive better care when a primary care physician shares efforts with specialists.

Translating Cough Mechanisms Into Better Cough Suppressants.

PubMed

Keller, Jennifer A; McGovern, Alice E; Mazzone, Stuart B

2017-10-01

Chronic cough is a significant problem, and in many patients cough remains refractive to both disease-specific therapies and current cough-suppressing medicines, creating a need for improved antitussive therapies. Most patients with chronic cough also display heightened sensitivity so that they experience a persistent sense of the need to cough, and often innocuous stimuli can trigger their coughing. This hypersensitivity underpins the newly described concept of cough hypersensitivity syndrome (CHS), a term that encapsulates the notion of common underlying mechanisms producing neuronal activation, sensitization and/or dysfunction, which are at the core of excessive coughing. Understanding these mechanisms has been a focus of recent research efforts in the field in the hope that new therapies can be developed to selectively target sensitized unproductive cough while maintaining the reflexive cough essential for airway protection. However, efforts to achieve this have been slower than expected, in part because of some significant challenges and limitations translating current cough models. In this review, we summarize recent advances in our understanding of the sensory circuits innervating the respiratory system that are important for cough, how cough sensory pathways become hypersensitive, and some of the recently described neural targets under development for treating chronic cough. We present the case that better use of current cough models or the development of new models, or both, is ultimately needed to advance our efforts to translate the discovery of basic cough mechanisms into effective medicines for treating patients with chronic cough. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Risk factors for treatment default among re-treatment tuberculosis patients in India, 2006.

PubMed

Jha, Ugra Mohan; Satyanarayana, Srinath; Dewan, Puneet K; Chadha, Sarabjit; Wares, Fraser; Sahu, Suvanand; Gupta, Devesh; Chauhan, L S

2010-01-25

Under India's Revised National Tuberculosis Control Programme (RNTCP), >15% of previously-treated patients in the reported 2006 patient cohort defaulted from anti-tuberculosis treatment. To assess the timing, characteristics, and risk factors for default amongst re-treatment TB patients. For this case-control study, in 90 randomly-selected programme units treatment records were abstracted from all 2006 defaulters from the RNTCP re-treatment regimen (cases), with one consecutively-selected non-defaulter per case. Patients who interrupted anti-tuberculosis treatment for >2 months were classified as defaulters. 1,141 defaulters and 1,189 non-defaulters were included. The median duration of treatment prior to default was 81 days (25%-75% interquartile range 44-117 days) and documented retrieval efforts after treatment interruption were inadequate. Defaulters were more likely to have been male (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.2-1.7), have previously defaulted anti-tuberculosis treatment (aOR 1.3 95%CI 1.1-1.6], have previous treatment from non-RNTCP providers (AOR 1.3, 95%CI 1.0-1.6], or have public health facility-based treatment observation (aOR 1.3, 95%CI 1.1-1.6). Amongst the large number of re-treatment patients in India, default occurs early and often. Improved pre-treatment counseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening.

The development and evaluation of an alternative powder prepregging technique for use with LaRC-TPI/graphite composites

NASA Technical Reports Server (NTRS)

Ogden, Andrea L.; Hyer, Michael W.; Wilkes, Garth L.; Loos, Alfred C.; St.clair, Terry L.

1991-01-01

An alternative powder prepregging method for use with LaRC-TPI (a thermoplastic polyimide)/graphite composites is investigated. The alternative method incorporates the idea of moistening the fiber prior to powder coating. Details of the processing parameters are given and discussed. The material was subsequently laminated into small coupons which were evaluated for processing defects using electron microscopy. After the initial evaluation of the material, no major processing defects were encountered but there appeared to be an interfacial adhesion problem. As a result, prepregging efforts were extended to include an additional fiber system, XAS, and a semicrystalline form of the matrix. The semicrystalline form of the matrix was the result of a complex heat treating cycle. Using scanning electron microscopy (SEM), the fiber/matrix adhesion was evaluated in these systems relative to the amorphous/XAS coupons. Based on these results, amorphous and semicrystalline/AS-4 and XAS materials were prepregged and laminated for transverse tensile testing. The results of these tests are presented, and in an effort to obtain more information on the effect of the matrix, remaining semicrystalline transverse tensile coupons were transformed back to the amorphous state and tested. The mechanical properties of the transformed coupons returned to the values observed for the original amorphous coupons, and the interfacial adhesion, as observed by SEM, was better than in any previous sample.

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa

PubMed Central

Yé, Yazoume; Eisele, Thomas P.; Eckert, Erin; Korenromp, Eline; Shah, Jui A.; Hershey, Christine L.; Ivanovich, Elizabeth; Newby, Holly; Carvajal-Velez, Liliana; Lynch, Michael; Komatsu, Ryuichi; Cibulskis, Richard E.; Moore, Zhuzhi; Bhattarai, Achuyt

2017-01-01

Abstract. Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality. PMID:28990923

HerDing: herb recommendation system to treat diseases using genes and chemicals

PubMed Central

Choi, Wonjun; Choi, Chan-Hun; Kim, Young Ran; Kim, Seon-Jong; Na, Chang-Su; Lee, Hyunju

2016-01-01

In recent years, herbs have been researched for new drug candidates because they have a long empirical history of treating diseases and are relatively free from side effects. Studies to scientifically prove the medical efficacy of herbs for target diseases often spend a considerable amount of time and effort in choosing candidate herbs and in performing experiments to measure changes of marker genes when treating herbs. A computational approach to recommend herbs for treating diseases might be helpful to promote efficiency in the early stage of such studies. Although several databases related to traditional Chinese medicine have been already developed, there is no specialized Web tool yet recommending herbs to treat diseases based on disease-related genes. Therefore, we developed a novel search engine, HerDing, focused on retrieving candidate herb-related information with user search terms (a list of genes, a disease name, a chemical name or an herb name). HerDing was built by integrating public databases and by applying a text-mining method. The HerDing website is free and open to all users, and there is no login requirement. Database URL: http://combio.gist.ac.kr/herding PMID:26980517

HerDing: herb recommendation system to treat diseases using genes and chemicals.

PubMed

Choi, Wonjun; Choi, Chan-Hun; Kim, Young Ran; Kim, Seon-Jong; Na, Chang-Su; Lee, Hyunju

2016-01-01

In recent years, herbs have been researched for new drug candidates because they have a long empirical history of treating diseases and are relatively free from side effects. Studies to scientifically prove the medical efficacy of herbs for target diseases often spend a considerable amount of time and effort in choosing candidate herbs and in performing experiments to measure changes of marker genes when treating herbs. A computational approach to recommend herbs for treating diseases might be helpful to promote efficiency in the early stage of such studies. Although several databases related to traditional Chinese medicine have been already developed, there is no specialized Web tool yet recommending herbs to treat diseases based on disease-related genes. Therefore, we developed a novel search engine, HerDing, focused on retrieving candidate herb-related information with user search terms (a list of genes, a disease name, a chemical name or an herb name). HerDing was built by integrating public databases and by applying a text-mining method. The HerDing website is free and open to all users, and there is no login requirement. Database URL: http://combio.gist.ac.kr/herding. © The Author(s) 2016. Published by Oxford University Press.

Determinants of women's satisfaction with maternal health care: a review of literature from developing countries.

PubMed

Srivastava, Aradhana; Avan, Bilal I; Rajbangshi, Preety; Bhattacharyya, Sanghita

2015-04-18

Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries. The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction.

Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates.

PubMed

Horan, William P; Reddy, L Felice; Barch, Deanna M; Buchanan, Robert W; Dunayevich, Eduardo; Gold, James M; Marder, Steven R; Wynn, Jonathan K; Young, Jared W; Green, Michael F

2015-09-01

Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Neurotechnology: a new approach for treating brain disorders.

PubMed

Robson, John A; Davenport, R John

2014-05-01

Advances in neuroscience, engineering and computer technologies are creating opportunities to connect the brain directly to devices to treat a variety of disorders, both neurological and psychiatric. They are opening a new field of neuroscience called "neurotechnology." This article reviews efforts in this area that are ongoing at Brown University and the hospitals affiliated with Brown's Alpert Medical School. Two general approaches are being used. One uses advanced electrodes to "sense" the activity of many individual neurons in the cerebral cortex and then use that activity for therapeutic purposes. The other uses various types of devices to stimulate specific networks in the brain in order to restore normal function and alleviate symptoms.

Preliminary screening of alternative technologies to incineration for treatment of chemical-agent-contaminated soil, Rocky Mountain Arsenal

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

Shem, L.M.; Rosenblatt, D.H.; Smits, M.P.

1995-12-01

In support of the U.S. Army`s efforts to determine the best technologies for remediation of soils, water, and structures contaminated with pesticides and chemical agents, Argonne National Laboratory has reviewed technologies for treating soils contaminated with mustard, lewisite, sarin, o-ethyl s-(2- (diisopropylamino)ethyl)methyl-phosphonothioate (VX), and their breakdown products. This report focuses on assessing alternatives to incineration for dealing with these contaminants. For each technology, a brief description is provided, its suitability and constraints on its use are identified, and its overall applicability for treating the agents of concern is summarized. Technologies that merit further investigation are identified.

Treating bulimia with hypnosis and low-level light therapy: a case report

NASA Astrophysics Data System (ADS)

Laser, Eleanor; Sassack, Michael

2012-03-01

This case report describes an effort to control bulimia nervosa by combining low-level laser therapy (LLLT)-the application of red and near-infrared light to specific body points-and hypnosis. A 29-year old female with a 14-year history of bulimia received one session of LLLT combined with hypnosis. Two weeks later, following a measurable decrease in bulimic episodes (purging), a session of psychotherapy and hypnosis was administered. Six months post-treatment, the patient has experienced a complete cessation of purging activities without recurrence. LLLT, when used in conjunction with hypnosis and psychotherapy, was effective in managing bulimia and may prove useful in treating other eating disorders.

History of osteochondral allograft transplantation.

PubMed

Nikolaou, V S; Giannoudis, P V

2017-07-01

Osteochondral defects or injuries represent the most challenging entities to treat, especially when occur to young and active patients. For centuries, it has been recognized that such defects are almost impossible to treat. However, surgeons have never stopped the effort to develop reliable methods to restore articular cartilage and salvage the endangered joint function. Osteochondral allograft transplantation in human was first introduced by Eric Lexer in 1908. Since that era, several pioneers have been worked in the field of osteochondral allotransplantation, presenting and developing the basic research, the methodology and the surgical techniques. Herein we present in brief, the history and the early clinical results of osteochondral allograft transplantation in human. Copyright © 2017 Elsevier Ltd. All rights reserved.

The impact of denying a direct-to-consumer advertised drug request on the patient/physician relationship.

PubMed

Blose, Julia E; Mack, Rhonda W

2009-01-01

Using a scenario-based approach, an experiment is conducted to test whether the decision a physician makes to deny a prescription request (when a patient has requested a drug he or she has seen in a direct-to-consumer [DTC] ad) significantly impacts patient outcomes such as patient satisfaction and compliance intentions. The results suggest physicians can expect patient response to the denial of such a request to vary by the patient's gender in addition to the criticality of the condition being treated. The results also suggest, when treating less critical conditions, a physician can mitigate the negative effects of a denial with relatively little additional effort.

A case study in innovative outreach--combining training, research, and technology transfer to address real-world problems.

PubMed Central

Chang, D P

1998-01-01

Outreach, training, technology transfer, and research are often treated as programmatically distinct activities. The interdisciplinary and applied aspects of the Superfund Basic Research Program offer an opportunity to explore different models. A case study is presented that describes a collaborative outreach effort that combines all of the above. It involves the University of California's Davis and Berkeley program projects, the University of California Systemwide Toxic Substances Research and Teaching Program, the U.S. Navy's civilian workforce at the former Mare Island Naval Shipyard, Vallejo, California (MINSY), a Department of Defense (DoD) Environmental Education Demonstration Grant program, and the Private Industry Council of Napa and Sonoma counties in California. The effort applied a Superfund-developed technology to a combined waste, radium and polychlorinated biphenyl contamination, stemming from a problematic removal action at an installation/restoration site at MINSY. The effort demonstrates that opportunities for similar collaborations are possible at DoD installations. PMID:9703494

Public-Private Partnerships for Providing Behavioral Health Care to Veterans and Their Families: What Do We Know, What Do We Need to Learn, and What Do We Need to Do?

PubMed

Pedersen, Eric R; Eberhart, Nicole K; Williams, Kayla M; Tanielian, Terri; Batka, Caroline; Scharf, Deborah M

2015-11-30

American veterans and their family members struggle with behavioral health problems, yet few engage in treatment to address these problems. Barriers to care include trouble accessing treatment and limited communication between civilian and military health care systems, which treat veterans and their family members separately. Even though the Department of Veterans Affairs (VA) is making efforts to address barriers to care, more work is needed to effectively serve veterans and their families. Public-private partnerships have been discussed as a potential solution and could include collaborations between a public agency, such as the VA, and a private organization, such as a veteran service organization, private industry, or private hospital. Despite the call for such partnerships, not much is known about what a public-private partnership would entail for addressing behavioral health concerns for veterans and their families. The health care literature is sparse in this area, and published examples and recommendations are limited. Thus, the authors wrote this article to inform the creation of public-private partnerships to better serve veterans and their families. The article outlines nine key components for public-private partnerships addressing veteran behavioral health care. These components are supported by qualitative interview data from five successful public-private partnerships that serve veterans and their families. This study will assist policymakers in the VA and other federal agencies in developing and fostering public-private partnerships to address the behavioral health care needs of veterans and their families. The article also discusses next steps for research and policymaking efforts with regard to these partnerships.

Identifying and Understanding the Gaps in Care Experienced by Adolescent and Young Adult Cancer Patients at the University of Iowa Hospitals and Clinics.

PubMed

Mobley, Erin M; Foster, Kristin J; Terry, William W

2018-06-20

In an effort to counteract the differences in improvement in survival rates of adolescents and young adults (AYA), compared to other age groups with cancer, the University of Iowa Hospitals and Clinics established an AYA cancer program. This study was conducted to gather feedback from AYAs in an effort to generate actionable data for program development. The target population included patients aged 13-31 treated for malignancy in one of the following disease sites: central nervous system, leukemia, lymphoma, neuroendocrine, sarcoma, and thyroid. A series of four focus groups was held to identify and describe gaps in care and provide suggestions for program development. A convergent parallel mixed-methods design was used. Qualitative data were derived from focus group discussion and free-response survey questions, while quantitative data were derived from objective survey questions and electronic medical record data. Across the four focus groups, 24 different AYAs participated, ranging from 8 to 19 individuals per session. Topics discussed included the following: communication, treatment experience, and overall AYA program; finances, work and school, and late effects; relationships, emotions, and spirituality; and body image, infertility, sexuality, risky behavior, and suicide. The results of the analyses corroborated what makes AYAs different from other age groups. The primary theme identified was the unique relationships of AYAs, which can be thought of along a continuum. Information obtained from these analyses has been used to inform specific projects within the development of the AYA program to address patient-identified gaps. For AYAs, the importance of relationships along a continuum should be considered when developing an AYA program, in addition to potential policy or health service research utilization in the future.

Sleep Architecture Linked to Airway Obstruction and Intracranial Hypertension in Children with Syndromic Craniosynostosis.

