Assessment and Management of Treatment-Refractory Obsessive-Compulsive Disorder in Children

PubMed Central

Bloch, Michael H.; Storch, Eric A.

2015-01-01

OBJECTIVE To review the assessment and treatment of treatment-refractory pediatric obsessive-compulsive disorder (OCD). METHOD A PubMed search was conducted to identify controlled trials in pediatric OCD. Additionally, practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan. RESULTS Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are effective treatments for pediatric OCD. Evidence suggests that CBT is additionally effective even in pediatric patients with refractory OCD symptoms. Antipsychotic augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but have not been studied in pediatric populations. CONCLUSION Several pharmacological treatment options exist for children with refractory OCD symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to evaluate the efficacy/side-effect profile of commonly used interventions in treatment-refractory pediatric OCD. PMID:25791142

Ecological Momentary Assessment and Alcohol Use Disorder Treatment

PubMed Central

Morgenstern, Jon; Kuerbis, Alexis; Muench, Frederick

2014-01-01

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

[Difficulty influence factors of dental caries clinical treatment].

PubMed

Xuedong, Zhou; Junqi, Ling; Jingping, Liang; Jiyao, Li; Lei, Cheng; Qing, Yu; Yumei, Niu; Bin, Guo; Hui, Chen

2017-02-01

Dental caries is a major disease that threaten human's oral healthy severely with the characteristics of high incidence, low rate of treatment and high rate of retreatment. At present, restorative treatment remains the main method for caries treatment. With the development of the Minimally Invasive Cosmetic Dentistry (MICD), reasonable application of various treatment technologies, maximum preservation of tooth tissues and realizing the maximization of treatment effects become problems that call for immediate solution in dental clinics. In addition, there still exist a large number of old restorations that need standard retreatments. Here, some difficulty influence factors of dental caries clinical treatment such as systemic and oral factors, individual caries susceptibility, treatment technologies and materials, retreatment methods of old restorations and technique sensitivity are analyzed, and corresponding processing strategies are also put forward.

Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review

PubMed Central

Ernst, E.

1998-01-01

BACKGROUND: Delayed onset muscle soreness (DOMS) is a frequent problem after unaccustomed exercise. No universally accepted treatment exists. Massage therapy is often recommended for this condition but uncertainty exists about its effectiveness. AIM: To determine whether post-exercise massage alleviates the symptoms of DOMS after a bout of strenuous exercise. METHOD: Various computerised literature searches were carried out and located seven controlled trials. RESULTS: Most of the trials were burdened with serious methodological flaws, and their results are far from uniform. However, most suggest that post-exercise massage may alleviate symptoms of DOMS. CONCLUSIONS: Massage therapy may be a promising treatment for DOMS. Definitive studies are warranted. 


 PMID:9773168

Global antioxidant response of meat.

PubMed

Carrillo, Celia; Barrio, Ángela; Del Mar Cavia, María; Alonso-Torre, Sara

2017-06-01

The global antioxidant response (GAR) method uses an enzymatic digestion to release antioxidants from foods. Owing to the importance of digestion for protein breakdown and subsequent release of bioactive compounds, the aim of the present study was to compare the GAR method for meat with the existing methodologies: the extraction-based method and QUENCHER. Seven fresh meats were analyzed using ABTS and FRAP assays. Our results indicated that the GAR of meat was higher than the total antioxidant capacity (TAC) assessed with the traditional extraction-based method. When evaluated with GAR, the thermal treatment led to an increase in the TAC of the soluble fraction, contrasting with a decreased TAC after cooking measured using the extraction-based method. The effect of thermal treatment on the TAC assessed by the QUENCHER method seemed to be dependent on the assay applied, since results from ABTS differed from FRAP. Our results allow us to hypothesize that the activation of latent bioactive peptides along the gastrointestinal tract should be taken into consideration when evaluating the TAC of meat. Therefore, we conclude that the GAR method may be more appropriate for assessing the TAC of meat than the existing, most commonly used methods. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Small Systems. Instructor Guide. Working for Clean Water: An Information Program for Advisory Groups.

ERIC Educational Resources Information Center

Cole, Charles A.

The rehabilitation of existing on-site wastewater treatment facilities is often the best approach to meeting waste disposal needs. Upon completing the learning session described in this instructor's guide, participants should understand the technology and treatment methods for low-volume wastewater flows. These materials are part of the Working…

Air powder abrasive treatment as an implant surface cleaning method: a literature review.

PubMed

Tastepe, Ceylin S; van Waas, Rien; Liu, Yuelian; Wismeijer, Daniel

2012-01-01

To evaluate the air powder abrasive treatment as an implant surface cleaning method for peri-implantitis based on the existing literature. A PubMed search was conducted to find articles that reported on air powder abrasive treatment as an implant surface cleaning method for peri-implantitis. The studies evaluated cleaning efficiency and surface change as a result of the method. Furthermore, cell response toward the air powder abrasive-treated discs, reosseointegration, and clinical outcome after treatment is also reported. The PubMed search resulted in 27 articles meeting the inclusion criteria. In vitro cleaning efficiency of the method is reported to be high. The method resulted in minor surface changes on titanium specimens. Although the air powder abrasive-treated specimens showed sufficient levels of cell attachment and cell viability, the cell response decreased compared with sterile discs. Considerable reosseointegration between 39% and 46% and improved clinical parameters were reported after treatment when applied in combination with surgical treatment. The results of the treatment are influenced by the powder type used, the application time, and whether powder was applied surgically or nonsurgically. The in vivo data on air powder abrasive treatment as an implant surface cleaning method is not sufficient to draw definitive conclusions. However, in vitro results allow the clinician to consider the method as a promising option for implant surface cleaning in peri-implantitis treatment.

Ensemble framework based real-time respiratory motion prediction for adaptive radiotherapy applications.

PubMed

Tatinati, Sivanagaraja; Nazarpour, Kianoush; Tech Ang, Wei; Veluvolu, Kalyana C

2016-08-01

Successful treatment of tumors with motion-adaptive radiotherapy requires accurate prediction of respiratory motion, ideally with a prediction horizon larger than the latency in radiotherapy system. Accurate prediction of respiratory motion is however a non-trivial task due to the presence of irregularities and intra-trace variabilities, such as baseline drift and temporal changes in fundamental frequency pattern. In this paper, to enhance the accuracy of the respiratory motion prediction, we propose a stacked regression ensemble framework that integrates heterogeneous respiratory motion prediction algorithms. We further address two crucial issues for developing a successful ensemble framework: (1) selection of appropriate prediction methods to ensemble (level-0 methods) among the best existing prediction methods; and (2) finding a suitable generalization approach that can successfully exploit the relative advantages of the chosen level-0 methods. The efficacy of the developed ensemble framework is assessed with real respiratory motion traces acquired from 31 patients undergoing treatment. Results show that the developed ensemble framework improves the prediction performance significantly compared to the best existing methods. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

A Novel Method to Identify Differential Pathways in Hippocampus Alzheimer's Disease.

PubMed

Liu, Chun-Han; Liu, Lian

2017-05-08

BACKGROUND Alzheimer's disease (AD) is the most common type of dementia. The objective of this paper is to propose a novel method to identify differential pathways in hippocampus AD. MATERIAL AND METHODS We proposed a combined method by merging existed methods. Firstly, pathways were identified by four known methods (DAVID, the neaGUI package, the pathway-based co-expressed method, and the pathway network approach), and differential pathways were evaluated through setting weight thresholds. Subsequently, we combined all pathways by a rank-based algorithm and called the method the combined method. Finally, common differential pathways across two or more of five methods were selected. RESULTS Pathways obtained from different methods were also different. The combined method obtained 1639 pathways and 596 differential pathways, which included all pathways gained from the four existing methods; hence, the novel method solved the problem of inconsistent results. Besides, a total of 13 common pathways were identified, such as metabolism, immune system, and cell cycle. CONCLUSIONS We have proposed a novel method by combining four existing methods based on a rank product algorithm, and identified 13 significant differential pathways based on it. These differential pathways might provide insight into treatment and diagnosis of hippocampus AD.

Treatment of Adolescent Substance Use Disorders and Co-Occurring Internalizing Disorders: A Critical Review and Proposed Model

PubMed Central

Hulvershorn, Leslie A.; Quinn, Patrick D.; Scott, Eric L.

2016-01-01

Background The past several decades have seen dramatic growth in empirically supported treatments for adolescent substance use disorders (SUDs), yet even the most well-established approaches struggle to produce large or long-lasting improvements. These difficulties may stem, in part, from the high rates of comorbidity between SUDs and other psychiatric disorders. Method We critically reviewed the treatment outcome literature for adolescents with co-occurring SUDs and internalizing disorders. Results Our review identified components of existing treatments that might be included in an integrated, evidence-based approach to the treatment of SUDs and internalizing disorders. An effective program may involve careful assessment, inclusion of parents or guardians, and tailoring of interventions via a modular strategy. Conclusions The existing literature guides the development of a conceptual evidence-based, modular treatment model targeting adolescents with co-occurring internalizing and SUDs. With empirical study, such a model may better address treatment outcomes for both disorder types in adolescents. PMID:25973718

A Review of Treatment Adherence Measurement Methods

ERIC Educational Resources Information Center

Schoenwald, Sonja K.; Garland, Ann F.

2013-01-01

Fidelity measurement is critical for testing the effectiveness and implementation in practice of psychosocial interventions. Adherence is a critical component of fidelity. The purposes of this review were to catalogue adherence measurement methods and assess existing evidence for the valid and reliable use of the scores that they generate and the…

MR Imaging Based Treatment Planning for Radiotherapy of Prostate Cancer

DTIC Science & Technology

2007-02-01

developed practical methods for heterogeneity correction for MRI - based dose calculations (Chen et al 2007). 6) We will use existing Monte Carlo ... Monte Carlo verification of IMRT dose distributions from a commercial treatment planning optimization system, Phys. Med. Biol., 45:2483-95 (2000) Ma...accuracy and consistency for MR based IMRT treatment planning for prostate cancer. A short paper entitled “ Monte Carlo dose verification of MR image based

Management of primary achalasia: The role of endoscopy

PubMed Central

Luján-Sanchis, Marisol; Suárez-Callol, Patricia; Monzó-Gallego, Ana; Bort-Pérez, Inmaculada; Plana-Campos, Lydia; Ferrer-Barceló, Luis; Sanchis-Artero, Laura; Llinares-Lloret, María; Tuset-Ruiz, Juan Antonio; Sempere-Garcia-Argüelles, Javier; Canelles-Gamir, Pilar; Medina-Chuliá, Enrique

2015-01-01

Achalasia is an oesophageal motor disorder which leads to the functional obstruction of the lower oesophageal sphincter (LES) and is currently incurable. The main objective of all existing therapies is to achieve a reduction in the obstruction of the distal oesophagus in order to improve oesophageal transit, relieve the symptomatology, and prevent long-term complications. The most common treatments used are pneumatic dilation (PD) and laparoscopic Heller myotomy, which involves partial fundoplication with comparable short-term success rates. The most economic non-surgical therapy is PD, with botulinum toxin injections reserved for patients with a higher surgical risk for whom the former treatment option is unsuitable. A new technology is peroral endoscopic myotomy, postulated as a possible non-invasive alternative to surgical myotomy. Other endoluminal treatments subject to research more recently include injecting ethanolamine into the LES and using a temporary self-expanding metallic stent. At present, there is not enough evidence permitting a routine recommendation of any of these three novel methods. Patients must undergo follow-up after treatment to guarantee that their symptoms are under control and to prevent complications. Most experts are in favour of some form of endoscopic follow-up, however no established guidelines exist in this respect. The prognosis for patients with achalasia is good, although a recurrence after treatment using any method requires new treatment. PMID:26078828

Analyzing medical costs with time-dependent treatment: The nested g-formula.

PubMed

Spieker, Andrew; Roy, Jason; Mitra, Nandita

2018-04-16

As medical expenses continue to rise, methods to properly analyze cost outcomes are becoming of increasing relevance when seeking to compare average costs across treatments. Inverse probability weighted regression models have been developed to address the challenge of cost censoring in order to identify intent-to-treat effects (i.e., to compare mean costs between groups on the basis of their initial treatment assignment, irrespective of any subsequent changes to their treatment status). In this paper, we describe a nested g-computation procedure that can be used to compare mean costs between two or more time-varying treatment regimes. We highlight the relative advantages and limitations of this approach when compared with existing regression-based models. We illustrate the utility of this approach as a means to inform public policy by applying it to a simulated data example motivated by costs associated with cancer treatments. Simulations confirm that inference regarding intent-to-treat effects versus the joint causal effects estimated by the nested g-formula can lead to markedly different conclusions regarding differential costs. Therefore, it is essential to prespecify the desired target of inference when choosing between these two frameworks. The nested g-formula should be considered as a useful, complementary tool to existing methods when analyzing cost outcomes. Copyright © 2018 John Wiley & Sons, Ltd.

Evacuate and backfill apparatus and method

DOEpatents

Oakley, David J.; Groves, Oliver J.

1985-01-01

An apparatus and method for treatment of hollow articles by evacuating existing gas or gases therefrom and purging or backfilling the articles with a second gas such as helium. The apparatus includes a sealed enclosure having an article storage drum mounted therein. A multiplicity of such articles are fed singly into the enclosure and loaded into radial slots formed in the drum. The enclosure is successively evacuated and purged with helium to replace the existing gas in the articles with helium. The purged articles are then discharged singly from the drum and transported out of the enclosure.

Current lipid extraction methods are significantly enhanced adding a water treatment step in Chlorella protothecoides.

PubMed

Ren, Xiaojie; Zhao, Xinhe; Turcotte, François; Deschênes, Jean-Sébastien; Tremblay, Réjean; Jolicoeur, Mario

2017-02-11

Microalgae have the potential to rapidly accumulate lipids of high interest for the food, cosmetics, pharmaceutical and energy (e.g. biodiesel) industries. However, current lipid extraction methods show efficiency limitation and until now, extraction protocols have not been fully optimized for specific lipid compounds. The present study thus presents a novel lipid extraction method, consisting in the addition of a water treatment of biomass between the two-stage solvent extraction steps of current extraction methods. The resulting modified method not only enhances lipid extraction efficiency, but also yields a higher triacylglycerols (TAG) ratio, which is highly desirable for biodiesel production. Modification of four existing methods using acetone, chloroform/methanol (Chl/Met), chloroform/methanol/H 2 O (Chl/Met/H 2 O) and dichloromethane/methanol (Dic/Met) showed respective lipid extraction yield enhancement of 72.3, 35.8, 60.3 and 60.9%. The modified acetone method resulted in the highest extraction yield, with 68.9 ± 0.2% DW total lipids. Extraction of TAG was particularly improved with the water treatment, especially for the Chl/Met/H 2 O and Dic/Met methods. The acetone method with the water treatment led to the highest extraction level of TAG with 73.7 ± 7.3 µg/mg DW, which is 130.8 ± 10.6% higher than the maximum value obtained for the four classical methods (31.9 ± 4.6 µg/mg DW). Interestingly, the water treatment preferentially improved the extraction of intracellular fractions, i.e. TAG, sterols, and free fatty acids, compared to the lipid fractions of the cell membranes, which are constituted of phospholipids (PL), acetone mobile polar lipids and hydrocarbons. Finally, from the 32 fatty acids analyzed for both neutral lipids (NL) and polar lipids (PL) fractions, it is clear that the water treatment greatly improves NL-to-PL ratio for the four standard methods assessed. Water treatment of biomass after the first solvent extraction step helps the subsequent release of intracellular lipids in the second extraction step, thus improving the global lipids extraction yield. In addition, the water treatment positively modifies the intracellular lipid class ratios of the final extract, in which TAG ratio is significantly increased without changes in the fatty acids composition. The novel method thus provides an efficient way to improve lipid extraction yield of existing methods, as well as selectively favoring TAG, a lipid of the upmost interest for biodiesel production.

Somatic coliphages as surrogates for enteroviruses in sludge hygienization treatments.

PubMed

Martín-Díaz, Julia; Casas-Mangas, Raquel; García-Aljaro, Cristina; Blanch, Anicet R; Lucena, Francisco

2016-01-01

Conventional bacterial indicators present serious drawbacks giving information about viral pathogens persistence during sludge hygienization treatments. This calls for the search of alternative viral indicators. Somatic coliphages' (SOMCPH) ability for acting as surrogates for enteroviruses was assessed in 47 sludge samples subjected to novel treatment processes. SOMCPH, infectious enteroviruses and genome copies of enteroviruses were monitored. Only one of these groups, the bacteriophages, was present in the sludge at concentrations that allowed the evaluation of treatment's performance. An indicator/pathogen relationship of 4 log10 (PFU/g dw) was found between SOMCPH and infective enteroviruses and their detection accuracy was assessed. The obtained results and the existence of rapid and standardized methods encourage the inclusion of SOMCPH quantification in future sludge directives. In addition, an existing real-time quantitative polymerase chain reaction (RT-qPCR) for enteroviruses was adapted and applied.

A Randomized Clinical Trial of Acceptance and Commitment Therapy versus Progressive Relaxation Training for Obsessive-Compulsive Disorder

ERIC Educational Resources Information Center

Twohig, Michael P.; Hayes, Steven C.; Plumb, Jennifer C.; Pruitt, Larry D.; Collins, Angela B.; Hazlett-Stevens, Holly; Woidneck, Michelle R.

2010-01-01

Objective: Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Method: Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37…

The Relation between the Absolute Level of Parenting and Differential Parental Treatment with Adolescent Siblings' Adjustment

ERIC Educational Resources Information Center

Tamrouti-Makkink, Ilse D.; Dubas, Judith Semon; Gerris, Jan R. M.; van Aken, Marcel A. G.

2004-01-01

Background: The present study extends existing studies on the role of differential parental treatment in explaining individual differences in adolescent problem behaviors above the absolute level of parenting and clarifies the function of gender of the child, birth rank and gender constellation of the sibling dyads. Method: The absolute level of…

Detection of Memory B Activity Against a Therapeutic Protein in Treatment-Naïve Subjects.

PubMed

Liao, Karen; Derbyshire, Stacy; Wang, Kai-Fen; Caucci, Cherilyn; Tang, Shuo; Holland, Claire; Loercher, Amy; Gunn, George R

2018-03-16

Bridging immunoassays commonly used to detect and characterize immunogenicity during biologic development do not provide direct information on the presence or development of a memory anti-drug antibody (ADA) response. In this study, a B cell ELISPOT assay method was used to evaluate pre-existing ADA for anti-TNFR1 domain antibody, GSK1995057, an experimental biologic in treatment naive subjects. This assay utilized a 7-day activation of PBMCs by a combination of GSK1995057 (antigen) and polyclonal stimulator followed by GSK1995057-specific ELISPOT for the enumeration of memory B cells that have differentiated into antibody secreting cells (ASC) in vitro. We demonstrated that GSK1995057-specific ASC were detectable in treatment-naïve subjects with pre-existing ADA; the frequency of drug-specific ASC was low and ranged from 1 to 10 spot forming units (SFU) per million cells. Interestingly, the frequency of drug-specific ASC correlated with the ADA level measured using an in vitro ADA assay. We further confirmed that the ASC originated from CD27 + memory B cells, not from CD27 - -naïve B cells. Our data demonstrated the utility of the B cell ELISPOT method in therapeutic protein immunogenicity evaluation, providing a novel way to confirm and characterize the cell population producing pre-existing ADA. This novel application of a B cell ELISPOT assay informs and characterizes immune memory activity regarding incidence and magnitude associated with a pre-existing ADA response.

Technical Fact Sheet – Polybrominated biphenyls (PBBs)

EPA Pesticide Factsheets

This fact sheet provides a brief summary of polybrominated biphenyls (PBB), including physical and chemical properties; environmental and health impacts; existing federal and state guidelines; detection and treatment methods; and additional sources of info

Brain Network Regional Synchrony Analysis in Deafness

PubMed Central

Xu, Lei; Liang, Mao-Jin

2018-01-01

Deafness, the most common auditory disease, has greatly affected people for a long time. The major treatment for deafness is cochlear implantation (CI). However, till today, there is still a lack of objective and precise indicator serving as evaluation of the effectiveness of the cochlear implantation. The goal of this EEG-based study is to effectively distinguish CI children from those prelingual deafened children without cochlear implantation. The proposed method is based on the functional connectivity analysis, which focuses on the brain network regional synchrony. Specifically, we compute the functional connectivity between each channel pair first. Then, we quantify the brain network synchrony among regions of interests (ROIs), where both intraregional synchrony and interregional synchrony are computed. And finally the synchrony values are concatenated to form the feature vector for the SVM classifier. What is more, we develop a new ROI partition method of 128-channel EEG recording system. That is, both the existing ROI partition method and the proposed ROI partition method are used in the experiments. Compared with the existing EEG signal classification methods, our proposed method has achieved significant improvements as large as 87.20% and 86.30% when the existing ROI partition method and the proposed ROI partition method are used, respectively. It further demonstrates that the new ROI partition method is comparable to the existing ROI partition method. PMID:29854776

A Study on the System for Treatment of ADHD Using Virtual Reality

DTIC Science & Technology

2001-10-25

following disadvantages; side - effects ( Ritalin can cause a cancer of liver[4]), needs of much time and efforts from many persons concerned. To...Unlike the existing treatment methods, VR Therapy system does not have any side effects and can present many situations to a subject without...system for treatment of ADHD using Virtual Reality technology. Psychotherapy using VR has some advantages that it is safer and more effective than

[Theatre systems as a basis for developing medical and rehabilitation methods in psychiatry].

PubMed

Stroganov, A E

2004-01-01

On the basis of existing and widely used in theatrical practice systems, a new direction in medical and rehabilitation psychiatry, namely transdramatherapy, was developed. The approach is illustrated by the original psychotherapeutic method of epos therapy directed to treatment of neurotic disorders, which has been already created and approbated.

Plate on plate osteosynthesis for the treatment of nonhealed periplate fractures.

PubMed

Arealis, Georgios; Nikolaou, Vassilios S; Lacon, Andrew; Ashwood, Neil; Hamlet, Mark

2014-01-01

Purpose. The purpose of this paper is to present our technique for the treatment of periplate fractures. Methods. From 2009 to 2012 we treated three patients. In all cases the existing plate was left and the new one placed over the existing. Locking screws were placed through both plates. The other screws in the new plate were used as best suited the fracture. Results. In all cases less than 6 months had passed between fractures. None of the original fractures had healed. Mean followup was 2 years. All fractures proceeded to union within 7 months. No complications were recorded. All the patients returned to their normal activities and were satisfied with the results of their treatment. Conclusion. Our plate on plate technique is effective for the treatment of periplate fractures. A solid fusion can be achieved at the new fracture site without disturbing the previous fixation.

Evacuate and backfill apparatus and method

DOEpatents

Oakley, D.J.; Groves, O.J.

1984-06-27

An apparatus and method as described for treatment of hollow articles by evacuating existing gas or gases therefrom and purging or backfilling the articles with a second gas such as helium. The apparatus includes a sealed enclosure having an article storage drum mounted therein. A multiplicity of such articles are fed singly into the enclosure and loaded into radial slots formed in the drum. The enclosure is successively evacuated and purged with helium to replace the existing gas in the articles with helium. The purged articles are then discharged singly from the drum and transported out of the enclosure.

Estimating the average treatment effect on survival based on observational data and using partly conditional modeling.

PubMed

Gong, Qi; Schaubel, Douglas E

2017-03-01

Treatments are frequently evaluated in terms of their effect on patient survival. In settings where randomization of treatment is not feasible, observational data are employed, necessitating correction for covariate imbalances. Treatments are usually compared using a hazard ratio. Most existing methods which quantify the treatment effect through the survival function are applicable to treatments assigned at time 0. In the data structure of our interest, subjects typically begin follow-up untreated; time-until-treatment, and the pretreatment death hazard are both heavily influenced by longitudinal covariates; and subjects may experience periods of treatment ineligibility. We propose semiparametric methods for estimating the average difference in restricted mean survival time attributable to a time-dependent treatment, the average effect of treatment among the treated, under current treatment assignment patterns. The pre- and posttreatment models are partly conditional, in that they use the covariate history up to the time of treatment. The pre-treatment model is estimated through recently developed landmark analysis methods. For each treated patient, fitted pre- and posttreatment survival curves are projected out, then averaged in a manner which accounts for the censoring of treatment times. Asymptotic properties are derived and evaluated through simulation. The proposed methods are applied to liver transplant data in order to estimate the effect of liver transplantation on survival among transplant recipients under current practice patterns. © 2016, The International Biometric Society.

Statistical methods to estimate treatment effects from multichannel electroencephalography (EEG) data in clinical trials.

PubMed

Ma, Junshui; Wang, Shubing; Raubertas, Richard; Svetnik, Vladimir

2010-07-15

With the increasing popularity of using electroencephalography (EEG) to reveal the treatment effect in drug development clinical trials, the vast volume and complex nature of EEG data compose an intriguing, but challenging, topic. In this paper the statistical analysis methods recommended by the EEG community, along with methods frequently used in the published literature, are first reviewed. A straightforward adjustment of the existing methods to handle multichannel EEG data is then introduced. In addition, based on the spatial smoothness property of EEG data, a new category of statistical methods is proposed. The new methods use a linear combination of low-degree spherical harmonic (SPHARM) basis functions to represent a spatially smoothed version of the EEG data on the scalp, which is close to a sphere in shape. In total, seven statistical methods, including both the existing and the newly proposed methods, are applied to two clinical datasets to compare their power to detect a drug effect. Contrary to the EEG community's recommendation, our results suggest that (1) the nonparametric method does not outperform its parametric counterpart; and (2) including baseline data in the analysis does not always improve the statistical power. In addition, our results recommend that (3) simple paired statistical tests should be avoided due to their poor power; and (4) the proposed spatially smoothed methods perform better than their unsmoothed versions. Copyright 2010 Elsevier B.V. All rights reserved.

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

PubMed Central

2010-01-01

Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage. PMID:20236531

Mind the gap: What is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians?

PubMed

Brett, Jonathan; Lee, K S Kylie; Gray, Dennis; Wilson, Scott; Freeburn, Bradley; Harrison, Kristie; Conigrave, Katherine

2016-07-01

Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need. In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need. Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2016;35:456-460]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Oak regeneration potential increased by shelterwood treatments

Treesearch

Richard C. Schlesinger; Ivan L. Sander; Kenneth R. Davidson

1993-01-01

In much of the Central Hardwood Forest Region, oak species are not regenerating well, even though large oak trees are common within the existing forests. The shelterwood method has been suggested as a potential tool for establishing and developing advanced regeneration where it is lacking. The 10-yr results from a study of several variants of the shelterwood method...

A computational method for drug repositioning using publicly available gene expression data.

PubMed

Shabana, K M; Abdul Nazeer, K A; Pradhan, Meeta; Palakal, Mathew

2015-01-01

The identification of new therapeutic uses of existing drugs, or drug repositioning, offers the possibility of faster drug development, reduced risk, lesser cost and shorter paths to approval. The advent of high throughput microarray technology has enabled comprehensive monitoring of transcriptional response associated with various disease states and drug treatments. This data can be used to characterize disease and drug effects and thereby give a measure of the association between a given drug and a disease. Several computational methods have been proposed in the literature that make use of publicly available transcriptional data to reposition drugs against diseases. In this work, we carry out a data mining process using publicly available gene expression data sets associated with a few diseases and drugs, to identify the existing drugs that can be used to treat genes causing lung cancer and breast cancer. Three strong candidates for repurposing have been identified- Letrozole and GDC-0941 against lung cancer, and Ribavirin against breast cancer. Letrozole and GDC-0941 are drugs currently used in breast cancer treatment and Ribavirin is used in the treatment of Hepatitis C.

Evaluation of the Stress Level of Children with Idiopathic Scoliosis in relation to the Method of Treatment and Parameters of the Deformity

PubMed Central

Leszczewska, Justyna; Czaprowski, Dariusz; Pawłowska, Paulina; Kolwicz, Aleksandra; Kotwicki, Tomasz

2012-01-01

Stress level due to existing body deformity as well as to the treatment with a corrective brace is one of factors influencing the quality of life of children with idiopathic scoliosis undergoing non-surgical management. The purpose of the study was to evaluate the stress level among children suffering from idiopathic scoliosis in relation to the method of treatment and the parameters of the deformity. Seventy-three patients with idiopathic scoliosis participated in the study. Fifty-two children were treated by means of physiotherapy, while 21 patients were treated with both Cheneau corrective brace and physiotherapy. To assess the stress level related to the deformity itself and to the method of treatment with corrective brace, the two Bad Sobernheim Stress Questionnaires (BSSQs) were applied, the BSSQ Deformity and the BSSQ Brace, respectively. PMID:22919333

Evaluation of the stress level of children with idiopathic scoliosis in relation to the method of treatment and parameters of the deformity.