PubMed

Spruijt, Bart; Mathijssen, Irene M J; Bredero-Boelhouwer, Hansje H; Cherian, Perumpillichira J; Corel, Linda J A; van Veelen, Marie-Lise; Hayward, Richard D; Tasker, Robert C; Joosten, Koen F M

2016-12-01

Children with syndromic craniosynostosis often have obstructive sleep apnea and intracranial hypertension. The authors aimed to evaluate (1) sleep architecture, and determine whether this is influenced by the presence of obstructive sleep apnea and/or intracranial hypertension; and (2) the effect of treatment on sleep architecture. This study included patients with syndromic craniosynostosis treated at a national referral center, undergoing screening for obstructive sleep apnea and intracranial hypertension. Obstructive sleep apnea was identified by polysomnography, and categorized into no, mild, moderate, or severe. Intracranial hypertension was identified by the presence of papilledema on funduscopy, supplemented by optical coherence tomography and/or intracranial pressure monitoring. Regarding sleep architecture, sleep was divided into rapid eye movement or non-rapid eye movement sleep; respiratory effort-related arousals and sleep efficiency were scored. The authors included 39 patients (median age, 5.9 years): 19 with neither obstructive sleep apnea nor intracranial hypertension, 11 with obstructive sleep apnea (four moderate/severe), six with intracranial hypertension, and three with obstructive sleep apnea and intracranial hypertension. Patients with syndromic craniosynostosis, independent of the presence of mild obstructive sleep apnea and/or intracranial hypertension, have normal sleep architecture compared with age-matched controls. Patients with moderate/severe obstructive sleep apnea have a higher respiratory effort-related arousal index (p < 0.01), lower sleep efficiency (p = 0.01), and less rapid eye movement sleep (p = 0.04). An improvement in sleep architecture was observed following monobloc surgery (n = 5; rapid eye movement sleep, 5.3 percent; p = 0.04). Children with syndromic craniosynostosis have in principle normal sleep architecture. However, moderate/severe obstructive sleep apnea does lead to disturbed sleep architecture, which fits within a framework of a unifying theory for obstructive sleep apnea, intracranial hypertension, and sleep. Risk, II.

How long must they suffer? success and failure of our efforts to end the animal tragedy in laboratories.

PubMed

Kolar, Roman

2015-05-01

Scientific findings have revealed how much we have dramatically underestimated the intellectual, social and emotional capabilities of non-human animals, including their levels of self-consciousness and ability to suffer from psychological stress. In the 21st century, the field of animal ethics has evolved as a serious scientific discipline, and nowadays largely advocates that the way we treat animals, both legally and in practice, is morally wrong. Politics and legislation have reacted to these facts, to some extent, but neither current legislation nor current practice reflect the scientific and moral state-of-the-art. Too often, the will to change things is watered down in the decision-making process, e.g. in the drafting of legislation. In the field of animal experimentation there have been many genuine efforts by various players, to advance and apply the principles behind the Three Rs. However, the fundamental problem, i.e. the overall number of animals sacrificed for scientific purposes, has increased. Clearly, if we are serious about our will to regard animal experimentation as an ethical and societal problem, we have to put much more emphasis on addressing the question of how to avoid the use of animals in science. To achieve this goal, certain issues need to be considered: a) the present system of ethical evaluation of animal experiments, including testing for regulatory purposes, needs to be reformed and applied effectively to meet the legal and moral requirements; b) animal testing must be avoided in future legislation, and existing legislation has to be revised in that regard; c) resources from animal-based research have to re-allocated toward alternatives; and d) the academic curricula must be reformed to foster and integrate ethical and animal welfare issues. 2015 FRAME.

Suppression of Emergence of Resistance in Pathogenic Bacteria: Keeping Our Powder Dry, Part 1

PubMed Central

Louie, Arnold; MacGowan, Alasdair; Hope, William

2015-01-01

We are in a crisis of bacterial resistance. For economic reasons, most pharmaceutical companies are abandoning antimicrobial discovery efforts, while, in health care itself, infection control and antibiotic stewardship programs have generally failed to prevent the spread of drug-resistant bacteria. At this point, what can be done? The first step has been taken. Governments and international bodies have declared there is a worldwide crisis in antibiotic drug resistance. As discovery efforts begin anew, what more can be done to protect newly developing agents and improve the use of new drugs to suppress resistance emergence? A neglected path has been the use of recent knowledge regarding antibiotic dosing as single agents and in combination to minimize resistance emergence, while also providing sufficient early bacterial kill. In this review, we look at the data for resistance suppression. Approaches include increasing the intensity of therapy to suppress resistant subpopulations; developing concepts of clinical breakpoints to include issues surrounding suppression of resistance; and paying attention to the duration of therapy, which is another important issue for resistance suppression. New understanding of optimizing combination therapy is of interest for difficult-to-treat pathogens like Pseudomonas aeruginosa, Acinetobacter spp., and multidrug-resistant (MDR) Enterobacteriaceae. These lessons need to be applied to our old drugs to preserve them as well and need to be put into national and international antibiotic resistance strategies. As importantly, from a regulatory perspective, new chemical entities should have a corresponding resistance suppression plan at the time of regulatory review. In this way, we can make the best of our current situation and improve future prospects. PMID:26711759

The Next Generation of Platinum Drugs: Targeted Pt(II) Agents, Nanoparticle Delivery, and Pt(IV) Prodrugs

PubMed Central

Johnstone, Timothy C.; Suntharalingam, Kogularamanan; Lippard, Stephen J.

2016-01-01

The platinum drugs, cisplatin, carboplatin, and oxaliplatin, prevail in the treatment of cancer,, but new platinum agents have been very slow to enter the clinic. Recently, however, there has been a surge of activity, based on a great deal of mechanistic information, aimed at developing non-classical platinum complexes that operate via mechanisms of action distinct from those of the approved drugs. The use of nanodelivery devices has also grown and many different strategies have been explored to incorporate platinum warheads into nanomedicine constructs. In this review, we discuss these efforts to create the next generation of platinum anticancer drugs. The introduction provides the reader with a brief overview of the use, development, and mechanism of action of the approved platinum drugs to provide the context in which more recent research has flourished. We then describe approaches that explore non-classical platinum(II) complexes with trans geometry and with a monofunctional coordination mode, polynuclear platinum(II) compounds, platinum(IV) prodrugs, dual-treat agents, and photoactivatable platinum(IV) complexes. Nanodelivery particles designed to deliver platinum(IV) complexes will also be discussed, including carbon nanotubes, carbon nanoparticles, gold nanoparticles, quantum dots, upconversion nanoparticles, and polymeric micelles. Additional nanoformulations including supramolecular self-assembled structures, proteins, peptides, metal-organic frameworks, and coordination polymers will then be described. Finally, the significant clinical progress made by nanoparticle formulations of platinum(II) agents will be reviewed. We anticipate that such a synthesis of disparate research efforts will not only help to generate new drug development ideas and strategies, but also reflect our optimism that the next generation of platinum cancer drugs is about to arrive. PMID:26865551

Time to Adjuvant Chemotherapy for Breast Cancer in National Comprehensive Cancer Network Institutions

PubMed Central

2013-01-01

Background High-quality care must be not only appropriate but also timely. We assessed time to initiation of adjuvant chemotherapy for breast cancer as well as factors associated with delay to help identify targets for future efforts to reduce unnecessary delays. Methods Using data from the National Comprehensive Cancer Network (NCCN) Outcomes Database, we assessed the time from pathological diagnosis to initiation of chemotherapy (TTC) among 6622 women with stage I to stage III breast cancer diagnosed from 2003 through 2009 and treated with adjuvant chemotherapy in nine NCCN centers. Multivariable models were constructed to examine factors associated with TTC. All statistical tests were two-sided. Results Mean TTC was 12.0 weeks overall and increased over the study period. A number of factors were associated with a longer TTC. The largest effects were associated with therapeutic factors, including immediate postmastectomy reconstruction (2.7 weeks; P < .001), re-excision (2.1 weeks; P < .001), and use of the 21-gene reverse-transcription polymerase chain reaction assay (2.2 weeks; P < .001). In comparison with white women, a longer TTC was observed among black (1.5 weeks; P < .001) and Hispanic (0.8 weeks; P < .001) women. For black women, the observed disparity was greater among women who transferred their care to the NCCN center after diagnosis (P interaction = .008) and among women with Medicare vs commercial insurance (P interaction < .001). Conclusions Most observed variation in TTC was related to use of appropriate therapeutic interventions. This suggests the importance of targeted efforts to minimize potentially preventable causes of delay, including inefficient transfers in care or prolonged appointment wait times. PMID:23264681

Outbreaks-of Ebola virus disease in the West African sub-region.

PubMed

Osungbade, K O; Oni, A A

2014-06-01

Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak. Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed. Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds. The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified.

Precision wildlife medicine: applications of the human-centred precision medicine revolution to species conservation.

PubMed

Whilde, Jenny; Martindale, Mark Q; Duffy, David J

2017-05-01

The current species extinction crisis is being exacerbated by an increased rate of emergence of epizootic disease. Human-induced factors including habitat degradation, loss of biodiversity and wildlife population reductions resulting in reduced genetic variation are accelerating disease emergence. Novel, efficient and effective approaches are required to combat these epizootic events. Here, we present the case for the application of human precision medicine approaches to wildlife medicine in order to enhance species conservation efforts. We consider how the precision medicine revolution, coupled with the advances made in genomics, may provide a powerful and feasible approach to identifying and treating wildlife diseases in a targeted, effective and streamlined manner. A number of case studies of threatened species are presented which demonstrate the applicability of precision medicine to wildlife conservation, including sea turtles, amphibians and Tasmanian devils. These examples show how species conservation could be improved by using precision medicine techniques to determine novel treatments and management strategies for the specific medical conditions hampering efforts to restore population levels. Additionally, a precision medicine approach to wildlife health has in turn the potential to provide deeper insights into human health and the possibility of stemming and alleviating the impacts of zoonotic diseases. The integration of the currently emerging Precision Medicine Initiative with the concepts of EcoHealth (aiming for sustainable health of people, animals and ecosystems through transdisciplinary action research) and One Health (recognizing the intimate connection of humans, animal and ecosystem health and addressing a wide range of risks at the animal-human-ecosystem interface through a coordinated, collaborative, interdisciplinary approach) has great potential to deliver a deeper and broader interdisciplinary-based understanding of both wildlife and human diseases. © 2016 John Wiley & Sons Ltd.

Association Between Hospital Financial Distress and Immediate Breast Reconstruction Surgery After Mastectomy Among Women With Ductal Carcinoma In Situ.

PubMed

Richards, Catherine A; Rundle, Andrew G; Wright, Jason D; Hershman, Dawn L

2018-04-01

Hospital financial distress (HFD) is a state in which a hospital is at risk of closure because of its financial condition. Hospital financial distress may reduce the services a hospital can offer, particularly unprofitable ones. Few studies have assessed the association of HFD with quality of care. To examine the association between HFD and receipt of immediate breast reconstruction surgery after mastectomy among women diagnosed with ductal carcinoma in situ (DCIS). This retrospective cohort study assessed data from the Nationwide Inpatient Sample of 5760 women older than 18 years (mean [SD] age: 57.5 [13.2]) with DCIS who underwent mastectomy in 2008-2012 at hospitals categorized by financial distress. Women treated at 1156 hospitals located in 538 different counties across Arkansas, Arizona, California, Colorado, Connecticut, Florida, Iowa, Kentucky, Massachusetts, Maryland, Missouri, North Carolina, New Hampshire, New Jersey, Nevada, New York, Oregon, Pennsylvania, Rhode Island, Utah, Virginia, Vermont, Washington, Wisconsin, West Virginia, and Wyoming were included. Of these, 2385 women (41.4%) underwent immediate breast reconstruction surgery. Women with invasive cancer were excluded. The database included unique hospital identification variables, and participants were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Data were analyzed from January 1, 2012, to February 28, 2014. The primary outcome was the adjusted association between HFD and receipt of immediate breast reconstruction surgery after mastectomy. In this analysis of database information, 2385 of 5760 women (41.4%) received immediate breast reconstruction surgery. Of these, 693 (36.7%) were treated at a hospital under high HFD and received immediate breast reconstruction surgery compared with 863 (44.0%) treated at a hospital under low HFD (P < .001). Reconstruction surgery was associated with younger age, white race, private insurance, treatment at a teaching and cancer hospital, private hospital ownership, and the percentage of individuals in the county with insurance. After adjustment, women treated at hospitals under high HFD (OR, 0.79; 95% CI, 0.62-0.99) and medium HFD (OR, 0.76; 95% CI, 0.61-0.94) were significantly less likely to receive reconstruction than women treated at hospitals with low to no HFD. The financial strength of the hospital where a patient receives treatment is associated with receipt of immediate breast reconstruction surgery. In addition to focusing on patient-related factors, efforts to improve quality should also focus on hospital-related factors.

Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 1—Psychometric Characteristics of 5 Paradigms.

PubMed

Reddy, L Felice; Horan, William P; Barch, Deanna M; Buchanan, Robert W; Dunayevich, Eduardo; Gold, James M; Lyons, Naomi; Marder, Stephen R; Treadway, Michael T; Wynn, Jonathan K; Young, Jared W; Green, Michael F

2015-09-01

Impairments in willingness to exert effort contribute to the motivational deficits characteristic of the negative symptoms of schizophrenia. The current study evaluated the psychometric properties of 5 new or adapted paradigms to determine their suitability for use in clinical trials of schizophrenia. This study included 94 clinically stable participants with schizophrenia and 40 healthy controls. The effort-based decision-making battery was administered twice to the schizophrenia group (baseline, 4-week retest) and once to the control group. The 5 paradigms included 1 that assesses cognitive effort, 1 perceptual effort, and 3 that assess physical effort. Each paradigm was evaluated on (1) patient vs healthy control group differences, (2) test-retest reliability, (3) utility as a repeated measure (ie, practice effects), and (4) tolerability. The 5 paradigms showed varying psychometric strengths and weaknesses. The Effort Expenditure for Rewards Task showed the best reliability and utility as a repeated measure, while the Grip Effort Task had significant patient-control group differences, and superior tolerability and administration duration. The other paradigms showed weaker psychometric characteristics in their current forms. These findings highlight challenges in adapting effort and motivation paradigms for use in clinical trials. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2015.

Foucault on the case: the pastoral and juridical foundation of medical power.

PubMed

Tierney, Thomas F

2004-01-01

This paper employs Foucault's concept of "governmentality" to examine critically the efforts by medical humanists to reform the medical case. I argue that these reform efforts contribute to the individualizing dimensions of medical power through the development of a "pastoral" technique that medicine has taken over from religious authority. Clinical experiences at this NEH Institute also revealed a juridical dimension of the medical case that treats a patient's statements as suspect and in need of corroboration by evidence provided by the patient's body. The combination of these pastoral and juridical dimensions of the case contributes to the normalizing power of modern medicine, and medical humanists need to be aware of their own contribution to this form of power as they reform the case.

Addressing Stigma in Medication Treatment of Adolescents With Opioid Use Disorder.

PubMed

Bagley, Sarah M; Hadland, Scott E; Carney, Brittany L; Saitz, Richard

: In September 2016, the American Academic of Pediatrics released a policy statement that adolescents with opioid use disorder should be offered pharmacotherapy with buprenorphine/naloxone, methadone, or naltrexone. In our clinical practice, however, we have encountered the perception among patients, families, and clinicians alike that medications should be used as a last resort. That we should wait until things get worse is a discarded approach. As addiction specialists, it is imperative that we prevent and identify risky use and use disorders, then intervene early and offer timely, evidence-based treatment. We suggest that adolescents deserve special attention and that specific efforts should be made to reduce the stigma associated with treating adolescents with opioid use disorder with medications to optimize those efforts.

Marinopyrroles: Unique Drug Discoveries Based on Marine Natural Products.

PubMed

Li, Rongshi

2016-01-01

Natural products provide a successful supply of new chemical entities (NCEs) for drug discovery to treat human diseases. Approximately half of the NCEs are based on natural products and their derivatives. Notably, marine natural products, a largely untapped resource, have contributed to drug discovery and development with eight drugs or cosmeceuticals approved by the U.S. Food and Drug Administration and European Medicines Agency, and ten candidates undergoing clinical trials. Collaborative efforts from drug developers, biologists, organic, medicinal, and natural product chemists have elevated drug discoveries to new levels. These efforts are expected to continue to improve the efficiency of natural product-based drugs. Marinopyrroles are examined here as a case study for potential anticancer and antibiotic agents. © 2015 Wiley Periodicals, Inc.

A compendium of computational fluid dynamics at the Langley Research Center

NASA Technical Reports Server (NTRS)

1980-01-01

Through numerous summary examples, the scope and general nature of the computational fluid dynamics (CFD) effort at Langley is identified. These summaries will help inform researchers in CFD and line management at Langley of the overall effort. In addition to the inhouse efforts, out of house CFD work supported by Langley through industrial contracts and university grants are included. Researchers were encouraged to include summaries of work in preliminary and tentative states of development as well as current research approaching definitive results.

Combating Terrorism: Issues in Managing Counterterrorist Programs

DTIC Science & Technology

2000-04-06

major effort to develop a national strategy, to date the strategy does not include a clear desired outcome to be achieved. Resources to combat...Federal exercises, in contrast to earlier years, are now practicing crisis and consequence management simultaneously and including state and local...categories—crisis management and consequence management. Crisis management includes efforts to stop a terrorist attack, arrest terrorists, and gather

Transplacental effects of 3,5-dimethyl-3'-isopropyl-L-thyronine on fetal hypothyroidism in primates

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

Bachrach, L.K.; Dibattista, D.; Burrow, G.N.

1983-06-01

Pregnant Rhesus monkeys treated with 131I at midgestation become hypothyroid and produce fetuses without demonstrable thyroid tissue. In an effort to prevent both maternal and fetal hypothyroidism, we treated 131I-treated pregnant monkeys with 3,5-dimethyl-3'-isopropyl-L-thyronine (DIMIT), a thyroid hormone analog with structural changes which facilitate placental transfer. Five pregnant monkeys were treated with 131I (mCi/kg) at 83-87 days of gestation. One week later, three monkeys were started on treatment with DIMIT (10 micrograms kg-1 day-1, im) and two on im L-T4 (2 micrograms kg-1 day-1). Treatment was continued until delivery by Caesarian section at 152-157 days of gestation. None of themore » DIMIT-treated mothers became clinically hypothyroid, nor did they have elevated serum TSH concentrations despite low serum levels of T3 and T4. T4-treated mothers were also maintained clinically and biochemically euthyroid. At delivery, infants of DIMIT-treated mothers had normal respiratory function and skeletal maturation. Basal and TRH-stimulated TSH concentrations were suppressed in two of the three infants. By contrast, both T4-treated infants resembled untreated cretinous newborns and died soon after delivery from respiratory failure. Serum TSH concentrations were elevated and skeletal maturation was markedly delayed in these animals. We conclude that DIMIT administration to 131I-treated monkeys prevents clinical and biochemical hypothyroidism in the mother and prevents the major clinical manifestations of cretinism in the fetus.« less

New Challenges in Articulation.

ERIC Educational Resources Information Center

Nelson, James H.

This speech reviews past articulation efforts on the national level, comments on present articulation efforts, and looks ahead to new forces which will probably affect articulation. Past and present efforts discussed included the Knoell-Medsker study, which generated articulation guidelines, Kintzer's "Nationwide Pilot Study on Articulation," and…

The Impact of Thermal Remediation on Soil Rehabilitation

NASA Astrophysics Data System (ADS)

Pape, Andrew; Switzer, Christine; Knapp, Charles

2013-04-01

In an effort to restore the social and economic value of brownfield sites contaminated by hazardous organic liquids, many new remediation techniques involving the use of elevated temperatures to desorb and extract or destroy these contaminants have been developed. These approaches are typically applied to heavily contaminated soils to effect substantial source removal from the subsurface. These processes operate over a range of temperatures from just above ambient to in excess of 1000˚C depending on technology choice and contaminant type. To facilitate the successful rehabilitation of treated soils for agriculture, biomass production, or habitat enrichment the effects of high temperatures on the ability of soil to support biological activity needs to be understood. Four soils were treated with high temperatures or artificially contaminated and subjected to a smouldering treatment (600-1100°C) in this investigation. Subsequent chemical analysis, plant growth trials and microbial analysis were used to characterise the impacts of these processes on soil geochemistry, plant health, and potential for recovery. Decreases were found in levels of carbon (>250˚C), nitrogen (>500˚C) and phosphorus (1000˚C) with intermediate temperatures having variable affects on bio-available levels. Macro and micro nutrients such as potassium, calcium, zinc and copper also showed changes with general trends towards reduced bioavailability at higher temperatures. Above 500°C, cation exchange capacity and phosphate adsorption were lowered indicating that nutrient retention will be a problem in some treated soils. In addition, these temperatures reduced the content of clay sized particles changing the texture of the soils. These changes had a statistically significant impact on plant growth with moderate growth reductions occurring at 250°C and 500°C. Above 750°C, growth was extremely limited and soils treated at these temperatures would need major restorative efforts. Microbial re-colonisation and activity were inhibited in soils treated above 500°C due to the lack of available carbon sources. Early experiments with organic amendments and green manures show promise in facilitating more rapid recolonisation. These results underscore the importance of considering long-term soil recovery as part of the remediation strategy.

Analysis of postmarket complaints database for the iFuse SI Joint Fusion System®: a minimally invasive treatment for degenerative sacroiliitis and sacroiliac joint disruption

PubMed Central

Miller, Larry E; Reckling, W Carlton; Block, Jon E

2013-01-01

Background The sacroiliac joint is a common but under-recognized source of low back and gluteal pain. Patients with degenerative sacroiliitis or sacroiliac joint disruption resistant to nonsurgical treatments may undergo open surgery with sacroiliac joint arthrodesis, although outcomes are mixed and risks are significant. Minimally invasive sacroiliac joint arthrodesis was developed to minimize the risk of iatrogenic injury and to improve patient outcomes compared with open surgery. Methods Between April 2009 and January 2013, 5319 patients were treated with the iFuse SI Joint Fusion System® for conditions including sacroiliac joint disruption and degenerative sacroiliitis. A database was prospectively developed to record all complaints reported to the manufacturer in patients treated with the iFuse device. Complaints were collected through spontaneous reporting mechanisms in support of ongoing mandatory postmarket surveillance efforts. Results Complaints were reported in 204 (3.8%) patients treated with the iFuse system. Pain was the most commonly reported clinical complaint (n = 119, 2.2%), with nerve impingement (n = 48, 0.9%) and recurrent sacroiliac joint pain (n = 43, 0.8%) most frequently cited. All other clinical complaints were rare (≤0.2%). Ninety-six revision surgeries were performed in 94 (1.8%) patients at a median follow-up of four (range 0–30) months. Revisions were typically performed in the early postoperative period for treatment of a symptomatic malpositioned implant (n = 46, 0.9%) or to correct an improperly sized implant in an asymptomatic patient (n = 10, 0.2%). Revisions in the late postoperative period were performed to treat symptom recurrence (n = 34, 0.6%) or for continued pain of undetermined etiology (n = 6, 0.1%). Conclusion Analysis of a postmarket product complaints database demonstrates an overall low risk of complaints with the iFuse SI Joint Fusion System in patients with degenerative sacroiliitis or sacroiliac joint disruption. PMID:23761982

Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey.

PubMed

Hrbacek, Jan; Mishra, Kavita K; Kacperek, Andrzej; Dendale, Remi; Nauraye, Catherine; Auger, Michel; Herault, Joel; Daftari, Inder K; Trofimov, Alexei V; Shih, Helen A; Chen, Yen-Lin E; Denker, Andrea; Heufelder, Jens; Horwacik, Tomasz; Swakoń, Jan; Hoehr, Cornelia; Duzenli, Cheryl; Pica, Alessia; Goudjil, Farid; Mazal, Alejandro; Thariat, Juliette; Weber, Damien C

2016-05-01

To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of postmarket complaints database for the iFuse SI Joint Fusion System®: a minimally invasive treatment for degenerative sacroiliitis and sacroiliac joint disruption.

PubMed

Miller, Larry E; Reckling, W Carlton; Block, Jon E

2013-01-01

The sacroiliac joint is a common but under-recognized source of low back and gluteal pain. Patients with degenerative sacroiliitis or sacroiliac joint disruption resistant to nonsurgical treatments may undergo open surgery with sacroiliac joint arthrodesis, although outcomes are mixed and risks are significant. Minimally invasive sacroiliac joint arthrodesis was developed to minimize the risk of iatrogenic injury and to improve patient outcomes compared with open surgery. Between April 2009 and January 2013, 5319 patients were treated with the iFuse SI Joint Fusion System® for conditions including sacroiliac joint disruption and degenerative sacroiliitis. A database was prospectively developed to record all complaints reported to the manufacturer in patients treated with the iFuse device. Complaints were collected through spontaneous reporting mechanisms in support of ongoing mandatory postmarket surveillance efforts. Complaints were reported in 204 (3.8%) patients treated with the iFuse system. Pain was the most commonly reported clinical complaint (n = 119, 2.2%), with nerve impingement (n = 48, 0.9%) and recurrent sacroiliac joint pain (n = 43, 0.8%) most frequently cited. All other clinical complaints were rare (≤0.2%). Ninety-six revision surgeries were performed in 94 (1.8%) patients at a median follow-up of four (range 0-30) months. Revisions were typically performed in the early postoperative period for treatment of a symptomatic malpositioned implant (n = 46, 0.9%) or to correct an improperly sized implant in an asymptomatic patient (n = 10, 0.2%). Revisions in the late postoperative period were performed to treat symptom recurrence (n = 34, 0.6%) or for continued pain of undetermined etiology (n = 6, 0.1%). Analysis of a postmarket product complaints database demonstrates an overall low risk of complaints with the iFuse SI Joint Fusion System in patients with degenerative sacroiliitis or sacroiliac joint disruption.

Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

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

Hrbacek, Jan, E-mail: Jan.hrbacek@psi.ch; Mishra, Kavita K.; Kacperek, Andrzej

Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uvealmore » melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post–radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.« less

Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture.

PubMed

Beilan, Jonathan A; Wallen, Jared J; Baumgarten, Adam S; Morgan, Kevin N; Parker, Justin L; Carrion, Rafael E

2018-04-01

The use of intralesional injection of collagenase Clostridium histolyticum (CCH) has become a valid treatment option in the management of Peyronie's disease (PD). Multiple studies have shown the drug's safety and efficacy. However, sparse literature exists on the utility of the injection protocol's 14-day "observation period," in which patients are instructed to abstain from all sexual activity. To summarize the contemporary literature and report on our series of patients treated with CCH in an effort to explore the effectiveness of the postinjection observation period. We retrospectively reviewed the clinical course of men treated with at least one CCH injection at our institution from April 2014 through February 2017. The main outcome measure for our cohort was complication rate (hematoma, fracture). Secondary outcomes included progression to corrective surgery. Of the 102 patients treated, 5 (4.9%) developed a corporal fracture. Four of these occurred outside the 14-day observation period. One fracture was managed conservatively and the rest underwent surgical exploration and repair. Twelve penile hematomas were reported; one of these patients was surgically explored because of suspicious magnetic resonance imaging findings. Seven patients (6.9%) progressed to corrective surgery. Penile hematoma and corporal fracture are serious complications that must be discussed with patients before initiation of intralesional CCH treatment. Little evidence exists to direct physicians on the proper management of post-CCH penile fractures; many caregivers and patients elect to treat these injuries conservatively and avoid surgical exploration. Further studies are warranted to generate discussion and reassessment regarding the safety and effectiveness of this 14-day observation period. Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev 2018;6:272-278. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Career Education: What It Is and Why We Need It from Leaders of Industry, Education, Labor and the Professions.

ERIC Educational Resources Information Center

Chamber of Commerce of the United States, Washington, DC.

The booklet treats career education as the total effort of education and the community to help all individuals become familiar with the values of a work-oriented society, to integrate such values into their personal value systems, and to implement those values in their lives so that work becomes possible, meaningful, and satisfying to each…

Core Scientific Effort for Biosurface Studies (TASK I).

DTIC Science & Technology

1992-06-30

using acrylamide (I) and both monosubstituted and disubstituted (on nitrogen) acrylamide derivatives (II and LI). CH2 = CH-CO-NH2 CH2 = CH-CO-NHR...of seven different monomers onto poly(ethylene terephthalate), PET. The grafted monomers are: acrylamide , N- isopropylacrylamide, N,N...comprehensive study (as an M.S. thesis) of the grafting of acrylamide on to surface- treated polyolefins is nearing completion. Acrylamide can be

Joint Force Quarterly. Issue 58, 3rd Quarter

DTIC Science & Technology

2010-06-01

rise to concerns over the future security of the Soviet nuclear arsenal. Anticipating the possibility of loosely controlled nuclear weapons inside...broader Cooperative Threat Reduction program—an unprecedented effort to reduce nuclear dangers by secur- ing or eliminating Russian weapons systems and...volume is about applications of the biological sciences, here called “biologi- cally inspired innovations,” to the military. Rather than treating

An evaluation of the Forest Service Hazardous Fuels Treatment Program—Are we treating enough to promote resiliency or reduce hazard?

Treesearch

Nicole M. Vaillant; Elizabeth D. Reinhardt

2017-01-01

The National Cohesive Wildland Fire Management Strategy recognizes that wildfire is a necessary natural process in many ecosystems and strives to reduce conflicts between fire-prone landscapes and people. In an effort to mitigate potential negative wildfire impacts proactively, the Forest Service fuels program reduces wildland fuels. As part of an internal program...

Black-chinned hummingbird nest-site selection and nest survival in response to fuel reduction in a southwestern riparian forest

Treesearch

D. Max Smith; Deborah M. Finch; David L. Hawksworth

2009-01-01

Despite widespread efforts to avert wildfire by reducing the density of flammable vegetation, little is known about the effects of this practice on the reproductive biology of forest birds. We examined nest-site selection and nest survival of the Black-chinned Hummingbird (Archilochus alexandri) in New Mexico riparian forests treated or not for fuel...

Preprosthetic surgery for the edentulous patients.

PubMed

Costello, B J; Betts, N J; Barber, H D; Fonseca, R J

1996-01-01

Preprosthetic surgery is a rapidly changing area of dentistry. A knowledge of the range, capabilities, and limitations of the commonly used surgical procedures is a must for anyone treating a patient who will receive a complete denture prosthesis. It cannot be overemphasized that the establishment of a clear treatment plan and close coordination of all parties involved in the reconstructive effort are essential to achieve the best overall result.

Estimating the Health Effects of Greenhouse Gas Mitigation Strategies: Addressing Parametric, Model, and Valuation Challenges

PubMed Central

Hess, Jeremy J.; Ebi, Kristie L.; Markandya, Anil; Balbus, John M.; Wilkinson, Paul; Haines, Andy; Chalabi, Zaid

2014-01-01

Background: Policy decisions regarding climate change mitigation are increasingly incorporating the beneficial and adverse health impacts of greenhouse gas emission reduction strategies. Studies of such co-benefits and co-harms involve modeling approaches requiring a range of analytic decisions that affect the model output. Objective: Our objective was to assess analytic decisions regarding model framework, structure, choice of parameters, and handling of uncertainty when modeling health co-benefits, and to make recommendations for improvements that could increase policy uptake. Methods: We describe the assumptions and analytic decisions underlying models of mitigation co-benefits, examining their effects on modeling outputs, and consider tools for quantifying uncertainty. Discussion: There is considerable variation in approaches to valuation metrics, discounting methods, uncertainty characterization and propagation, and assessment of low-probability/high-impact events. There is also variable inclusion of adverse impacts of mitigation policies, and limited extension of modeling domains to include implementation considerations. Going forward, co-benefits modeling efforts should be carried out in collaboration with policy makers; these efforts should include the full range of positive and negative impacts and critical uncertainties, as well as a range of discount rates, and should explicitly characterize uncertainty. We make recommendations to improve the rigor and consistency of modeling of health co-benefits. Conclusion: Modeling health co-benefits requires systematic consideration of the suitability of model assumptions, of what should be included and excluded from the model framework, and how uncertainty should be treated. Increased attention to these and other analytic decisions has the potential to increase the policy relevance and application of co-benefits modeling studies, potentially helping policy makers to maximize mitigation potential while simultaneously improving health. Citation: Remais JV, Hess JJ, Ebi KL, Markandya A, Balbus JM, Wilkinson P, Haines A, Chalabi Z. 2014. Estimating the health effects of greenhouse gas mitigation strategies: addressing parametric, model, and valuation challenges. Environ Health Perspect 122:447–455; http://dx.doi.org/10.1289/ehp.1306744 PMID:24583270

Neurofeedback and its possible relevance for the treatment of Tourette syndrome.