PubMed

Leszczewska, Justyna; Czaprowski, Dariusz; Pawłowska, Paulina; Kolwicz, Aleksandra; Kotwicki, Tomasz

2012-01-01

Stress level due to existing body deformity as well as to the treatment with a corrective brace is one of factors influencing the quality of life of children with idiopathic scoliosis undergoing non-surgical management. The purpose of the study was to evaluate the stress level among children suffering from idiopathic scoliosis in relation to the method of treatment and the parameters of the deformity. Seventy-three patients with idiopathic scoliosis participated in the study. Fifty-two children were treated by means of physiotherapy, while 21 patients were treated with both Cheneau corrective brace and physiotherapy. To assess the stress level related to the deformity itself and to the method of treatment with corrective brace, the two Bad Sobernheim Stress Questionnaires (BSSQs) were applied, the BSSQ Deformity and the BSSQ Brace, respectively.

The Impact of Pre-Existing Mental Health Disorders on the Diagnosis, Treatment and Survival among Lung Cancer Patients in the U.S. Military Health System

PubMed Central

Lin, Jie; McGlynn, Katherine A.; Carter, Corey A.; Nations, Joel A.; Anderson, William F.; Shriver, Craig D.; Zhu, Kangmin

2018-01-01

Background Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed pre-existing mental health disorders and stage at diagnosis, receipt of cancer treatment and overall survival among non-small cell lung cancer (NSCLC) patients in the U.S. MHS. Methods The study used data from the linked database from the Department of Defense’s Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007. Results Patients with a pre-existing mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without (Adjusted Hazard ratio (HR) =1.11, 95% CI=1.03 to 1.20). Conclusions Poor survival in NSCLC in patients with a pre-existing mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment. Impact This study contributes to the current understanding that health care access is not sufficient to explain the poor survival among NSCLC patients with pre-existing mental health disorder. PMID:27566418

Occurrence and spread of nonnative invasive plants in stands treated with fire and/or mechanical treatments in the upper piedmont of South Carolina

Treesearch

Ross J. Phillips; Thomas A. Waldrop; Aaron D. Stottlemyer

2013-01-01

Increasing numbers of nonnative invasive plant species and the expansion of existing nonnative plant populations provide challenges for land managers trying to achieve commercial and restoration goals. Some methods used to achieve these goals, e.g., prescribed fire and mechanical treatments, may result in disturbances that promote the establishment and spread of...

Differences exist across insurance schemes in China post-consolidation

PubMed Central

Yi, Danhui; Wang, Xiaojun; Jiang, Yan; Wang, Yu; Liu, Xinchun

2017-01-01

Background In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance), URBMI (Urban Resident Basic Medical Insurance), and NCMS (New Cooperative Medical Scheme), across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation. Methods A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects’ characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket) cost, and insurance reimbursement rate. Results Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate. Conclusions Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences. PMID:29125837

Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan?: A preliminary international investigation

PubMed Central

Kato, Takahiro A.; Tateno, Masaru; Shinfuku, Naotaka; Fujisawa, Daisuke; Teo, Alan R.; Sartorius, Norman; Akiyama, Tsuyoshi; Ishida, Tetsuya; Choi, Tae Young; Balhara, Yatan Pal Singh; Matsumoto, Ryohei; Umene-Nakano, Wakako; Fujimura, Yota; Wand, Anne; Chang, Jane Pei-Chen; Chang, Rita Yuan-Feng; Shadloo, Behrang; Ahmed, Helal Uddin; Lerthattasilp, Tiraya; Kanba, Shigenobu

2016-01-01

Purpose To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. Methods Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. Results Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. Conclusions Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings. PMID:21706238

Rural sewage treatment processing in Yongjia County, Zhejiang Province

NASA Astrophysics Data System (ADS)

Wang, W. H.; Kuan, T. H.

2016-08-01

Issues regarding water pollution in rural areas of China have garnered increased attention over the years. Further discussion on the circumstances and results of existing domestic sewage treatment methods may serve as an appropriate reference in solving these important issues. This article explored the current conditions of water contamination in rural areas of China, introduced the characteristics and effects of applicable sewage treatment technology, and summarized the results of the planning, installation, and operation of rural sewage treatment facilities in Yongjia County in Zhejiang Province. However, relying on a single technical design rule is not adequate for solving the practical problems that these villages face. Instead, methods of planning rural sewage treatment should be adapted to better suit local conditions and different residential forms. It is crucial, ultimately, for any domestic sewage treatment system in a rural area to be commissioned, engineered, and maintained by a market-oriented professional company.

General imaging of advanced 3D mask objects based on the fully-vectorial extended Nijboer-Zernike (ENZ) theory

NASA Astrophysics Data System (ADS)

van Haver, Sven; Janssen, Olaf T. A.; Braat, Joseph J. M.; Janssen, Augustus J. E. M.; Urbach, H. Paul; Pereira, Silvania F.

2008-03-01

In this paper we introduce a new mask imaging algorithm that is based on the source point integration method (or Abbe method). The method presented here distinguishes itself from existing methods by exploiting the through-focus imaging feature of the Extended Nijboer-Zernike (ENZ) theory of diffraction. An introduction to ENZ-theory and its application in general imaging is provided after which we describe the mask imaging scheme that can be derived from it. The remainder of the paper is devoted to illustrating the advantages of the new method over existing methods (Hopkins-based). To this extent several simulation results are included that illustrate advantages arising from: the accurate incorporation of isolated structures, the rigorous treatment of the object (mask topography) and the fully vectorial through-focus image formation of the ENZ-based algorithm.

Acoustic Treatment Design Scaling Methods. Volume 1; Overview, Results, and Recommendations

NASA Technical Reports Server (NTRS)

Kraft, R. E.; Yu, J.

1999-01-01

Scale model fan rigs that simulate new generation ultra-high-bypass engines at about 1/5-scale are achieving increased importance as development vehicles for the design of low-noise aircraft engines. Testing at small scale allows the tests to be performed in existing anechoic wind tunnels, which provides an accurate simulation of the important effects of aircraft forward motion on the noise generation. The ability to design, build, and test miniaturized acoustic treatment panels on scale model fan rigs representative of the fullscale engine provides not only a cost-savings, but an opportunity to optimize the treatment by allowing tests of different designs. The primary objective of this study was to develop methods that will allow scale model fan rigs to be successfully used as acoustic treatment design tools. The study focuses on finding methods to extend the upper limit of the frequency range of impedance prediction models and acoustic impedance measurement methods for subscale treatment liner designs, and confirm the predictions by correlation with measured data. This phase of the program had as a goal doubling the upper limit of impedance measurement from 6 kHz to 12 kHz. The program utilizes combined analytical and experimental methods to achieve the objectives.

[Determination of iodine and its species in plant samples using ion chromatography-inductively coupled plasma mass spectrometry].

PubMed

Lin, Li; Chen, Guang; Chen, Yuhong

2011-07-01

A method was established for the determination of iodine and its species in plant samples using ion chromatography-inductively coupled plasma mass spectrometry (IC-ICP/ MS). Alkaline extraction and IC-ICP/MS were applied as the sample pre-treatment method and the detection technique respectively, for iodate and iodide determination. Moreover, high-temperature pyrolysis absorption was adopted as the pre-treatment method for total iodine analysis, which finally converted all the iodine species into iodide and measured the iodide by IC-ICP/MS. The recoveries of iodine for alkaline extraction and high-temperature pyrolysis absorption were 89.6%-97.5% and 95.2%-111.2%, respectively. The results were satisfactory. The detection limit of iodine was 0.010 mg/kg. The iodine and its speciation contents in several kinds of plant samples such as seaweeds, kelp, cabbage, tea leaf and spinach were investigated. It was shown that the iodine in seaweeds mainly existed as organic iodine; while the ones in kelp, cabbage, tea leaf and spinach mainly existed as inorganic iodine.

Interventions for Age-Related Macular Degeneration: Are Practice Guidelines Based on Systematic Reviews?

PubMed Central

Lindsley, Kristina; Li, Tianjing; Ssemanda, Elizabeth; Virgili, Gianni; Dickersin, Kay

2016-01-01

Topic Are existing systematic reviews of interventions for age-related macular degeneration incorporated into clinical practice guidelines? Clinical relevance High-quality systematic reviews should be used to underpin evidence-based clinical practice guidelines and clinical care. We have examined the reliability of systematic reviews of interventions for age-related macular degeneration (AMD) and described the main findings of reliable reviews in relation to clinical practice guidelines. Methods Eligible publications are systematic reviews of the effectiveness of treatment interventions for AMD. We searched a database of systematic reviews in eyes and vision and employed no language or date restrictions; the database is up-to-date as of May 6, 2014. Two authors independently screened records for eligibility and abstracted and assessed the characteristics and methods of each review. We classified reviews as “reliable” when they reported eligibility criteria, comprehensive searches, appraisal of methodological quality of included studies, appropriate statistical methods for meta-analysis, and conclusions based on results. We mapped treatment recommendations from the American Academy of Ophthalmology Preferred Practice Patterns (AAO PPP) for AMD to the identified systematic reviews and assessed whether any reliable systematic review was cited or could have been cited to support each treatment recommendation. Results Of 1,570 systematic reviews in our database, 47 met our inclusion criteria. Most of the systematic reviews targeted neovascular AMD and investigated anti-vascular endothelial growth factor (anti-VEGF) interventions, dietary supplements or photodynamic therapy. We classified over two-thirds (33/47) of the reports as reliable. The quality of reporting varied, with criteria for reliable reporting met more often for Cochrane reviews and for reviews whose authors disclosed conflicts of interest. Although most systematic reviews were reliable, anti-VEGF agents and photodynamic therapy were the only interventions identified as effective by reliable reviews. Of 35 treatment recommendations extracted from the AAO PPP, 15 could have been supported with reliable systematic reviews; however, only one recommendation had an accompanying intervention systematic review citation, which we assessed as a reliable systematic review. No reliable systematic review was identified for 20 treatment recommendations, highlighting areas of evidence gaps. Conclusions For AMD, reliable systematic reviews exist for many treatment recommendations in the AAO PPP and should be used to support these recommendations. We also identified areas where no high-level evidence exists. Mapping clinical practice guidelines to existing systematic reviews is one way to highlight areas where evidence generation or evidence synthesis is either available or needed. PMID:26804762

In Situ Catalytic Groundwater Treatment Using Pd-Catalysts and Horizontal Flow Treatment Wells

DTIC Science & Technology

2007-02-01

1,2,4-Trichlorobenzene Hexachlorobutadiene Naphthalene 1,2,3-Trichlorobenzene Internal Standards Fluorobenzene 2-Bromo- 1 - chloropropane a Retention...internal standard method using a purge-and-trap. Internal standards were: Fluorobenzene for PID, 2-Bromo- 1 - chloropropane for HECD. b Detector does not...information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and

Can Mathematical Models Predict the Outcomes of Prostate Cancer Patients Undergoing Intermittent Androgen Deprivation Therapy?

NASA Astrophysics Data System (ADS)

Everett, R. A.; Packer, A. M.; Kuang, Y.

Androgen deprivation therapy is a common treatment for advanced or metastatic prostate cancer. Like the normal prostate, most tumors depend on androgens for proliferation and survival but often develop treatment resistance. Hormonal treatment causes many undesirable side effects which significantly decrease the quality of life for patients. Intermittently applying androgen deprivation in cycles reduces the total duration with these negative effects and may reduce selective pressure for resistance. We extend an existing model which used measurements of patient testosterone levels to accurately fit measured serum prostate specific antigen (PSA) levels. We test the model's predictive accuracy, using only a subset of the data to find parameter values. The results are compared with those of an existing piecewise linear model which does not use testosterone as an input. Since actual treatment protocol is to re-apply therapy when PSA levels recover beyond some threshold value, we develop a second method for predicting the PSA levels. Based on a small set of data from seven patients, our results showed that the piecewise linear model produced slightly more accurate results while the two predictive methods are comparable. This suggests that a simpler model may be more beneficial for a predictive use compared to a more biologically insightful model, although further research is needed in this field prior to implementing mathematical models as a predictive method in a clinical setting. Nevertheless, both models are an important step in this direction.

Can Mathematical Models Predict the Outcomes of Prostate Cancer Patients Undergoing Intermittent Androgen Deprivation Therapy?

NASA Astrophysics Data System (ADS)

Everett, R. A.; Packer, A. M.; Kuang, Y.

2014-04-01

Androgen deprivation therapy is a common treatment for advanced or metastatic prostate cancer. Like the normal prostate, most tumors depend on androgens for proliferation and survival but often develop treatment resistance. Hormonal treatment causes many undesirable side effects which significantly decrease the quality of life for patients. Intermittently applying androgen deprivation in cycles reduces the total duration with these negative effects and may reduce selective pressure for resistance. We extend an existing model which used measurements of patient testosterone levels to accurately fit measured serum prostate specific antigen (PSA) levels. We test the model's predictive accuracy, using only a subset of the data to find parameter values. The results are compared with those of an existing piecewise linear model which does not use testosterone as an input. Since actual treatment protocol is to re-apply therapy when PSA levels recover beyond some threshold value, we develop a second method for predicting the PSA levels. Based on a small set of data from seven patients, our results showed that the piecewise linear model produced slightly more accurate results while the two predictive methods are comparable. This suggests that a simpler model may be more beneficial for a predictive use compared to a more biologically insightful model, although further research is needed in this field prior to implementing mathematical models as a predictive method in a clinical setting. Nevertheless, both models are an important step in this direction.

[Reason for dormancy of Cuscuta chinensis seed and solving method].

PubMed

Wang, Xuemin; He, Jiaqing; Cai, Jing; Dong, Zhenguo

2010-02-01

To study the reason for the deep dormancy of the aged Cuscuta chinensis seed and find the solving method. The separated and combined treatments were applied in the orthogonal designed experiments. The aged seed had well water-absorbency; the water and ethanol extracts of the seeds showed an inhibition effect on germination capacity of the seeds. The main reason for the deep dormancy of aged C. chinensis seed is the inhibitors existed in seed. There are two methods to solve the problem. The seeds is immersed in 98% of H2SO4 for 2 min followed by 500 mg x L(-1) of GA3 treatment for 60 min, or in 100 mg x L(-1) of NaOH for 20 min followed by 500 mg x L(-1) of GA3 treatment for 120 min.

Accuracy of lagoon gas emissions using an inverse dispersion method

USDA-ARS?s Scientific Manuscript database

Measuring gas emissions from treatment lagoons and storage ponds poses challenging conditions for existing micrometeorological techniques because of non-ideal wind conditions. These include those induced by trees and crops surrounding the lagoons, and lagoons with dimensions too small to establish ...

Economic evaluation of knee arthroscopy treatment in a general hospital.

PubMed

Blatnik, Patricia; Tušak, Matej; Bojnec, Štefan; Brezigar Masten, Arjana

2017-02-01

Aim The economic evaluation of medical programs applies procedures that search for and ensure the cheapest methods of medical treatment with the best feasible health results. The aim of this study was to thoroughly examine both the costs and results of medical outcomes, which were based upon two alternative methods of treatment. The purpose was to offer obtained information to the medical profession and hospital management, since they must decide on how to use the funds designed for knee arthroscopy surgery. Methods A cost-utility analysis of two competitive treatments for knee arthroscopy was evaluated: the first one was executed by a standard department of surgery and the second one for the implementation within the framework of ambulatory treatment. Results The direct costs of the existing knee arthroscopy surgery amount to 930.39 euro, while the alternative treatment amount to 419.80 euro. The second alternative treatment would significantly reduce labor costs, depreciation costs and material costs. The implementation of the second alternative would reduce the total cost by 54.88%. Outpatient surgical procedures can bring numerous potential advantages such as lower costs and unchanged or improved medical outcomes, when compared to the classical method of outpatient treatment. The results show that the outpatient treatment does not sacrifice quality in order to reduce hospital costs. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

A novel algorithm for the reconstruction of an entrance beam fluence from treatment exit patient portal dosimetry images

NASA Astrophysics Data System (ADS)

Sperling, Nicholas Niven

The problem of determining the in vivo dosimetry for patients undergoing radiation treatment has been an area of interest since the development of the field. Most methods which have found clinical acceptance work by use of a proxy dosimeter, e.g.: glass rods, using radiophotoluminescence; thermoluminescent dosimeters (TLD), typically CaF or LiF; Metal Oxide Silicon Field Effect Transistor (MOSFET) dosimeters, using threshold voltage shift; Optically Stimulated Luminescent Dosimeters (OSLD), composed of Carbon doped Aluminum Dioxide crystals; RadioChromic film, using leuko-dye polymers; Silicon Diode dosimeters, typically p-type; and ion chambers. More recent methods employ Electronic Portal Image Devices (EPID), or dosimeter arrays, for entrance or exit beam fluence determination. The difficulty with the proxy in vivo dosimetery methods is the requirement that they be placed at the particular location where the dose is to be determined. This precludes measurements across the entire patient volume. These methods are best suited where the dose at a particular location is required. The more recent methods of in vivo dosimetry make use of detector arrays and reconstruction techniques to determine dose throughout the patient volume. One method uses an array of ion chambers located upstream of the patient. This requires a special hardware device and places an additional attenuator in the beam path, which may not be desirable. A final approach is to use the existing EPID, which is part of most modern linear accelerators, to image the patient using the treatment beam. Methods exist to deconvolve the detector function of the EPID using a series of weighted exponentials. Additionally, this method has been extended to determine in vivo dosimetry. The method developed here employs the use of EPID images and an iterative deconvolution algorithm to reconstruct the impinging primary beam fluence on the patient. This primary fluence may then be employed to determine dose through the entire patient volume. The method requires patient specific information, including a CT for deconvolution/dose reconstruction. With the large-scale adoption of Cone Beam CT (CBCT) systems on modern linear accelerators, a treatment time CT is readily available for use in this deconvolution and in dose representation.

The least-squares finite element method for low-mach-number compressible viscous flows

NASA Technical Reports Server (NTRS)

Yu, Sheng-Tao

1994-01-01

The present paper reports the development of the Least-Squares Finite Element Method (LSFEM) for simulating compressible viscous flows at low Mach numbers in which the incompressible flows pose as an extreme. Conventional approach requires special treatments for low-speed flows calculations: finite difference and finite volume methods are based on the use of the staggered grid or the preconditioning technique; and, finite element methods rely on the mixed method and the operator-splitting method. In this paper, however, we show that such difficulty does not exist for the LSFEM and no special treatment is needed. The LSFEM always leads to a symmetric, positive-definite matrix through which the compressible flow equations can be effectively solved. Two numerical examples are included to demonstrate the method: first, driven cavity flows at various Reynolds numbers; and, buoyancy-driven flows with significant density variation. Both examples are calculated by using full compressible flow equations.

Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism.

PubMed

Rada, Robert E

2013-08-01

Individuals with autism can be quite challenging to treat in a routine dental-office setting, especially when extensive dental treatment and disruptive behavioral issues exist. Individuals with autism may also be at higher risk for oral disease. Frequently, general anesthesia is the only method to facilitate completion of the needed dental treatment. General anesthesia is not without complications, and unique occurrences are a necessary consideration for special-needs populations. In addition, behavior challenges may occur which can be disruptive to hospital staff. This article describes treatment needs and determines adverse events during the perioperative period for individuals with autism who have had general anesthesia for comprehensive dental treatment in the hospital.

Struvite scale formation and control.

PubMed

Parsons, S A; Doyle, J D

2004-01-01

Struvite scale formation is a major operational issue at both conventional and biological nutrient removal wastewater treatment plants. Factors affecting the formation of struvite scales were investigated including supersaturation, pH and pipe material and roughness. A range of control methods have been investigated including low fouling materials, pH control, inhibitor and chemical dosing. Control methods exist to reduce scale formation although each has its advantages and disadvantages.

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA.

PubMed

Mithoefer, Michael C; Grob, Charles S; Brewerton, Timothy D

2016-05-01

4-phosphorloxy-N,N-dimethyltryptamine (psilocybin) and methylenedioxymethamfetamine (MDMA), best known for their illegal use as psychedelic drugs, are showing promise as therapeutics in a resurgence of clinical research during the past 10 years. Psilocybin is being tested for alcoholism, smoking cessation, and in patients with advanced cancer with anxiety. MDMA is showing encouraging results as a treatment for refractory post-traumatic stress disorder, social anxiety in autistic adults, and anxiety associated with a life-threatening illness. Both drugs are studied as adjuncts or catalysts to psychotherapy, rather than as stand-alone drug treatments. This model of drug-assisted psychotherapy is a possible alternative to existing pharmacological and psychological treatments in psychiatry. Further research is needed to fully assess the potential of these compounds in the management of these common disorders that are difficult to treat with existing methods. Copyright © 2016 Elsevier Ltd. All rights reserved.

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines

PubMed Central

Young, Allan; Yatham, Lakshmi; Grunze, Heinz; Vieta, Eduard; Blier, Pierre; Moeller, Hans Jurgen; Kasper, Siegfried

2017-01-01

Abstract Background: This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. Methods: The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. Results: The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. Conclusion: The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper. PMID:27815414

Robotic path-finding in inverse treatment planning for stereotactic radiosurgery with continuous dose delivery

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

Vandewouw, Marlee M., E-mail: marleev@mie.utoronto

Purpose: Continuous dose delivery in radiation therapy treatments has been shown to decrease total treatment time while improving the dose conformity and distribution homogeneity over the conventional step-and-shoot approach. The authors develop an inverse treatment planning method for Gamma Knife® Perfexion™ that continuously delivers dose along a path in the target. Methods: The authors’ method is comprised of two steps: find a path within the target, then solve a mixed integer optimization model to find the optimal collimator configurations and durations along the selected path. Robotic path-finding techniques, specifically, simultaneous localization and mapping (SLAM) using an extended Kalman filter, aremore » used to obtain a path that travels sufficiently close to selected isocentre locations. SLAM is novelly extended to explore a 3D, discrete environment, which is the target discretized into voxels. Further novel extensions are incorporated into the steering mechanism to account for target geometry. Results: The SLAM method was tested on seven clinical cases and compared to clinical, Hamiltonian path continuous delivery, and inverse step-and-shoot treatment plans. The SLAM approach improved dose metrics compared to the clinical plans and Hamiltonian path continuous delivery plans. Beam-on times improved over clinical plans, and had mixed performance compared to Hamiltonian path continuous plans. The SLAM method is also shown to be robust to path selection inaccuracies, isocentre selection, and dose distribution. Conclusions: The SLAM method for continuous delivery provides decreased total treatment time and increased treatment quality compared to both clinical and inverse step-and-shoot plans, and outperforms existing path methods in treatment quality. It also accounts for uncertainty in treatment planning by accommodating inaccuracies.« less

A Causal Model for Joint Evaluation of Placebo and Treatment-Specific Effects in Clinical Trials

PubMed Central

Zhang, Zhiwei; Kotz, Richard M.; Wang, Chenguang; Ruan, Shiling; Ho, Martin

2014-01-01

Summary Evaluation of medical treatments is frequently complicated by the presence of substantial placebo effects, especially on relatively subjective endpoints, and the standard solution to this problem is a randomized, double-blinded, placebo-controlled clinical trial. However, effective blinding does not guarantee that all patients have the same belief or mentality about which treatment they have received (or treatmentality, for brevity), making it difficult to interpret the usual intent-to-treat effect as a causal effect. We discuss the causal relationships among treatment, treatmentality and the clinical outcome of interest, and propose a causal model for joint evaluation of placebo and treatment-specific effects. The model highlights the importance of measuring and incorporating patient treatmentality and suggests that each treatment group should be considered a separate observational study with a patient's treatmentality playing the role of an uncontrolled exposure. This perspective allows us to adapt existing methods for dealing with confounding to joint estimation of placebo and treatment-specific effects using measured treatmentality data, commonly known as blinding assessment data. We first apply this approach to the most common type of blinding assessment data, which is categorical, and illustrate the methods using an example from asthma. We then propose that blinding assessment data can be collected as a continuous variable, specifically when a patient's treatmentality is measured as a subjective probability, and describe analytic methods for that case. PMID:23432119

Structural redundancy of data from wastewater treatment systems. Determination of individual balance equations.

PubMed

Spindler, A

2014-06-15

Although data reconciliation is intensely applied in process engineering, almost none of its powerful methods are employed for validation of operational data from wastewater treatment plants. This is partly due to some prerequisites that are difficult to meet including steady state, known variances of process variables and absence of gross errors. However, an algorithm can be derived from the classical approaches to data reconciliation that allows to find a comprehensive set of equations describing redundancy in the data when measured and unmeasured variables (flows and concentrations) are defined. This is a precondition for methods of data validation based on individual mass balances such as CUSUM charts. The procedure can also be applied to verify the necessity of existing or additional measurements with respect to the improvement of the data's redundancy. Results are given for a large wastewater treatment plant. The introduction aims at establishing a link between methods known from data reconciliation in process engineering and their application in wastewater treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of Image Segmentation Methods for Intracranial Aneurysms

PubMed Central

Qian, Yi; Morgan, Michael

2013-01-01

Though providing vital means for the visualization, diagnosis, and quantification of decision-making processes for the treatment of vascular pathologies, vascular segmentation remains a process that continues to be marred by numerous challenges. In this study, we validate eight aneurysms via the use of two existing segmentation methods; the Region Growing Threshold and Chan-Vese model. These methods were evaluated by comparison of the results obtained with a manual segmentation performed. Based upon this validation study, we propose a new Threshold-Based Level Set (TLS) method in order to overcome the existing problems. With divergent methods of segmentation, we discovered that the volumes of the aneurysm models reached a maximum difference of 24%. The local artery anatomical shapes of the aneurysms were likewise found to significantly influence the results of these simulations. In contrast, however, the volume differences calculated via use of the TLS method remained at a relatively low figure, at only around 5%, thereby revealing the existence of inherent limitations in the application of cerebrovascular segmentation. The proposed TLS method holds the potential for utilisation in automatic aneurysm segmentation without the setting of a seed point or intensity threshold. This technique will further enable the segmentation of anatomically complex cerebrovascular shapes, thereby allowing for more accurate and efficient simulations of medical imagery. PMID:23606905

Comparing biomarkers as principal surrogate endpoints.

PubMed

Huang, Ying; Gilbert, Peter B

2011-12-01

Recently a new definition of surrogate endpoint, the "principal surrogate," was proposed based on causal associations between treatment effects on the biomarker and on the clinical endpoint. Despite its appealing interpretation, limited research has been conducted to evaluate principal surrogates, and existing methods focus on risk models that consider a single biomarker. How to compare principal surrogate value of biomarkers or general risk models that consider multiple biomarkers remains an open research question. We propose to characterize a marker or risk model's principal surrogate value based on the distribution of risk difference between interventions. In addition, we propose a novel summary measure (the standardized total gain) that can be used to compare markers and to assess the incremental value of a new marker. We develop a semiparametric estimated-likelihood method to estimate the joint surrogate value of multiple biomarkers. This method accommodates two-phase sampling of biomarkers and is more widely applicable than existing nonparametric methods by incorporating continuous baseline covariates to predict the biomarker(s), and is more robust than existing parametric methods by leaving the error distribution of markers unspecified. The methodology is illustrated using a simulated example set and a real data set in the context of HIV vaccine trials. © 2011, The International Biometric Society.

Why Measure Outcomes?

PubMed

Kuhn, John E

2016-01-01

The concept of measuring the outcomes of treatment in health care was promoted by Ernest Amory Codman in the early 1900s, but, until recently, his ideas were generally ignored. The forces that have advanced outcome measurement to the forefront of health care include the shift in payers for health care from the patient to large insurance companies or government agencies, the movement toward assessing the care of populations not individuals, and the effort to find value (or cost-effective treatments) amid rising healthcare costs. No ideal method exists to measure outcomes, and the information gathered depends on the reason the outcome information is required. Outcome measures used in research are best able to answer research questions. The methods for assessing physician and hospital performance include process measures, patient-experience measures, structure measures, and measures used to assess the outcomes of treatment. The methods used to assess performance should be validated, be reliable, and reflect a patient's perception of the treatment results. The healthcare industry must measure outcomes to identify which treatments are most effective and provide the most benefit to patients.

Interventions for Age-Related Macular Degeneration: Are Practice Guidelines Based on Systematic Reviews?

PubMed

Lindsley, Kristina; Li, Tianjing; Ssemanda, Elizabeth; Virgili, Gianni; Dickersin, Kay

2016-04-01

Are existing systematic reviews of interventions for age-related macular degeneration incorporated into clinical practice guidelines? High-quality systematic reviews should be used to underpin evidence-based clinical practice guidelines and clinical care. We examined the reliability of systematic reviews of interventions for age-related macular degeneration (AMD) and described the main findings of reliable reviews in relation to clinical practice guidelines. Eligible publications were systematic reviews of the effectiveness of treatment interventions for AMD. We searched a database of systematic reviews in eyes and vision without language or date restrictions; the database was up to date as of May 6, 2014. Two authors independently screened records for eligibility and abstracted and assessed the characteristics and methods of each review. We classified reviews as reliable when they reported eligibility criteria, comprehensive searches, methodologic quality of included studies, appropriate statistical methods for meta-analysis, and conclusions based on results. We mapped treatment recommendations from the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for AMD to systematic reviews and citations of reliable systematic reviews to support each treatment recommendation. Of 1570 systematic reviews in our database, 47 met inclusion criteria; most targeted neovascular AMD and investigated anti-vascular endothelial growth factor (VEGF) interventions, dietary supplements, or photodynamic therapy. We classified 33 (70%) reviews as reliable. The quality of reporting varied, with criteria for reliable reporting met more often by Cochrane reviews and reviews whose authors disclosed conflicts of interest. Anti-VEGF agents and photodynamic therapy were the only interventions identified as effective by reliable reviews. Of 35 treatment recommendations extracted from the PPPs, 15 could have been supported with reliable systematic reviews; however, only 1 recommendation cited a reliable intervention systematic review. No reliable systematic review was identified for 20 treatment recommendations, highlighting areas of evidence gaps. For AMD, reliable systematic reviews exist for many treatment recommendations in the AAO PPPs and should be cited to support these recommendations. We also identified areas where no high-level evidence exists. Mapping clinical practice guidelines to existing systematic reviews is one way to highlight areas where evidence generation or evidence synthesis is either available or needed. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Improving Clinical Practices for Children with Language and Learning Disorders

ERIC Educational Resources Information Center

Kamhi, Alan G.

2014-01-01

Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

Generalizability of causal inference in observational studies under retrospective convenience sampling.

PubMed

Hu, Zonghui; Qin, Jing

2018-05-20

Many observational studies adopt what we call retrospective convenience sampling (RCS). With the sample size in each arm prespecified, RCS randomly selects subjects from the treatment-inclined subpopulation into the treatment arm and those from the control-inclined into the control arm. Samples in each arm are representative of the respective subpopulation, but the proportion of the 2 subpopulations is usually not preserved in the sample data. We show in this work that, under RCS, existing causal effect estimators actually estimate the treatment effect over the sample population instead of the underlying study population. We investigate how to correct existing methods for consistent estimation of the treatment effect over the underlying population. Although RCS is adopted in medical studies for ethical and cost-effective purposes, it also has a big advantage for statistical inference: When the tendency to receive treatment is low in a study population, treatment effect estimators under RCS, with proper correction, are more efficient than their parallels under random sampling. These properties are investigated both theoretically and through numerical demonstration. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Physiotherapy for functional motor disorders: a consensus recommendation

PubMed Central

Nielsen, Glenn; Stone, Jon; Matthews, Audrey; Brown, Melanie; Sparkes, Chris; Farmer, Ross; Masterton, Lindsay; Duncan, Linsey; Winters, Alisa; Daniell, Laura; Lumsden, Carrie; Carson, Alan; David, Anthony S; Edwards, Mark

2015-01-01

Background Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment. Methods A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience. Results We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms. Conclusions Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package. PMID:25433033

An empirical study on energy efficiency improvement through photovoltaic systems and a LED lighting control system

NASA Astrophysics Data System (ADS)

Choi, Young Kwan; Lee, Jae Hyeong

2015-09-01

In this research, a facility was constructed and its performance was analyzed to improve the energy efficiency of a vertical-type water treatment building. After the design and construction of a fixed tilt Photovoltaic in Building (PVIB) on the rooftop using a crystalline silicon solar cell module and photovoltaic generator integrated with the building by using a Building Integrated Photovoltaic System (BIPV), a thin-film module on the rooftop and outer wall of water treatment building, and the generation efficiency was analyzed. Also, a DC distribution was established for use of a brushless DC (BLDC) pump motor, and the existing lighting-facility-based manual on-off method was turned into a system for energy conservation by controlling light emitting diode (LED) through a wireless motion sensor and dimming control. In addition, a Building Energy Management System (BEMS) for a real-time analysis of the energy efficiency for a vertical0type water treatment building was prepared and tested. The vertical-type water treatment building developed in this study is currently operating the BEMS. The vertical-type water treatment building reported in this paper is expected to reduce energy consumption by about 30% compared to existing water treatment systems.

Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques.

PubMed

Costrini, A

1990-02-01

This manuscript compares the whole body cooling techniques in the emergency treatment of heatstroke. Historically, the use of cold water immersion with skin massage has been quite successful in rapidly lowering body temperature and in avoiding severe complications or death. Recent studies have suggested alternative therapies, including the use of a warm air spray, the use of helicopter downdraft, and pharmacological agents. While evidence exists to support these methods, they have not been shown to reduce fatalities as effectively as ice water immersion. Although several cooling methods may have clinical use, all techniques rely on the prompt recognition of symptoms and immediate action in the field.

Simultaneous Nonrigid Registration, Segmentation, and Tumor Detection in MRI Guided Cervical Cancer Radiation Therapy

PubMed Central

Lu, Chao; Chelikani, Sudhakar; Jaffray, David A.; Milosevic, Michael F.; Staib, Lawrence H.; Duncan, James S.

2013-01-01

External beam radiation therapy (EBRT) for the treatment of cancer enables accurate placement of radiation dose on the cancerous region. However, the deformation of soft tissue during the course of treatment, such as in cervical cancer, presents significant challenges for the delineation of the target volume and other structures of interest. Furthermore, the presence and regression of pathologies such as tumors may violate registration constraints and cause registration errors. In this paper, automatic segmentation, nonrigid registration and tumor detection in cervical magnetic resonance (MR) data are addressed simultaneously using a unified Bayesian framework. The proposed novel method can generate a tumor probability map while progressively identifying the boundary of an organ of interest based on the achieved nonrigid transformation. The method is able to handle the challenges of significant tumor regression and its effect on surrounding tissues. The new method was compared to various currently existing algorithms on a set of 36 MR data from six patients, each patient has six T2-weighted MR cervical images. The results show that the proposed approach achieves an accuracy comparable to manual segmentation and it significantly outperforms the existing registration algorithms. In addition, the tumor detection result generated by the proposed method has a high agreement with manual delineation by a qualified clinician. PMID:22328178

Physical Methods for Intracellular Delivery: Practical Aspects from Laboratory Use to Industrial-Scale Processing

PubMed Central

Meacham, J. Mark; Durvasula, Kiranmai; Degertekin, F. Levent; Fedorov, Andrei G.

2015-01-01

Effective intracellular delivery is a significant impediment to research and therapeutic applications at all processing scales. Physical delivery methods have long demonstrated the ability to deliver cargo molecules directly to the cytoplasm or nucleus, and the mechanisms underlying the most common approaches (microinjection, electroporation, and sonoporation) have been extensively investigated. In this review, we discuss established approaches, as well as emerging techniques (magnetofection, optoinjection, and combined modalities). In addition to operating principles and implementation strategies, we address applicability and limitations of various in vitro, ex vivo, and in vivo platforms. Importantly, we perform critical assessments regarding (1) treatment efficacy with diverse cell types and delivered cargo molecules, (2) suitability to different processing scales (from single cell to large populations), (3) suitability for automation/integration with existing workflows, and (4) multiplexing potential and flexibility/adaptability to enable rapid changeover between treatments of varied cell types. Existing techniques typically fall short in one or more of these criteria; however, introduction of micro-/nanotechnology concepts, as well as synergistic coupling of complementary method(s), can improve performance and applicability of a particular approach, overcoming barriers to practical implementation. For this reason, we emphasize these strategies in examining recent advances in development of delivery systems. PMID:23813915

Drug Delivery Systems, CNS Protection, and the Blood Brain Barrier

PubMed Central

Upadhyay, Ravi Kant

2014-01-01

Present review highlights various drug delivery systems used for delivery of pharmaceutical agents mainly antibiotics, antineoplastic agents, neuropeptides, and other therapeutic substances through the endothelial capillaries (BBB) for CNS therapeutics. In addition, the use of ultrasound in delivery of therapeutic agents/biomolecules such as proline rich peptides, prodrugs, radiopharmaceuticals, proteins, immunoglobulins, and chimeric peptides to the target sites in deep tissue locations inside tumor sites of brain has been explained. In addition, therapeutic applications of various types of nanoparticles such as chitosan based nanomers, dendrimers, carbon nanotubes, niosomes, beta cyclodextrin carriers, cholesterol mediated cationic solid lipid nanoparticles, colloidal drug carriers, liposomes, and micelles have been discussed with their recent advancements. Emphasis has been given on the need of physiological and therapeutic optimization of existing drug delivery methods and their carriers to deliver therapeutic amount of drug into the brain for treatment of various neurological diseases and disorders. Further, strong recommendations are being made to develop nanosized drug carriers/vehicles and noninvasive therapeutic alternatives of conventional methods for better therapeutics of CNS related diseases. Hence, there is an urgent need to design nontoxic biocompatible drugs and develop noninvasive delivery methods to check posttreatment clinical fatalities in neuropatients which occur due to existing highly toxic invasive drugs and treatment methods. PMID:25136634

Utilization of communication technology by patients enrolled in substance abuse treatment

PubMed Central

McClure, Erin A.; Acquavita, Shauna; Harding, Emily; Stitzer, Maxine

2012-01-01

Background Technology-based applications represent a promising method for providing efficacious, widely available interventions to substance abuse treatment patients. However, limited access to communication technology (i.e., mobile phones, computers, internet, and e-mail) could significantly impact the feasibility of these efforts, and little is known regarding technology utilization in substance abusing populations. Methods A survey was conducted to characterize utilization of communication technology in 266 urban, substance abuse treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy clinics. Results Survey participants averaged 41 years of age and 57% had a yearly household income of less than $15,000. The vast majority reported access to a mobile phone (91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and yearly mobile contract was higher for White participants, and also for those with higher education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer use was much lower (39–45%), with younger age, higher education and income predicting greater use. No such differences existed for the use of mobile phones however. Conclusions Concern regarding the digital divide for marginalized populations appears to be disappearing with respect to mobile phones, but still exists for computer, internet, and e-mail access and use. Results suggest that mobile phone and texting applications may be feasibly applied for use in program-client interactions in substance abuse treatment. Careful consideration should be given to frequent phone number changes, access to technology, and motivation to engage with communication technology for treatment purposes. PMID:23107600

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults

PubMed Central

Fuller, Thomas E.; Haider, Haula F.; Kikidis, Dimitris; Lapira, Alec; Mazurek, Birgit; Norena, Arnaud; Rabau, Sarah; Lardinois, Rachelle; Cederroth, Christopher R.; Edvall, Niklas K.; Brueggemann, Petra G.; Rosing, Susanne N.; Kapandais, Anestis; Lungaard, Dorte; Hoare, Derek J.; Cima, Rilana F. F

2017-01-01

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe. PMID:28275357

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults.

PubMed

Fuller, Thomas E; Haider, Haula F; Kikidis, Dimitris; Lapira, Alec; Mazurek, Birgit; Norena, Arnaud; Rabau, Sarah; Lardinois, Rachelle; Cederroth, Christopher R; Edvall, Niklas K; Brueggemann, Petra G; Rosing, Susanne N; Kapandais, Anestis; Lungaard, Dorte; Hoare, Derek J; Cima, Rilana F F

2017-01-01

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.

Cellular Imaging With MRI.

PubMed

Makela, Ashley V; Murrell, Donna H; Parkins, Katie M; Kara, Jenna; Gaudet, Jeffrey M; Foster, Paula J

2016-10-01

Cellular magnetic resonance imaging (MRI) is an evolving field of imaging with strong translational and research potential. The ability to detect, track, and quantify cells in vivo and over time allows for studying cellular events related to disease processes and may be used as a biomarker for decisions about treatments and for monitoring responses to treatments. In this review, we discuss methods for labeling cells, various applications for cellular MRI, the existing limitations, strategies to address these shortcomings, and clinical cellular MRI.

[Gender reassignment surgery in transsexualism from a urological perspective].

PubMed

Althaus, Peter

2006-01-01

The surgical treatment of transsexual patients can barely be called satisfactory. Poor quality surgical operations cause the life of the patients so treated to become unhappy. Transsexual surgery should only be performed in centres where a sufficient amount of experience has been gathered, and--what is equally important--an understanding amounting to affinity exists with the problem of transsexualism. There is a great need for better treatment methods. The present situation is far from being optimal.

Use of Psychotherapy by Rural and Urban Veterans

ERIC Educational Resources Information Center

Cully, Jeffrey A.; Jameson, John P.; Phillips, Laura L.; Kunik, Mark E.; Fortney, John C.

2010-01-01

Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted…

Hypnosis in the Treatment of Depression: Considerations in Research Design and Methods

PubMed Central

McCann, Barbara S.; Landes, Sara J.

2010-01-01

Depressive disorders constitute a serious problem in the United States. The appearance of practice guidelines and lists of evidenced based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what we do and do not know about the treatment of depression leaves plenty of room for improved approaches to addressing this condition. Although there has been a dearth of research on the treatment of depression using hypnosis, there are several compelling arguments for the inclusion of hypnotic approaches in the array of strategies for dealing with depression. However, traditional “gold standard” research methods, namely randomized controlled trials (RCTs) have many potential shortcomings for identifying the potential impact of hypnosis on depression. Other strategies, notably single-case design and benchmarking approaches, may offer a more practical solution to the problem of determining “what works for depression.” PMID:20390688

Virtual reality exposure therapy for the treatment of anxiety disorders: an evaluation of research quality.

PubMed

McCann, Russell A; Armstrong, Christina M; Skopp, Nancy A; Edwards-Stewart, Amanda; Smolenski, Derek J; June, Jennifer D; Metzger-Abamukong, Melinda; Reger, Greg M

2014-08-01

Randomized controlled trials (RCTs) support the effectiveness of virtual reality exposure therapy (VRET) for anxiety disorders; however, the overall quality of the VRET RCT literature base has yet to be evaluated. This study reviewed 27 VRET RCTs and the degree of adherence to 8 RCT research design criteria derived from existing standards. Adherence to the study quality criteria was generally low as the articles met an average 2.85 criteria (SD=1.56). None of the studies met more than six quality criteria. Study quality did not predict effect size; however, a reduction in effect size magnitude was observed for studies with larger sample sizes when comparing VRET to non-active control groups. VRET may be an effective method of treatment but caution should be exercised in interpreting the existing body of literature supporting VRET relative to existing standards of care. The need for well-designed VRET research is discussed. Copyright © 2014. Published by Elsevier Ltd.

Treated Wastewater Effluent as a Source of Microbial Pollution of Surface Water Resources

PubMed Central

Naidoo, Shalinee; Olaniran, Ademola O.

2013-01-01

Since 1990, more than 1.8 billion people have gained access to potable water and improved sanitation worldwide. Whilst this represents a vital step towards improving global health and well-being, accelerated population growth coupled with rapid urbanization has further strained existing water supplies. Whilst South Africa aims at spending 0.5% of its GDP on improving sanitation, additional factors such as hydrological variability and growing agricultural needs have further increased dependence on this finite resource. Increasing pressure on existing wastewater treatment plants has led to the discharge of inadequately treated effluent, reinforcing the need to improve and adopt more stringent methods for monitoring discharged effluent and surrounding water sources. This review provides an overview of the relative efficiencies of the different steps involved in wastewater treatment as well as the commonly detected microbial indicators with their associated health implications. In addition, it highlights the need to enforce more stringent measures to ensure compliance of treated effluent quality to the existing guidelines. PMID:24366046

Combined electron-beam and coagulation purification of molasses distillery slops. Features of the method, technical and economic evaluation of large-scale facility

NASA Astrophysics Data System (ADS)

Pikaev, A. K.; Ponomarev, A. V.; Bludenko, A. V.; Minin, V. N.; Elizar'eva, L. M.

2001-04-01

The paper summarizes the results obtained from the study on combined electron-beam and coagulation method for purification of molasses distillery slops from distillery produced ethyl alcohol by fermentation of grain, potato, beet and some other plant materials. The method consists in preliminary mixing of industrial wastewater with municipal wastewater, electron-beam treatment of the mixture and subsequent coagulation. Technical and economic evaluation of large-scale facility (output of 7000 m 3 day -1) with two powerful cascade electron accelerators (total maximum beam power of 400 kW) for treatment of the wastewater by the above method was carried out. It was calculated that the cost of purification of the wastes is equal to 0.25 US$ m -3 that is noticeably less than in the case of the existing method.

Evaluating ethanol-based sample preservation to facilitate use of DNA barcoding in routine freshwater biomonitoring programs using benthic macroinvertebrates.

PubMed

Stein, Eric D; White, Bryan P; Mazor, Raphael D; Miller, Peter E; Pilgrim, Erik M

2013-01-01

Molecular methods, such as DNA barcoding, have the potential to enhance biomonitoring programs worldwide. Altering routinely used sample preservation methods to protect DNA from degradation may pose a potential impediment to application of DNA barcoding and metagenomics for biomonitoring using benthic macroinvertebrates. Using higher volumes or concentrations of ethanol, requirements for shorter holding times, or the need to include additional filtering may increase cost and logistical constraints to existing biomonitoring programs. To address this issue we evaluated the efficacy of various ethanol-based sample preservation methods at maintaining DNA integrity. We evaluated a series of methods that were minimally modified from typical field protocols in order to identify an approach that can be readily incorporated into existing monitoring programs. Benthic macroinvertebrates were collected from a minimally disturbed stream in southern California, USA and subjected to one of six preservation treatments. Ten individuals from five taxa were selected from each treatment and processed to produce DNA barcodes from the mitochondrial gene cytochrome c oxidase I (COI). On average, we obtained successful COI sequences (i.e. either full or partial barcodes) for between 93-99% of all specimens across all six treatments. As long as samples were initially preserved in 95% ethanol, successful sequencing of COI barcodes was not affected by a low dilution ratio of 2∶1, transfer to 70% ethanol, presence of abundant organic matter, or holding times of up to six months. Barcoding success varied by taxa, with Leptohyphidae (Ephemeroptera) producing the lowest barcode success rate, most likely due to poor PCR primer efficiency. Differential barcoding success rates have the potential to introduce spurious results. However, routine preservation methods can largely be used without adverse effects on DNA integrity.

Evaluating Ethanol-based Sample Preservation to Facilitate Use of DNA Barcoding in Routine Freshwater Biomonitoring Programs Using Benthic Macroinvertebrates

PubMed Central

Stein, Eric D.; White, Bryan P.; Mazor, Raphael D.; Miller, Peter E.; Pilgrim, Erik M.

2013-01-01

Molecular methods, such as DNA barcoding, have the potential to enhance biomonitoring programs worldwide. Altering routinely used sample preservation methods to protect DNA from degradation may pose a potential impediment to application of DNA barcoding and metagenomics for biomonitoring using benthic macroinvertebrates. Using higher volumes or concentrations of ethanol, requirements for shorter holding times, or the need to include additional filtering may increase cost and logistical constraints to existing biomonitoring programs. To address this issue we evaluated the efficacy of various ethanol-based sample preservation methods at maintaining DNA integrity. We evaluated a series of methods that were minimally modified from typical field protocols in order to identify an approach that can be readily incorporated into existing monitoring programs. Benthic macroinvertebrates were collected from a minimally disturbed stream in southern California, USA and subjected to one of six preservation treatments. Ten individuals from five taxa were selected from each treatment and processed to produce DNA barcodes from the mitochondrial gene cytochrome c oxidase I (COI). On average, we obtained successful COI sequences (i.e. either full or partial barcodes) for between 93–99% of all specimens across all six treatments. As long as samples were initially preserved in 95% ethanol, successful sequencing of COI barcodes was not affected by a low dilution ratio of 2∶1, transfer to 70% ethanol, presence of abundant organic matter, or holding times of up to six months. Barcoding success varied by taxa, with Leptohyphidae (Ephemeroptera) producing the lowest barcode success rate, most likely due to poor PCR primer efficiency. Differential barcoding success rates have the potential to introduce spurious results. However, routine preservation methods can largely be used without adverse effects on DNA integrity. PMID:23308097

A novel approach for targeted delivery to motoneurons using cholera toxin-B modified protocells

PubMed Central

Gonzalez Porras, Maria A.; Durfee, Paul N.; Gregory, Ashley M.; Sieck, Gary C.; Brinker, C. Jeffrey; Mantilla, Carlos B.

2017-01-01

Background Trophic interactions between muscle fibers and motoneurons at the neuromuscular junction (NMJ) play a critical role in determining motor function throughout development, ageing, injury, or disease. Treatment of neuromuscular disorders is hindered by the inability to selectively target motoneurons with pharmacological and genetic interventions. New method We describe a novel delivery system to motoneurons using mesoporous silica nanoparticles encapsulated within a lipid bilayer (protocells) and modified with the atoxic subunit B of the cholera toxin (CTB) that binds to gangliosides present on neuronal membranes. Results CTB modified protocells showed significantly greater motoneuron uptake compared to unmodified protocells after 24 h of treatment (60% vs. 15%, respectively). CTB-protocells showed specific uptake by motoneurons compared to muscle cells and demonstrated cargo release of a surrogate drug. Protocells showed a lack of cytotoxicity and unimpaired cellular proliferation. In isolated diaphragm muscle-phrenic nerve preparations, preferential axon terminal uptake of CTB-modified protocells was observed compared to uptake in surrounding muscle tissue. A larger proportion of axon terminals displayed uptake following treatment with CTB-protocells compared to unmodified protocells (40% vs. 6%, respectively). Comparison with existing method(s) Current motoneuron targeting strategies lack the functionality to load and deliver multiple cargos. CTB-protocells capitalizes on the advantages of liposomes and mesoporous silica nanoparticles allowing a large loading capacity and cargo release. The ability of CTB-protocells to target motoneurons at the NMJ confers a great advantage over existing methods. Conclusions CTB-protocells constitute a viable targeted motoneuron delivery system for drugs and genes facilitating various therapies for neuromuscular diseases. PMID:27641118

Combined Treatment on the Inactivation of Naturally Existing Bacteria and Escherichia coli O157:H7 Inoculated on Fresh-Cut Kale.

PubMed

Kang, Ji Hoon; Song, Kyung Bin

2017-02-28

An aqueous chlorine dioxide (ClO₂) treatment combined with highly activated calcium oxide (CaO) and mild heat was tested for inactivating naturally existing bacteria and Escherichia coli O157:H7 inoculated on fresh-cut kale. Kale samples were treated with different concentrations of ClO₂ (10, 30, and 50 ppm), CaO (0.01%, 0.05%, 0.1%, and 0.2%), and mild heat (25°C, 45°C, 55°C, and 65°C) as well with combinations of 30 or 50 ppm ClO₂ and 0.2% CaO at 55°C for 3 min. An increasing concentration of ClO₂ and CaO significantly reduced the microbialpopulation compared with the control. In addition, mild heating at 55°C elicited greater microbial reduction than the other temperatures. A combined treatment of 50 ppm ClO₂ and 0.2% CaO at 55°C reduced the population of naturally existing bacteria on kale by 3.10 logcolony forming units (CFU)/g, and the counts of E. coli O157:H7 were below the detection limit (1 log CFU/g). In addition, no significant differences in the Hunter color values were evident in any treatment during storage. Therefore, a combined treatment of ClO₂ and active CaO at 55°C can be an effective sanitizing method to improve the microbiological safety of fresh-cut kale without affecting its quality.

Evidence Gaps in the Use of Spinal Cord Stimulation for Treating Chronic Spine Conditions.

PubMed

Provenzano, David A; Amirdelfan, Kasra; Kapural, Leonardo; Sitzman, B Todd

2017-07-15

A review of literature. The aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions. Although over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist. A literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored. The efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine. Evidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions. N/A.

Sensory quality of broiler breast meat influenced by low atmospheric pressure stunning, deboning time and cooking methods.

PubMed

Schilling, M W; Radhakrishnan, V; Vizzier-Thaxton, Y; Christensen, K; Williams, J B; Joseph, P

2015-06-01

Stunning method (low atmospheric pressure stunning, LAPS and electrical stunning, ES), deboning time (0.75 h and 4 h), and cooking method (baking, frying, and sous vide) were evaluated for their impact on the descriptive sensory characteristics and consumer acceptability of breast meat (n=576, 144 birds per stunning × deboning time combination). Sensory evaluation was conducted by trained descriptive (n=8) and consumer (n=185) panels. On average, no differences (P>0.05) existed in the sensory acceptability of fried and sous vide cooked broiler breast treatment combinations. However, for oven-baking, the LAPS treatment that was deboned at 4 h was more acceptable (P<0.05) than other treatments and the ES and LAPS 4 h samples had greater (P<0.05) acceptability for texture than their ES and LAPS 0.75 h counterparts. Since consumers were highly variable in their liking of chicken breast treatments, consumers were grouped into clusters for each cooking method based on liking and preference. Cluster analysis data revealed that the largest groups of consumers liked (score≥6.0) all chicken breast treatments, but a larger proportion of consumers liked the 4 h LAPS and ES treatments when compared to the 0.75 h LAPS and ES treatments for all cooking methods. In addition, the consumers who indicated that baked chicken breast was highly acceptable preferred (P<0.05) 4 h LAPS over the 4 h ES samples. Based on sensory results, chicken breast meat from all stunning and deboning method combinations was highly acceptable to the majority of consumers, but the LAPS 4 h treatment had enhanced sensory characteristics when baked. © 2015 Poultry Science Association Inc.

Revealing metabolite biomarkers for acupuncture treatment by linear programming based feature selection.

PubMed

Wang, Yong; Wu, Qiao-Feng; Chen, Chen; Wu, Ling-Yun; Yan, Xian-Zhong; Yu, Shu-Guang; Zhang, Xiang-Sun; Liang, Fan-Rong

2012-01-01

Acupuncture has been practiced in China for thousands of years as part of the Traditional Chinese Medicine (TCM) and has gradually accepted in western countries as an alternative or complementary treatment. However, the underlying mechanism of acupuncture, especially whether there exists any difference between varies acupoints, remains largely unknown, which hinders its widespread use. In this study, we develop a novel Linear Programming based Feature Selection method (LPFS) to understand the mechanism of acupuncture effect, at molecular level, by revealing the metabolite biomarkers for acupuncture treatment. Specifically, we generate and investigate the high-throughput metabolic profiles of acupuncture treatment at several acupoints in human. To select the subsets of metabolites that best characterize the acupuncture effect for each meridian point, an optimization model is proposed to identify biomarkers from high-dimensional metabolic data from case and control samples. Importantly, we use nearest centroid as the prototype to simultaneously minimize the number of selected features and the leave-one-out cross validation error of classifier. We compared the performance of LPFS to several state-of-the-art methods, such as SVM recursive feature elimination (SVM-RFE) and sparse multinomial logistic regression approach (SMLR). We find that our LPFS method tends to reveal a small set of metabolites with small standard deviation and large shifts, which exactly serves our requirement for good biomarker. Biologically, several metabolite biomarkers for acupuncture treatment are revealed and serve as the candidates for further mechanism investigation. Also biomakers derived from five meridian points, Zusanli (ST36), Liangmen (ST21), Juliao (ST3), Yanglingquan (GB34), and Weizhong (BL40), are compared for their similarity and difference, which provide evidence for the specificity of acupoints. Our result demonstrates that metabolic profiling might be a promising method to investigate the molecular mechanism of acupuncture. Comparing with other existing methods, LPFS shows better performance to select a small set of key molecules. In addition, LPFS is a general methodology and can be applied to other high-dimensional data analysis, for example cancer genomics.