PubMed

Farkas, Aniko; Bluschke, Annet; Roessner, Veit; Beste, Christian

2015-04-01

Neurofeedback is an increasingly recognized therapeutic option in various neuropsychiatric disorders to treat dysfunctions in cognitive control as well as disorder-specific symptoms. In this review we propose that neurofeedback may also reflect a valuable therapeutic option to treat executive control functions in Gilles-de-la-Tourette syndrome (GTS). Deficits in executive control functions when ADHD symptoms appear in GTS likely reflect pathophysiological processes in cortico-thalamic-striatal circuits and may also underlie the motor symptoms in GTS. Such executive control deficits evident in comorbid GTS/ADHD depend on neurophysiological processes well-known to be modifiable by neurofeedback. However, so far efforts to use neurofeedback to treat cognitive dysfunctions are scarce. We outline why neurofeedback should be considered a promising treatment option, what forms of neurofeedback may prove to be most effective and how neurofeedback may be implemented in existing intervention strategies to treat comorbid GTS/ADHD and associated dysfunctions in cognitive control. As cognitive control deficits in GTS mostly appear in comorbid GTS/ADHD, neurofeedback may be most useful in this frequent combination of disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Promoting Dark Sky Protection in Chile: the Gabriel Mistral IDA Dark Sky Sanctuary and Other AURA Initiatives

NASA Astrophysics Data System (ADS)

Smith, R. Chris; Smith, Malcolm; Pompea, Stephen; Sanhueza, Pedro; AURA-Chile EPO Team

2018-01-01

For over 20 years, AURA has been leading efforts promoting the protection of dark skies in northern Chile. Efforts began in the early 1990s at AURA's Cerro Tololo Inter-American Observatory (CTIO), working in collaboration with other international observatories in Chile including Las Campanas Observatory (LCO) and the European Southern Observatory (ESO). CTIO also partnered with local communities, for example supporting Vicuña's effort to establish the first municipal observatory in Chile. Today we have developed a multifaceted effort of dark sky protection, including proactive government relations at national and local levels, a strong educational and public outreach program, and a program of highlighting international recognition of the dark skies through the IDA Dark Sky Places program. Work on international recognition has included the declaration of the Gabriel Mistral IDA Dark Sky Sanctuary, the first such IDA sanctuary in the world.

WITHDRAWN: Carbamazepine for cocaine dependence.

PubMed

Lima Reisser, Anelise A R L; Silva de Lima, Mauricio; Soares, Bernardo Garcia de Oliveira; Farrell, Michael

2009-01-21

Cocaine dependence has become a public health problem, developing a significant number of medical, psychological and social problems. Although there is no consensus regarding how to treat cocaine dependence, effective pharmacotherapy has a potentially major role to play as part of a broader treatment milieu. The anti-convulsant carbamazepine, a tricyclic medication that is widely used to treat a variety of neurological and psychiatric disorders, has been used for treatment of cocaine dependence, although its effectiveness has not been established. To determine whether carbamazepine is effective for the treatment of cocaine dependence. We searched: Cochrane Controlled Trials Register (Cochrane Library issue 1, 1999), MEDLINE (f1966 - October 1997), EMBASE (1980 - October 1997), PsycLIT (1974 - July 1997), Biological Abstracts and LILACS (1982 - 1997); scan of reference list of relevant articles; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. The specialised register of trials of Cochrane Group on Drugs and Alcohol until February 2003. All randomised controlled trials focused on the use of carbamazepine versus placebo on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. The reviewers extracted the data independently, Odds Ratios, weighted mean difference and number needed to treat were estimated. Qualitative assessments of the methodology of eligible studies were carried out using validated checklists. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. Where possible analysis was carried out according to the "intention to treat" principles. 5 studies were included (455 participants). No differences regarding positive urine sample for cocaine metabolites. Scores on Spielberg State Anxiety Inventory slightly favoured carbamazepine, but not statistical significance. Dropouts were high in both groups, less dropout occurred in the carbamazepine group (RR 0.87 95%CI 0.71-1.06). When no retention in treatment was due to side effects no differences were found. The number of participants presenting at least one side effect, was higher in the carbamazepine group (RR 4.33 95% CI 1.45-12.91). There is no current evidence supporting the clinical use of Carbamazepine in the treatment of cocaine dependence. Larger randomised investigation must be considered taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence.

Partial reversal of the effort-related motivational effects of tetrabenazine with the MAO-B inhibitor deprenyl (selegiline): Implications for treating motivational dysfunctions.

PubMed

Contreras-Mora, Hector; Rowland, Margaret A; Yohn, Samantha E; Correa, Merce; Salamone, John D

2018-03-01

People with depression and Parkinsonism frequently show effort-related motivational symptoms, such as anergia, psychomotor retardation, and fatigue. Tasks that assess effort-related choice are being used as animal models of these motivational symptoms. The present studies characterized the ability of monoamine oxidase (MAO) inhibitors with varying selectivity profiles to reverse the low effort bias induced by the monoamine storage inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans, and because of its selective inhibition of VMAT-2, it preferentially depletes DA at low doses. Effort-based decision making is studied with tasks offering choices between high effort options leading to highly valued reinforcers vs. low effort/low reward options. Tetrabenazine shifted choice behavior, reducing selection of fixed ratio 5 lever pressing, but increasing intake of the concurrently available but less preferred lab chow. These effects of 0.75mg/kg tetrabenazine were attenuated by co-administration of the MAO-B inhibitor deprenyl (selegiline). The ability of deprenyl to reverse the effects of tetrabenazine was marked by an inverted-U shaped dose response curve, with the middle dose (2.5mg/kg) being effective. In contrast, neither the MAO-A selective antagonist moclobemide nor the nonselective drug pargyline reversed the effects of tetrabenazine, and moclobemide decreased lever pressing when administered alone. Deprenyl was originally developed as an antiparkinsonian drug, but it also has been shown to have antidepressant effects in humans and induce antidepressant-like effects in classical rodent models of depression. These studies have implications for the potential use of MAO-B inhibitors as treatments for the motivational symptoms of depression and Parkinsonism. Copyright © 2017. Published by Elsevier Inc.

Including All Staff in an Alternative School's Effort to Reduce Violence

ERIC Educational Resources Information Center

Waterman, Stephanie J.; Burstyn, Joan N.

2008-01-01

Interview data from non-teaching staff at Garfield alternative school revealed how the entire staff-including custodians, secretaries, and hall monitors-contributed to the success of the school's violence prevention efforts. The school functioned democratically: non-teaching staff attended violence prevention workshops offered to all staff; the…

Exploring the role of insomnia in the relation between PTSD and pain in veterans with polytrauma injuries.

PubMed

Lang, Katie P; Veazey-Morris, Katherine; Andrasik, Frank

2014-01-01

Soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom experience polytrauma injuries including traumatic brain injury. Traumatic brain injury is often complicated by symptoms of insomnia, posttraumatic stress disorder (PTSD), and pain that can impact treatment and rehabilitation. The medical records of 137 veterans seen at a Veterans Affairs Medical Center Polytrauma clinic who sustained traumatic brain injury in combat were reviewed for this study. Demographic variables include age, sex, ethnicity, military branch, and service connection. Outcome measures include PTSD, pain, and insomnia. Analyses revealed a high prevalence of PTSD, insomnia, and pain co-occurring in 51.8% of veterans. Increased PTSD symptomatology was significantly correlated with reports of more pain severity (r = 0.53), pain interference (r = 0.61), and insomnia (r = 0.67). Further analyses, controlling for service connection, indicated that insomnia partially mediated the relation between PTSD and both pain severity and interference. These results highlight the overlap and complexity of presenting complaints in veterans and help identify the role of sleep disturbances in complicating diagnosis and treatment of veterans. As sleep problems reduce pain tolerance and exacerbate other symptoms, such as cognitive deficits and irritability, failure to address sleep disturbances may compromise rehabilitation efforts, suggesting the importance of a multidisciplinary team approach to assessing and treating these veterans.

The Practice of Respect in the ICU.

PubMed

Brown, Samuel M; Azoulay, Elie; Benoit, Dominique; Butler, Terri Payne; Folcarelli, Patricia; Geller, Gail; Rozenblum, Ronen; Sands, Ken; Sokol-Hessner, Lauge; Talmor, Daniel; Turner, Kathleen; Howell, Michael D

2018-06-01

Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

Adapting to Climate Change in the Great Lakes Region: The Wisconsin Initiative on Climate Change Impacts

NASA Astrophysics Data System (ADS)

Vimont, D.; Liebl, D.

2012-12-01

The mission of the Wisconsin Initiative on Climate Change Impacts (WICCI; http://www.wicci.wisc.edu) is to assess the impacts of climate change on Wisconsin's natural, human, and built environments; and to assist in developing, recommending, and implementing climate adaptation strategies in Wisconsin. WICCI originated in 2007 as a partnership between the University of Wisconsin Nelson Institute and the Wisconsin Department of Natural Resources, and has since grown to include numerous other state, public, and private institutions. In 2011, WICCI released its First Assessment Report, which documents the efforts of over 200 individuals around the state in assessing vulnerability and estimating the risk that regional climate change poses to Wisconsin. The success of WICCI as an organization can be traced to its existence as a partnership between academic and state institutions, and as a boundary organization that catalyzes cross-disciplinary efforts between science and policy. WICCI's organizational structure and its past success at assessing climate impacts in Wisconsin will be briefly discussed. As WICCI moves into its second phase, it is increasing its emphasis on the second part of its mission: development, and implementation of adaptation strategies. Towards these goals WICCI has expanded its organizational structure to include a Communications and Outreach Committee that further ensures a necessary two-way communication of information between stakeholders / decision makers, and scientific efforts. WICCI is also increasing its focus on place-based efforts that include climate change information as one part of an integrated effort at sustainable development. The talk will include a discussion of current outreach and education efforts, as well as future directions for WICCI efforts.

Antimicrobial effects of a new therapeutic liquid dentifrice formulation on oral bacteria including odorigenic species.

PubMed

Sreenivasan, P K; Furgang, D; Zhang, Y; DeVizio, W; Fine, D H

2005-03-01

The control of oral malodor is well-recognized in efforts to improve oral health. Antimicrobial formulations can mitigate oral malodor, however, procedures to assess effects on oral bacteria including those implicated in halitosis are unavailable. This investigation examined the antimicrobial effects of a new liquid triclosan/copolymer dentifrice (test) formulation that demonstrated significant inhibition of oral malodor in previous organoleptic clinical studies. Procedures compared antimicrobial effects of the test and control formulations on a range of oral micro-organisms including members implicated in halitosis, substantive antimicrobial effects of formulations with hydroxyapatite as a surrogate for human teeth and ex vivo effects on oral bacteria from human volunteers. With Actinomyces viscosus, as a model system, the test formulation demonstrated a dose-dependent effect. At these concentrations the test formulation provided significant antimicrobial effects on 13 strains of oral bacteria including those implicated in bad breath at selected posttreatment time points. Treatment of hydroxyapatite by the test dentifrice resulted in a significant and substantive antimicrobial effect vs. controls. Oral bacteria from subjects treated ex vivo with the test dentifrice resulted in significant reductions in cultivable oral bacteria and odorigenic bacteria producing hydrogen sulfide. In summary, microbiological methods adapted to study odorigenic bacteria demonstrate the significant antimicrobial effects of the test (triclosan/copolymer) dentifrice with laboratory and clinical strains of oral bacteria implicated in bad breath.

Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes.

PubMed

Segal, Dale N; Wilson, Jacob M; Staley, Christopher; Yoon, Tim S

2018-06-11

Retrospective cohort study. To compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement surgery. Cervical total disc replacement (TDR) is a motion sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce healthcare costs are driving spine surgery to be performed in the outpatient setting. As cervical total disc replacement surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006-2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data was compared between the inpatient and outpatient cohort using univariate analysis. There were 531 (34.2%) patients treated as outpatients and 1,022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. There was no difference between 30-day complications, readmission and reoperation rates between inpatients and outpatients who underwent a single-level cervical total disc replacement. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. 3.

Synergistic inhibition of glioma cell proliferation by Withaferin A and tumor treating fields.

PubMed

Chang, Edwin; Pohling, Christoph; Beygui, Nooshin; Patel, Chirag B; Rosenberg, Jarrett; Ha, Dong Ho; Gambhir, Sanjiv S

2017-09-01

Glioblastoma (GBM) is the most aggressive and lethal form of brain cancer. Standard therapies are non-specific and often of limited effectiveness; thus, efforts are underway to uncover novel, unorthodox therapies against GBM. In previous studies, we investigated Withaferin A, a steroidal lactone from Ayurvedic medicine that inhibits proliferation in cancers including GBM. Another novel approach, tumor treating fields (TTFields), is thought to disrupt mitotic spindle formation and stymie proliferation of actively dividing cells. We hypothesized that combining TTFields with Withaferin A would synergistically inhibit proliferation in glioblastoma. Human glioblastoma cells (GBM2, GBM39, U87-MG) and human breast adenocarcinoma cells (MDA-MB-231) were isolated from primary tumors. The glioma cell lines were genetically engineered to express firefly luciferase. Proliferative potential was assessed either by bioluminescence imaging or cell counting via hemocytometer. TTFields (4 V/cm) significantly inhibited growth of the four cancer cell lines tested (n = 3 experiments per time point, four measurements per sample, p < 0.02 at least; 2-way ANOVA, control vs. treatment). The combination of Withaferin A (10-100 nM) with TTFields significantly inhibited the growth of the glioma cells to a degree beyond that of Withaferin A or TTFields alone. The interaction of the Withaferin A and TTFields on glioma cells was found to be synergistic in nature (p < 0.01, n = 3 experiments). These findings were validated by both bioluminescence and hemocytometric measurements. The combination of Withaferin A with TTFields represents a novel approach to treat GBM in a manner that is likely better than either treatment alone and that is synergistic.

Phytopharmacological Profile of Jasminum grandiflorum Linn. (Oleaceae).

PubMed

Arun, Mittal; Satish, Sardana; Anima, Pandey

2016-04-01

Plants are the real basis towards animal life and are also central to people's livelihood. The contributions of the plants in performing varied religious celebrations and in other multiple beneficiaries like medicine, human happiness as well as in treating deadly diseases can never be neglected. In treating diseases, the plants and their constituents are better choice than any other synthetic chemical. The nature has been kind enough to provide the human beings with various types of medicinal plants and in the real sense these form the storehouse of curing almost all the ailments. Consequently, most of the drugs which are being used in preparing formulations have their origin and roots in the plants which form the chief natural source of medicines. Even in modern era, the plant-derived drugs are being extensively used, either in their original or semi-synthetic form. It is because their natural phytoconstituents are highly innocuous posing relatively fewer or no side effects. Based upon their observations, analysis and experience, our ancestors used many plants for medicinal purposes and thus their efforts need to be supported by scientific evidence. Jasminum grandiflorum Linn. is one of such important plants. It has been extensively used by the tribes all over India to treat different diseases which mainly include body pains, toothache, stomach ache, ulcers, and sexual impotency. Chemistry of the plant revealed the presence of mainly secoiridoids, terpenoids, flavonoids and tannins. Not much scientific support was given to the folklore claims for this plant but some of its traditional uses were investigated like spasmolytic, wound healing, antimicrobial, angiotensin converting enzyme inhibitor, antiulcer and antioxidant activities. This article is the review of research works done on the plant Jasminum grandiflorum Linn. to date. As a part of it the local names, morphology, traditional claims, chemistry and pharmacological activities have been discussed.