Revealing metabolite biomarkers for acupuncture treatment by linear programming based feature selection

PubMed Central

2012-01-01

Background Acupuncture has been practiced in China for thousands of years as part of the Traditional Chinese Medicine (TCM) and has gradually accepted in western countries as an alternative or complementary treatment. However, the underlying mechanism of acupuncture, especially whether there exists any difference between varies acupoints, remains largely unknown, which hinders its widespread use. Results In this study, we develop a novel Linear Programming based Feature Selection method (LPFS) to understand the mechanism of acupuncture effect, at molecular level, by revealing the metabolite biomarkers for acupuncture treatment. Specifically, we generate and investigate the high-throughput metabolic profiles of acupuncture treatment at several acupoints in human. To select the subsets of metabolites that best characterize the acupuncture effect for each meridian point, an optimization model is proposed to identify biomarkers from high-dimensional metabolic data from case and control samples. Importantly, we use nearest centroid as the prototype to simultaneously minimize the number of selected features and the leave-one-out cross validation error of classifier. We compared the performance of LPFS to several state-of-the-art methods, such as SVM recursive feature elimination (SVM-RFE) and sparse multinomial logistic regression approach (SMLR). We find that our LPFS method tends to reveal a small set of metabolites with small standard deviation and large shifts, which exactly serves our requirement for good biomarker. Biologically, several metabolite biomarkers for acupuncture treatment are revealed and serve as the candidates for further mechanism investigation. Also biomakers derived from five meridian points, Zusanli (ST36), Liangmen (ST21), Juliao (ST3), Yanglingquan (GB34), and Weizhong (BL40), are compared for their similarity and difference, which provide evidence for the specificity of acupoints. Conclusions Our result demonstrates that metabolic profiling might be a promising method to investigate the molecular mechanism of acupuncture. Comparing with other existing methods, LPFS shows better performance to select a small set of key molecules. In addition, LPFS is a general methodology and can be applied to other high-dimensional data analysis, for example cancer genomics. PMID:23046877

Solving phase appearance/disappearance two-phase flow problems with high resolution staggered grid and fully implicit schemes by the Jacobian-free Newton–Krylov Method

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

Zou, Ling; Zhao, Haihua; Zhang, Hongbin

2016-04-01

The phase appearance/disappearance issue presents serious numerical challenges in two-phase flow simulations. Many existing reactor safety analysis codes use different kinds of treatments for the phase appearance/disappearance problem. However, to our best knowledge, there are no fully satisfactory solutions. Additionally, the majority of the existing reactor system analysis codes were developed using low-order numerical schemes in both space and time. In many situations, it is desirable to use high-resolution spatial discretization and fully implicit time integration schemes to reduce numerical errors. In this work, we adapted a high-resolution spatial discretization scheme on staggered grid mesh and fully implicit time integrationmore » methods (such as BDF1 and BDF2) to solve the two-phase flow problems. The discretized nonlinear system was solved by the Jacobian-free Newton Krylov (JFNK) method, which does not require the derivation and implementation of analytical Jacobian matrix. These methods were tested with a few two-phase flow problems with phase appearance/disappearance phenomena considered, such as a linear advection problem, an oscillating manometer problem, and a sedimentation problem. The JFNK method demonstrated extremely robust and stable behaviors in solving the two-phase flow problems with phase appearance/disappearance. No special treatments such as water level tracking or void fraction limiting were used. High-resolution spatial discretization and second- order fully implicit method also demonstrated their capabilities in significantly reducing numerical errors.« less

Scientific approach and practical experience for reconstruction of waste water treatment plants in Russia

NASA Astrophysics Data System (ADS)

Makisha, Nikolay; Gogina, Elena

2017-11-01

Protection of water bodies has a strict dependence on reliable operation of engineering systems and facilities for water supply and sewage. The majority of these plants and stations has been constructed in 1970-1980's in accordance with rules and regulations of that time. So now most of them require reconstruction due to serious physical or/and technological wear. The current condition of water supply and sewage systems and facilities frequently means a hidden source of serious danger for normal life support and ecological safety of cities and towns. The article reveals an obtained experience and modern approaches for reconstruction of waste water and sludge treatment plants that proved their efficiency even if applied in limited conditions such as area limits, investments limits. The main directions of reconstruction: overhaul repair and partial modernization of existing facilities on the basis of initial project; - restoration and modernization of existing systems on the basis on the current documents and their current condition; upgrade of waste water treatment plants (WWTPs) performance on the basis of modern technologies and methods; reconstruction of sewage systems and facilities and treatment quality improvement.

The effect of the medicine administration route on health-related quality of life: Results from a time trade-off survey in patients with bipolar disorder or schizophrenia in 2 Nordic countries.

PubMed

Jørgensen, Tine Rikke; Emborg, Charlotte; Dahlen, Karianne; Bøgelund, Mette; Carlborg, Andreas

2016-07-16

Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.

High-dose-rate prostate brachytherapy inverse planning on dose-volume criteria by simulated annealing.

PubMed

Deist, T M; Gorissen, B L

2016-02-07

High-dose-rate brachytherapy is a tumor treatment method where a highly radioactive source is brought in close proximity to the tumor. In this paper we develop a simulated annealing algorithm to optimize the dwell times at preselected dwell positions to maximize tumor coverage under dose-volume constraints on the organs at risk. Compared to existing algorithms, our algorithm has advantages in terms of speed and objective value and does not require an expensive general purpose solver. Its success mainly depends on exploiting the efficiency of matrix multiplication and a careful selection of the neighboring states. In this paper we outline its details and make an in-depth comparison with existing methods using real patient data.

Contaminated waste incinerator modification study. Final report

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

Wolf, F.

1995-08-01

An explosive waste incinerator (EWI) can be installed in the existing Badger AAP Contaminated Waste Processor (CWP). An engineering evaluation of installing a rotary kiln furnace to dispose of waste energetic material has shown the installation to be possible. An extensive literature search was completed to develop the known proven methods of energetic waste disposal. Current incineration practice including thermal treatment alternatives was investigated. Existing and new equipment was reviewed for adequacy. Current CWP operations and hazardous waste to be disposed of were determined. Comparisons were made with other AAP`s EWI.

Usual and Unusual Care: Existing Practice Control Groups In Randomized Controlled Trials of Behavioral Interventions

PubMed Central

Freedland, Kenneth E.; Mohr, David C.; Davidson, Karina W.; Schwartz, Joseph E.

2011-01-01

Objective To examine the use of existing practice control groups in randomized controlled trials of behavioral interventions, and the role of extrinsic healthcare services in the design and conduct of behavioral trials. Method Selective qualitative review. Results Extrinsic healthcare services, also known as nonstudy care, have important but under-recognized effects on the design and conduct of behavioral trials. Usual care, treatment as usual, standard of care, and other existing practice control groups pose a variety of methodological and ethical challenges, but they play a vital role in behavioral intervention research. Conclusion This review highlights the need for a scientific consensus statement on control groups in behavioral trials. PMID:21536837

A Randomized Prospective Trial Comparing Paravertebral Block and General Anesthesia for Operative Treatment of Breast Cancer

DTIC Science & Technology

2001-10-01

block the anesthetic of choice for operative treatment of breast cancer. To test this hypothesis we proposed a prospective randomized clinical trial ...coordinators. Months 4-6. Status: Complete The study’s existing part-time Clinical Trial Coordinator, Mr. John Arbo, was enlisted full-time in June...of full-time Clinical Trial Coordinator for Mount Sinai. ■ Poster presentation by Mount Sinai staff of study goals and methods at a Department of

What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology.

PubMed

Nanavati, Sujal M

2014-12-01

Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

Review of various treatment methods for the abatement of phenolic compounds from wastewater.

PubMed

Girish, C R; Murty, V Ramachandra

2012-04-01

Phenol and its derivatives are considered among the most hazardous organic pollutants from industrial wastewater and they are toxic even at low concentrations. Besides the existence of phenol in natural water source it can lead to the formation of other toxic substituted compounds. So this has led to growing concern on setting up of rigid limits on the acceptable level of phenol in the environment. The various methods for the treatment of phenol from wastewater streams are briefly reviewed. The various technologies like distillation, liquid-liquid extraction with different solvents, adsorption over activated carbons and polymeric and inorganic adsorbents, membrane pervaporation and membrane-solvent extraction, have been elucidated. The advantages and disadvantages of the various methods are illustrated and their performances are compared.

Translational research: precision medicine, personalized medicine, targeted therapies: marketing or science?

PubMed

Marquet, Pierre; Longeray, Pierre-Henry; Barlesi, Fabrice; Ameye, Véronique; Augé, Pascale; Cazeneuve, Béatrice; Chatelut, Etienne; Diaz, Isabelle; Diviné, Marine; Froguel, Philippe; Goni, Sylvia; Gueyffier, François; Hoog-Labouret, Natalie; Mourah, Samia; Morin-Surroca, Michèle; Perche, Olivier; Perin-Dureau, Florent; Pigeon, Martine; Tisseau, Anne; Verstuyft, Céline

2015-01-01

Personalized medicine is based on: 1) improved clinical or non-clinical methods (including biomarkers) for a more discriminating and precise diagnosis of diseases; 2) targeted therapies of the choice or the best drug for each patient among those available; 3) dose adjustment methods to optimize the benefit-risk ratio of the drugs chosen; 4) biomarkers of efficacy, toxicity, treatment discontinuation, relapse, etc. Unfortunately, it is still too often a theoretical concept because of the lack of convenient diagnostic methods or treatments, particularly of drugs corresponding to each subtype of pathology, hence to each patient. Stratified medicine is a component of personalized medicine employing biomarkers and companion diagnostics to target the patients likely to present the best benefit-risk balance for a given active compound. The concept of targeted therapy, mostly used in cancer treatment, relies on the existence of a defined molecular target, involved or not in the pathological process, and/or on the existence of a biomarker able to identify the target population, which should logically be small as compared to the population presenting the disease considered. Targeted therapies and biomarkers represent important stakes for the pharmaceutical industry, in terms of market access, of return on investment and of image among the prescribers. At the same time, they probably represent only the first generation of products resulting from the combination of clinical, pathophysiological and molecular research, i.e. of translational research. © 2015 Société Française de Pharmacologie et de Thérapeutique.

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines.

PubMed

Fountoulakis, Konstantinos N; Young, Allan; Yatham, Lakshmi; Grunze, Heinz; Vieta, Eduard; Blier, Pierre; Moeller, Hans Jurgen; Kasper, Siegfried

2017-02-01

This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper. © The Author 2016. Published by Oxford University Press on behalf of CINP.

Retrofitting existing chemical scrubbers to biotrickling filters for H2S emission control

PubMed Central

Gabriel, David; Deshusses, Marc A.

2003-01-01

Biological treatment is a promising alternative to conventional air-pollution control methods, but thus far biotreatment processes for odor control have always required much larger reactor volumes than chemical scrubbers. We converted an existing full-scale chemical scrubber to a biological trickling filter and showed that effective treatment of hydrogen sulfide (H2S) in the converted scrubber was possible even at gas contact times as low as 1.6 s. That is 8–20 times shorter than previous biotrickling filtration reports and comparable to usual contact times in chemical scrubbers. Significant removal of reduced sulfur compounds, ammonia, and volatile organic compounds present in traces in the air was also observed. Continuous operation for >8 months showed stable performance and robust behavior for H2S treatment, with pollutant-removal performance comparable to that achieved by using a chemical scrubber. Our study demonstrates that biotrickling filters can replace chemical scrubbers and be a safer, more economical technique for odor control. PMID:12740445

Retrofitting existing chemical scrubbers to biotrickling filters for H2S emission control.

PubMed

Gabriel, David; Deshusses, Marc A

2003-05-27

Biological treatment is a promising alternative to conventional air-pollution control methods, but thus far biotreatment processes for odor control have always required much larger reactor volumes than chemical scrubbers. We converted an existing full-scale chemical scrubber to a biological trickling filter and showed that effective treatment of hydrogen sulfide (H2S) in the converted scrubber was possible even at gas contact times as low as 1.6 s. That is 8-20 times shorter than previous biotrickling filtration reports and comparable to usual contact times in chemical scrubbers. Significant removal of reduced sulfur compounds, ammonia, and volatile organic compounds present in traces in the air was also observed. Continuous operation for >8 months showed stable performance and robust behavior for H2S treatment, with pollutant-removal performance comparable to that achieved by using a chemical scrubber. Our study demonstrates that biotrickling filters can replace chemical scrubbers and be a safer, more economical technique for odor control.

Status of domestic wastewater management in relation to drinking-water supply in two states of India.

PubMed

Pandey, R A; Kaul, S N

2000-01-01

In India, supply of drinking water, treatment and disposal of domestic wastewater including faecal matter are managed by local bodies. The existing status of water supply, characteristics of domestic wastewater, modes of collection, treatment and disposal system for sewage and faecal matter in 82 municipalities and 4 municipal corporations were assessed in the States of Bihar and West Bengal in India. Domestic wastewater in the municipal areas is collected and discharged through open kachha (earthen), pucca (cement-concrete) and natural drains and discharged into water courses or disposed on land. Scavenger carriage system for night soil disposal is in-vogue at several places in the surveyed States. Open defecation by the inhabitants in some of the municipalities also occurs. The existing methods of collection, treatment and disposal of sewage impairs the water quality of different water sources. Techno-economically viable remedial measures for providing basic amenities, namely safe drinking-water supply and proper sanitation to the communities of these two States of India are suggested and discussed.

The acute management of haemorrhoids

PubMed Central

Cohen, CRG

2014-01-01

Introduction Although the acute thrombosis and strangulation of haemorrhoids is a common condition, there is no consensus as to its most effective treatment. Methods A PubMed search was undertaken for papers describing the aetiology and treatment of the acute complications of haemorrhoids. Results The anatomy and treatments for strangulated internal haemorrhoids and thrombosed perianal varices are discussed. Studies of the effectiveness and complications of conservative and operative treatments are reviewed. Conclusions Ambiguities exist in the terminology used to describe the two separate pathologies that make up the acute complications of haemorrhoids. These complications have traditionally been treated conservatively. There is evidence that early operative intervention for strangulated internal haemorrhoids is safe and effective. A suggested algorithm for treatment is given, based on the published literature. PMID:25245728

The effectiveness of water treatment processes against schistosome cercariae: A systematic review

PubMed Central

Templeton, Michael R.

2018-01-01

Background Schistosomiasis is one of the most disabling neglected tropical diseases, ranking second in terms of years lived with disability. While treatment with the drug praziquantel can have immediate beneficial effects, reinfection can occur rapidly if people are in contact with cercaria-infested water. Water treatment for schistosomiasis control seeks to eliminate viable cercariae from water, thereby providing safe alternative water supplies for recreational and domestic activities including laundry and bathing. This provision may reduce contact with infested water, which is crucial for reducing reinfection following chemotherapy and cutting schistosome transmission. Methodology A qualitative systematic review was carried out to summarize the existing knowledge on the effectiveness of water treatment in removing or inactivating human schistosome cercariae. Four online databases were searched. Studies were screened and categorized into five water treatment processes: storage, heating, chlorination, filtration, and ultraviolet (UV) disinfection. Conclusions All five water treatment methods can remove or inactivate cercariae in water, and hence produce cercaria-free water. However, reliable design guidelines for treating water do not exist as there are insufficient data. Overall, the review found that cercariae are inactivated when storing water for 10–72 hours (depending on temperature), or with chlorination values of 3–30 mg-min/l. UV fluences between 3–60 mJ/cm2 may significantly damage or kill cercariae, and sand filters with 0.18–0.35 mm grain size have been shown to remove cercariae. This systematic review identified 67 studies about water treatment and schistosomiasis published in the past 106 years. It highlights the many factors that influence the results of water treatment experiments, which include different water quality conditions and methods for measuring key parameters. Variation in these factors limit comparability, and therefore currently available information is insufficient for providing complete water treatment design recommendations. PMID:29608589

Inference of median difference based on the Box-Cox model in randomized clinical trials.

PubMed

Maruo, K; Isogawa, N; Gosho, M

2015-05-10

In randomized clinical trials, many medical and biological measurements are not normally distributed and are often skewed. The Box-Cox transformation is a powerful procedure for comparing two treatment groups for skewed continuous variables in terms of a statistical test. However, it is difficult to directly estimate and interpret the location difference between the two groups on the original scale of the measurement. We propose a helpful method that infers the difference of the treatment effect on the original scale in a more easily interpretable form. We also provide statistical analysis packages that consistently include an estimate of the treatment effect, covariance adjustments, standard errors, and statistical hypothesis tests. The simulation study that focuses on randomized parallel group clinical trials with two treatment groups indicates that the performance of the proposed method is equivalent to or better than that of the existing non-parametric approaches in terms of the type-I error rate and power. We illustrate our method with cluster of differentiation 4 data in an acquired immune deficiency syndrome clinical trial. Copyright © 2015 John Wiley & Sons, Ltd.

Life cycle assessment for emerging materials: case study of a garden bed constructed from lumber produced with three different copper treatments

EPA Science Inventory

Although important data and methodological challenges facing LCA and emerging materials exist, this LCA captures material and process changes that are important drivers of environmental impacts. LCA methods need to be amended to reflect properties of emerging materials that deter...

Dysphagia Therapy in Stroke: A Survey of Speech and Language Ttherapists

ERIC Educational Resources Information Center

Archer, S. K.; Wellwood, I.; Smith, C. H.; Newham, D. J.

2013-01-01

Background: Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. Aims: To…

Motivating Latino Caregivers of Children with Asthma to Quit Smoking: A Randomized Trial

ERIC Educational Resources Information Center

Borrelli, Belinda; McQuaid, Elizabeth L.; Novak, Scott P.; Hammond, S. Katharine; Becker, Bruce

2010-01-01

Objective: Secondhand smoke exposure is associated with asthma onset and exacerbation. Latino children have higher rates of asthma morbidity than other groups. The current study compared the effectiveness of a newly developed smoking cessation treatment with existing clinical guidelines for smoking cessation. Method: Latino caregivers who smoked…

The Association of Physical Activity and Academic Behavior: A Systematic Review

ERIC Educational Resources Information Center

Sullivan, Rachel A.; Kuzel, AnnMarie H.; Vaandering, Michael E.; Chen, Weiyun

2017-01-01

Background: In this systematic review, we assessed the existing research describing the effects of physical activity (PA) on academic behavior, with a special focus on the effectiveness of the treatments applied, study designs, outcome measures, and results. Methods: We obtained data from various journal search engines and 218 journal articles…

Adults with ADHD Benefit from Cognitive-Behaviorally Oriented Group Rehabilitation: A Study of 29 Participants

ERIC Educational Resources Information Center

Virta, Maarit; Vedenpaa, Anita; Gronroos, Nina; Chydenius, Esa; Partinen, Markku; Vataja, Risto; Kaski, Markus; Iivanainen, Matti

2008-01-01

Objective: In clinical practice, a growing need exists for effective nonpharmacological treatments of adult ADHD. The authors present results from a cognitive-behaviorally oriented psychological group rehabilitation for adult ADHD. Method: A total of 29 adults with ADHD participated. Rehabilitation consisted of 10 or 11 weekly sessions.…

Treatment of Heroin Dependence: Effectiveness, Costs, and Benefits of Methadone Maintenance

ERIC Educational Resources Information Center

Schilling, Robert; Dornig, Katrina; Lungren, Lena

2006-01-01

Objectives: Social workers will increasingly be required to attend to the cost-effectiveness of practices, programs, and policies. In the area of substance abuse, there is little evidence to suggest that social workers' decisions are based on evidence of either effectiveness or costs. Method: This article provides an overview of existing evidence…

Landscape silviculture for late-successional reserve management

Treesearch

S Hummel; R.J. Barbour

2007-01-01

The effects of different combinations of multiple, variable-intensity silvicultural treatments on fire and habitat management objectives were evaluated for a ±6,000 ha forest reserve using simulation models and optimization techniques. Our methods help identify areas within the reserve where opportunities exist to minimize conflict between the dual landscape objectives...

Effects of Alternate Test Formats in Online Courses

ERIC Educational Resources Information Center

Francis, Alan

2010-01-01

The purpose of this study was to compare differences in methods of testing for two undergraduate online courses to determine the effect of alternate test formats in relation to participant grades. Specific purposes of this study were to determine whether a difference existed in student test scores between the control and treatment groups and…

Evaluation of Career Guidance Programs: Models, Methods, and Microcomputers. Information Series No. 317.

ERIC Educational Resources Information Center

Crites, John O.

Evaluating the effectiveness of career guidance programs is a complex process, and few comprehensive models for evaluating such programs exist. Evaluation of career guidance programs has been hampered by the myth that program outcomes are uniform and monolithic. Findings from studies of attribute treatment interactions have revealed only a few…

An improved method to quantitate mature plant microRNA in biological matrices using periodate treatment and internal control

USDA-ARS?s Scientific Manuscript database

MicroRNAs (miRNAs) ubiquitously exist in microorganisms, plants and animals, and appear to modulate a wide range of critical biological processes. However, no definitive conclusion has been reached regarding the uptake of exogenous dietary small RNAs into mammalian circulation and organs and cross-k...

Treatment of Pediatric Bipolar Disorder: A Review

PubMed Central

Washburn, Jason J.; West, Amy E.; Heil, Jennifer A.

2011-01-01

Aim To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). Methods A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. Results A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. Conclusion Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain. PMID:21822352

Osteochondral lesions of the ankle joint in professional soccer players: treatment with autologous matrix-induced chondrogenesis.

PubMed

Valderrabano, Victor; Barg, Alexej; Alattar, Abdulhameed; Wiewiorski, Martin

2014-12-01

Acute and recurrent ankle sprains and other trauma to the ankle joint are common injuries in soccer and can be accompanied by or result in osteochondral lesions of the ankle joint, majorly of the talus. Conservative treatment frequently fails. Several operative treatment techniques exist; however, the choice of the right procedure is difficult due to lack of literature with a high level of evidence. We present our treatment method for acute and chronic ankle osteochondral lesions with cystic formation approached by a new surgical technique combining bone plasty and a collagen matrix (autologous matrix-induced chondrogenesis). Therapeutic, Level IV: Case series. © 2014 The Author(s).

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

Orth, R.; Dauda, T.; McKenzie, D.E.

Contamination in low-permeability soils poses a significant technical challenge to in-situ remediation efforts. Poor accessibility to the contaminants and difficulty in delivery of treatment reagents have rendered existing in-situ treatments such as bioremediation, vapor extraction, and pump and treat rather ineffective when applied to low permeability soils present at many contaminated sites. The technology is an integrated in-situ treatment in which established geotechnical methods are used to install degradation zones directly in the contaminated soil and electro-osmosis is utilized to move the contaminants back and forth through those zones until the treatment is completed. The present Topical Report for Taskmore » {number_sign}3.3 summarizes the iron dechlorination research conducted by Monsanto Company.« less

[The drawbacks of diagnostic diligence].

PubMed

Giard, R W; Coebergh, J W

1998-10-03

More, earlier and better diagnostic work is being done nowadays, leasing to detection of abnormalities and preliminary stages that used to remain undetected; a large reservoir of subclinical disorders is found to exist. More intensive and sensitive diagnostic methods as a rule lead to higher disease prevalence figures, with the consequences of a seeming increase of disease risk, unnecessary further examinations, treatment and follow-up of individuals and overestimation of the effects of treatment. This may even start a vicious circle. More attention should be given to using diagnostic methods in such a way that the earlier and more frequent detection of disease actually profits the patient. The proof of this should be found in scientific (population) studies of the magnitude and severity of the burden of disease, the determinants of progression, the severity of abnormalities and diseases and the favourable effect of (early) treatment.

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

PubMed Central

Arnold, Benjamin; Arana, Byron; Mäusezahl, Daniel; Hubbard, Alan; Colford, John M

2009-01-01

Background The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities. Methods We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age. Results The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02–0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth. Conclusions To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials. PMID:19574492

Enhancing to method for extracting Social network by the relation existence

NASA Astrophysics Data System (ADS)

Elfida, Maria; Matyuso Nasution, M. K.; Sitompul, O. S.

2018-01-01

To get the trusty information about the social network extracted from the Web requires a reliable method, but for optimal resultant required the method that can overcome the complexity of information resources. This paper intends to reveal ways to overcome the constraints of social network extraction leading to high complexity by identifying relationships among social actors. By changing the treatment of the procedure used, we obtain the complexity is smaller than the previous procedure. This has also been demonstrated in an experiment by using the denial sample.

Diagnosis of coccidioidomycosis by culture: safety considerations, traditional methods, and susceptibility testing.

PubMed

Sutton, Deanna A

2007-09-01

The recovery of Coccidioides spp. by culture and confirmation utilizing the AccuProbe nucleic acid hybridization method by GenProbe remain the definitive diagnostic method. Biosafety considerations from specimen collection through culture confirmation in the mycology laboratory are critical, as acquisition of coccidioidomycosis by laboratory workers is well documented. The designation of Coccidioides spp. as select agents of potential bioterrorism has mandated strict regulation of their transport and inventory. The genus appears generally susceptible, in vitro, although no defined breakpoints exist. Susceptibility testing may assist in documenting treatment failures.

From conditioning shampoo to nanomechanics and haptics of human hair.

PubMed

Wood, Claudia; Sugiharto, Albert Budiman; Max, Eva; Fery, Andreas

2011-01-01

Shampoo treatment and hair conditioning have a direct impact on our wellbeing via properties like combability and haptic perception of hair. Therefore, systematic investigations leading to quality improvement of hair care products are of major interest. The aim of our work is a better understanding of complex testing and the correlation with quantitative parameters. The motivation for the development of physical testing methods for hair feel relates to the fact that an ingredient supplier like BASF can only find new, so far not yet toxicologically approved chemistries for hair cosmetics, if an in-vitro method exists.In this work, the effects of different shampoo treatments with conditioning polymers are investigated. The employed physical test method, dry friction measurements and AFM observe friction phenomena on a macroscopic as well as on a nanoscale directly on hair. They are an approach to complement sensoric evaluation with an objective in-vitro method.

Mediation and moderation of treatment effects in randomised controlled trials of complex interventions.

PubMed

Emsley, Richard; Dunn, Graham; White, Ian R

2010-06-01

Complex intervention trials should be able to answer both pragmatic and explanatory questions in order to test the theories motivating the intervention and help understand the underlying nature of the clinical problem being tested. Key to this is the estimation of direct effects of treatment and indirect effects acting through intermediate variables which are measured post-randomisation. Using psychological treatment trials as an example of complex interventions, we review statistical methods which crucially evaluate both direct and indirect effects in the presence of hidden confounding between mediator and outcome. We review the historical literature on mediation and moderation of treatment effects. We introduce two methods from within the existing causal inference literature, principal stratification and structural mean models, and demonstrate how these can be applied in a mediation context before discussing approaches and assumptions necessary for attaining identifiability of key parameters of the basic causal model. Assuming that there is modification by baseline covariates of the effect of treatment (i.e. randomisation) on the mediator (i.e. covariate by treatment interactions), but no direct effect on the outcome of these treatment by covariate interactions leads to the use of instrumental variable methods. We describe how moderation can occur through post-randomisation variables, and extend the principal stratification approach to multiple group methods with explanatory models nested within the principal strata. We illustrate the new methodology with motivating examples of randomised trials from the mental health literature.

Bayesian propensity scores for high-dimensional causal inference: A comparison of drug-eluting to bare-metal coronary stents.

PubMed

Spertus, Jacob V; Normand, Sharon-Lise T

2018-04-23

High-dimensional data provide many potential confounders that may bolster the plausibility of the ignorability assumption in causal inference problems. Propensity score methods are powerful causal inference tools, which are popular in health care research and are particularly useful for high-dimensional data. Recent interest has surrounded a Bayesian treatment of propensity scores in order to flexibly model the treatment assignment mechanism and summarize posterior quantities while incorporating variance from the treatment model. We discuss methods for Bayesian propensity score analysis of binary treatments, focusing on modern methods for high-dimensional Bayesian regression and the propagation of uncertainty. We introduce a novel and simple estimator for the average treatment effect that capitalizes on conjugacy of the beta and binomial distributions. Through simulations, we show the utility of horseshoe priors and Bayesian additive regression trees paired with our new estimator, while demonstrating the importance of including variance from the treatment regression model. An application to cardiac stent data with almost 500 confounders and 9000 patients illustrates approaches and facilitates comparison with existing alternatives. As measured by a falsifiability endpoint, we improved confounder adjustment compared with past observational research of the same problem. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Use of multimodality imaging and artificial intelligence for diagnosis and prognosis of early stages of Alzheimer's disease.

PubMed

Liu, Xiaonan; Chen, Kewei; Wu, Teresa; Weidman, David; Lure, Fleming; Li, Jing

2018-04-01

Alzheimer's disease (AD) is a major neurodegenerative disease and the most common cause of dementia. Currently, no treatment exists to slow down or stop the progression of AD. There is converging belief that disease-modifying treatments should focus on early stages of the disease, that is, the mild cognitive impairment (MCI) and preclinical stages. Making a diagnosis of AD and offering a prognosis (likelihood of converting to AD) at these early stages are challenging tasks but possible with the help of multimodality imaging, such as magnetic resonance imaging (MRI), fluorodeoxyglucose (FDG)-positron emission topography (PET), amyloid-PET, and recently introduced tau-PET, which provides different but complementary information. This article is a focused review of existing research in the recent decade that used statistical machine learning and artificial intelligence methods to perform quantitative analysis of multimodality image data for diagnosis and prognosis of AD at the MCI or preclinical stages. We review the existing work in 3 subareas: diagnosis, prognosis, and methods for handling modality-wise missing data-a commonly encountered problem when using multimodality imaging for prediction or classification. Factors contributing to missing data include lack of imaging equipment, cost, difficulty of obtaining patient consent, and patient drop-off (in longitudinal studies). Finally, we summarize our major findings and provide some recommendations for potential future research directions. Copyright © 2018 Elsevier Inc. All rights reserved.