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis.

PubMed

Safavi, Arash; Skarsgard, Erik D; Rhee, Peter; Zangbar, Bardiya; Kulvatunyou, Narong; Tang, Andrew; O'Keeffe, Terence; Friese, Randall S; Joseph, Bellal

2016-03-01

Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs. Published by Elsevier Inc.

Ethnobotanical study on the medicinal plants in the Mainarde Mountains (central-southern Apennine, Italy).

PubMed

Fortini, P; Di Marzio, P; Guarrera, P M; Iorizzi, M

2016-05-26

New documentation of the uses of plants in the popular medicine of the Mainarde Mountain, a protected area of the central-southern Apennine characterised by a high floristic richness, is here reported. Field data were collected through semi-structured and open interviews with native People between 2011 and 2014. The plants were identified and vouchers specimens were scanned to create a Virtual Herbarium. The Ethnobotanicity Index (EI), the Relative Importance Index (RI) and the Fidelity Level Index (FL) were calculated. The plant uses surveyed in the study area were compared with those described in medical and ethnobotanical literature. Seventy-one interviews were conducted, the age range of the informants was between 21 and 98 years. The inventory included 106 taxa belonging to 45 families; among these, 87 were wild species and 20 were cultivated species. The uses recorded were 429, among these, 69.1% of the uses concerned internal applications to treat digestive system disorders, infections and respiratory system disorders mainly, while 31.9% concerned external applications, especially to treat skin/subcutaneous cellular tissue disorders and injuries. In particular, 17 new uses and 16 unusual and rarely mentioned plants are documented. The data collected support evidence on traditional uses for plant in the Apennine. Findings from medical flora and from new or rare medical uses reinforce the usefulness of such research efforts. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Treating epidermal melasma with a 4% hydroquinone skin care system plus tretinoin cream 0.025%.

PubMed

Grimes, Pearl; Watson, JoAnne

2013-01-01

We sought to evaluate the efficacy and tolerability of treating melasma using a 4% hydroquinone skin care system, including a proprietary cleanser, toner, 4% hydroquinone, exfoliation enhancer, and sunscreen, plus tretinoin cream 0.025%. Together these products offer not only treatment of melasma but also a complete skin care regimen. Twenty participants with mild or moderate epidermal melasma with Fitzpatrick skin types III to VI were instructed to use the hydroquinone skin care system and tretinoin cream for 12 weeks. Melasma severity, melasma pigmentation intensity, and melasma area and severity index (MASI) score were significantly reduced from week 4 onward relative to baseline (P < or = .01). The proportion of participants who felt embarrassed or self-conscious about their skin very much or a lot declined from 80% (16/20) to 20% (4/20) between baseline and week 12. Similarly, the proportion of those who made very much or a lot of effort to hide their skin discoloration declined from 90% (18/20) to 37% (7/19). In total, 85% (17/20) of participants were satisfied with the overall effectiveness of the study treatment. Three participants had adverse events probably related to treatment (dryness, erythema, peeling, and stinging sensation). The 4% hydroquinone skin care system plus tretinoin cream 0.025% is effective and well-tolerated in the treatment of melasma.

Median Arcuate Ligament Syndrome: A Single-Center Experience with 23 Patients

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

Nasr, Layla A.; Faraj, Walid G.; Al-Kutoubi, Aghiad

BackgroundMedian arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result.MethodsThis is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center. Computed tomographic (CT) scans, medical records, and patient follow-up were reviewed.ResultsThe number of patients included herein was 23. The median age wasmore » 56 years (17–83). Sixteen patients (69.6%) had a significant arterial collateral circulation. Eleven patients (47.8%) were found to have visceral artery aneurysms; 4 patients (36.4%) bled secondary to aneurysm rupture. All ruptured aneurysms were treated with endovascular approach. The severity of the hemodynamic changes appears to be greater with complete occlusion,ConclusionsMALS causes pathological hemodynamic changes within the abdominal vasculature. Follow-up is advised for patients who develop a collateral circulation. Resulting aneurysms should preferably be treated when the size ratio approaches three. Treatment of these aneurysms can be done via an endovascular approach coupled with possible celiac artery decompression to restore physiologic blood flow.« less

Cyclotron in the Materials and Stresses Building

NASA Image and Video Library

1976-11-21

Researchers check the cyclotron in the Materials and Stresses Building at the National Aeronautics and Space Administration (NASA) Lewis Research Center. The Materials and Stresses Building, built in 1949, contained a number of laboratories to test the strength, diffusion, and other facets of materials. The materials could be subjected to high temperatures, high stresses, corrosion, irradiation, and hot gasses. The Physics of Solids Laboratory included a cyclotron, cloud chamber, helium cryostat, and metallurgy cave. The cyclotron was built in the early 1950s to test the effects of radiation on different materials so that the proper materials could be used to construct a nuclear aircraft engine and other components. By the late 1950s, the focus had shifted to similar studies for rockets. NASA cancelled its entire nuclear program in January 1973, and the cyclotron was mothballed. In 1975 the Cleveland Clinic Foundation partnered with NASA Lewis to use the cyclotron to treat cancer patients with a new type of radiation therapy. The cyclotron split beryllium atoms which caused neutrons to be released. The neutrons were streamed directly at the patient’s tumor. Over the course of five years, the cyclotron was used to treat 1200 patients. The program was terminated in 1980 as the Clinic shifted its efforts to concentrate on non-radiation treatments. The Lewis cyclotron was mothballed for a number of years before being demolished.

A pilot study to characterize fine particles in the environment of an automotive machining facility.

PubMed

Sioutas, C

1999-04-01

The main goal of this study was to characterize fine particles (e.g., smaller than about 3 microns) in an automotive machining environment. The Toledo Machining Plant of Chrysler Corporation was selected for this purpose. The effect of local mechanical processes as aerosol sources was a major part of this investigation. To determine the size-dependent mass concentration of particles in the plant, the Micro-Orifice Uniform Deposit Impactor (MOUDI Model 100, MSP Corp., Minneapolis, Minnesota) was used. The MOUDI was placed at central locations in departments with sources inside the plant, so that the obtained information on the size distribution realistically represents the aerosol to which plant workers are exposed. Sampling was conducted over a 4-day period, and during three periods per day, each matching the work shifts. A special effort was made to place the MOUDI at a central location of a department with relatively homogeneous particle sources. The selected sampling sites included welding, grinding, steel machining, and heat treating processes. The average 24-hour mass concentrations of particles smaller than 3.2 microns in aerodynamic diameter were 167.8, 103.9, 201.7, and 112.7 micrograms/m3 for welding, grinding, mild steel, and heat treating processes, respectively. Finally, the mass median diameters of welding, heat treatment, machining, and grinding operations were approximately 0.5, 0.5, 0.6, and 0.8 micron, respectively.

Odor-baited trap trees: a novel management tool for plum curculio (Coleoptera: Curculionidae).

PubMed

Leskey, Tracy C; Piñero, Jaime C; Prokopy, Ronald J

2008-08-01

The plum curculio, Conotrachelus nenuphar (Herbst) (Coleoptera: Curculionidae), one of the most important pests of apple (Malus spp.) in eastern and central North America, historically has been managed in New England apple orchards by three full block insecticide applications. Efforts to reduce insecticide inputs against plum curculio include perimeter row sprays, particularly after petal fall, to control immigrating adults. The odor-baited trap tree approach represents a new reduced input strategy for managing plum curculio based on the application of insecticides to a few perimeter-row trap trees rather than the entire perimeter row or full orchard block. Here, we compared the efficacy of a trap tree approach with perimeter row treatments to manage populations after petal fall in commercial apple orchards in 2005 and 2006. Injury was significantly greater in trap trees compared with unbaited perimeter row treated trees in both years of the study. In 2005, heavy rains prevented growers from applying insecticide applications at regular intervals resulting in high injury in nearly all blocks regardless of type of management strategy. In 2006, both the trap-tree and perimeter-row treatments prevented penetration by immigrating populations and resulted in economically acceptable levels of injury. The trap tree management strategy resulted in a reduction of approximately 70% total trees being treated with insecticide compared with perimeter row sprays and 93% compared with standard full block sprays.

More than meets the eye: social, economic, and emotional impacts of work-related injury and illness.

PubMed

Lax, Michael B; Klein, Rosemary

2008-01-01

The impact of an occupational illness or injury on an injured worker can be severe. This study assessed several dimensions of the impact on a group of 50 injured workers, all patients at an Occupational Health Center. The dimensions assessed included aspects of access to health care, support from treating physicians in obtaining Workers' Compensation benefits, financial impacts, the role of attorneys and "Independent Medical Examiners," and the impact on mental health. Many reported that their treating physician did not want to become involved in Workers' Compensation, despite indicating a belief that the health condition was work-related. The financial impacts of a work-related diagnosis were particularly striking, with respondents reporting that they were burdened both with costs directly related to the medical care of their condition, and with coping with ongoing general expenses on a reduced income. Many respondents reported depleting savings, borrowing money, taking out retirement funds, and declaring bankruptcy in efforts to cope. Emotionally, respondents almost universally reported their diagnosis and related issues were associated with depression, anxiety, and loss of identity and self-worth. This study demonstrates how a work-related injury or illness can extend far beyond the physical impact for injured workers. Existing systems fail to adequately compensate or rehabilitate injured workers, leaving them to their own devices to deal with their losses, medical or otherwise.

Pre-oxidation of low-density polyethylene (LDPE) by ultraviolet light (UV) promotes enhanced degradation of LDPE in soil.

PubMed

Tribedi, Prosun; Dey, Samrat

2017-11-09

Polyethylene represents nearly 64% of all the synthetic plastics produced and are mainly used for domestic and industrial applications. Their extensive use poses a serious environmental threat because of their non-biodegradable nature. Among all the polyethylene remediation strategies, in situ bioremediation happens to be the safest and efficient one. In the current study, efforts had been given to compare the extent of LDPE degradation under UV-treated and UV-untreated conditions by soil microcosm. Landfill soil was collected and UV-treated and UV-untreated LDPE were added separately to the soil following incubation under similar conditions. Electron microscopic images as well as the weight loss and the tensile strength results clearly revealed that UV-treated LDPE showed better degradation than the non-treated ones in soil. To elucidate the mechanism of this enhanced biodegradation, the bond spectra of differentially treated LDPE were analyzed by FTIR. The results obtained from bond spectra studies revealed that UV treatment increases both carbonyl and terminal double-bond index of the LDPE, thereby making it highly susceptible for microbial degradation. Moreover, incubation of UV-treated LDPE with soil favors better adherence of metabolically active and significantly higher number of microorganisms on it. Taken together, all these results demonstrate the higher microbial association and their better metabolic potential to the UV-treated LDPE that lead to enhanced degradation of the LDPE by the soil microorganisms.

The role of low cognitive effort and negative symptoms in neuropsychological impairment in schizophrenia.

PubMed

Strauss, Gregory P; Morra, Lindsay F; Sullivan, Sara K; Gold, James M

2015-03-01

Two experiments were conducted to examine whether insufficient effort, negative symptoms (e.g., avolition, anhedonia), and psychological variables (e.g., anhedonia and perception of low cognitive resources) predict generalized neurocognitive impairment in individuals with schizophrenia (SZ). In Experiment 1, participants included 97 individuals with SZ and 63 healthy controls (CN) who completed the Victoria Symptom Validity Test (VSVT), the MATRICS Consensus Cognitive Battery (MCCB), and self-report anhedonia questionnaires. In Experiment 2, participants included 46 individuals with SZ and 33 CN who completed Green's Word Memory Test (WMT), the MCCB, and self-reports of anhedonia, defeatist performance beliefs, and negative expectancy appraisals. RESULTS indicated that a low proportion of individuals with SZ failed effort testing (1.0% Experiment 1; 15.2% Experiment 2); however, global neurocognitive impairment was significantly predicted by low effort and negative symptoms. Findings indicate that low effort does not threaten the validity of neuropsychological test results in the majority of individuals with schizophrenia; however, effort testing may be useful in SZ patients with severe negative symptoms who may be more likely to put forth insufficient effort due to motivational problems. Although the base rate of failure is relatively low, it may be beneficial to screen for insufficient effort in SZ and exclude individuals who fail effort testing from pharmacological or cognitive remediation trials. PsycINFO Database Record (c) 2015 APA, all rights reserved.

ATOD Prevention Programming in the Non-School Hours and Adolescent Substance Use

ERIC Educational Resources Information Center

Alter, Randi J.; Jun, Mi Kyung; J-McKyer, E. Lisako

2007-01-01

To reduce problems associated with youth substance use, Indiana developed funding streams and infrastructure to facilitate coordination of statewide prevention efforts. These prevention efforts aimed at youth include programming in the non-school hours. To examine the relationship between these efforts and youth substance abuse, students…

Inception of a national multidisciplinary registry for stereotactic radiosurgery.

PubMed

Sheehan, Jason P; Kavanagh, Brian D; Asher, Anthony; Harbaugh, Robert E

2016-01-01

Stereotactic radiosurgery (SRS) represents a multidisciplinary approach to the delivery of ionizing high-dose radiation to treat a wide variety of disorders. Much of the radiosurgical literature is based upon retrospective single-center studies along with a few randomized controlled clinical trials. More timely and effective evidence is needed to enhance the consistency and quality of and clinical outcomes achieved with SRS. The authors summarize the creation and implementation of a national SRS registry. The American Association of Neurological Surgeons (AANS) through NeuroPoint Alliance, Inc., started a successful registry effort with its lumbar spine initiative. Following a similar approach, the AANS and NeuroPoint Alliance collaborated with corporate partners and the American Society for Radiation Oncology to devise a data dictionary for an SRS registry. Through administrative and financial support from professional societies and corporate partners, a framework for implementation of the registry was created. Initial plans were devised for a 3-year effort encompassing 30 high-volume SRS centers across the country. Device-specific web-based data-extraction platforms were built by the corporate partners. Data uploaders were then used to port the data to a common repository managed by Quintiles, a national and international health care trials company. Audits of the data for completeness and veracity will be undertaken by Quintiles to ensure data fidelity. Data governance and analysis are overseen by an SRS board comprising equal numbers of representatives from the AANS and NeuroPoint Alliance. Over time, quality outcome assessments and post hoc research can be performed to advance the field of SRS. Stereotactic radiosurgery offers a high-technology approach to treating complex intracranial disorders. Improvements in the consistency and quality of care delivered to patients who undergo SRS should be afforded by the national registry effort that is underway.

A Proposal to Study the Scientific Uses of Solar Electric Propulsion for Space Physics Missions

NASA Technical Reports Server (NTRS)

Kurth, William S.

1999-01-01

This effort was for the participation of Dr. William S. Kurth in the study of the application of spacecraft using solar electric propulsion (SEP) for a range of space physics missions. This effort included the participation of Dr. Kurth in the Tropix Science Definition Team but also included the generalization to various space physics and planetary missions, including specific Explorer mission studies.

Recommended Resources for Planning to Evaluate Program Improvement Efforts (Including the SSIP)

ERIC Educational Resources Information Center

National Center for Systemic Improvement at WestEd, 2015

2015-01-01

This document provides a list of recommended existing resources for state Part C and Part B 619 staff and technical assistance (TA) providers to utilize to support evaluation planning for program improvement efforts (including the State Systemic Improvement Plan, SSIP). There are many resources available related to evaluation and evaluation…

Further Studies into Synthetic Image Generation using CameoSim

DTIC Science & Technology

2011-08-01

preparation of the validation effort a study of BRDF models has been completed, which includes the physical plausibility of models , how measured data...the visible to shortwave infrared. In preparation of the validation effort a study of BRDF models has been completed, which includes the physical...Example..................................................................................................................... 17 4. MODELLING BRDFS

Space station final study report. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1987-01-01

Volume 1 of the Final Study Report provides an Executive Summary of the Phase B study effort conducted under contract NAS8-36526. Space station Phase B implementation resulted in the timely establishment of preliminary design tasks, including trades and analyses. A comprehensive summary of project activities in conducting this study effort is included.