Bayesian additive decision trees of biomarker by treatment interactions for predictive biomarker detection and subgroup identification.

PubMed

Zhao, Yang; Zheng, Wei; Zhuo, Daisy Y; Lu, Yuefeng; Ma, Xiwen; Liu, Hengchang; Zeng, Zhen; Laird, Glen

2017-10-11

Personalized medicine, or tailored therapy, has been an active and important topic in recent medical research. Many methods have been proposed in the literature for predictive biomarker detection and subgroup identification. In this article, we propose a novel decision tree-based approach applicable in randomized clinical trials. We model the prognostic effects of the biomarkers using additive regression trees and the biomarker-by-treatment effect using a single regression tree. Bayesian approach is utilized to periodically revise the split variables and the split rules of the decision trees, which provides a better overall fitting. Gibbs sampler is implemented in the MCMC procedure, which updates the prognostic trees and the interaction tree separately. We use the posterior distribution of the interaction tree to construct the predictive scores of the biomarkers and to identify the subgroup where the treatment is superior to the control. Numerical simulations show that our proposed method performs well under various settings comparing to existing methods. We also demonstrate an application of our method in a real clinical trial.

Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy.

PubMed

Hargrave, Catriona; Mason, Nicole; Guidi, Robyn; Miller, Julie-Anne; Becker, Jillian; Moores, Matthew; Mengersen, Kerrie; Poulsen, Michael; Harden, Fiona

2016-03-01

Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT). CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients. The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations. The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.

Agreement among dentists' restorative treatment planning thresholds for primary occlusal caries, primary proximal caries, and existing restorations: findings from The National Dental Practice-Based Research Network.

PubMed

Heaven, Tim J; Gordan, Valeria V; Litaker, Mark S; Fellows, Jeffrey L; Brad Rindal, D; Firestone, Allen R; Gilbert, Gregg H

2013-08-01

The aim of this study was to quantify the agreement among individual National Dental Practice-Based Research Network dentists' self-reported treatment decisions for primary occlusal caries, primary proximal caries, and existing restorations. Five hypothetical clinical scenarios were presented: primary occlusal caries; primary proximal caries; and whether three existing restorations should be repaired or replaced. We quantified the probability that dentists who recommended later restorative intervention for primary caries were the same ones who recommended that existing restorations be repaired instead of replaced. Dentists who recommended later restorative treatment of primary occlusal caries and proximal caries at a more-advanced stage were significantly more likely to recommend repair instead of replacement. Agreement among dentists on a threshold stage for the treatment of primary caries ranged from 40 to 68%, while that for repair or replacement of existing restorations was 36 to 43%. Dentists who recommended repair rather than replacement of existing restorations were significantly more likely to recommend later treatment of primary caries. Conversely, dentists who recommended treatment of primary caries at an earlier stage were significantly more likely to recommend replacement of the entire restoration. Between-dentist agreement for primary caries treatment was better than between-dentist agreement for repair or replacement of existing restorations. These findings suggest consistency in how individual dentists approach the treatment of primary caries and existing restorations. However, substantial variation was found between dentists in their treatment decisions about the same teeth. Copyright © 2013 Elsevier Ltd. All rights reserved.

Correlation between microdilution, Etest, and disk diffusion methods for antifungal susceptibility testing of fluconazole against Candida sp. blood isolates.

PubMed

Menezes, Everardo Albuquerque; Vasconcelos Júnior, Antônio Alexandre de; Ângelo, Maria Rozzelê Ferreira; Cunha, Maria da Conceição dos Santos Oliveira; Cunha, Francisco Afrânio

2013-01-01

Antifungal susceptibility testing assists in finding the appropriate treatment for fungal infections, which are increasingly common. However, such testing is not very widespread. There are several existing methods, and the correlation between such methods was evaluated in this study. The susceptibility to fluconazole of 35 strains of Candida sp. isolated from blood cultures was evaluated by the following methods: microdilution, Etest, and disk diffusion. The correlation between the methods was around 90%. The disk diffusion test exhibited a good correlation and can be used in laboratory routines to detect strains of Candida sp. that are resistant to fluconazole.

Complication Reducing Effect of the Information Technology-Based Diabetes Management System on Subjects with Type 2 Diabetes

PubMed Central

Cho, Jae-Hyoung; Lee, Jin-Hee; Oh, Jeong-Ah; Kang, Mi-Ja; Choi, Yoon-Hee; Kwon, Hyuk-Sang; Chang, Sang-Ah; Cha, Bong-Yun; Son, Ho-Young; Yoon, Kun-Ho

2008-01-01

Objective We introduced a new information technology-based diabetes management system, called the Internet-based glucose monitoring system (IBGMS), and demonstrated its short-term and long-term favorable effects. However, there has been no report on clinical effects of such a new diabetes management system on the development of diabetic complications so far. This study was used to simulate the complication reducing effect of the IBGMS, given in addition to existing treatments in patients with type 2 diabetes. Research Design and Methods The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to project long-term clinical outcomes in type 2 diabetes patients receiving the IBGMS in addition to their existing treatment. The model combined standard Markov submodels to simulate the incidence and progression of diabetes-related complications. Results The addition of IBGMS was associated with improvements in reducing diabetic complications, mainly microangiopathic complications, including diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and diabetic foot ulcer. The IBGMS also delayed the development of all diabetic complications for more than 1 year. Conclusions This study demonstrated that the simulated IBGMS, compared to existing treatment, was associated with a reduction of diabetic complications. As a result, it provides valuable evidence for practical application to the public in the world. PMID:19885180

Innovative research methods for studying treatments for rare diseases: methodological review.

PubMed

Gagne, Joshua J; Thompson, Lauren; O'Keefe, Kelly; Kesselheim, Aaron S

2014-11-24

To examine methods for generating evidence on health outcomes in patients with rare diseases. Methodological review of existing literature. PubMed, Embase, and Academic Search Premier searched for articles describing innovative approaches to randomized trial design and analysis methods and methods for conducting observational research in patients with rare diseases. We assessed information related to the proposed methods, the specific rare disease being studied, and outcomes from the application of the methods. We summarize methods with respect to their advantages in studying health outcomes in rare diseases and provide examples of their application. We identified 46 articles that proposed or described methods for studying patient health outcomes in rare diseases. Articles covered a wide range of rare diseases and most (72%) were published in 2008 or later. We identified 16 research strategies for studying rare disease. Innovative clinical trial methods minimize sample size requirements (n=4) and maximize the proportion of patients who receive active treatment (n=2), strategies crucial to studying small populations of patients with limited treatment choices. No studies describing unique methods for conducting observational studies in patients with rare diseases were identified. Though numerous studies apply unique clinical trial designs and considerations to assess patient health outcomes in rare diseases, less attention has been paid to innovative methods for studying rare diseases using observational data. © Gagne et al 2014.

Droplet Microarray Based on Superhydrophobic-Superhydrophilic Patterns for Single Cell Analysis.

PubMed

Jogia, Gabriella E; Tronser, Tina; Popova, Anna A; Levkin, Pavel A

2016-12-09

Single-cell analysis provides fundamental information on individual cell response to different environmental cues and is a growing interest in cancer and stem cell research. However, current existing methods are still facing challenges in performing such analysis in a high-throughput manner whilst being cost-effective. Here we established the Droplet Microarray (DMA) as a miniaturized screening platform for high-throughput single-cell analysis. Using the method of limited dilution and varying cell density and seeding time, we optimized the distribution of single cells on the DMA. We established culturing conditions for single cells in individual droplets on DMA obtaining the survival of nearly 100% of single cells and doubling time of single cells comparable with that of cells cultured in bulk cell population using conventional methods. Our results demonstrate that the DMA is a suitable platform for single-cell analysis, which carries a number of advantages compared with existing technologies allowing for treatment, staining and spot-to-spot analysis of single cells over time using conventional analysis methods such as microscopy.

Communication Skills Training in Pediatric Oncology: Moving Beyond Role Modeling

PubMed Central

Feraco, Angela M.; Brand, Sarah R.; Mack, Jennifer W.; Kesselheim, Jennifer C.; Block, Susan D.; Wolfe, Joanne

2018-01-01

Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatment-related or disease-related death. However, parents, patients, and providers report substantial communication deficits. Poor communication outcomes may stem, in part, from insufficient communication skills training, overreliance on role modeling, and failure to utilize best practices. This review summarizes evidence for existing methods to enhance communication skills and calls for revitalizing communication skills training within pediatric oncology. PMID:26822066

Communication Skills Training in Pediatric Oncology: Moving Beyond Role Modeling.

PubMed

Feraco, Angela M; Brand, Sarah R; Mack, Jennifer W; Kesselheim, Jennifer C; Block, Susan D; Wolfe, Joanne

2016-06-01

Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatment-related or disease-related death. However, parents, patients, and providers report substantial communication deficits. Poor communication outcomes may stem, in part, from insufficient communication skills training, overreliance on role modeling, and failure to utilize best practices. This review summarizes evidence for existing methods to enhance communication skills and calls for revitalizing communication skills training within pediatric oncology. © 2016 Wiley Periodicals, Inc.

Application of Theranostics in Oncology.

PubMed

Lymperopoulos, Georgios; Lymperopoulos, Panagiotis; Alikari, Victoria; Dafogianni, Chrisoula; Zyga, Sofia; Margari, Nikoletta

2017-01-01

In recent years, due to the development of nanotechnology new horizons in treatment and diagnosis of cancer open up. Development of nano-systems for simultaneous transfer of active substances and imaging of tumor regions gathers an important amount of scientific interest. This new category of nano-systems is called Theranostics. Theranostics methods can provide multiple benefits by inserting nanoparticles into the patient and using photodynamic therapy and pave the way for personalized medicine. The objective of this paper is to study the use and application of Theranostics in the diagnosis and treatment of cancer, in order to achieve personalized anticancer treatment. For this purpose, investigation of existing literature has been conducted using electronic databases, PubMed, Google Scholar and IEEE Xplore. In addition, there was a secondary research phase, using paper citations found during the first research phase. It has to be pointed out that nanoparticles are the basis of Theranostics, since, due to their properties, they provide the ability to display accurate imaging and provide diagnosis along with simultaneous treatment of diseases. Theranostics methods may be applied in treatment of esophageal cancer, prostate cancer, breast cancer, in treatment of actinic keratosis, actinic cheilitis and Bowen's disease and in treatment of basal cell epithelioma and macular degeneration. As a result, application of Theranostics can provide multiple benefits by inserting nanoparticles into the patient. This method is currently encountering many challenges, but continuation of research on the field is necessary not only for the improvement of the medical field and the healthcare techniques, but also for the creation of new treatment methods for patients with diseases that are incurable until now.

Proposal of an environmental performance index to assess solid waste treatment technologies.

PubMed

Coelho, Hosmanny Mauro Goulart; Lange, Liséte Celina; Coelho, Lineker Max Goulart

2012-07-01

Although the concern with sustainable development and environment protection has considerably grown in the last years it is noted that the majority of decision making models and tools are still either excessively tied to economic aspects or geared to the production process. Moreover, existing models focus on the priority steps of solid waste management, beyond waste energy recovery and disposal. So, in order to help the lack of models and tools aiming at the waste treatment and final disposal, a new concept is proposed: the Cleaner Treatment, which is based on the Cleaner Production principles. This paper focuses on the development and validation of the Cleaner Treatment Index (CTI), to assess environmental performance of waste treatment technologies based on the Cleaner Treatment concept. The index is formed by aggregation (summation or product) of several indicators that consists in operational parameters. The weights of the indicator were established by Delphi Method and Brazilian Environmental Laws. In addition, sensitivity analyses were carried out comparing both aggregation methods. Finally, index validation was carried out by applying the CTI to 10 waste-to-energy plants data. From sensitivity analysis and validation results it is possible to infer that summation model is the most suitable aggregation method. For summation method, CTI results were superior to 0.5 (in a scale from 0 to 1) for most facilities evaluated. So, this study demonstrates that CTI is a simple and robust tool to assess and compare the environmental performance of different treatment plants being an excellent quantitative tool to support Cleaner Treatment implementation. Copyright © 2012 Elsevier Ltd. All rights reserved.

A modular approach to intensity-modulated arc therapy optimization with noncoplanar trajectories

NASA Astrophysics Data System (ADS)

Papp, Dávid; Bortfeld, Thomas; Unkelbach, Jan

2015-07-01

Utilizing noncoplanar beam angles in volumetric modulated arc therapy (VMAT) has the potential to combine the benefits of arc therapy, such as short treatment times, with the benefits of noncoplanar intensity modulated radiotherapy (IMRT) plans, such as improved organ sparing. Recently, vendors introduced treatment machines that allow for simultaneous couch and gantry motion during beam delivery to make noncoplanar VMAT treatments possible. Our aim is to provide a reliable optimization method for noncoplanar isocentric arc therapy plan optimization. The proposed solution is modular in the sense that it can incorporate different existing beam angle selection and coplanar arc therapy optimization methods. Treatment planning is performed in three steps. First, a number of promising noncoplanar beam directions are selected using an iterative beam selection heuristic; these beams serve as anchor points of the arc therapy trajectory. In the second step, continuous gantry/couch angle trajectories are optimized using a simple combinatorial optimization model to define a beam trajectory that efficiently visits each of the anchor points. Treatment time is controlled by limiting the time the beam needs to trace the prescribed trajectory. In the third and final step, an optimal arc therapy plan is found along the prescribed beam trajectory. In principle any existing arc therapy optimization method could be incorporated into this step; for this work we use a sliding window VMAT algorithm. The approach is demonstrated using two particularly challenging cases. The first one is a lung SBRT patient whose planning goals could not be satisfied with fewer than nine noncoplanar IMRT fields when the patient was treated in the clinic. The second one is a brain tumor patient, where the target volume overlaps with the optic nerves and the chiasm and it is directly adjacent to the brainstem. Both cases illustrate that the large number of angles utilized by isocentric noncoplanar VMAT plans can help improve dose conformity, homogeneity, and organ sparing simultaneously using the same beam trajectory length and delivery time as a coplanar VMAT plan.

Microbial sequencing methods for monitoring of anaerobic treatment of antibiotics to optimize performance and prevent system failure.

PubMed

Aydin, Sevcan

2016-06-01

As a result of developments in molecular technologies and the use of sequencing technologies, the analyses of the anaerobic microbial community in biological treatment process has become increasingly prevalent. This review examines the ways in which microbial sequencing methods can be applied to achieve an extensive understanding of the phylogenetic and functional characteristics of microbial assemblages in anaerobic reactor if the substrate is contaminated by antibiotics which is one of the most important toxic compounds. It will discuss some of the advantages and disadvantages associated with microbial sequencing techniques that are more commonly employed and will assess how a combination of the existing methods may be applied to develop a more comprehensive understanding of microbial communities and improve the validity and depth of the results for the enhancement of the stability of anaerobic reactors.

SU-F-T-242: A Method for Collision Avoidance in External Beam Radiation Therapy

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

Buzurovic, I; Cormack, R

2016-06-15

Purpose: We proposed a method for collision avoidance (CA) in external beam radiation therapy (EBRT). The method encompasses the analysis of all positions of the moving components of the beam delivery system such as the treatment table and gantry, including patient specific information obtained from the CT images. This method eliminates the need for time-consuming dry-runs prior to the actual treatments. Methods: The QA procedure for EBRT requires that the collision should be checked prior to treatment. We developed a system capable of a rigorous computer simulation of all moving components including positions of the couch and gantry during themore » delivery, position of the patients, and imaging equipment. By running this treatment simulation it is possible to quantify and graphically represent all positions and corresponding trajectories of all points of the moving parts during the treatment delivery. The development of the workflow for implementation of the CA includes several steps: a) derivation of combined dynamic equation of motion of the EBRT delivery systems, b) developing the simulation model capable of drawing the motion trajectories of the specific points, c) developing the interface between the model and the treatment plan parameters such as couch and gantry parameters for each field. Results: The patient CT images were registered to the treatment couch so the patient dimensions were included into the simulation. The treatment field parameters were structured in the xml-file which was used as the input into the dynamic equations. The trajectories of the moving components were plotted on the same graph using the dynamic equations. If the trajectories intersect that was the signal that collision exists. Conclusion: This CA method was proved to be effective in the simulation of treatment delivery. The proper implementation of this system can potentially improve the QA program and increase the efficacy in the clinical setup.« less

Education Level and Critical Thinking Skills among Substance Use Counselors Nationwide: A Descriptive Comparative Study

ERIC Educational Resources Information Center

Eakman, Teresa L.

2017-01-01

As a high percentage of substance use counselors are in recovery, using adult learning methods such as constructivism and transformational learning are needed to neutralize any preestablished views of treatment modalities that may exist, as well as combat any possible issues of countertransference. Teaching critical thinking leads to student…

Within-Subject Comparison of Changes in a Pretest-Posttest Design

ERIC Educational Resources Information Center

Hennig, Christian; Mullensiefen, Daniel; Bargmann, Jens

2010-01-01

The authors propose a method to compare the influence of a treatment on different properties within subjects. The properties are measured by several Likert-type-scaled items. The results show that many existing approaches, such as repeated measurement analysis of variance on sum and mean scores, a linear partial credit model, and a graded response…

A Parent-Only Group Intervention for Children with Anxiety Disorders: Pilot Study

ERIC Educational Resources Information Center

Thienemann, Margo; Moore, Phoebe; Tompkins, Kim

2006-01-01

Objective: Working to optimize treatment outcome and use resources efficiently, investigators conducted the first test of an existing parent-only group cognitive-behavioral therapy protocol to treat 24 children 7 to 16 years old with primary anxiety disorder diagnoses. Method: Over the course of 7 months, the authors evaluated a manual-based…

Enhancing the Effectiveness of Juvenile Drug Courts by Integrating Evidence-Based Practices

ERIC Educational Resources Information Center

Henggeler, Scott W.; McCart, Michael R.; Cunningham, Phillippe B.; Chapman, Jason E.

2012-01-01

Objective: The primary purpose of this study was to test a relatively efficient strategy for enhancing the capacity of juvenile drug courts (JDC) to reduce youth substance use and criminal behavior by incorporating components of evidence-based treatments into their existing services. Method: Six JDCs were randomized to a condition in which…

Efficiency of Artemia cysts removal as a model invasive spore using a continuous microwave system with heat recovery.

PubMed

Balasubramanian, Sundar; Ortego, Jeffrey; Rusch, Kelly A; Boldor, Dorin

2008-12-15

A continuous microwave system to treat ballast water inoculated with Artemia salina cysts as a model invasive spore was tested for its efficacy in inactivating the cysts present. The system was tested at two different flow rates (1 and 2 L x min(-1)) and two different power levels (2.5 and 4.5 kW). Temperature profiles indicate that the system could deliver heating loads in excess of 100 degrees C in a uniform and near-instantaneous manner when using a heat recovery system. Except for a power and flow rate combination of 2.5 kW and 2 L x min(-1), complete inactivation of the cysts was observed at all combinations at holding times below 100 s. The microwave treatment was better or equal to the control treatment in inactivating the cysts. Use of heat exchangers increased the power conversion efficiency and the overall efficiency of the treatment system. Cost economics analysis indicates that in the present form of development microwave treatment costs are higher than the existing ballast water treatment methods. Overall, tests results indicated that microwave treatment of ballast water is a promising method that can be used in conjunction with other methods to form an efficient treatment system that can prevent introduction of potentially invasive spore forming species in non-native waters.

Density matters: Review of approaches to setting organism-based ballast water discharge standards

USGS Publications Warehouse

Lee II,; Frazier,; Ruiz,

2010-01-01

As part of their effort to develop national ballast water discharge standards under NPDES permitting, the Office of Water requested that WED scientists identify and review existing approaches to generating organism-based discharge standards for ballast water. Six potential approaches were identified and the utility and uncertainties of each approach was evaluated. During the process of reviewing the existing approaches, the WED scientists, in conjunction with scientists at the USGS and Smithsonian Institution, developed a new approach (per capita invasion probability or "PCIP") that addresses many of the limitations of the previous methodologies. THE PCIP approach allows risk managers to generate quantitative discharge standards using historical invasion rates, ballast water discharge volumes, and ballast water organism concentrations. The statistical power of sampling ballast water for both the validation of ballast water treatment systems and ship-board compliance monitoring with the existing methods, though it should be possible to obtain sufficient samples during treatment validation. The report will go to a National Academy of Sciences expert panel that will use it in their evaluation of approaches to developing ballast water discharge standards for the Office of Water.

On Bayesian methods of exploring qualitative interactions for targeted treatment.

PubMed

Chen, Wei; Ghosh, Debashis; Raghunathan, Trivellore E; Norkin, Maxim; Sargent, Daniel J; Bepler, Gerold

2012-12-10

Providing personalized treatments designed to maximize benefits and minimizing harms is of tremendous current medical interest. One problem in this area is the evaluation of the interaction between the treatment and other predictor variables. Treatment effects in subgroups having the same direction but different magnitudes are called quantitative interactions, whereas those having opposite directions in subgroups are called qualitative interactions (QIs). Identifying QIs is challenging because they are rare and usually unknown among many potential biomarkers. Meanwhile, subgroup analysis reduces the power of hypothesis testing and multiple subgroup analyses inflate the type I error rate. We propose a new Bayesian approach to search for QI in a multiple regression setting with adaptive decision rules. We consider various regression models for the outcome. We illustrate this method in two examples of phase III clinical trials. The algorithm is straightforward and easy to implement using existing software packages. We provide a sample code in Appendix A. Copyright © 2012 John Wiley & Sons, Ltd.

Metformin: A Review of Characteristics, Properties, Analytical Methods and Impact in the Green Chemistry.

PubMed

da Trindade, Mariana Teixeira; Kogawa, Ana Carolina; Salgado, Hérida Regina Nunes

2018-01-02

Diabetes mellitus (DM) is considered a public health problem. The initial treatment consists of improving the lifestyle and making changes in the diet. When these changes are not enough, the use of medication becomes necessary. The metformin aims to reduce the hepatic production of glucose and is the preferred treatment for type 2. The objective is to survey the characteristics and properties of metformin, as well as hold a discussion on the existing analytical methods to green chemistry and their impacts for both the operator and the environment. For the survey, data searches were conducted by scientific papers in the literature as well as in official compendium. The characteristics and properties are shown, also, methods using liquid chromatography techniques, titration, absorption spectrophotometry in the ultraviolet and the infrared region. Most of the methods presented are not green chemistry oriented. It is necessary the awareness of everyone involved in the optimization of the methods applied through the implementation of green chemistry to determine the metformin.

Effect of atmospheric plasma treatment on seed germination of rice (Oryza sativa L.)

NASA Astrophysics Data System (ADS)

Penado, Keith Nealson M.; Mahinay, Christian Lorenz S.; Culaba, Ivan B.

2018-01-01

Multiple methods of improving plant development have been utilized over the past decades. Despite these improvements, there still exists a need for better planting methods due to the increasing population of a global community. Studies have reported that plasma treatment affects the growth and germination of a variety of plant species, including a multitude of grains which often takes the bulk in the diet of the average human being. This study explores the effect of atmospheric air plasma jet treatment on the seed germination of rice (Oryza sativa L.). The seeds were treated using an atmospheric air plasma jet for 1, 2, and 3 s. The effect of plasma exposure shows a reduction of trichomes on the surface of the seed. This caused a possible increase in wettability which significantly affected the seed germ length but did not affect the seed germination count after the germination period of 72 h.

Foley catheter balloon endometrial ablation: successful treatment of three cases.

PubMed

Api, Murat; Api, Olus

2012-03-01

Endometrial ablation is one of the most effective methods for treatment of dysfunctional uterine bleeding (DUB). Balloon devices with circulating hot water inside or electrodes on the outer surface and radiofrequency-induced thermal destructors are the most recently introduced available tools for endometrial ablation. All of these methods are effective and simple but expensive technologies. The aim of this brief report is to evaluate the effectiveness and safety of a new, simple and money-saving procedure, namely foley catheter balloon endometrial ablation (FCBEA), for treatment of DUB. We present our experience with FCBEA performed on 3 women with severe meno-metrorrhagia unresponsive to medical therapy. There were no procedure-related complications with achievement of complete amenorrhea for a 19 months follow-up period. Although FCBA has yielded encouraging results, there exists a need for further investigation and validation on larger groups, before its universal application.

Application of TOPSIS and VIKOR improved versions in a multi criteria decision analysis to develop an optimized municipal solid waste management model.

PubMed

Aghajani Mir, M; Taherei Ghazvinei, P; Sulaiman, N M N; Basri, N E A; Saheri, S; Mahmood, N Z; Jahan, A; Begum, R A; Aghamohammadi, N

2016-01-15

Selecting a suitable Multi Criteria Decision Making (MCDM) method is a crucial stage to establish a Solid Waste Management (SWM) system. Main objective of the current study is to demonstrate and evaluate a proposed method using Multiple Criteria Decision Making methods (MCDM). An improved version of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) applied to obtain the best municipal solid waste management method by comparing and ranking the scenarios. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Besides, Viekriterijumsko Kompromisno Rangiranje (VIKOR) compromise solution method applied for sensitivity analyses. The proposed method can assist urban decision makers in prioritizing and selecting an optimized Municipal Solid Waste (MSW) treatment system. Besides, a logical and systematic scientific method was proposed to guide an appropriate decision-making. A modified TOPSIS methodology as a superior to existing methods for first time was applied for MSW problems. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Next, 11 scenarios of MSW treatment methods are defined and compared environmentally and economically based on the waste management conditions. Results show that integrating a sanitary landfill (18.1%), RDF (3.1%), composting (2%), anaerobic digestion (40.4%), and recycling (36.4%) was an optimized model of integrated waste management. An applied decision-making structure provides the opportunity for optimum decision-making. Therefore, the mix of recycling and anaerobic digestion and a sanitary landfill with Electricity Production (EP) are the preferred options for MSW management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bonding between oxide ceramics and adhesive cement systems: a systematic review.

PubMed

Papia, Evaggelia; Larsson, Christel; du Toit, Madeleine; Vult von Steyern, Per

2014-02-01

The following aims were set for this systematic literature review: (a) to make an inventory of existing methods to achieve bondable surfaces on oxide ceramics and (b) to evaluate which methods might provide sufficient bond strength. Current literature of in vitro studies regarding bond strength achieved using different surface treatments on oxide ceramics in combination with adhesive cement systems was selected from PubMed and systematically analyzed and completed with reference tracking. The total number of publications included for aim a was 127 studies, 23 of which were used for aim b. The surface treatments are divided into seven main groups: as-produced, grinding/polishing, airborne particle abrasion, surface coating, laser treatment, acid treatment, and primer treatment. There are large variations, making comparison of the studies difficult. An as-produced surface of oxide ceramic needs to be surface treated to achieve durable bond strength. Abrasive surface treatment and/or silica-coating treatment with the use of primer treatment can provide sufficient bond strength for bonding oxide ceramics. This conclusion, however, needs to be confirmed by clinical studies. There is no universal surface treatment. Consideration should be given to the specific materials to be cemented and to the adhesive cement system to be used. Copyright © 2013 Wiley Periodicals, Inc.

Nonoperative treatment of low back pain.

PubMed

Malanga, G A; Nadler, S F

1999-11-01

Low back pain is a common problem with substantial social and economic issues. Physicians continue to have difficulty managing this condition despite an increased awareness of its magnitude. In addition, there is a misperception about the outcome of patients affected with low back pain; most continue to suffer from pain. We present a nonoperative approach and review various diagnostic and treatment strategies with respect to both scientific and clinical merit. Although many treatment strategies have not been well proved in the scientific literature, thoughtful review of the available information provides a basis for the use of these treatment methods in the patient with refractory pain. This approach can be used in conjunction with existing information to assist clinicians in the management of patients with acute low back pain.

Neurofeedback Treatment and Posttraumatic Stress Disorder: Effectiveness of Neurofeedback on Posttraumatic Stress Disorder and the Optimal Choice of Protocol.

PubMed

Reiter, Karen; Andersen, Søren Bo; Carlsson, Jessica

2016-02-01

Neurofeedback is an alternative, noninvasive approach used in the treatment of a wide range of neuropsychiatric disorders, including posttraumatic stress disorder (PTSD). Many different neurofeedback protocols and methods exist. Likewise, PTSD is a heterogeneous disorder. To review the evidence on effectiveness and preferred protocol when using neurofeedback treatment on PTSD, a systematic search of PubMed, PsychInfo, Embase, and Cochrane databases was undertaken. Five studies were included in this review. Neurofeedback had a statistically significant effect in three studies. Neurobiological changes were reported in three studies. Interpretation of results is, however, limited by differences between the studies and several issues regarding design. The optimistic results presented here qualify neurofeedback as probably efficacious for PTSD treatment.

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

Athmer, C.; Ho, S.V.; Hughes, B.M.

Contamination in low-permeability soils poses a significant technical challenge to in-situ remediation efforts. Poor accessibility to the contaminants and difficulty in delivery of treatment reagents have rendered existing in-situ treatments such as bioremediation, vapor extraction, and pump and treat rather ineffective when applied to low permeability soils present at many contaminated sites. The technology is an integrated in-situ treatment in which established geotechnical methods are used to install degradation zones directly in the contaminated soil and electro-osmosis is utilized to move the contaminants back and forth through those zones until the treatment is completed. The present Topical Report for Taskmore » {number_sign}7.2 summarizes the Field Scale Test conducted by Monsanto Company, DuPont, and General Electric.« less

Empirical likelihood inference in randomized clinical trials.

PubMed

Zhang, Biao

2017-01-01

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

Evaluation of the hazardous impact of landfill leachates by toxicity and biodegradability tests.

PubMed

Kalcíková, G; Vávrová, M; Zagorc-Koncan, J; Gotvajn, A Zgajnar

2011-01-01

The aim of our research was to assess the ecotoxicity and biodegradability of leachates originating from two parts of a municipal landfill before and after biological treatment in the existing treatment plant. Biotests represent important tools for adequate environmental characterization of landfill leachates and could be helpful in reliable assessment and monitoring of the treatment plant efficiency. For ecotoxicity testing of landfill leachate before and after biological treatment, different organisms were chosen: the bacteria Vibrio fischeri, a mixed culture of activated sludge, duckweed Lemna minor, white mustard Sinapis alba, brine shrimp Artemia salina, and water flea Daphnia magna. For assessment of biodegradability, the method for determination of oxygen demand in a closed respirometer was used. The investigated leachates were heavily polluted, and in some cases, effluent limits were exceeded even after treatment. Results indicated that toxicity tests and physico-chemical parameters determined before and after treatment equivalently assess the efficiency of the existing treatment plant. However, the investigated leachates showed higher toxicity to Daphnia magna and especially to Lemna minor in contrast to Vibrio fischeri and Artemia salina (neither was sensitive to any of the leachates). No leachates were readily biodegradable. Experiments confirmed that the battery of toxicity tests should be applied for more comprehensive assessment of landfill leachate treatment and for reliable assessment of the treated leachate's subsequent environmental impact. It was confirmed that treated leachate, in spite of its better physico-chemical characteristics, still represents a potential environmental risk and thus should not be released into the environment.

A Review: Hair Health, Concerns of Shampoo Ingredients and Scalp Nourishing Treatments.

PubMed

Chiu, Chin-Hsien T; Huang, Shu-Hung; Wang, Hui-Min D

2015-01-01

Human hair serves a biological purpose of protecting the scalp, as well as physical attractiveness to the perception of beauty. Hair loss, graying of hair, dandruff and other conditions affecting hair conditions can be distressing to patients, as hair condition is often considered important in people's own assessment of physical beauty. Different hair types can benefit from different treatment methods to promote hair health and growth. External factors like exposure to the sun and smoking, dietary factors including malnutrition of essential fatty acids and vitamins, and chemicals applied to the hair and scalp in shampoos and other treatments can all cause damage to existing hair and impair hair growth. Specific chemicals found in many shampoos, including antimicrobial agents, surfactants and preservatives, can all impair different aspects of hair health. In this review, we aim to discuss the main hair issues, such as hair loss, followed by the safety assessments of selected ingredients in shampoo, and possible nourishment for scalp improvement. This review highlights areas of disagreement in the existing literature, and points to new directions for future studies. Key conclusions include the carcinogenic chemicals to avoid, alternatives of such ingredients, and scalp nourishing treatments with micronutrients.

Treatment of PTSD-Related Anger in Troops Returning from Hazardous Deployments

DTIC Science & Technology

2007-03-01

adapt an existing evidenced- based cognitive- behavioral intervention (CBI) for the treatment of anger to specific needs of military personnel...related anger problems. The specific objectives are to adapt an existing evidenced-based cognitive- behavioral intervention (CBI) for the treatment of anger...objectives are to 1) adapt an existing evidenced- based cognitive- behavioral intervention (CBI) for the treatment of anger to specific needs of military

Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

NASA Astrophysics Data System (ADS)

Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

2015-05-01

Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

A method for the definition of a self-awareness behavior dimension with clinical subjects: a latent trait analysis.

PubMed

Mannarini, Stefania

2009-11-01

The main scope of the present study was to devise a method in order to define a dimension characteristic of self-awareness behaviors with clinical subjects. To do so, I adopted a latent trait methodological approach. I studied the way patients expressed their treatment requests through their behaviors, both during their admission to a medical center in Northern Italy and after a period of treatment that involved an integrated (psychoanalytical and pharmacological) approach. The subjects were 48 females suffering from affective disorders, often combined with personality disorders. Five self-awareness indicators were identified, based both on interviews conducted with the patients and on the literature on the subject. The data gathered were analyzed by means of the many-facet Rasch model (Linacre, 1989). The results confirmed the existence of a self-awareness dimension characterized by the five indicators. Moreover, there was evidence that an improvement in self-awareness occurred during the pretreatment to posttreatment time period for both the affective disorders with personality problems patients and the affective disorders without personality problems patients. The estimation of bias/interactions showed the existence of specific behavioral differences between the two groups of patients. This study demonstrates the appropriateness of the methodological tool adopted, opening new expectations with regard to the integration of two approaches-psychoanalytical and pharmacological ones-in the treatment of psychiatric subjects.

L-Asparaginase encapsulated intact erythrocytes for treatment of acute lymphoblastic leukemia (ALL).

PubMed

Kwon, Young Min; Chung, Hee Sun; Moon, Cheol; Yockman, James; Park, Yoon Jeong; Gitlin, Scott D; David, Allan E; Yang, Victor C

2009-11-03

As a primary drug for the treatment of acute lymphoblastic leukemia (ALL), encapsulation of L-asparaginase (ASNase) into red blood cells (RBC) has been popular to circumvent immunogenicity from the exogenous protein. Unlike existing methods that perturbs RBC membranes, we introduce a novel method of RBC-incorporation of proteins using the membrane-translocating low molecular weight protamine (LMWP). Confocal study of fluorescence-labeled LMWP-ovalbumin, as a model protein conjugate, has shown significant fluorescence inside RBCs. Surface morphology by scanning electron microscopy of the RBCs loaded with LMWP-ASNase was indistinguishable with normal RBCs. These drug loaded RBCs also closely resembled the profile of the native erythrocytes in terms of osmotic fragility, oxygen dissociation and hematological parameters. The in vivo half-life of enzyme activity after administering 8 units of RBC/LMWP-ASNase in DBA/2 mice was prolonged to 4.5+/-0.5 days whereas that of RBCs loaded with ASNase via a hypotonic method was 2.4+/-0.7 days. Furthermore, the mean survival time of DBA/2 mice bearing mouse lymphoma cell L5178Y was improved by approximately 44% compared to the saline control group after treatment with the RBC loaded enzymes. From these data, an innovative, novel method for encapsulating proteins into intact and fully functional erythrocytes was established for potential treatment of ALL.

[FMEA applied to the radiotherapy patient care process].

PubMed

Meyrieux, C; Garcia, R; Pourel, N; Mège, A; Bodez, V

2012-10-01

Failure modes and effects analysis (FMEA), is a risk analysis method used at the Radiotherapy Department of Institute Sainte-Catherine as part of a strategy seeking to continuously improve the quality and security of treatments. The method comprises several steps: definition of main processes; for each of them, description for every step of prescription, treatment preparation, treatment application; identification of the possible risks, their consequences, their origins; research of existing safety elements which may avoid these risks; grading of risks to assign a criticality score resulting in a numerical organisation of the risks. Finally, the impact of proposed corrective actions was then estimated by a new grading round. For each process studied, a detailed map of the risks was obtained, facilitating the identification of priority actions to be undertaken. For example, we obtain five steps in patient treatment planning with an unacceptable level of risk, 62 a level of moderate risk and 31 an acceptable level of risk. The FMEA method, used in the industrial domain and applied here to health care, is an effective tool for the management of risks in patient care. However, the time and training requirements necessary to implement this method should not be underestimated. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Proposal of an environmental performance index to assess solid waste treatment technologies

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

Goulart Coelho, Hosmanny Mauro, E-mail: hosmanny@hotmail.com; Lange, Lisete Celina; Coelho, Lineker Max Goulart

2012-07-15

Highlights: Black-Right-Pointing-Pointer Proposal of a new concept in waste management: Cleaner Treatment. Black-Right-Pointing-Pointer Development of an index to assess quantitatively waste treatment technologies. Black-Right-Pointing-Pointer Delphi Method was carried out so as to define environmental indicators. Black-Right-Pointing-Pointer Environmental performance evaluation of waste-to-energy plants. - Abstract: Although the concern with sustainable development and environment protection has considerably grown in the last years it is noted that the majority of decision making models and tools are still either excessively tied to economic aspects or geared to the production process. Moreover, existing models focus on the priority steps of solid waste management, beyond wastemore » energy recovery and disposal. So, in order to help the lack of models and tools aiming at the waste treatment and final disposal, a new concept is proposed: the Cleaner Treatment, which is based on the Cleaner Production principles. This paper focuses on the development and validation of the Cleaner Treatment Index (CTI), to assess environmental performance of waste treatment technologies based on the Cleaner Treatment concept. The index is formed by aggregation (summation or product) of several indicators that consists in operational parameters. The weights of the indicator were established by Delphi Method and Brazilian Environmental Laws. In addition, sensitivity analyses were carried out comparing both aggregation methods. Finally, index validation was carried out by applying the CTI to 10 waste-to-energy plants data. From sensitivity analysis and validation results it is possible to infer that summation model is the most suitable aggregation method. For summation method, CTI results were superior to 0.5 (in a scale from 0 to 1) for most facilities evaluated. So, this study demonstrates that CTI is a simple and robust tool to assess and compare the environmental performance of different treatment plants being an excellent quantitative tool to support Cleaner Treatment implementation.« less

Evaluation of standardized and applied variables in predicting treatment outcomes of polytrauma patients.

PubMed

Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Muhovic, Samir; Gavric, Igor

2011-01-01

Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury.

PubMed

Tao, Zhen-Yu; Gao, Peng; Yan, Yu-Hui; Li, Hong-Yan; Song, Jie; Yang, Jing-Xian

2017-01-01

Neuroendoscopy processes can cause severe traumatic brain injury. Existing therapeutic methods, such as neural stem cell transplantation and osthole have not been proven effective. Therefore, there is an emerging need on the development of new techniques for the treatment of brain injuries. In this study we propose to combine the above stem cell based methods and then evaluate the efficiency and accuracy of the new method. Mice were randomly divided into four groups: group 1 (brain injury alone); group 2 (osthole); group 3 (stem cell transplantation); and group 4 (osthole combined with stem cell transplantation). We carried out water maze task to exam spatial memory. Immunocytochemistry was used to test the inflammatory condition of each group, and the differentiation of stem cells. To evaluate the condition of the damaged blood brain barrier restore, we detect the Evans blue (EB) extravasation across the blood brain barrier. The result shows that osthole and stem cell transplantation combined therapeutic method has a potent effect on improving the spatial memory. This combined method was more effective on inhibiting inflammation and preventing neuronal degeneration than the single treated ones. In addition, there was a distinct decline of EB extravasation in the combined treatment groups, which was not observed in single treatment groups. Most importantly, the combined usage of osthole and stem cell transplantation provide a better treatment for the traumatic brain injury caused by neuroendoscopy. The collective evidence indicates osthole combined with neural stem cell transplantation is superior than either method alone for the treatment of traumatic brain injury caused by neuroendoscopy.

4D dose calculation and delivery with interplay effects between respiratory motion and uniform scanning proton beam

NASA Astrophysics Data System (ADS)

Zhao, Qingya

2011-12-01

Proton radiotherapy has advantages to deliver accurate high conformal radiation dose to the tumor while sparing the surrounding healthy tissue and critical structures. However, the treatment effectiveness is degraded greatly due to patient free breathing during treatment delivery. Motion compensation for proton radiotherapy is especially challenging as proton beam is more sensitive to the density change along the beam path. Tumor respiratory motion during treatment delivery will affect the proton dose distribution and the selection of optimized parameters for treatment planning, which has not been fully addressed yet in the existing approaches for proton dose calculation. The purpose of this dissertation is to develop an approach for more accurate dose delivery to a moving tumor in proton radiotherapy, i.e., 4D proton dose calculation and delivery, for the uniform scanning proton beam. A three-step approach has been carried out to achieve this goal. First, a solution for the proton output factor calculation which will convert the prescribed dose to machine deliverable monitor unit for proton dose delivery has been proposed and implemented. The novel sector integration method is accurate and time saving, which considers the various beam scanning patterns and treatment field parameters, such as aperture shape, aperture size, measuring position, beam range, and beam modulation. Second, tumor respiratory motion behavior has been statistically characterized and the results have been applied to advanced image guided radiation treatment. Different statistical analysis and correlation discovery approaches have been investigated. The internal / external motion correlation patterns have been simulated, analyzed, and applied in a new hybrid gated treatment to improve the target coverage. Third, a dose calculation method has been developed for 4D proton treatment planning which integrates the interplay effects of tumor respiratory motion patterns and proton beam delivery mechanism. These three steps provide an innovative integrated framework for accurate 4D proton dose calculation and treatment planning for a moving tumor, which extends the functionalities of existing 3D planning systems. In short, this dissertation work addresses a few important problems for effective proton radiotherapy to a moving target. The outcomes of the dissertation are very useful for motion compensation with advanced image guided proton treatment.

Treatment of cervical cancer in HIV-seropositive women from developing countries: a protocol for a systematic review.

PubMed

Mapanga, Witness; Chipato, Tsungai; Feresu, Shingairai A

2018-01-25

Cervical cancer has become the most common cancer affecting women in Africa. Significantly, 85% of these annual deaths occur in the developing world, with the majority being middle-aged women. Research has shown that in sub-Saharan Africa, cervical cancer trends are on the rise in the past two decades because of HIV and this has resulted in an increase in cervical cancer cases among young women. However, little or no information exists that has shown that any of the available treatment methods are more effective than others when it comes to treating cervical cancer in HIV-seropositive women. The aim of this protocol is to offer a plan on how to systematically review cervical cancer treatment methods available for HIV-seropositive women in developing countries. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement was used to develop the protocol for the systematic review which will be reported in accordance with the PRISMA guidelines. A number of databases, Embase, MEDLINE, PubMed, CINAHL and Cochrane Library, will be searched for relevant studies, and citation and reference list tracking will be used to search for additional studies. Prospective and retrospective cohort studies, case-control, randomised controlled trials and cross-sectional studies that were carried out in and for the developing world will be eligible for inclusion. Peer-reviewed studies and grey literature examining cervical cancer treatment modalities in HIV-seropositive women will be included. Descriptive statistics and tables will be used to summarise results, and meta-analysis will be used where appropriate. The review findings will provide the current picture of the existing treatment methods being used to treat cervical cancer in HIV-seropositive women in developing countries. The findings might be used for the establishment of evidence-based guidelines for treatment of cervical cancer in seropositive women as well as prompt policy-makers and governments to decide and support future research in a way to find a lasting solution. PROSPERO CRD42017054676 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=54676.

Systematic Review of Patients' and Parents' Preferences for ADHD Treatment Options and Processes of Care.

PubMed

Schatz, Nicole K; Fabiano, Gregory A; Cunningham, Charles E; dosReis, Susan; Waschbusch, Daniel A; Jerome, Stephanie; Lupas, Kellina; Morris, Karen L

2015-12-01

Patient preferences are an important topic of study with respect to attention-deficit hyperactivity disorder (ADHD) interventions, as there are multiple treatment choices available, multiple developmental levels to consider, and multiple potential individuals involved in treatment (children, parents, and adults with ADHD). Stated preference methods such as discrete choice experiment (DCE), best-worst scaling (BWS), and other utility value methods such as standard gamble interview (SGI) and time trade-off (TTO) are becoming more common in research addressing preferences for ADHD treatments. A synthesis of this research may facilitate improved patient-centered and family-centered treatment for ADHD. The purpose of this review was to synthesize reports across existing DCE, BWS, TTO, and SGI studies to assess which aspects of ADHD treatment are most studied as well as most preferred and influential in treatment decisions. MEDLINE, PsycINFO. A total of 41 studies referring to preferences for ADHD treatment were identified through the initial search and contact with researchers. Of these, 13 reported ADHD treatment preference data from a study using DCE, BWS, or SGI methods. No TTO studies were identified that met inclusion criteria. Methods and designs varied considerably across studies. Relatively few studies focused on preferences among children, adolescents, and adults compared with those that focused on the preferences of parents of children with ADHD. The majority of studies focused primarily on medication treatments, with many fewer focused on psychosocial treatments. Some studies indicated that parents of children with ADHD prefer to avoid stimulant medications in favor of behavioral or psychosocial interventions. Others report that parents see medication as a preferred treatment. Treatment outcome is a particularly salient attribute for treatment decisions for many informants. Potential outcomes of various treatments play a proximal role in patients' and families' decisions for ADHD treatment. Because the majority of studies focus on medication treatments for children with ADHD, more research is necessary to understand preferences related to behavioral and other psychosocial treatments both as stand-alone interventions and used in combination with medication. Additional research is also needed to assess the treatment preferences of adults with ADHD. In general, DCE, BWS, and SGI methods allow measurement of patient preferences in a manner that approximates the uncertainty and trade-offs inherent in real-world treatment decision making and provides valuable information to inform patient-centered and family-centered treatment.

Extensions of Existing Methods for Use with a New Class of Experimental Designs Useful when There Is Treatment Effect Contamination

ERIC Educational Resources Information Center

Rhoads, Christopher

2011-01-01

Researchers planning a randomized field trial to evaluate the effectiveness of an educational intervention often face the following dilemma. They plan to recruit schools to participate in their study. The question is, "Should the researchers randomly assign individuals (either students or teachers, depending on the intervention) within schools to…

Creating Abbreviated Rating Scales to Monitor Classroom Inattention-Overactivity, Aggression, and Peer Conflict: Reliability, Validity, and Treatment Sensitivity

ERIC Educational Resources Information Center

Volpe, Robert J.; Gadow, Kenneth D.

2010-01-01

Rating scales developed to measure child emotional and behavioral problems typically are so long as to make their use in progress monitoring impractical in typical school settings. This study examined two methods of selecting items from existing rating scales to create shorter instruments for use in assessing response to intervention. The…

Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety

PubMed Central

Schueller, Stephen M

2016-01-01

Background Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services. Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient’s feedback on the resultant program. Methods This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results In response to clinicians’ feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood disorders. Further research should focus on the benefits accrued from such a service. However, this article highlights how a publicly available eHealth product can be leveraged to create new services in a health care setting. PMID:27001373

The use of skin Fe levels as a surrogate marker for organ Fe levels, to monitor treatment in cases of iron overload

NASA Astrophysics Data System (ADS)

Farquharson, Michael J.; Bagshaw, Andrew P.; Porter, John B.; Abeysinghe, R. D.

2000-05-01

A system based on the detection of K-shell x-ray fluorescence (XRF) has been used to investigate whether a correlation exists between the concentration of iron in the skin and the concentration of iron in the liver, as the degree of iron loading increases. The motivation behind this work is to develop a non-invasive method of determining the extent of the body's iron stores via measurements on the skin, in order to monitor the efficacy of chelation therapy administered to patients with β-thalassaemia. Sprague-Dawley rats were iron loaded via injections of iron dextran and subsequently treated with the iron chelator CP94. The non-haem iron concentrations of the liver, heart and spleen were determined using bathophenanthroline sulphonate as the chromogen reagent. Samples of abdominal skin were taken and the iron concentrations determined using XRF. A strong correlation between the skin iron concentration and the liver iron concentration has been demonstrated (R2 = 0.86). Similar correlations exist for the heart and the spleen. These results show that this method holds great potential as a tool in the diagnosis and treatment of hereditary haemochromatosis and β-thalassaemia.

American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

PubMed

Kampman, Kyle; Jarvis, Margaret

2015-01-01

The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.

Buprenorphine Treatment of Opioid-Dependent Pregnant Women: A Comprehensive Review

PubMed Central

Jones, Hendrée E.; Arria, Amelia M.; Baewert, Andjela; Heil, Sarah H.; Kaltenbach, Karol; Martin, Peter R.; Coyle, Mara G.; Selby, Peter; Stine, Susan M.; Fischer, Gabriele

2015-01-01

Aims This paper reviews the published literature regarding outcomes following maternal treatment with buprenorphine in five areas: maternal efficacy, fetal effects, neonatal effects, effects on breast milk, and longer-term developmental effects. Methods Within each outcome area, findings are summarized first for the 3 randomized controlled trials and then for the 44 non-randomized studies (i.e., prospective studies, case reports and series, and retrospective chart reviews), only 28 of which involve independent samples. Results Results indicate that maternal treatment with buprenorphine has comparable efficacy to methadone, although difficulties may exist with current buprenorphine induction methods. The available fetal data suggest buprenorphine results in less physiologic suppression of fetal heart rate and movements than methadone. Regarding neonatal effects, perhaps the single definitive conclusion is that prenatal buprenorphine treatment results in a clinically significant less severe neonatal abstinence syndrome (NAS) than treatment with methadone. The limited research suggests that, like methadone, buprenorphine is compatible with breastfeeding. Data available thus far suggest that there are no deleterious effects of in utero buprenorphine exposure on infant development. Conclusions Buprenorphine produces a less severe neonatal abstinence syndrome than methadone, but there is still a role for methadone in the treatment of opioid dependence during pregnancy. PMID:23106923

Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method

PubMed Central

White, Richard A.; Lu, Chunling; Rodriguez, Carly A.; Bayona, Jaime; Becerra, Mercedes C.; Burgos, Marcos; Centis, Rosella; Cohen, Theodore; Cox, Helen; D'Ambrosio, Lia; Danilovitz, Manfred; Falzon, Dennis; Gelmanova, Irina Y.; Gler, Maria T.; Grinsdale, Jennifer A.; Holtz, Timothy H.; Keshavjee, Salmaan; Leimane, Vaira; Menzies, Dick; Milstein, Meredith B.; Mishustin, Sergey P.; Pagano, Marcello; Quelapio, Maria I.; Shean, Karen; Shin, Sonya S.; Tolman, Arielle W.; van der Walt, Martha L.; Van Deun, Armand; Viiklepp, Piret

2016-01-01

Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. PMID:27587552

Metal artifacts in computed tomography for radiation therapy planning: dosimetric effects and impact of metal artifact reduction.

PubMed

Giantsoudi, Drosoula; De Man, Bruno; Verburg, Joost; Trofimov, Alexei; Jin, Yannan; Wang, Ge; Gjesteby, Lars; Paganetti, Harald

2017-04-21

A significant and increasing number of patients receiving radiation therapy present with metal objects close to, or even within, the treatment area, resulting in artifacts in computed tomography (CT) imaging, which is the most commonly used imaging method for treatment planning in radiation therapy. In the presence of metal implants, such as dental fillings in treatment of head-and-neck tumors, spinal stabilization implants in spinal or paraspinal treatment or hip replacements in prostate cancer treatments, the extreme photon absorption by the metal object leads to prominent image artifacts. Although current CT scanners include a series of correction steps for beam hardening, scattered radiation and noisy measurements, when metal implants exist within or close to the treatment area, these corrections do not suffice. CT metal artifacts affect negatively the treatment planning of radiation therapy either by causing difficulties to delineate the target volume or by reducing the dose calculation accuracy. Various metal artifact reduction (MAR) methods have been explored in terms of improvement of organ delineation and dose calculation in radiation therapy treatment planning, depending on the type of radiation treatment and location of the metal implant and treatment site. Including a brief description of the available CT MAR methods that have been applied in radiation therapy, this article attempts to provide a comprehensive review on the dosimetric effect of the presence of CT metal artifacts in treatment planning, as reported in the literature, and the potential improvement suggested by different MAR approaches. The impact of artifacts on the treatment planning and delivery accuracy is discussed in the context of different modalities, such as photon external beam, brachytherapy and particle therapy, as well as by type and location of metal implants.

Metal artifacts in computed tomography for radiation therapy planning: dosimetric effects and impact of metal artifact reduction

NASA Astrophysics Data System (ADS)

Giantsoudi, Drosoula; De Man, Bruno; Verburg, Joost; Trofimov, Alexei; Jin, Yannan; Wang, Ge; Gjesteby, Lars; Paganetti, Harald

2017-04-01

A significant and increasing number of patients receiving radiation therapy present with metal objects close to, or even within, the treatment area, resulting in artifacts in computed tomography (CT) imaging, which is the most commonly used imaging method for treatment planning in radiation therapy. In the presence of metal implants, such as dental fillings in treatment of head-and-neck tumors, spinal stabilization implants in spinal or paraspinal treatment or hip replacements in prostate cancer treatments, the extreme photon absorption by the metal object leads to prominent image artifacts. Although current CT scanners include a series of correction steps for beam hardening, scattered radiation and noisy measurements, when metal implants exist within or close to the treatment area, these corrections do not suffice. CT metal artifacts affect negatively the treatment planning of radiation therapy either by causing difficulties to delineate the target volume or by reducing the dose calculation accuracy. Various metal artifact reduction (MAR) methods have been explored in terms of improvement of organ delineation and dose calculation in radiation therapy treatment planning, depending on the type of radiation treatment and location of the metal implant and treatment site. Including a brief description of the available CT MAR methods that have been applied in radiation therapy, this article attempts to provide a comprehensive review on the dosimetric effect of the presence of CT metal artifacts in treatment planning, as reported in the literature, and the potential improvement suggested by different MAR approaches. The impact of artifacts on the treatment planning and delivery accuracy is discussed in the context of different modalities, such as photon external beam, brachytherapy and particle therapy, as well as by type and location of metal implants.

Microbiome and pancreatic cancer: A comprehensive topic review of literature

PubMed Central

Ertz-Archambault, Natalie; Keim, Paul; Von Hoff, Daniel

2017-01-01

AIM To review microbiome alterations associated with pancreatic cancer, its potential utility in diagnostics, risk assessment, and influence on disease outcomes. METHODS A comprehensive literature review was conducted by all-inclusive topic review from PubMed, MEDLINE, and Web of Science. The last search was performed in October 2016. RESULTS Diverse microbiome alterations exist among several body sites including oral, gut, and pancreatic tissue, in patients with pancreatic cancer compared to healthy populations. CONCLUSION Pilot study successes in non-invasive screening strategies warrant further investigation for future translational application in early diagnostics and to learn modifiable risk factors relevant to disease prevention. Pre-clinical investigations exist in other tumor types that suggest microbiome manipulation provides opportunity to favorably transform cancer response to existing treatment protocols and improve survival. PMID:28348497

Canadian Treatment Guidelines on Psychosocial Treatment of Schizophrenia in Children and Youth

PubMed Central

Abidi, Sabina; Garcia-Ortega, Iliana; Mian, Irfan; Jackson, Kevin; Jackson, Kim; Norman, Ross

2017-01-01

Objective: A panel of experts, including researchers, clinicians and people with lived experience, was brought together to develop the new Canadian schizophrenia guidelines for the psychosocial treatment of children and youth with schizophrenia or psychotic disorders. Method: The ADAPTE process, which relies on adapting existing high-quality guidelines, was used. Existing guidelines for children and youth (mostly from the National Institute for Health and Care Excellence [NICE]), as well as CPA adult guidelines, were reviewed and discussed in terms of their adaptability to the Canadian context and their level of recommendation for children and youth. New treatments were also considered when recent meta-analyses suggested their usefulness. Results: The children and youth psychosocial guidelines include many cross-sectional recommendations in terms of clinical and interpersonal skills needed to work with this clientele, setting and collaboration issues and needed adaptations for specific subpopulations. In terms of specific treatments, the treatments most strongly recommended are family intervention and cognitive behavior therapy. Also recommended, although with different degrees of support, are supported employment/supported education programs, patient education, cognitive remediation, and social skills training. Novel and upcoming psychosocial treatments are also briefly discussed. Conclusion: These novel Canadian guidelines for the psychosocial treatment of children and youth with schizophrenia or psychotic disorders report evidence-based treatments as well as important considerations for providers who work with this clientele. More studies with children and youth with schizophrenia and psychotic disorders are warranted. If followed, these guidelines should facilitate the recovery of children and youth with schizophrenia or psychotic disorders as well as the recovery of their families. PMID:28886670

Meta-analysis of randomized, controlled trials comparing particular doses of griseofulvin and terbinafine for the treatment of tinea capitis.