Geotail MCA plasma wave data analysis

NASA Astrophysics Data System (ADS)

Anderson, Roger R.

NASA Grant NAG 5-2346 supports the data analysis effort at The University of Iowa for the GEOTAIL Multi-Channel Analyzer (MCA) which is a part of the GEOTAIL Plasma Wave Instrument (PWI). At the beginning of this reporting period we had just begun to receive our GEOTAIL Sirius data on CD-ROMs. Much programming effort went into adapting and refining the data analysis programs to include the CD-ROM inputs. Programs were also developed to display the high-frequency-resolution PWI Sweep Frequency Analyzer (SFA) data and to include in all the various plot products the electron cyclotron frequency derived from the magnitude of the magnetic field extracted from the GEOTAIL Magnetic Field (MGF) data included in the GEOTAIL Sirius data. We also developed programs to use the MGF data residing in the Institute of Space and Astronautical Science (ISAS) GEOTAIL Scientific Data Base (SDB). Our programmers also developed programs and provided technical support for the GEOTAIL data analysis efforts of Co-lnvestigator William W. L. Taylor at Nichols Research Corporation (NRC). At the end of this report we have included brief summaries of the NRC effort and the progress being made.

Geotail MCA plasma wave data analysis

NASA Technical Reports Server (NTRS)

Anderson, Roger R.

1994-01-01

NASA Grant NAG 5-2346 supports the data analysis effort at The University of Iowa for the GEOTAIL Multi-Channel Analyzer (MCA) which is a part of the GEOTAIL Plasma Wave Instrument (PWI). At the beginning of this reporting period we had just begun to receive our GEOTAIL Sirius data on CD-ROMs. Much programming effort went into adapting and refining the data analysis programs to include the CD-ROM inputs. Programs were also developed to display the high-frequency-resolution PWI Sweep Frequency Analyzer (SFA) data and to include in all the various plot products the electron cyclotron frequency derived from the magnitude of the magnetic field extracted from the GEOTAIL Magnetic Field (MGF) data included in the GEOTAIL Sirius data. We also developed programs to use the MGF data residing in the Institute of Space and Astronautical Science (ISAS) GEOTAIL Scientific Data Base (SDB). Our programmers also developed programs and provided technical support for the GEOTAIL data analysis efforts of Co-lnvestigator William W. L. Taylor at Nichols Research Corporation (NRC). At the end of this report we have included brief summaries of the NRC effort and the progress being made.

A Virtual Screen Discovers Novel, Fragment-Sized Inhibitors of Mycobacterium tuberculosis InhA

PubMed Central

Perryman, Alexander L.; Yu, Weixuan; Wang, Xin; Ekins, Sean; Forli, Stefano; Li, Shao-Gang; Freundlich, Joel S.; Tonge, Peter J.; Olson, Arthur J.

2015-01-01

Isoniazid (INH) is usually administered to treat latent Mycobacterium tuberculosis (Mtb) infections, and is used in combination therapy to treat active tuberculosis disease (TB). Unfortunately, resistance to this drug is hampering its clinical effectiveness. INH is a prodrug that must be activated by Mtb catalase peroxidase (KatG) before it can inhibit InhA (Mtb enoyl-acyl-carrier-protein reductase). Isoniazid-resistant cases of TB found in clinical settings usually involve mutations in or deletion of katG, which abrogate INH activation. Compounds that inhibit InhA without requiring prior activation by KatG would not be affected by this resistance mechanism and hence would display continued potency against these drug-resistant isolates of Mtb. Virtual screening experiments versus InhA in the GO Fight Against Malaria project (GO FAM) were designed to discover new scaffolds that display base stacking interactions with the NAD cofactor. GO FAM experiments included targets from other pathogens, including Mtb, when they had structural similarity to a malaria target. Eight of the sixteen soluble compounds identified by docking against InhA plus visual inspection were modest inhibitors and did not require prior activation by KatG. The best two inhibitors discovered are both fragment-sized compounds and displayed Ki values of 54 and 59 μM, respectively. Importantly, the novel inhibitors discovered have low structural similarity to known InhA inhibitors and, thus, help expand the number of chemotypes on which future medicinal chemistry efforts can be focused. These new fragment hits could eventually help advance the fight against INH-resistant Mtb strains, which pose a significant global health threat. PMID:25636146

Life cycle environmental impacts of advanced wastewater treatment techniques for removal of pharmaceuticals and personal care products (PPCPs).

PubMed

Zepon Tarpani, Raphael Ricardo; Azapagic, Adisa

2018-06-01

Pharmaceutical and personal care products (PPCPs) are of increasing interest because of their ecotoxicological properties and environmental impacts. Wastewater treatment plants (WWTPs) are the main pathway for their release into freshwaters due to the inefficiency of conventional WWTPs in removing many of these contaminants from effluents. Therefore, different advanced effluent treatment techniques have been proposed for their treatment. However, it is not known at present how effective these treatment methods are and whether on a life cycle basis they cause other environmental impacts which may outweigh the benefits of the treatment. In an effort to provide an insight into this question, this paper considers life cycle environmental impacts of the following advanced treatment techniques aimed at reducing freshwater ecotoxicity potential of PPCPs: granular activated carbon (GAC), nanofiltration (NF), solar photo-Fenton (SPF) and ozonation. The results suggest that on average NF has the lowest impacts for 13 out of 18 categories considered. GAC is the best alternative for five impacts, including metals and water depletion, but it has the highest marine eutrophication. SPF and ozonation are the least sustainable for eight impacts, including ecotoxicity and climate change. GAC and NF are also more efficient in treating heavy metals while avoiding generation of harmful by-products during the treatment, thus being more suitable for potable reuse of wastewater. However, releasing the effluent without advanced treatment to agricultural land achieves a much higher reduction of freshwater ecotoxicity than treating it by any of the advanced treatments and releasing to the environment. Therefore, the use of advanced effluent treatment for agricultural purposes is not recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

Guideline recommendations for diagnosis and clinical management of Ring14 syndrome-first report of an ad hoc task force.

PubMed

Rinaldi, Berardo; Vaisfeld, Alessandro; Amarri, Sergio; Baldo, Chiara; Gobbi, Giuseppe; Magini, Pamela; Melli, Erto; Neri, Giovanni; Novara, Francesca; Pippucci, Tommaso; Rizzi, Romana; Soresina, Annarosa; Zampini, Laura; Zuffardi, Orsetta; Crimi, Marco

2017-04-11

Ring chromosome 14 syndrome is a rare chromosomal disorder characterized by early onset refractory epilepsy, intellectual disability, autism spectrum disorder and a number of diverse health issues. The aim of this work is to provide recommendations for the diagnosis and management of persons affected by ring chromosome 14 syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years subjects affected by ring chromosome 14 syndrome. The literature search was performed in 2016. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conventional cytogenetics is the primary tool to identify a ring chromosome. Children with a terminal deletion of chromosome 14q ascertained by molecular karyotyping (CGH/SNP array) should be tested secondarily by conventional cytogenetics for the presence of a ring chromosome. Early diagnosis should be pursued in order to provide medical and social assistance by a multidisciplinary team. Clinical investigations, including neurophysiology for epilepsy, should be performed at the diagnosis and within the follow-up. Following the diagnosis, patients and relatives/caregivers should receive regular care for health and social issues. Epilepsy should be treated from the onset with anticonvulsive therapy. Likewise, feeding difficulties should be treated according to need. Nutritional assessment is recommended for all patients and nutritional support for malnourishment can include gastrostomy feeding in selected cases. Presence of autistic traits should be carefully evaluated. Many patients with ring chromosome 14 syndrome are nonverbal and thus maintaining their ability to communicate is always essential; every effort should be made to preserve their autonomy.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed

Burns, L R; Chilingerian, J A; Wholey, D R

1994-12-01

This study examines variations in the efficient use of hospital resources across individual physicians. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior.

The effect of physician practice organization on efficient utilization of hospital resources.

PubMed Central

Burns, L R; Chilingerian, J A; Wholey, D R

1994-01-01

OBJECTIVE. This study examines variations in the efficient use of hospital resources across individual physicians. DATA SOURCES AND SETTING. The study is conducted over a two-year period (1989-1990) in all short-term general hospitals with 50 or more beds in Arizona. We examine hospital discharge data for 43,625 women undergoing cesarean sections and vaginal deliveries without complications. These data include physician identifiers that permit us to link patient information with information on physicians provided by the state medical association. STUDY DESIGN. The study first measures the contribution of physician characteristics to the explanatory power of regression models that predict resource use. It then tests hypothesized effects on resource utilization exerted by two sets of physician level factors: physician background and physician practice organization. The latter includes effects of hospital practice volume, concentration of hospital practice, percent managed care patients in one's hospital practice, and diversity of patients treated. Efficiency (inefficiency) is measured as the degree of variation in patient charges and length of stay below (above) the average of treating all patients with the same condition in the same hospital in the same year with the same severity of illness, controlling for discharge status and the presence of complications. PRINCIPAL FINDINGS. After controlling for patient factors, physician characteristics explain a significant amount of the variability in hospital charges and length of stay in the two maternity conditions. Results also support hypotheses that efficiency is influenced by practice organization factors such as patient volume and managed care load. Physicians with larger practices and a higher share of managed care patients appear to be more efficient. CONCLUSIONS. The results suggest that health care reform efforts to develop physician-hospital networks and managed competition may promote greater parsimony in physicians' practice behavior. PMID:8002351

Waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: results of an international randomized, controlled trial.

PubMed

Freese, John P; Jorgenson, Dawn B; Liu, Ping-Yu; Innes, Jennifer; Matallana, Luis; Nammi, Krishnakant; Donohoe, Rachael T; Whitbread, Mark; Silverman, Robert A; Prezant, David J

2013-08-27

Ventricular fibrillation (VF) waveform properties have been shown to predict defibrillation success and outcomes among patients treated with immediate defibrillation. We postulated that a waveform analysis algorithm could be used to identify VF unlikely to respond to immediate defibrillation, allowing selective initial treatment with cardiopulmonary resuscitation in an effort to improve overall survival. In a multicenter, double-blind, randomized study, out-of-hospital cardiac arrest patients in 2 urban emergency medical services systems were treated with automated external defibrillators using either a VF waveform analysis algorithm or the standard shock-first protocol. The VF waveform analysis used a predefined threshold value below which return of spontaneous circulation (ROSC) was unlikely with immediate defibrillation, allowing selective treatment with a 2-minute interval of cardiopulmonary resuscitation before initial defibrillation. The primary end point was survival to hospital discharge. Secondary end points included ROSC, sustained ROSC, and survival to hospital admission. Of 6738 patients enrolled, 987 patients with VF of primary cardiac origin were included in the primary analysis. No immediate or long-term survival benefit was noted for either treatment algorithm (ROSC, 42.5% versus 41.2%, P=0.70; sustained ROSC, 32.4% versus 33.4%, P=0.79; survival to admission, 34.1% versus 36.4%, P=0.46; survival to hospital discharge, 15.6% versus 17.2%, P=0.55, respectively). Use of a waveform analysis algorithm to guide the initial treatment of out-of-hospital cardiac arrest patients presenting in VF did not improve overall survival compared with a standard shock-first protocol. Further study is recommended to examine the role of waveform analysis for the guided management of VF.

Distinct enough? A national examination of Catholic hospital affiliation and patient perceptions of care

PubMed Central

Kutney-Lee, Ann; Melendez-Torres, G.J.; McHugh, Matthew D.; Wall, Barbra Mann

2014-01-01

Background Catholic hospitals play a critical role in the provision of health care in the United States; yet, empirical evidence of patient outcomes in these institutions is practically absent in the literature. Purpose The purpose of this study was to determine whether patient perceptions of care are more favorable in Catholic hospitals as compared with non-Catholic hospitals in a national sample of hospitals. Methodology This cross-sectional secondary analysis used linked data from the 2008 American Hospital Association Annual Survey, the 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the 2008 Medicare Case Mix Index file, and the 2010 Religious Congregations and Membership Study. The study included over 3,400 hospitals nationwide, including 494 Catholic hospitals. Propensity score matching and ordinary least-squares regression models were used to examine the relationship between Catholic affiliation and various HCAHPS measures. Findings Our findings revealed that patients treated in Catholic hospitals appear to rate their hospital experience similar to patients treated in non-Catholic hospitals. Catholic hospitals maintain a very slight advantage above their non-Catholic peers on five HCAHPS measures related to nurse communication, receipt of discharge information, quietness of the room at night, overall rating, and recommendation of the hospital; yet, these differences were minimal. Practice Implications If the survival of Catholic health care services is contingent upon how its provision of care is distinct, administrators of Catholic hospitals must show differences more clearly. Given the great importance of Catholic hospitals to the health of millions of patients in the United States, this study provides Catholic hospitals with a set of targeted areas on which to focus improvement efforts, especially in light of current pay-for-performance initiatives. PMID:23493045

Assessment of Fever Advisory Cards (FACs) as an Initiative to Improve Febrile Neutropenia Management in a Regional Cancer Center Emergency Department.

PubMed

Kapil, Priyanka; MacMillan, Meghan; Carvalho, Maritza; Lymburner, Patricia; Fung, Ron; Almeida, Bernadette; Van Dorn, Laurie; Enright, Katherine

2016-09-01

We aimed to improve the time to antibiotics (TTA) for patients treated with chemotherapy who present to the emergency department (ED) with febrile neutropenia (FN) by using standardized fever advisory cards (FACs). Patients treated with chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada, with suspected FN were identified, before (April 2012 to March 2013) and after (October 2013 to March 2014) FAC implementation. The primary outcome of interest was TTA. Additional process measures included Canadian Triage and Acuity Scale score, time to physician assessment, and FAC compliance. Outcomes were analyzed with descriptive statistics and control charts to determine whether the change in primary measures were within statistical control over time. Between the pre-FAC cohort (n = 239) and post-FAC cohort (n = 69), TTA did not change significantly post-FACs (195 v 244 min, P = .09), with monthly averages demonstrating normal variation by statistical process control methodology. The introduction of FACs increased the percentage of patients with correctly assigned Canadian Triage and Acuity Scale scores (87% v 100%) but did not affect time to physician assessment. Compliance with FACs among patients was not ideal, with only 62.5% using them as intended. The distribution of FACs was associated with an improved incidence of correct FN triaging but did not demonstrate a meaningful improvement in the quality of FN management. This may be explained by FAC use among patients not being ideal. Next steps in the continued effort toward high-quality FN care include redesign of FACs, reinforcement of provider and patient education, and ED outreach. Copyright © 2016 by American Society of Clinical Oncology.

Deployment Health Centers Review, 2016-2017

DTIC Science & Technology

2017-08-21

the short and long-term adverse effects of military service on the physical and mental health of veterans. We recommend that the DHB continue to...adverse effects of military service on the physical and mental health of veterans” by expanding on current clinical, surveillance, and research efforts...the ability to identify, treat, and minimize the short- and long-term adverse effects of military service on the mental and physical health of

Radiological Dispersal Devices: Select Issues in Consequence Management

DTIC Science & Technology

2004-03-10

goals, following which medical treatment of the radiation effects can be provided.10 Post- exposure medical therapy is designed to treat the consequences ...the approach that radiation related health effects can be extrapolated, i.e. the damage caused by radiation exposure CRS-3 8 For example, see Health...effort to determine the validity of these models, the federal government funds research into the health effects of radiation exposure through the

Advances in MRSA drug discovery: where are we and where do we need to be?