PubMed

Gupta, Aditya K; Drummond-Main, Chris

2013-01-01

Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval in the United States, but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. The goals of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25-12.5 mg/kg/day) to 4 weeks of terbinafine (3.125-6.25 mg/kg/day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel-Haenszel method and random effects model; results were expressed as odds ratios with 95% confidence intervals. Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporum spp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied. © 2012 Wiley Periodicals, Inc.

The Cultural Ecogram: A Tool for Enhancing Culturally Anchored Shared Understanding in the Treatment of Ethnic Minority Families

PubMed Central

YASUI, MIWA

2015-01-01

Ethnic and racial disparities in mental health care continue to exist, highlighting the increasing concern within the realm of clinical practice as to how clinicians are to effectively integrate the central role of culture and context into the treatment delivery process for culturally diverse children and families. The current paper presents the Cultural Ecogram, - a clinical engagement tool designed to facilitate the development of a culturally anchored shared understanding – as one method that may facilitate clinician-client shared understanding on the client’s cultural, ethnic and racial context central to the effective implementation of treatments with ethnic minority children and families. PMID:26273233

Cost-effective treatment of existing guardrail systems.

DOT National Transportation Integrated Search

2013-05-01

A cost-effective means for upgrading existing guardrail systems with deviations from current practice (i.e., low-rail heights, antiquated end : treatments, and improper installation) does not exist. As a result these systems remain on U.S. highways. ...

Virtual reality treatment and assessments for post-stroke unilateral spatial neglect: A systematic literature review.

PubMed

Ogourtsova, Tatiana; Souza Silva, Wagner; Archambault, Philippe S; Lamontagne, Anouk

2017-04-01

Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.

Deep Brain Stimulation as a Treatment for Refractory Epilepsy: Review of the Current State-of-the-Art.

PubMed

Ganguli, Malika P; Upton, Adrian R M; Kamath, Markad V

2017-01-01

Epilepsy affects ∼ 1% of the global population, and 33% of patients are nonresponsive to medication and must seek alternative treatment options. Alternative options such as surgery and ablation exist but are not appropriate treatment plans for some patients. Neurostimulation methods such as vagal nerve stimulation, responsive neural stimulation, and deep brain stimulation (DBS) are viable alternatives for medically refractory patients. DBS stimulation has been used in the treatment of Parkinson's disease, dystonia, and pain management. For the treatment of epilepsy, DBS has been found to be an effective treatment plan, with promising results of reduced seizure frequency and intensity. In this review, we discuss DBS surgery and equipment, mechanisms of DBS for epilepsy, and efficacy, technological specifications, and suggestions for future research. We also review a historical summary of experiments involving DBS for epilepsy. Our literature review suggests that further studies are warranted for medically refractory epilepsy using DBS.

Differences exist across insurance schemes in China post-consolidation.

PubMed

Li, Yang; Zhao, Yinjun; Yi, Danhui; Wang, Xiaojun; Jiang, Yan; Wang, Yu; Liu, Xinchun; Ma, Shuangge

2017-01-01

In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance), URBMI (Urban Resident Basic Medical Insurance), and NCMS (New Cooperative Medical Scheme), across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation. A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects' characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket) cost, and insurance reimbursement rate. Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate. Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences.

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

PubMed

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

2008-09-01

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

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

PubMed Central

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

2013-01-01

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

Clinical Trial Design for HIV Prevention Research: Determining Standards of Prevention.

PubMed

Dawson, Liza; Zwerski, Sheryl

2015-06-01

This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Content and Methods used to Train Tobacco Cessation Treatment Providers: An International Survey.

PubMed

Kruse, Gina R; Rigotti, Nancy A; Raw, Martin; McNeill, Ann; Murray, Rachael; Piné-Abata, Hembadoon; Bitton, Asaf; McEwen, Andy

2017-12-01

There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world. To measure the prevalence of tobacco cessation treatment content, skills training and teaching methods reported by tobacco treatment training programs across the world. Web-based survey in May-September 2013 among tobacco cessation training experts across six geographic regions and four World Bank income levels. Response rate was 73% (84 of 115 countries contacted). Of 104 individual programs from 84 countries, most reported teaching brief advice (78%) and one-to-one counseling (74%); telephone counseling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programs in lower income countries less often reported teaching about medications, behavioral treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programs reported a median 15 hours of training. Face-to-face training was common (85%); online programs were rare (19%). Almost half (47%) included no learner assessment. Only 35% offered continuing education. Nearly all programs reported teaching evidence-based treatment modalities in a face-to-face format. Few programs delivered training online or offered continuing education. Skills-based training was less common among low- and middle-income countries (LMICs). There is a large unmet need for tobacco treatment training protocols which emphasize practical skills, and which are more rapidly scalable than face-to-face training in LMICs.

The Voice of the Patient Methodology: A Novel Mixed-Methods Approach to Identifying Treatment Goals for Men with Prostate Cancer.

PubMed

Saigal, Christopher S; Lambrechts, Sylvia I; Seenu Srinivasan, V; Dahan, Ely

2017-06-01

Many guidelines advocate the use of shared decision making for men with newly diagnosed prostate cancer. Decision aids can facilitate the process of shared decision making. Implicit in this approach is the idea that physicians understand which elements of treatment matter to patients. Little formal work exists to guide physicians or developers of decision aids in identifying these attributes. We use a mixed-methods technique adapted from marketing science, the 'Voice of the Patient', to describe and identify treatment elements of value for men with localized prostate cancer. We conducted semi-structured interviews with 30 men treated for prostate cancer in the urology clinic of the West Los Angeles Veteran Affairs Medical Center. We used a qualitative analysis to generate themes in patient narratives, and a quantitative approach, agglomerative hierarchical clustering, to identify attributes of treatment that were most relevant to patients making decisions about prostate cancer. We identified five 'traditional' prostate cancer treatment attributes: sexual dysfunction, bowel problems, urinary problems, lifespan, and others' opinions. We further identified two novel treatment attributes: a treatment's ability to validate a sense of proactivity and the need for an incision (separate from risks of surgery). Application of a successful marketing technique, the 'Voice of the Customer', in a clinical setting elicits non-obvious attributes that highlight unique patient decision-making concerns. Use of this method in the development of decision aids may result in more effective decision support.

Symbiotic relationship between hydrothermal carbonization technology and anaerobic digestion for food waste in China.

PubMed

Zhou, Ying; Engler, Nils; Nelles, Michael

2018-07-01

Food waste (FW) is traditionally disposed through landfills and incineration in China. Nowadays, there are some promising methods, such as anaerobic digestion (AD) or feeding and composting, which are being applied in pilot cities. However, the inherent characteristics of Chinese FW may be regarded as a double-edged sword in the practical applications of these disposal methods. To overcome these challenges, two modes of the hydrothermal carbonization (HTC) process were reviewed as innovative strategies in this article. Meanwhile, the "symbiotic relationship" between Chinese FW and HTC technologies was highlighted. To improve treatment efficiency of FW, we should not only try different methods and develop existing technologies, but also pay more attention to the utilization and "1 + 1 > 2" synergistic effect of their combinations, such as the combination of HTC and AD as a co-treatment method for saving on the construction cost and avoiding redistribution of social resources. Copyright © 2018 Elsevier Ltd. All rights reserved.

Environmental friendly method for the extraction of coir fibre and isolation of nanofibre.

PubMed

Abraham, Eldho; Deepa, B; Pothen, L A; Cintil, J; Thomas, S; John, M J; Anandjiwala, R; Narine, S S

2013-02-15

The objective of this work was to develop an environmental friendly method for the effective utilization of coir fibre by adopting steam pre-treatment. The retting of the coconut bunch makes strong environmental problems which can be avoided by this method. Chemical characterization of the fibre during each processing stages confirmed the increase of cellulose content from raw (40%) to final steam treated fibres (93%). Morphological and dynamic light scattering analyses of the fibres at different processing stages revealed that the isolation of cellulose nano fibres occur in the final step of the process as an aqueous suspension. FT-IR and XRD analysis demonstrated that the treatments lead to the gradual removal of lignin and hemicelluloses from the fibres. The existence of strong lignin-cellulose complex in the raw coir fibre is proved by its enhanced thermal stability. Steam explosion has been proved to be a green method to expand the application areas of coir fibre. Copyright © 2012 Elsevier Ltd. All rights reserved.

Case Mis-Conceptualization in Psychological Treatment: An Enduring Clinical Problem.

PubMed

Ridley, Charles R; Jeffrey, Christina E; Roberson, Richard B

2017-04-01

Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians' level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization. © 2017 Wiley Periodicals, Inc.

Quantifying discipline practices using absolute versus relative frequencies: clinical and research implications for child welfare.

PubMed

Lindhiem, Oliver; Shaffer, Anne; Kolko, David J

2014-01-01

In the parent intervention outcome literatures, discipline practices are generally quantified as absolute frequencies or, less commonly, as relative frequencies. These differences in methodology warrant direct comparison as they have critical implications for study results and conclusions among treatments targeted at reducing parental aggression and harsh discipline. In this study, we directly compared the absolute frequency method and the relative frequency method for quantifying physically aggressive, psychologically aggressive, and nonaggressive discipline practices. Longitudinal data over a 3-year period came from an existing data set of a clinical trial examining the effectiveness of a psychosocial treatment in reducing parental physical and psychological aggression and improving child behavior (N = 139). Discipline practices (aggressive and nonaggressive) were assessed using the Conflict Tactics Scale. The two methods yielded different patterns of results, particularly for nonaggressive discipline strategies. We suggest that each method makes its own unique contribution to a more complete understanding of the association between parental aggression and intervention effects.

The genetics of addiction—a translational perspective

PubMed Central

Agrawal, A; Verweij, K J H; Gillespie, N A; Heath, A C; Lessov-Schlaggar, C N; Martin, N G; Nelson, E C; Slutske, W S; Whitfield, J B; Lynskey, M T

2012-01-01

Addictions are serious and common psychiatric disorders, and are among the leading contributors to preventable death. This selective review outlines and highlights the need for a multi-method translational approach to genetic studies of these important conditions, including both licit (alcohol, nicotine) and illicit (cannabis, cocaine, opiates) drug addictions and the behavioral addiction of disordered gambling. First, we review existing knowledge from twin studies that indicates both the substantial heritability of substance-specific addictions and the genetic overlap across addiction to different substances. Next, we discuss the limited number of candidate genes which have shown consistent replication, and the implications of emerging genomewide association findings for the genetic architecture of addictions. Finally, we review the utility of extensions to existing methods such as novel phenotyping, including the use of endophenotypes, biomarkers and neuroimaging outcomes; emerging methods for identifying alternative sources of genetic variation and accompanying statistical methodologies to interpret them; the role of gene–environment interplay; and importantly, the potential role of genetic variation in suggesting new alternatives for treatment of addictions. PMID:22806211

TOPICAL REVIEW: Anatomical imaging for radiotherapy

NASA Astrophysics Data System (ADS)

Evans, Philip M.

2008-06-01

The goal of radiation therapy is to achieve maximal therapeutic benefit expressed in terms of a high probability of local control of disease with minimal side effects. Physically this often equates to the delivery of a high dose of radiation to the tumour or target region whilst maintaining an acceptably low dose to other tissues, particularly those adjacent to the target. Techniques such as intensity modulated radiotherapy (IMRT), stereotactic radiosurgery and computer planned brachytherapy provide the means to calculate the radiation dose delivery to achieve the desired dose distribution. Imaging is an essential tool in all state of the art planning and delivery techniques: (i) to enable planning of the desired treatment, (ii) to verify the treatment is delivered as planned and (iii) to follow-up treatment outcome to monitor that the treatment has had the desired effect. Clinical imaging techniques can be loosely classified into anatomic methods which measure the basic physical characteristics of tissue such as their density and biological imaging techniques which measure functional characteristics such as metabolism. In this review we consider anatomical imaging techniques. Biological imaging is considered in another article. Anatomical imaging is generally used for goals (i) and (ii) above. Computed tomography (CT) has been the mainstay of anatomical treatment planning for many years, enabling some delineation of soft tissue as well as radiation attenuation estimation for dose prediction. Magnetic resonance imaging is fast becoming widespread alongside CT, enabling superior soft-tissue visualization. Traditionally scanning for treatment planning has relied on the use of a single snapshot scan. Recent years have seen the development of techniques such as 4D CT and adaptive radiotherapy (ART). In 4D CT raw data are encoded with phase information and reconstructed to yield a set of scans detailing motion through the breathing, or cardiac, cycle. In ART a set of scans is taken on different days. Both allow planning to account for variability intrinsic to the patient. Treatment verification has been carried out using a variety of technologies including: MV portal imaging, kV portal/fluoroscopy, MVCT, conebeam kVCT, ultrasound and optical surface imaging. The various methods have their pros and cons. The four x-ray methods involve an extra radiation dose to normal tissue. The portal methods may not generally be used to visualize soft tissue, consequently they are often used in conjunction with implanted fiducial markers. The two CT-based methods allow measurement of inter-fraction variation only. Ultrasound allows soft-tissue measurement with zero dose but requires skilled interpretation, and there is evidence of systematic differences between ultrasound and other data sources, perhaps due to the effects of the probe pressure. Optical imaging also involves zero dose but requires good correlation between the target and the external measurement and thus is often used in conjunction with an x-ray method. The use of anatomical imaging in radiotherapy allows treatment uncertainties to be determined. These include errors between the mean position at treatment and that at planning (the systematic error) and the day-to-day variation in treatment set-up (the random error). Positional variations may also be categorized in terms of inter- and intra-fraction errors. Various empirical treatment margin formulae and intervention approaches exist to determine the optimum strategies for treatment in the presence of these known errors. Other methods exist to try to minimize error margins drastically including the currently available breath-hold techniques and the tracking methods which are largely in development. This paper will review anatomical imaging techniques in radiotherapy and how they are used to boost the therapeutic benefit of the treatment.

Evaluating the Acoustic Benefits of Over-the-Rotor Acoustic Treatments Installed on the Advanced Noise Control Fan

NASA Technical Reports Server (NTRS)

Gazella, Matthew R.; Takakura, Tamuto; Sutliff, Daniel L.; Bozak, Richard F.; Tester, Brian J.

2017-01-01

Over the last 15 years, over-the-rotor acoustic treatments have been evaluated by NASA with varying success. Recently, NASA has been developing the next generation of over-the-rotor acoustic treatments for fan noise reduction. The NASA Glenn Research Centers Advanced Noise Control Fan was used as a Low Technology Readiness Level test bed. A rapid prototyped in-duct array consisting of 50 microphones was employed, and used to correlate the in-duct analysis to the far-field acoustic levels and to validate an existing beam-former method. The goal of this testing was to improve the Technology Readiness Level of various over-the-rotor acoustic treatments by advancing the understanding of the physical mechanisms and projecting the far-field acoustic benefit.

User-Centered Design for Psychosocial Intervention Development and Implementation

PubMed Central

Lyon, Aaron R.; Koerner, Kelly

2018-01-01

The current paper articulates how common difficulties encountered when attempting to implement or scale-up evidence-based treatments are exacerbated by fundamental design problems, which may be addressed by a set of principles and methods drawn from the contemporary field of user-centered design. User-centered design is an approach to product development that grounds the process in information collected about the individuals and settings where products will ultimately be used. To demonstrate the utility of this perspective, we present four design concepts and methods: (a) clear identification of end users and their needs, (b) prototyping/rapid iteration, (c) simplifying existing intervention parameters/procedures, and (d) exploiting natural constraints. We conclude with a brief design-focused research agenda for the developers and implementers of evidence-based treatments. PMID:29456295

ONCOLOGISTS’ ASSESSMENTS OF LUNG CANCER PATIENT AND FAMILY DISAGREEMENTS REGARDING TREATMENT DECISION MAKING

PubMed Central

Siminoff, Laura A.; Dorflinger, Lindsey; Agyemang, Amma; Baker, Sherman; Wilson-Genderson, Maureen

2012-01-01

Summary Background Disagreements between cancer patients and their caregivers about treatment and care can affect the patient’s physical and mental well-being. Therefore it is important to understand if oncologists can accurately identify the presence of patient-caregiver decisional conflict. This study examined assessments made by lung cancer patients, their caregivers, and their oncologists regarding patient-caregiver disagreements concerning treatment and care decisions. Participants and methods We assessed the extent to which the patient, caregiver, and oncologist reported disagreement between the patient and the family member regarding treatment decisions in 134 patient-caregiver-oncologist triads. Descriptive statistics were used to explore rates of concordance amongst all possible combinations of raters. Loglinear models were tested for 3-way agreement. Results Most patient-caregiver pairs, 82.1% (n=110), reported agreement concerning presence or absence of decisional conflict. Oncologists were more successful in detecting absence of conflict than the presence of conflict. When the caregiver and the oncologist agreed, it was regarding the absence of conflict (64.9%), rather than the presence of conflict. In 10.6 % (n = 15) of cases, oncologists reported that conflictual relationships negatively impacted their ability to provide patient care. Conclusions Recent models of cancer patient care promote including the caregiver fully in the process while respecting the primacy of the patient’s perspective. However, these models assume that the oncologist will recognize when disagreements exist and be able to assist in conflict resolution. The degree to which the oncologist identified that conflict exists and implications for their ability to provide patient care when familial disagreements existed are discussed. PMID:22405569

An optical microfluidic platform for spatiotemporal biofilm treatment monitoring

NASA Astrophysics Data System (ADS)

Kim, Young Wook; Mosteller, Matthew P.; Subramanian, Sowmya; Meyer, Mariana T.; Bentley, William E.; Ghodssi, Reza

2016-01-01

Bacterial biofilms constitute in excess of 65% of clinical microbial infections, with the antibiotic treatment of biofilm infections posing a unique challenge due to their high antibiotic tolerance. Recent studies performed in our group have demonstrated that a bioelectric effect featuring low-intensity electric signals combined with antibiotics can significantly improve the efficacy of biofilm treatment. In this work, we demonstrate the bioelectric effect using sub-micron thick planar electrodes in a microfluidic device. This is critical in efforts to develop microsystems for clinical biofilm infection management, including both in vivo and in vitro applications. Adaptation of the method to the microscale, for example, can enable the development of localized biofilm infection treatment using microfabricated medical devices, while augmenting existing capabilities to perform biofilm management beyond the clinical realm. Furthermore, due to scale-down of the system, the voltage requirement for inducing the electric field is reduced further below the media electrolysis threshold. Enhanced biofilm treatment using the bioelectric effect in the developed microfluidic device elicited a 56% greater reduction in viable cell density and 26% further decrease in biomass growth compared to traditional antibiotic therapy. This biofilm treatment efficacy, demonstrated in a micro-scale device and utilizing biocompatible voltage ranges, encourages the use of this method for future clinical biofilm treatment applications.

A simple analytical procedure to replace HPLC for monitoring treatment concentrations of chloramine-T on fish culture facilities

USGS Publications Warehouse

Dawson, Verdel K.; Meinertz, Jeffery R.; Schmidt, Larry J.; Gingerich, William H.

2003-01-01

Concentrations of chloramine-T must be monitored during experimental treatments of fish when studying the effectiveness of the drug for controlling bacterial gill disease. A surrogate analytical method for analysis of chloramine-T to replace the existing high-performance liquid chromatography (HPLC) method is described. A surrogate method was needed because the existing HPLC method is expensive, requires a specialist to use, and is not generally available at fish hatcheries. Criteria for selection of a replacement method included ease of use, analysis time, cost, safety, sensitivity, accuracy, and precision. The most promising approach was to use the determination of chlorine concentrations as an indicator of chloramine-T. Of the currently available methods for analysis of chlorine, the DPD (N,N-diethyl-p-phenylenediamine) colorimetric method best fit the established criteria. The surrogate method was evaluated under a variety of water quality conditions. Regression analysis of all DPD colorimetric analyses with the HPLC values produced a linear model (Y=0.9602 X+0.1259) with an r2 value of 0.9960. The average accuracy (percent recovery) of the DPD method relative to the HPLC method for the combined set of water quality data was 101.5%. The surrogate method was also evaluated with chloramine-T solutions that contained various concentrations of fish feed or selected densities of rainbow trout. When samples were analyzed within 2 h, the results of the surrogate method were consistent with those of the HPLC method. When samples with high concentrations of organic material were allowed to age more than 2 h before being analyzed, the DPD method seemed to be susceptible to interference, possibly from the development of other chloramine compounds. However, even after aging samples 6 h, the accuracy of the surrogate DPD method relative to the HPLC method was within the range of 80–120%. Based on the data comparing the two methods, the U.S. Food and Drug Administration has concluded that the DPD colorimetric method is appropriate to use to measure chloramine-T in water during pivotal efficacy trials designed to support the approval of chloramine-T for use in fish culture.

Response of falciparum malaria to different antimalarials in Myanmar.

PubMed Central

Ejov, M. N.; Tun, T.; Aung, S.; Sein, K.

1999-01-01

The purpose of the study was to ascertain the therapeutic efficacy of different treatments for uncomplicated falciparum malaria in the hospitals in Sagaing, northern and eastern Shan, to facilitate updating the existing national antimalarial drug policy. The proposed 14-day trial for monitoring the efficacy of treatments of uncomplicated falciparum malaria is an efficient method for identifying treatment failure patterns at the intermediate level (township hospital) in the Union of Myanmar. Minimal clinical and parasitological data for days 0-14 were required to classify treatment failure and success. Clinical and parasitiological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine is five times more likely to be effective than chloroquine and sulfadoxine pyrimethamine (S-P), whereas chloroquine and S-P treatments have nearly identical failure patterns. The alarming frequency of clinical and parasitological failure (failure rate > 50%) following chloroquine treatment was reported in Sagaing and following S-P treatment in Sagaing and eastern Shan. PMID:10212515

A systematic review of sensory-based treatments for children with disabilities.

PubMed

Barton, Erin E; Reichow, Brian; Schnitz, Alana; Smith, Isaac C; Sherlock, Daniel

2015-02-01

Sensory-based therapies are designed to address sensory processing difficulties by helping to organize and control the regulation of environmental sensory inputs. These treatments are increasingly popular, particularly with children with behavioral and developmental disabilities. However, empirical support for sensory-based treatments is limited. The purpose of this review was to conduct a comprehensive and methodologically sound evaluation of the efficacy of sensory-based treatments for children with disabilities. Methods for this review were registered with PROSPERO (CRD42012003243). Thirty studies involving 856 participants met our inclusion criteria and were included in this review. Considerable heterogeneity was noted across studies in implementation, measurement, and study rigor. The research on sensory-based treatments is limited due to insubstantial treatment outcomes, weak experimental designs, or high risk of bias. Although many people use and advocate for the use of sensory-based treatments and there is a substantial empirical literature on sensory-based treatments for children with disabilities, insufficient evidence exists to support their use. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Dose That Works: Low Level Laser Treatment of Tendinopathy

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

Tumilty, Steve; Munn, Joanne; David Baxter, G.

2010-05-31

Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using establishedmore » guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.« less

The Dose That Works: Low Level Laser Treatment of Tendinopathy

NASA Astrophysics Data System (ADS)

Tumilty, Steve; Munn, Joanne; McDonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

2010-05-01

Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

PubMed

Vladimirov, B; Petkov, R; Viiachki, I; Damianov, D; Iarŭmov, N

1996-01-01

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Using three-dimensional imaging to assess treatment outcomes in orthodontics: a progress report from the University of the Pacific.

PubMed

Baumrind, S; Carlson, S; Beers, A; Curry, S; Norris, K; Boyd, R L

2003-01-01

Past research in integrated three-dimensional (3D) craniofacial mapping at the Craniofacial Research Instrumentation Laboratory (CRIL) of the University of the Pacific is summarized in narrative form. The advantages and limitations of recent commercial developments in the application of cone beam geometry volumetric X-ray scanners in dentistry and surface digital mapping of study casts are discussed. The rationale for methods currently in development at CRIL for merging longitudinal information from existing 3D study casts and two-dimensional lateral X-ray cephalograms in studies of orthodontic treatment outcome is presented.

Patient Engagement and Study Design of PROP UP: A multi-site patient-centered prospective observational study of patients undergoing hepatitis C treatment

PubMed Central

Evon, Donna M.; Golin, Carol E.; Stewart, Paul; Fried, Michael W.; Alston, Shani; Reeve, Bryce; Lok, Anna S.; Sterling, Richard K.; Lim, Joseph K.; Reau, Nancy; Sarkar, Souvik; Nelson, David R.; Reddy, K. Rajender; Di Bisceglie, Adrian M.

2017-01-01

Background New highly efficacious direct-acting antiviral (DAA) therapies are available to treat chronic hepatitis C viral (HCV) infection. Real-world, patient-centered data on harms and benefits associated with these therapies are needed. Methods PROP UP is a multi-center prospective observational study that plans to enroll 1,600 patients starting treatment with recently-approved DAA regimens. Informed by extensive input from a HCV patient engagement group who prioritized outcomes most important to them, patient-reported outcomes will be characterized using surveys at five time points: Baseline (T1), treatment week 4 (T2), end of treatment (T3), 12 weeks post-treatment (T4), 12 months post-treatment (T5). Outcomes (1) Changes in side effects, functioning, pre-existing conditions, and out-of-pocket costs during therapy (T1 vs T2/T3); (2) Medication adherence in relation to a history of mental health/substance abuse, treatment regimens, pill burden, reasons for missed doses, and cure rates; (3) Short term impact of cure on functioning and amelioration of symptoms (T1 vs T4); (4) Long-term treatment harms or benefits of cure on symptoms, side effects, pre-existing conditions, and functioning (T1 vs T5). Similarities between regimens will be examined where comparisons are appropriate and meaningful. Conclusion PROP UP complements previous clinical trials by focusing on patient-reported outcomes in a representative sample of patients treated in clinical practice, by collaborating with a patient engagement group, by characterizing the experiences of vulnerable subgroups, and by investigating long-term harms and benefits of treatments. PROP UP is designed to provide novel and detailed information to support informed decision-making for patients and providers contemplating HCV treatment (PCORI CER-1408-20660; NCT02601820). PMID:28342989

Commencement Bay Nearshore/Tideflats Superfund Site, Tacoma, Washington Remedial Investigations. Evaluation of Alternative Dredging Methods and Equipment, Disposal Methods and Sites, and Site Control and Treatment Practices for Contaminated Sediments.

DTIC Science & Technology

1985-06-01

material may have on ground water and drain- age systems and the possible burial of hazardous materials already existing on the site. The Port of Tacoma is...good resistance to inorganic chemicals; high gas permeability Asphalt- Core layer Of blown asphalt M Flexible enough to conform to Ages rapidly in hot...Tendst to harden on aging ; low polyethylene reacting polyethylene with acids, and alkalis tensile strength; tenoericy to chlorine and sulfur dioxide

Social construction of the patient through problems of safety, uninsurance, and unequal treatment.

PubMed

Trigg, Lisa J

2009-01-01

The purpose of this research was to study how the Institute of Medicine discourse promoting health information technology may reproduce existing social inequalities in healthcare. Social constructionist and critical discourse analysis combined with corpus linguistics methods have been used to study the subject positions constructed for receivers of healthcare across the executive summaries of 3 different Institute of Medicine reports. Data analysis revealed differences in the way receivers of healthcare are constructed through variations of social action through language use in the 3 texts selected for this method's testing.

40 CFR 63.1584 - When do I have to comply?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Standards for Hazardous Air Pollutants: Publicly Owned Treatment Works Industrial Potw Treatment Plant Description and Requirements § 63.1584 When do I have to comply? (a) Existing industrial POTW treatment plant. If you have an existing industrial POTW treatment plant, the appropriate NESHAP(s) for the industrial...

Tailoring Cognitive Behavioral Treatment for Binge Eating in Adolescent Girls

ERIC Educational Resources Information Center

Yarborough, Bobbi Jo; DeBar, Lynn L.; Firemark, Alison; Leung, Sue; Clarke, Gregory N.; Wilson, G. Terence

2013-01-01

Whereas effective treatments exist for adults with recurrent binge eating, developmental factors specific to adolescents point to the need for a modified treatment approach for youth. We adapted an existing cognitive behavioral therapy treatment manual for adults with bulimia nervosa and binge eating disorder (Fairburn, 2008) for use with…

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

Wroe, A; Slater, J; McAuley, G

Purpose: To design, implement and evaluate a shielding system that will reduce out-of-field dose experienced by the patient and associated electronic systems in passively scattered proton therapy treatment. Methods: A multi-stage neutron shielding system was retrofitted to the Gantry 1 treatment nozzle at Loma Linda University Medical Center. The system uses multiple borated polyethylene plates staged after the primary beam modifying devices to attenuate and absorb neutrons produced by such devices. This arrangement locates increasing levels of shielding between the sources of secondary particles in the nozzle and the patient. Additionally, the design of this shielding structure allows it tomore » be easily retrofitted to an existing proton nozzle system without impacting design or treatment beam characteristics. The effectiveness of the shielding was evaluated both through experimental measurements and Geant4 Monte Carlo simulations. Results: Measurements were completed with Landauer Luxel+ dosimeters that use optically stimulated luminescence and CR-39 to detect fast neutrons, thermal neutrons, protons, photons and beta particles. Measurements of a 250 MeV proton beam indicated that the shielding system reduced out-of-field dose to the patient by almost half with dose equivalent values at 50 and 40 cm from the field edge decreasing from 0.965 and 1.262 mSv/Gy to 0.596 and 0.777 mSv/Gy respectively. The installation of the multi-stage shielding system also reduced dose equivalent experienced by electronic systems installed in the treatment room by up to 80%. Geant4 simulations were also used to evaluate the neutron fluence at various positions in the treatment room as well as provide information on microdosimetry spectra within the patient and treatment room. Conclusion: The shielding system described above proved to be an effective an inexpensive method of reducing out-of-field doses to the patient and electronic systems and can be easily retrofitted to existing passive scattering nozzles.« less

A novel statistical approach for identification of the master regulator transcription factor.