PubMed

Kurosu, Michio; Siricilla, Shajila; Mitachi, Katsuhiko

2013-09-01

Methicillin-resistant Staphylococcus aureus (MRSA) have been on the increase during the past decade, due to the steady growth of the elderly and immunocompromised patients, and the emergence of multidrug-resistant (MDR) bacterial strains. Although there are a limited number of anti-MRSA drugs available, a number of different combination antimicrobial drug regimens have been used to treat serious MRSA infections. Thus, the addition of several new antistaphylococcal drugs into clinical practice should broaden clinician's therapeutic options. As MRSA is one of the most common and problematic bacteria associated with increasing antimicrobial resistance, continuous efforts for the discovery of lead compounds as well as development of alternative therapies and faster diagnostics are required. This article summarizes the FDA-approved drugs to treat MRSA infections, the drugs in clinical trials, and the drug leads for MRSA and related Gram-positive bacterial infections. In addition, the article discusses the mode of action of antistaphylococcal molecules and the resistant mechanisms of some molecules. The number of pipeline drugs presently undergoing clinical trials is not particularly encouraging. There are limited and rather expensive therapeutic options for MRSA infections in the critically ill. Further research efforts are required for effective phage therapy on MRSA infections in clinical use, which seem to be attractive therapeutic options for the future.

Arrhenius parameters for primary thermal injury in human tonsillar tissue

NASA Astrophysics Data System (ADS)

McMillan, Kathleen; Radabaugh, Rebecca; Coad, James E.

2011-03-01

Clinical implementation of a thermal therapy requires the ability to predict tissue injury following exposures to specific thermal histories. As part of an effort to develop a nonexcisional alternative to tonsillectomy, the degree of primary hyperthermic tissue injury in human tonsil was characterized. Fifteen fresh pediatric hypertrophic tonsillectomy specimens were sectioned and treated in a NIST-calibrated saline bath at temperatures of 40 to 70°C with hold times of one to seven minutes. The treated tissues were subsequently nitroblue tetrazolium (NBT) stained to assess for thermal respiratory enzyme inactivation as a marker of cellular injury/death. The NBT stains were quantitatively image analyzed and used to calculate Arrhenius parameters for primary thermal injury in human tonsils.

Electron-processing technology: A promising application for the viscose industry

NASA Astrophysics Data System (ADS)

Stepanik, T. M.; Rajagopal, S.; Ewing, D.; Whitehouse, R.

1998-06-01

In marketing its IMPELA ® line of high power, high-throughput industrial accelerators, Atomic Energy of Canada Limited (AECL) is working with viscose (rayon) companies world-wide to integrate electron-processing technology as part of the viscose manufacturing process. The viscose industry converts cellulose wood pulp into products such as staple fiber, filament, cord, film, packaging, and non-edible sausage casings. This multibillion dollar industry is currently suffering from high production costs, and is facing increasingly stringent environmental regulations. The use of electron-treated pulp can significantly lower production costs and can provide equally significant environmental benefits. This paper describes our current understanding of the benefits of using electron-treated pulp in this process, and AECL's efforts in developing this technology.

[Homeostasis and Disorder of Musculoskeletal System.Diagnosis and Treatment of Congenital Musculoskeletal Diseases.

PubMed

Michigami, Toshimi

Congenital skeletal dysplasias have been considered to be fundamentally untreatable diseases. However, molecular diagnosis by genetic testing has become more prevalent, and efforts are being made to develop novel therapies based on the pathogenesis. As treatments for osteogenesis imperfecta, in addition to anti-resorptive agents, neutralizing antibodies against sclerostin and transforming growth factor(TGF)-β and chemical chaperones can be beneficial. Enzyme replacement therapy using bone-targeting recombinant alkaline phosphatase has been recently developed to treat hypophosphatasia and has much improved the prognosis of the patients affected with severe forms of the disease. To treat the severe short stature in achondroplasia, drugs targeting the fibroblast growth factor receptor 3(FGFR3)-mediated signal are in development for clinical use.

Repurposing pharma assets: an accelerated mechanism for strengthening the schistosomiasis drug development pipeline.

PubMed

Ramamoorthi, Roopa; Graef, Katy M; Dent, Jennifer

2015-01-01

Schistosomiasis, one of 17 diseases deemed to be neglected by the World Health Organization, has received little attention from the biopharmaceutical industry. Due to this, only a handful of drugs have been developed to treat schistosomiasis, with only one, praziquantel, used in most endemic regions. Growing concern over resistance coupled with praziquantel's incomplete efficacy across all stages of the Schistosoma platyhelminth life cycle highlights the urgent need for new drugs. The WIPO Re:Search consortium is a platform whereupon biopharmaceutical company compounds are being repurposed to efficiently and cost-effectively develop new drugs for neglected diseases such as schistosomiasis. This article summarizes recent clinical-stage efforts to identify new antischistosomals and highlights biopharmaceutical company compounds with potential for repurposing to treat schistosomiasis.

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

PubMed Central

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

2011-01-01

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

[Fatigue syndrome: Stress, Burnout and depression in Urology.

PubMed

Rodríguez-Socarrás, Moisés; Vasquez, Juan Luis; Uvin, Pieter; Skjold-Kingo, Pernille; Gómez Rivas, Juan

2018-01-01

To determine the factors related to stress, Burnout and depression in urology, as well as consequences in residents and urologists, in addition to the possible applicable strategies to diminish and treat them. Depression, stress and Burnout syndrome has become a problem in urology specialty. These topics have gained interest in international congresses and urological associations. Efforts are being made to find related factors as well as possible strategies and applicable support programs. Burnout frequency is higher among health professionals than general population, 40-76% in students and residents, its incidence has skyrocketed in recent years, in addition Urology is one of the specialties with highest incidence and severity. Its increase has been related to work overload, documentation, administrative/bureaucratic workload, hostile work environment; its consequences include poor work performance, medical errors, depression, substance abuse, disruption in family and couple relationships and suicidal ideation. Strategies for prevention including resilience training, lifestyle balance, teamwork, and support programs. Stress, burnout and depression are problems in urology, early detection, promoting individual techniques in resilience, lifestyle and teamwork are fundamental now and for the future of the specialty. Developing and implementing support programs should be seriously considered by health systems and urological associations.

Practical perspectives on the management of overweight and obesity.

PubMed

Gregory, Robert S; Handelsman, Yehuda; Pezalla, Edmund J; Pikelny, Dan

2014-03-01

The prevalence of obesity, defined as a body mass index of 30 or more, has reached epidemic proportions in the United States. Obesity is associated with an increased risk of multiple conditions, including type 2 diabetes mellitus, cardiovascular disease, arthritis, and sleep apnea. To discuss issues related to obesity in the workplace, healthcare, and managed care settings, stakeholders from these areas participated in a roundtable discussion on several topics, including the management of obesity, managed care coverage policies for obesity treatments, and potential strategies for improving patient outcomes. Participants agreed that obesity is a challenging condition to treat. Lifestyle modification, one of the most commonly recommended treatment modalities, is often inadequate on its own, as patients are unable to maintain weight loss over time. Although lifestyle modification remains important, additional tools are needed. In patients who undergo bariatric surgery, lifestyle modification is also necessary for long-term weight maintenance; however, surgery is not appropriate for all patients. Pharmacologic treatment may also be considered, but cost and managed care coverage policies have the potential to limit patient access to this treatment modality. Increased awareness and additional efforts on the part of all stakeholders are needed to improve outcomes for patients affected by obesity.

Engineering and physical sciences in oncology: challenges and opportunities.

PubMed

Mitchell, Michael J; Jain, Rakesh K; Langer, Robert

2017-11-01

The principles of engineering and physics have been applied to oncology for nearly 50 years. Engineers and physical scientists have made contributions to all aspects of cancer biology, from quantitative understanding of tumour growth and progression to improved detection and treatment of cancer. Many early efforts focused on experimental and computational modelling of drug distribution, cell cycle kinetics and tumour growth dynamics. In the past decade, we have witnessed exponential growth at the interface of engineering, physics and oncology that has been fuelled by advances in fields including materials science, microfabrication, nanomedicine, microfluidics, imaging, and catalysed by new programmes at the National Institutes of Health (NIH), including the National Institute of Biomedical Imaging and Bioengineering (NIBIB), Physical Sciences in Oncology, and the National Cancer Institute (NCI) Alliance for Nanotechnology. Here, we review the advances made at the interface of engineering and physical sciences and oncology in four important areas: the physical microenvironment of the tumour and technological advances in drug delivery; cellular and molecular imaging; and microfluidics and microfabrication. We discussthe research advances, opportunities and challenges for integrating engineering and physical sciences with oncology to develop new methods to study, detect and treat cancer, and we also describe the future outlook for these emerging areas.

Pathogenesis of Pancreatic Cancer: Lessons from Animal Models

PubMed Central

Murtaugh, L. Charles

2014-01-01

The past several decades have seen great effort devoted to mimicking the key features of pancreatic ductal adenocarcinoma (PDAC) in animals, and have produced two robust models of this deadly cancer. Carcinogen-treated Syrian hamsters develop PDAC with genetic lesions that reproduce those of human, including activation of the Kras oncogene, and early studies in this species validated non-genetic risk factors for PDAC including pancreatitis, obesity and diabetes. More recently, PDAC research has been invigorated by the development of genetically-engineered mouse models based on tissue-specific Kras activation and deletion of tumor suppressor genes. Surprisingly, mouse PDAC appears to arise from exocrine acinar rather than ductal cells, via a process of phenotypic reprogramming that is accelerated by inflammation. Studies in both models have uncovered molecular mechanisms by which inflammation promotes and sustains PDAC, and identified targets for chemoprevention to suppress PDAC in high-risk individuals. The mouse model, in particular, has also been instrumental in developing new approaches to early detection as well as treatment of advanced disease. Together, animal models enable diverse approaches to basic and preclinical research on pancreatic cancer, the results of which will accelerate progress against this currently intractable cancer. PMID:24178582

State of the art and perspectives in the treatment of glioblastoma.

PubMed

Grimm, Sean A; Chamberlain, Marc C

2012-09-01

Glioblastoma is the most common malignant primary brain tumor. Cures are rare and median survival varies from several to 22 months. Standard treatment for good performance patients consists of maximal safe surgical resection followed by radiotherapy with concurrent temozolomide (TMZ) chemotherapy and six cycles of postradiotherapy TMZ. At recurrence, treatment options include repeat surgery (with or without Gliadel wafer placement), reirradiation or systemic therapy. Most patients with good performance status are treated with cytotoxic chemotherapy or targeted biologic therapy following or in lieu of repeat surgery. Cytotoxic chemotherapy options include nitrosoureas, rechallenge with TMZ, platins, phophoramides and topoisomerase inhibitors, although efficacy is limited. Despite the intense effort of developing biologic agents that target angiogenesis and growth and proliferative pathways, bevacizumab is the only agent that has shown efficacy in clinical trials. It was awarded accelerated approval in the USA after demonstrating an impressive radiographic response in two open-label, prospective Phase II studies. Two randomized, Phase III trials of upfront bevacizumab have completed and may demonstrate survival benefit; however, results are pending at this time. Given the limited treatment options at tumor recurrence, consideration for enrollment on a clinical trial is encouraged.

Cost-benefit decision circuitry: proposed modulatory role for acetylcholine.

PubMed

Fobbs, Wambura C; Mizumori, Sheri J Y

2014-01-01

In order to select which action should be taken, an animal must weigh the costs and benefits of possible outcomes associate with each action. Such decisions, called cost-benefit decisions, likely involve several cognitive processes (including memory) and a vast neural circuitry. Rodent models have allowed research to begin to probe the neural basis of three forms of cost-benefit decision making: effort-, delay-, and risk-based decision making. In this review, we detail the current understanding of the functional circuits that subserve each form of decision making. We highlight the extensive literature by detailing the ability of dopamine to influence decisions by modulating structures within these circuits. Since acetylcholine projects to all of the same important structures, we propose several ways in which the cholinergic system may play a local modulatory role that will allow it to shape these behaviors. A greater understanding of the contribution of the cholinergic system to cost-benefit decisions will permit us to better link the decision and memory processes, and this will help us to better understand and/or treat individuals with deficits in a number of higher cognitive functions including decision making, learning, memory, and language. © 2014 Elsevier Inc. All rights reserved.

Sub-Saharan Rubiaceae: a review of their traditional uses, phytochemistry and biological activities.

PubMed

Karou, Simplice D; Tchacondo, Tchadjobo; Ilboudo, Denise P; Simpore, Jacques

2011-02-01

Rubiaceae family is a large family of 630 genera and about 13000 species found worldwide, especially in tropical and warm regions. These plants are not only ornamental but they are also used in African folk medicine to treat several diseases. Based on online published data and library bibliographic research, we herein reported accumulated information related to their traditional usages in sub-Saharan traditional medicine, their chemical composition and the screened pharmacological activities. Indeed, more than 60 species are used for more than 70 medicinal indications including malaria, hepatitis, eczema, oedema, cough, hypertension, diabetes and sexual weakness. Through biological screening following leads supplied with traditional healers, many of these plants exhibited antimalarial, antimicrobial, antihypertension, antidiabetic, antioxidant and anti-inflammatory activities. Bioactive compounds including indole alkaloids, terpenoids and anthraquinones have been isolated from these bioguided fractionation studies. It is evidence that great attention has been paid to species such as Nauclea latifolia, Morinda lucida, Mitragyna inermis and Crossopteryx febrifuga; however, several compounds should be waiting to be discovered since none of these plants has been systematically investigated for its biochemical composition. According the current global health context with the recrudescence of HIV, much effort should be oriented towards this virus when screening Rubiaceae.

Baseline Assessment of TREAT for Modeling and Analysis Needs

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

Bess, John Darrell; DeHart, Mark David

2015-10-01

TREAT is an air-cooled, graphite moderated, thermal, heterogeneous test facility designed to evaluate reactor fuels and structural materials under conditions simulating various types of nuclear excursions and transient undercooling situations that could occur in a nuclear reactor. After 21 years in a standby mode, TREAT is being re-activated to revive transient testing capabilities. Given the time elapsed and the concurrent loss of operating experience, current generation and advanced computational methods are being applied to begin TREAT modeling and simulation prior to renewed at-power operations. Such methods have limited value in predicting the behavior of TREAT without proper validation. Hence, themore » U.S. DOE has developed a number of programs to support development of benchmarks for both critical and transient operations. Extensive effort has been expended at INL to collect detailed descriptions, drawings and specifications for all aspects of TREAT, and to resolve conflicting data found through this process. This report provides a collection of these data, with updated figures that are significantly more readable than historic drawings and illustrations, compositions, and dimensions based on the best available sources. This document is not nor should it be considered to be a benchmark report. Rather, it is intended to provide one-stop shopping, to the extent possible, for other work that seeks to prepare detailed, accurate models of the core and its components. Given the nature of the variety of historic documents available and the loss of institutional memory, the only completely accurate database of TREAT data is TREAT itself. Unfortunately, disassembly of TREAT for inspection, assay, and measurement is highly unlikely. Hence the data provided herein is intended serve as a best-estimate substitute.« less

An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR.

PubMed

Vorasane, Savina; Jimba, Masamine; Kikuchi, Kimiyo; Yasuoka, Junko; Nanishi, Keiko; Durham, Jo; Sychareun, Vanphanom

2017-02-10

Despite global efforts, HIV-related stigma continues to negatively impact the health and well-being of people living with HIV/AIDS. Even in healthcare settings, people with HIV/AIDS experience discrimination. Anecdotal evidence suggests that healthcare professionals in the Lao People's Democratic Republic, a lower-middle income country situated in Southeast Asia, stigmatize HIV/AID patients. The purpose of this study was to assess HIV stigmatizing attitudes within Laotian healthcare service providers and examine some of the factors associated with HIV/AIDS-related stigma among doctors and nurses. A structured questionnaire, which included a HIV-related stigma scale consisting of 17 items, was self-completed by 558 healthcare workers from 12 of the 17 hospitals in Vientiane. Five hospitals were excluded because they had less than 10 staff and these staff were not always present. The questionnaire was pre-tested with 40 healthcare workers. Descriptive statistical analysis was performed and comparisons between groups undertaken using chi-square test and t-test. Bivariate and multiple linear regression analyses were carried out to examine the associations between stigmatizing attitudes and independent variables. Out of the 558 participating healthcare workers, 277 (49.7%) were doctors and 281 (50.3%) were nurses. Nearly 50% of doctors and nurses included in the study had high levels of stigmatizing attitudes towards people living with HIV/AIDS. Across the different health professionals included in this study, lower levels of HIV/AIDS knowledge were associated with higher levels of stigmatizing attitudes towards people living with HIV/AIDS. Stigmatizing attitudes, including discrimination at work, fear of AIDS, and prejudice, were lower in healthcare workers with more experience in treating HIV/AIDS patients. This study is the first to report on HIV/AIDS-related stigmatization among healthcare workers in Lao PDR. Stigmatizing attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts to manage and prevent HIV. Reversing stigmatizing attitudes and practices requires interventions that address affective, cognitive and behavioral aspects of stigma. Alongside this, health professionals need to be enabled to enact universal precautions and prevent occupational transmission of HIV.

76 FR 21044 - Notice of Entering Into a Compact With the Republic of Malawi

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

...) Operations: MCC funding will support change management efforts, designing human resources strategies... efforts to implement a suitable market model which will include efforts to: (a) Study and design a single... from time to time in accordance with the terms hereof, the ``Program'') to counter a key binding...

Achieving Common Expectations for Overall Goals amid Diversity among Cooperative Extension Faculty.

ERIC Educational Resources Information Center

Taylor, Barbara

As a part of the initial phase of a strategic planning effort for the development of Florida's 1988 through 1991 long-range cooperative extension program, an effort was initiated to achieve common expectations for overall organizational mission and purpose among diverse cooperative extension faculty. The unification effort included the following…

Ion separation effects in mixed-species ablators for inertial-confinement-fusion implosions

NASA Astrophysics Data System (ADS)

Amendt, Peter; Bellei, Claudio; Ross, J. Steven; Salmonson, Jay

2015-02-01

Recent efforts to demonstrate significant self-heating of the fuel and eventual ignition at the National Ignition Facility make use of plastic (CH) ablators [O. A. Hurricane et al., Phys. Plasmas 21, 056314 (2014), 10.1063/1.4874330]. Mainline simulation techniques for modeling CH capsule implosions treat the ablator as an average-atom fluid and neglect potential species separation phenomena. The mass-ablation process for a mixture is shown to lead to the potential for species separation, parasitic energy loss according to thermodynamic arguments, and reduced rocket efficiency. A generalized plasma barometric formula for a multispecies concentration gradient that includes collisionality and steady flows in spherical geometry is presented. A model based on plasma expansion into a vacuum is used to interpret reported experimental evidence for ablator species separation in an inertial-confinement-fusion target [J. S. Ross et al., Rev. Sci. Instrum. 83, 10E323 (2012)]. The possibility of "runaway" hydrogen ions in the thermoelectric field of the ablation front is conjectured.

Enhancing the utility of existing antibiotics by targeting bacterial behaviour?

PubMed Central

Rogers, Geraint B; Carroll, Mary P; Bruce, Kenneth D

2012-01-01

The discovery of novel classes of antibiotics has slowed dramatically. This has occurred during a time when the appearance of resistant strains of bacteria has shown a substantial increase. Concern is therefore mounting over our ability to continue to treat infections in an effective manner using the antibiotics that are currently available. While ongoing efforts to discover new antibiotics are important, these must be coupled with strategies that aim to maintain as far as possible the spectrum of activity of existing antibiotics. In many instances, the resistance to antibiotics exhibited by bacteria in chronic infections is mediated not by direct resistance mechanisms, but by the adoption of modes of growth that confer reduced susceptibility. These include the formation of biofilms and the occurrence of subpopulations of ‘persister’ cells. As our understanding of these processes has increased, a number of new potential drug targets have been revealed. Here, advances in our ability to disrupt these systems that confer reduced susceptibility, and in turn increase the efficacy of antibiotic therapy, are discussed. PMID:21864314

Zerovalent bismuth nanoparticles inhibit Streptococcus mutans growth and formation of biofilm

PubMed Central

Hernandez-Delgadillo, Rene; Velasco-Arias, Donaji; Diaz, David; Arevalo-Niño, Katiushka; Garza-Enriquez, Marianela; De la Garza-Ramos, Myriam A; Cabral-Romero, Claudio

2012-01-01

Background and methods Despite continuous efforts, the increasing prevalence of resistance among pathogenic bacteria to common antibiotics has become one of the most significant concerns in modern medicine. Nanostructured materials are used in many fields, including biological sciences and medicine. While some bismuth derivatives has been used in medicine to treat vomiting, nausea, diarrhea, and stomach pain, the biocidal activity of zerovalent bismuth nanoparticles has not yet been studied. The objective of this investigation was to analyze the antimicrobial activity of bismuth nanoparticles against oral bacteria and their antibiofilm capabilities. Results Our results showed that stable colloidal bismuth nanoparticles had 69% antimicrobial activity against Streptococcus mutans growth and achieved complete inhibition of biofilm formation. These results are similar to those obtained with chlorhexidine, the most commonly used oral antiseptic agent. The minimal inhibitory concentration of bismuth nanoparticles that interfered with S. mutans growth was 0.5 mM. Conclusion These results suggest that zerovalent bismuth nanoparticles could be an interesting antimicrobial agent to be incorporated into an oral antiseptic preparation. PMID:22619547

Research with Pregnant Women: New Insights on Legal Decision-Making

PubMed Central

Mastroianni, Anna C.; Henry, Leslie Meltzer; Robinson, David; Bailey, Theodore; Faden, Ruth R.; Little, Margaret O.; Lyerly, Anne Drapkin

2017-01-01

Although pregnant women rely on medical interventions to treat and prevent a wide variety of health conditions, they are frequently excluded or underrepresented in clinical research. The resulting dearth of pregnancy-specific evidence to guide clinical decisionmaking routinely exposes pregnant women, and their future offspring, to risk of uncertain harms for uncertain benefits. The two legal factors regularly cited as obstacles to such research are the federal regulatory scheme and fear of liability. This article reveals a far more nuanced and complex view of the legal context. First, legal professionals may—at any time from product conception to marketing—influence decisions about research with pregnant women. Second, factors not previously articulated in the literature may prompt legal professionals to slow or halt such research. They include: financial interests, regulatory ambiguity, obstacles to risk management, and site-specific laws unrelated to research. Any efforts to promote the ethical inclusion of pregnant women in research must acknowledge the role of legal decisionmakers and address their professional concerns. PMID:28543423

Rectal route in the 21st Century to treat children.

PubMed

Jannin, Vincent; Lemagnen, Gilles; Gueroult, Pascale; Larrouture, Denis; Tuleu, Catherine

2014-06-01

The rectal route can be considered a good alternative to the oral route for the paediatric population because these dosage forms are neither to be swallowed nor need to be taste-masked. Rectal forms can also be administered in an emergency to unconscious or vomiting children. Their manufacturing cost is low with excipients generally regarded as safe. Some new formulation strategies, including mucoadhesive gels and suppositories, were introduced to increase patient acceptability. Even if recent paediatric clinical studies have demonstrated the equivalence of the rectal route with others, in order to enable the use of this promising route for the treatment of children in the 21st Century, some effort should be focused on informing and educating parents and care givers. This review is the first ever to address all the aforementioned items, and to list all drugs used in paediatric rectal forms in literature and marketed products in developed countries. Copyright © 2014 Elsevier B.V. All rights reserved.

Disaster relief activities of the Japan self-defense force following the Great East Japan Earthquake.

PubMed

Nishiyama, Yasumasa

2014-06-01

Cooperation between civilian and military forces, including the Japan Self-Defense Force (JSDF), enabled wide-ranging disaster relief after the Great East Japan Earthquake. Nevertheless, many preventable fatalities occurred, particularly related to an inability to treat chronic disease, indicating the need to plan for the provision of long-term medical aid after natural disasters in stricken areas and evacuation shelters. To assist in this effort, this report (1) provides an overview of the consequences of the medical response to the Great East Japan Earthquake, the largest natural disaster ever to hit Japan, focusing on the role and actions of the JSDF; (2) discusses the lessons learned regarding the provision of medical aid and management by the JSDF after this disaster, looking at the special challenges of meeting the needs of a rapidly aging population in a disaster situation; and (3) provides recommendations for the development of strategies for the long-term medical aid and support after natural disasters, especially with regard to the demographics of the Japanese population.

The use of extrapolation concepts to augment the Frequency Separation Technique

NASA Astrophysics Data System (ADS)

Alexiou, Spiros

2015-03-01

The Frequency Separation Technique (FST) is a general method formulated to improve the speed and/or accuracy of lineshape calculations, including strong overlapping collisions, as is the case for ion dynamics. It should be most useful when combined with ultrafast methods, that, however have significant difficulties when the impact regime is approached. These difficulties are addressed by the Frequency Separation Technique, in which the impact limit is correctly recovered. The present work examines the possibility of combining the Frequency Separation Technique with the addition of extrapolation to improve results and minimize errors resulting from the neglect of fast-slow coupling and thus obtain the exact result with a minimum of extra effort. To this end the adequacy of one such ultrafast method, the Frequency Fluctuation Method (FFM) for treating the nonimpact part is examined. It is found that although the FFM is unable to reproduce the nonimpact profile correctly, its coupling with the FST correctly reproduces the total profile.

Non-cultivated plants present a season-long route of pesticide exposure for honey bees

PubMed Central

Long, Elizabeth Y.; Krupke, Christian H.

2016-01-01

Recent efforts to evaluate the contribution of neonicotinoid insecticides to worldwide pollinator declines have focused on honey bees and the chronic levels of exposure experienced when foraging on crops grown from neonicotinoid-treated seeds. However, few studies address non-crop plants as a potential route of pollinator exposure to neonicotinoid and other insecticides. Here we show that pollen collected by honey bee foragers in maize- and soybean-dominated landscapes is contaminated throughout the growing season with multiple agricultural pesticides, including the neonicotinoids used as seed treatments. Notably, however, the highest levels of contamination in pollen are pyrethroid insecticides targeting mosquitoes and other nuisance pests. Furthermore, pollen from crop plants represents only a tiny fraction of the total diversity of pollen resources used by honey bees in these landscapes, with the principle sources of pollen originating from non-cultivated plants. These findings provide fundamental information about the foraging habits of honey bees in these landscapes. PMID:27240870

Comparing three approaches of evapotranspiration estimation in mixed urban vegetation; field-based, remote sensing-based and observational-based methods

USGS Publications Warehouse

Nouri, Hamideh; Glenn, Edward P.; Beecham, Simon; Chavoshi Boroujeni, Sattar; Sutton, Paul; Alaghmand, Sina; Nagler, Pamela L.; Noori, Behnaz

2016-01-01

Despite being the driest inhabited continent, Australia has one of the highest per capita water consumptions in the world. In addition, instead of having fit-for-purpose water supplies (using different qualities of water for different applications), highly treated drinking water is used for nearly all of Australia’s urban water supply needs, including landscape irrigation. The water requirement of urban landscapes, and particularly urban parklands, is of growing concern. The estimation of ET and subsequently plant water requirements in urban vegetation needs to consider the heterogeneity of plants, soils, water and climate characteristics. Accurate estimation of evapotranspiration (ET), which is the main component of a plant’s water requirement, in urban parks is highly desirable because this water maintains the health of green infrastructure and this in turn provides essential ecosystem services. This research contributes to a broader effort to establish sustainable irrigation practices within the Adelaide Parklands in Adelaide, South Australia.

PEER REVIEW SUPPORTING THE STANDARDS FOR THE ...

EPA Pesticide Factsheets

EPA has been working on developing risk assessments to assist regulators, industry, and the public in evaluating the environmental risks associated with Fossil Fuel Combustion Waste(s) (FFCW) management/disposal in landfills, surface impoundments, other disposal procedures and beneficial uses. The U.S. Environmental Protection Agency (EPA) is evaluating management options for solid wastes from coal combustion (e.g., fly ash, bottom ash, slag). As part of this effort, EPA has prepared the Draft Human and Ecological Risk Assessment of Coal Combustion Wastes. The purpose of this draft risk assessment is to identify and quantify human health and ecological risks that may be associated with current disposal practices for high-volume coal combustion waste (CCW), including fly ash, bottom ash, boiler slag, flue gas desulfurization (FGD) sludge, coal refuse waste, and wastes from fluidized-bed combustion (FBC) units. These risk estimates will help inform EPA’s decisions about how to treat CCW under Subtitle D of the Resource Conservation and Recovery Act.

Role of probiotics in urogenital healthcare

PubMed Central

Waigankar, Santosh S.; Patel, Vimal

2011-01-01

Urogenital infections are one of the most common causes for a woman to visit a gynecologist or a urologist. The well-known association between abnormal vaginal microbial flora and its formidable risk in the increased incidence of urinary tract infection underscores the importance of understanding the microbial flora and the efforts needed to maintain it, for ensuring urogenital health. Surprisingly in spite of the increased incidence urogenital infections receive very less attention from the medical fraternity. Growing awareness among people and newer advances in the medical field has brought them into the limelight. The importance of replenishing these depleting commensals with ‘probiotics’ has resurfaced in a big way. As the days go by science and medicines will touch new milestones, which will include probiotics. The value of a probiotics cannot be taken at face value. Probiotics must not be considered a panacea for treating urogenital infections. However, the available data promises that it will be a strong option in improving and maintaining urogenital health. PMID:21897732

Pharming Pharmacopoeia: Living Apothecaries from the Sea

NASA Astrophysics Data System (ADS)

Baden, D. G.

2012-12-01

The quest for, and development of, new drugs to treat extant and emerging diseases is an interdisciplinary effort, often requiring isolation of pro-drugs from new organisms, environments, and species followed by activity measurement. Exploitation of cultivated microalgae from marine sources has produced some of the most potent natural biological agents known, with specific receptor-mediated activities in pulmonary medicine, toxicology, cancer chemotherapy, the cardiovascular system, central and peripheral nervous system, and in dermatology. Our recent discovery that one class of marine-derived molecule promotes trans-membrane transport, a second that enhances mucus secretion, and a third which is an inhibitor of inflammation--- all isolated from the same organism, highlights the increasingly broad potential for innovative exploitation of natural products that occur in marine microalgae. Approaches that include interdisciplinary teams, permanent innovation, and disruptive technologies all will be described in the context of discoveries made in the treatment of cystic fibrosis, in the improvement of drug efficacy, and in the development of multiple for translational sciences in the ocean and health arenas.

Ion separation effects in mixed-species ablators for inertial-confinement-fusion implosions.

PubMed

Amendt, Peter; Bellei, Claudio; Ross, J Steven; Salmonson, Jay

2015-02-01

Recent efforts to demonstrate significant self-heating of the fuel and eventual ignition at the National Ignition Facility make use of plastic (CH) ablators [O. A. Hurricane et al., Phys. Plasmas 21, 056314 (2014)]. Mainline simulation techniques for modeling CH capsule implosions treat the ablator as an average-atom fluid and neglect potential species separation phenomena. The mass-ablation process for a mixture is shown to lead to the potential for species separation, parasitic energy loss according to thermodynamic arguments, and reduced rocket efficiency. A generalized plasma barometric formula for a multispecies concentration gradient that includes collisionality and steady flows in spherical geometry is presented. A model based on plasma expansion into a vacuum is used to interpret reported experimental evidence for ablator species separation in an inertial-confinement-fusion target [J. S. Ross et al., Rev. Sci. Instrum. 83, 10E323 (2012)]. The possibility of "runaway" hydrogen ions in the thermoelectric field of the ablation front is conjectured.

[Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America].

PubMed

Mota-Hernández, F

1990-01-01

Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.