PubMed

Sikdar, Sinjini; Datta, Susmita

2017-02-02

Transcription factors are known to play key roles in carcinogenesis and therefore, are gaining popularity as potential therapeutic targets in drug development. A 'master regulator' transcription factor often appears to control most of the regulatory activities of the other transcription factors and the associated genes. This 'master regulator' transcription factor is at the top of the hierarchy of the transcriptomic regulation. Therefore, it is important to identify and target the master regulator transcription factor for proper understanding of the associated disease process and identifying the best therapeutic option. We present a novel two-step computational approach for identification of master regulator transcription factor in a genome. At the first step of our method we test whether there exists any master regulator transcription factor in the system. We evaluate the concordance of two ranked lists of transcription factors using a statistical measure. In case the concordance measure is statistically significant, we conclude that there is a master regulator. At the second step, our method identifies the master regulator transcription factor, if there exists one. In the simulation scenario, our method performs reasonably well in validating the existence of a master regulator when the number of subjects in each treatment group is reasonably large. In application to two real datasets, our method ensures the existence of master regulators and identifies biologically meaningful master regulators. An R code for implementing our method in a sample test data can be found in http://www.somnathdatta.org/software . We have developed a screening method of identifying the 'master regulator' transcription factor just using only the gene expression data. Understanding the regulatory structure and finding the master regulator help narrowing the search space for identifying biomarkers for complex diseases such as cancer. In addition to identifying the master regulator our method provides an overview of the regulatory structure of the transcription factors which control the global gene expression profiles and consequently the cell functioning.

Oral aniracetam treatment in C57BL/6J mice without pre-existing cognitive dysfunction reveals no changes in learning, memory, anxiety or stereotypy

PubMed Central

Reynolds, Conner D.; Jefferson, Taylor S.; Volquardsen, Meagan; Pandian, Ashvini; Smith, Gregory D.; Holley, Andrew J.; Lugo, Joaquin N.

2017-01-01

Background: The piracetam analog, aniracetam, has recently received attention for its cognition enhancing potential, with minimal reported side effects.  Previous studies report the drug to be effective in both human and non-human models with pre-existing cognitive dysfunction, but few studies have evaluated its efficacy in healthy subjects. A previous study performed in our laboratory found no cognitive enhancing effects of oral aniracetam administration 1-hour prior to behavioral testing in naïve C57BL/6J mice. Methods: The current study aims to further evaluate this drug by administration of aniracetam 30 minutes prior to testing in order to optimize any cognitive enhancing effects. In this study, all naïve C57BL/6J mice were tested in tasks of delayed fear conditioning, novel object recognition, rotarod, open field, elevated plus maze, and marble burying. Results: Across all tasks, animals in the treatment group failed to show enhanced learning when compared to controls. Conclusions: These results provide further evidence suggesting that aniracetam conveys no therapeutic benefit to subjects without pre-existing cognitive dysfunction. PMID:29946420

Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study.

PubMed

Ndizeye, Zacharie; Vanden Broeck, Davy; Vermandere, Heleen; Bogers, John Paul; Van Geertruyden, Jean-Pierre

2018-01-16

Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.

The ABC's of Teaching Social Skills to Adolescents with Autism Spectrum Disorder in the Classroom: The UCLA "PEERS®" Program

ERIC Educational Resources Information Center

Laugeson, Elizabeth A.; Ellingsen, Ruth; Sanderson, Jennifer; Tucci, Lara; Bates, Shannon

2014-01-01

Social skills training is a common treatment method for adolescents with autism spectrum disorder (ASD), yet very few evidence-based interventions exist to improve social skills for high-functioning adolescents on the spectrum, and even fewer studies have examined the effectiveness of teaching social skills in the classroom. This study examines…

Acyl-homoserine lactone-based quorum sensing and quorum quenching hold promise to determine the performance of biological wastewater treatments: An overview.

PubMed

Huang, Jinhui; Shi, Yahui; Zeng, Guangming; Gu, Yanling; Chen, Guiqiu; Shi, Lixiu; Hu, Yi; Tang, Bi; Zhou, Jianxin

2016-08-01

Quorum sensing (QS) is a communication process between cells, in which bacteria secrete and sense the specific chemicals, and regulate gene expression in response to population density. Quorum quenching (QQ) blocks QS system, and inhibits gene expression mediating bacterial behaviors. Given the extensive research of acyl-homoserine lactone (AHL) signals, existences and effects of AHL-based QS and QQ in biological wastewater treatments are being subject to high concern. This review summarizes AHL structure, synthesis mode, degradation mechanisms, analytical methods, environmental factors, AHL-based QS and QQ mechanisms. The existences and roles of AHL-based QS and QQ in biomembrane processes, activated sludge processes and membrane bioreactors are summarized and discussed, and corresponding exogenous regulation strategy by selective enhancement of AHL-based QS or QQ coexisting in biological wastewater treatments is suggested. Such strategies including the addition of AHL signals, AHL-producing bacteria as well as quorum quenching enzyme or bacteria can effectively improve wastewater treatment performance without killing or limiting bacterial survival and growth. This review will present the theoretical and practical cognition for bacterial AHL-based QS and QQ, suggest the feasibility of exogenous regulation strategies in biological wastewater treatments, and provide useful information to scientists and engineers who work in this field. Copyright © 2016 Elsevier Ltd. All rights reserved.

An evaluation of technologies for the heavy metal remediation of dredged sediments.

PubMed

Mulligan, C N; Yong, R N; Gibbs, B F

2001-07-30

Sediments dewatering is frequently necessary after dredging to remediate and treat contaminants. Methods include draining of the water in lagoons with or without coagulants and flocculants, or using presses or centrifuges. Treatment methods are similar to those used for soil and include pretreatment, physical separation, thermal processes, biological decontamination, stabilization/solidification and washing. However, compared to soil treatment, few remediation techniques have been commercially used for sediments. In this paper, a review of the methods that have been used and an evaluation of developed and developing technologies is made. Sequential extraction technique can be a useful tool for determining metal speciation before and after washing. Solidification/stabilization techniques are successful but significant monitoring is required, since the solidification process can be reversible. In addition, the presence of organics can reduce treatment efficiency. Vitrification is applicable for sediments but expensive. Only if a useful glass product can be sold will this process be economically viable. Thermal processes are only applicable for removal of volatile metals, such as mercury and costs are high. Biological processes are under development and have the potential to be low cost. Since few low cost metal treatment processes for sediments are available, there exists significant demand for further development. Pretreatment may be one of the methods that can reduce costs by reducing the volumes of sediments that need to be treated.

Treatment of severe burn with DermACELL(®), an acellular dermal matrix.

PubMed

Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Wang, Chih-Hsin

2012-01-01

For treatment of skin burn injuries, there exist several methods of treatment related to tissue regeneration, including the use of autograft skin and cryopreserved skin. However, each method has drawbacks. An alternative method for tissue regeneration is allograft acellular dermal matrix, with potential as a biocompatible scaffold for new tissue growth. One recently produced material of this type is DermACELL(®), which was used in this case presentation for treating a scar resulting from second- and third-degree burns in a 33-year-old female patient. The patient presented with significant hypertrophic scarring from the elbow to the hand and with limited wrist and elbow motion. The scarring was removed, and the patient was treated with a 1:3 mesh of DermACELL. The wound was resurfaced with a split thickness skin graft, and postoperative care included application of pressure garment and silicone sheet, as well as range of motion exercise and massage. At 30 days after DermACELL application, the wound appeared well-healed with little scar formation. At 180 days post-application, the wound continued to appear healed well without significant scar formation. Additionally, the wound was supple, and the patient experienced significant improvement in range of motion. In the case presented, DermACELL appears to have been a successful method of treatment for scarring due to severe burns by preventing further scar formation and improving range of motion.

Treatment of hypophosphatemia in the intensive care unit: a review

PubMed Central

2010-01-01

Introduction Currently no evidence-based guideline exists for the approach to hypophosphatemia in critically ill patients. Methods We performed a narrative review of the medical literature to identify the incidence, symptoms, and treatment of hypophosphatemia in critically ill patients. Specifically, we searched for answers to the questions whether correction of hypophosphatemia is associated with improved outcome, and whether a certain treatment strategy is superior. Results Incidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Treatment: hypophosphatemia is generally corrected when it is symptomatic or severe. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Outcome: in some studies, hypophosphatemia was associated with higher mortality; a paucity of randomized controlled evidence exists for whether correction of hypophosphatemia improves the outcome in critically ill patients. Conclusions Additional studies addressing the current approach to hypophosphatemia in critically ill patients are required. Studies should focus on the association between hypophosphatemia and morbidity and/or mortality, as well as the effect of correction of this electrolyte disorder. PMID:20682049

Pharmacokinetic interactions of herbal medicines for the treatment of chronic hepatitis.

PubMed

Hsueh, Tun-Pin; Lin, Wan-Ling; Tsai, Tung-Hu

2017-04-01

Chronic liver disease is a serious global health problem, and an increasing number of patients are seeking alternative medicines or complementary treatment. Herbal medicines account for 16.8% of patients with chronic liver disease who use complementary and alternative therapies. A survey of the National Health Insurance Research Database in Taiwan reported that Long-Dan-Xie-Gan-Tang, Jia-Wei-Xia-Yao-San, and Xiao-Chai-Hu-Tang (Sho-saiko-to) were the most frequent formula prescriptions for chronic hepatitis used by traditional Chinese medicine physicians. Bioanalytical methods of herbal medicines for the treatment of chronic hepatitis were developed to investigate pharmacokinetics properties, but multicomponent herbal formulas have been seldom discussed. The pharmacokinetics of herbal formulas is closely related to efficacy, efficiency, and patient safety of traditional herbal medicines. Potential herbal formula-drug interactions are another essential issue during herbal formula administration in chronic hepatitis patients. In a survey with the PubMed database, this review article evaluates the existing evidence-based data associated with the documented pharmacokinetics profiles and potential herbal-drug interactions of herbal formulas for the treatment of chronic hepatitis. In addition, the existing pharmacokinetic profiles were further linked with clinical practice to provide insight for the safety and specific use of traditional herbal medicines. Copyright © 2016. Published by Elsevier B.V.

Disparities in the Utilization of Laparoscopic Surgery for Colon Cancer in Rural Nebraska: A Call for Placement and Training of Rural General Surgeons

PubMed Central

Gruber, Kelli; Soliman, Amr S.; Schmid, Kendra; Rettig, Bryan; Ryan, June; Watanabe-Galloway, Shinobu

2015-01-01

Background Advances in medical technology are changing surgical standards for colon cancer treatment. The laparoscopic colectomy is equivalent to the standard open colectomy while providing additional benefits. It is currently unknown what factors influence utilization of laparoscopic surgery in rural areas and if treatment disparities exist. The objectives of this study were to examine demographic and clinical characteristics associated with receiving laparoscopic colectomy and to examine the differences between rural and urban patients who received either procedure. Methods This study utilized a linked dataset of Nebraska Cancer Registry and hospital discharge data on colon cancer patients diagnosed and treated in the entire state of Nebraska from 2008–2011 (N=1,062). Multiple logistic regression analysis was performed to identify predictors of receiving the laparoscopic treatment. Results Rural colon cancer patients were 40% less likely to receive laparoscopic colectomy compared to urban patients. Independent predictors of receiving laparoscopic colectomy were younger age (<60), urban residence, ≥3 comorbidities, elective admission, smaller tumor size, and early stage at diagnosis. Additionally, rural patients varied demographically compared to urban patients. Conclusions Laparoscopic surgery is becoming the new standard of treatment for colon cancer and important disparities exist for rural cancer patients in accessing the specialized treatment. As cancer treatment becomes more specialized, the importance of training and placement of general surgeons in rural communities must be a priority for health care planning and professional training institutions. PMID:25951881

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

Millis, Andrew

Understanding the behavior of interacting electrons in molecules and solids so that one can predict new superconductors, catalysts, light harvesters, energy and battery materials and optimize existing ones is the ``quantum many-body problem’’. This is one of the scientific grand challenges of the 21 st century. A complete solution to the problem has been proven to be exponentially hard, meaning that straightforward numerical approaches fail. New insights and new methods are needed to provide accurate yet feasible approximate solutions. This CMSCN project brought together chemists and physicists to combine insights from the two disciplines to develop innovative new approaches. Outcomesmore » included the Density Matrix Embedding method, a new, computationally inexpensive and extremely accurate approach that may enable first principles treatment of superconducting and magnetic properties of strongly correlated materials, new techniques for existing methods including an Adaptively Truncated Hilbert Space approach that will vastly expand the capabilities of the dynamical mean field method, a self-energy embedding theory and a new memory-function based approach to the calculations of the behavior of driven systems. The methods developed under this project are now being applied to improve our understanding of superconductivity, to calculate novel topological properties of materials and to characterize and improve the properties of nanoscale devices.« less

A review on laser and light-based therapies for alopecia areata.

PubMed

Mlacker, Stephanie; Aldahan, Adam Souhail; Simmons, Brian James; Shah, Vidhi; McNamara, Colin Andrew; Samarkandy, Sahal; Nouri, Keyvan

2017-04-01

Alopecia areata is a form of non-scarring alopecia that results from a hyperactive immune response of T cells against hair follicles. Many patients with visible hair loss experience psychological and emotional distress, as a result of their cosmetic disfigurement, and frequently seek treatment. However, existing treatment methods, such as corticosteroids, topical irritants, sensitizing agents, immunosuppressants, and psoralen plus ultraviolet light A, may result in various adverse effects and often lack efficacy. Laser and light treatments offer a safe and effective alternative. This review aims to provide clinicians with a comprehensive summary of laser and light-based modalities used for the treatment of alopecia areata. Currently, the excimer laser is the most widely studied device and has shown positive results thus far. However, the development of future randomized controlled clinical trials will help determine the appropriate treatment protocols necessary, in order to achieve superior clinical outcomes.

Seeking new acne treatment from natural products, devices and synthetic drug discovery.

PubMed

Yang, Ji Hoon; Yoon, Ji Young; Kwon, Hyuck Hoon; Min, Seonguk; Moon, Jungyoon; Suh, Dae Hun

2017-01-01

Despite lots of research on the pathogenesis of acne, the development of new therapeutic agents is still stagnant. Conventional agents which target multiple pathological processes have some serious side effects and this makes seeking new treatment options important for treating acne. As new therapeutic options, researchers are focusing on natural products, synthetic drugs and devices. From natural products, epigallocatechin-3 gallate, lupeol, cannabidiol and Lactobacillus fermented Chamaecyperis obtusa were reported to be possible candidates for novel drugs, targeting multiple pathogenic factors. Synthetic anti- P.acnes agent, nitric oxide nanoparticles and α-mangostin nanoparticles are shown to be effective in acne treatment. Device or procedural methods such as fractional microneedling radiofrequency, cryolysis, photothermolysis and daylight photodynamic therapy have potential as new treatment options for acne. Further large clinical trials comparing these new treatments with existing agents will be necessary in the future.

Seeking new acne treatment from natural products, devices and synthetic drug discovery

PubMed Central

Yoon, Ji Young; Kwon, Hyuck Hoon; Min, Seonguk; Suh, Dae Hun

2017-01-01

ABSTRACT Despite lots of research on the pathogenesis of acne, the development of new therapeutic agents is still stagnant. Conventional agents which target multiple pathological processes have some serious side effects and this makes seeking new treatment options important for treating acne. As new therapeutic options, researchers are focusing on natural products, synthetic drugs and devices. From natural products, epigallocatechin-3 gallate, lupeol, cannabidiol and Lactobacillus fermented Chamaecyperis obtusa were reported to be possible candidates for novel drugs, targeting multiple pathogenic factors. Synthetic anti-P.acnes agent, nitric oxide nanoparticles and α-mangostin nanoparticles are shown to be effective in acne treatment. Device or procedural methods such as fractional microneedling radiofrequency, cryolysis, photothermolysis and daylight photodynamic therapy have potential as new treatment options for acne. Further large clinical trials comparing these new treatments with existing agents will be necessary in the future. PMID:29484092

Dynamic fractal signature dissimilarity analysis for therapeutic response assessment using dynamic contrast-enhanced MRI

PubMed Central

Wang, Chunhao; Subashi, Ergys; Yin, Fang-Fang; Chang, Zheng

2016-01-01

Purpose: To develop a dynamic fractal signature dissimilarity (FSD) method as a novel image texture analysis technique for the quantification of tumor heterogeneity information for better therapeutic response assessment with dynamic contrast-enhanced (DCE)-MRI. Methods: A small animal antiangiogenesis drug treatment experiment was used to demonstrate the proposed method. Sixteen LS-174T implanted mice were randomly assigned into treatment and control groups (n = 8/group). All mice received bevacizumab (treatment) or saline (control) three times in two weeks, and one pretreatment and two post-treatment DCE-MRI scans were performed. In the proposed dynamic FSD method, a dynamic FSD curve was generated to characterize the heterogeneity evolution during the contrast agent uptake, and the area under FSD curve (AUCFSD) and the maximum enhancement (MEFSD) were selected as representative parameters. As for comparison, the pharmacokinetic parameter Ktrans map and area under MR intensity enhancement curve AUCMR map were calculated. Besides the tumor’s mean value and coefficient of variation, the kurtosis, skewness, and classic Rényi dimensions d1 and d2 of Ktrans and AUCMR maps were evaluated for heterogeneity assessment for comparison. For post-treatment scans, the Mann–Whitney U-test was used to assess the differences of the investigated parameters between treatment/control groups. The support vector machine (SVM) was applied to classify treatment/control groups using the investigated parameters at each post-treatment scan day. Results: The tumor mean Ktrans and its heterogeneity measurements d1 and d2 values showed significant differences between treatment/control groups in the second post-treatment scan. In contrast, the relative values (in reference to the pretreatment value) of AUCFSD and MEFSD in both post-treatment scans showed significant differences between treatment/control groups. When using AUCFSD and MEFSD as SVM input for treatment/control classification, the achieved accuracies were 93.8% and 93.8% at first and second post-treatment scan days, respectively. In comparison, the classification accuracies using d1 and d2 of Ktrans map were 87.5% and 100% at first and second post-treatment scan days, respectively. Conclusions: As quantitative metrics of tumor contrast agent uptake heterogeneity, the selected parameters from the dynamic FSD method accurately captured the therapeutic response in the experiment. The potential application of the proposed method is promising, and its addition to the existing DCE-MRI techniques could improve DCE-MRI performance in early assessment of treatment response. PMID:26936718

ECONOMICS OF INDIVIDUALIZATION IN COMPARATIVE EFFECTIVENESS RESEARCH AND A BASIS FOR A PATIENT-CENTERED HEALTH CARE

PubMed Central

Basu, Anirban

2011-01-01

The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset. PMID:21601299

Angular dose anisotropy around gold nanoparticles exposed to X-rays.

PubMed

Gadoue, Sherif M; Toomeh, Dolla; Zygmanski, Piotr; Sajo, Erno

2017-07-01

Gold nanoparticle (GNP) radiotherapy has recently emerged as a promising modality in cancer treatment. The use of high atomic number nanoparticles can lead to enhanced radiation dose in tumors due to low-energy leakage electrons depositing in the vicinity of the GNP. A single metric, the dose enhancement ratio has been used in the literature, often in substantial disagreement, to quantify the GNP's capacity to increase local energy deposition. This 1D approach neglects known sources of dose anisotropy and assumes that one average value is representative of the dose enhancement. Whether this assumption is correct and within what accuracy limits it could be trusted, have not been studied due to computational difficulties at the nanoscale. Using a next-generation deterministic computational method, we show that significant dose anisotropy exists which may have radiobiological consequences, and can impact the treatment outcome as well as the development of treatment planning computational methods. Copyright © 2017 Elsevier Inc. All rights reserved.

Economics of individualization in comparative effectiveness research and a basis for a patient-centered health care.

PubMed

Basu, Anirban

2011-05-01

The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset. Copyright © 2011 Elsevier B.V. All rights reserved.

Large loop excision of the transformation zone for treating cervical intraepithelial neoplasia: a 12-year experience.

PubMed

Paraskevaidis, E; Koliopoulos, G; Malamou-Mitsi, V; Zikopoulos, K; Paschopoulos, M; Pappa, L; Agnantis, N J; Loli, D E

2001-01-01

Although the existing evidence suggests that there is no obviously superior conservative method for treating cervical intraepithelial neoplasia (CIN), one of the most widely used is the large loop excision of the transformation zone (LLETZ). A total of 897 women who were treated with LLETZ at our colposcopy clinic from 1989 to 2000 were retrospectively studied. Forty women did not have significant cervical pathology (4.5% over-treatment rate). Clear margins of excision were obtained in 748 (88.5%) of the 845 cases of CIN or microinvasive cancers. Treatment failure rates were 4.7% for clear margins and 26.8% for involved or uncertain. LLETZ is a fast and reliable method of treating CIN and microinvasive carcinoma. Generalized cauterization of the resulting crater should be avoided and satellite HPV lesions ablated. Involved margins have a higher treatmentfailure rate, therefore a larger excision is recommended as cervical craters regenerate. Treatment in pregnant women can be delayed until postpartum provided they have adequate surveillance during pregnancy.

Fashion, science and technical change: the history of the treatment of glue ear.

PubMed

Black, N A

1985-02-01

One reason for the current epidemic in the rate of surgery for glue ear in children is that a shift in treatment has taken place from non-surgical to surgical methods. An historical review of the treatment of this condition reveals the existence of previous 'surgical epidemics' and the importance of two particular factors-technical developments, such as the design of tympanostomy tubes and the introduction of antibacterial drugs; and the lure of panaceas such as ionizing radiation. In addition, it reveals how medical practice is, like most human behaviour, subject to fashion. Despite this, there is a constant desire by practitioners to be adjudged 'scientific' in their work, and definitions of science are equally susceptible to change over time.

[The current state and prospect of Chinese medicine gastroenterology].

PubMed

Zhang, Sheng-Sheng; Zhou, Tao

2012-03-01

The progress and existent problems of Chinese medicine (CM) gastroenterology since the National Eleventh Five-Year Plan were discussed in this article in terms of theory innovation, formulation of clinical pathway and diagnosis-treatment consensus, efficacy assessment, formulation of efficacy assessment scale, advantage diseases, and exploration of the syndrome standardization, progress in science research, academic exchange, and the construction of study platform, and so on. Meanwhile, the development of CM gastroenterology was prospected in the following five aspects: to enhance the theory inheritance and innovation, the construction of discipline standardization; to establish scientific clinical efficacy assessment methods and the standard system; to expend treatment technologies and feature therapies; and to clarify the modern scientific connotation of CM theory and treatment.

Pharmaceuticals and personal care products (PPCPs) in surface and treated waters of Louisiana, USA and Ontario, Canada.

PubMed

Boyd, Glen R; Reemtsma, Helge; Grimm, Deborah A; Mitra, Siddhartha

2003-07-20

A newly developed analytical method was used to measure concentrations of nine pharmaceuticals and personal care products (PPCPs) in samples from two surface water bodies, a sewage treatment plant effluent and various stages of a drinking water treatment plant in Louisiana, USA, and from one surface water body, a drinking water treatment plant and a pilot plant in Ontario, Canada. The analytical method provides for simultaneous extraction and quantification of the following broad range of PPCPs and endocrine-disrupting chemicals: naproxen; ibuprofen; estrone; 17beta-estradiol; bisphenol A; clorophene; triclosan; fluoxetine; and clofibric acid. Naproxen was detected in Louisiana sewage treatment plant effluent at 81-106 ng/l and Louisiana and Ontario surface waters at 22-107 ng/l. Triclosan was detected in Louisiana sewage treatment plant effluent at 10-21 ng/l. Of the three surface waters sampled, clofibric acid was detected in Detroit River water at 103 ng/l, but not in Mississippi River or Lake Pontchartrain waters. None of the other target analytes were detected above their method detection limits. Based on results at various stages of treatment, conventional drinking-water treatment processes (coagulation, flocculation and sedimentation) plus continuous addition of powdered activated carbon at a dosage of 2 mg/l did not remove naproxen from Mississippi River waters. However, chlorination, ozonation and dual media filtration processes reduced the concentration of naproxen below detection in Mississippi River and Detroit River waters and reduced clofibric acid in Detroit River waters. Results of this study demonstrate that existing water treatment technologies can effectively remove certain PPCPs. In addition, our study demonstrates the importance of obtaining data on removal mechanisms and byproducts associated with PPCPs and other endocrine-disrupting chemicals in drinking water and sewage treatment processes.

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

Eley, J; Mehta, M; Molitoris, J

Purpose: The purpose of this study was to propose a method to implement arc therapy that is compatible with existing particle therapy systems having gantries and pencil-beam scanning capacities. Furthermore, we sought to demonstrate expected benefits of this method for selected clival chordoma patients. Methods: We propose that a desired particle arc treatment plan can be discretized into a finite number of fixed beams and that only one (or a subset) of these beams be delivered in any single treatment fraction; the target should receive uniform dose during each fraction. For 3 clival-chordoma patients, robust-optimized, scanned proton beams were simulatedmore » to deliver 78 Gy (RBE) to clinical target volumes (CTVs), using either a single-field plan with a posterior-anterior (PA) beam or a discrete-arc plan with 16 beams that were equally spaced throughout a 360-degree axial arc. Dose-volume metrics were compared with emphasis on the brainstem, since risk of radiation necrosis there can often restrict application of tumoricidal doses for chordomas. Results: The mean volume of brainstem receiving a dose of 60 Gy (RBE) or higher (V60Gy) was 10.3±0.9 cm{sup 3} for the single-field plan and 4.7±1.8 cm{sup 3} for the discrete-arc plan, a reduction of 55% in favor of arcs. The mean dose to the brainstem was also reduced using arcs, by 18%, while the maximum dose was nearly identical for both methods. For the whole brain, V60Gy was reduced by 23%, in favor of arcs. Mean dose to the CTVs were nearly identical for both strategies, within 0.3%. Conclusion: Discrete arc treatments can be implemented using existing scanned particle-beam facilities. Aside from the physical advantages, the biological uncertainties of particle therapy, particularly high in the distal edge, can be reduced by arc therapy via rotational smearing, which may be of benefit for tumors near the brainstem.« less

Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications

PubMed Central

Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.

2005-01-01

BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209

Settling for second best: when should doctors agree to parental demands for suboptimal medical treatment?

PubMed Central

Nair, Tara; Savulescu, Julian; Everett, Jim; Tonkens, Ryan; Wilkinson, Dominic

2017-01-01

Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead (suboptimal being defined as less effective and/or more expensive). Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results. Results Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses (73.6%). Respondents’ agreement to provide treatment decreased as the risk or cost of the requested substitute increased (p<0.001). More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child (<5%) and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed (p<0.001). Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results. Conclusion Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests. PMID:28947505

Recovery of Platinum Group Metals from Spent Catalysts Using Iron Chloride Vapor Treatment

NASA Astrophysics Data System (ADS)

Taninouchi, Yu-ki; Okabe, Toru H.

2018-05-01

The recovery of platinum group metals (PGMs) from spent automobile catalysts is a difficult process because of their relatively low contents in the scrap. In this study, to improve the efficiency of the existing recycling techniques, a novel physical concentration method involving treatment with FeCl2 vapor has been examined. The reactions occurring between typical catalyst components and FeCl2 vapor are discussed from the thermodynamic point of view, and the validity of the proposed technique was experimentally verified. The obtained results indicate that the vapor treatment at around 1200 K (927 °C) can effectively alloy PGMs (Pt, Pd, and Rh) with Fe, resulting in the formation of a ferromagnetic alloy. It was also confirmed that cordierite and alumina (the major catalyst components) remained unreacted after the vapor treatment, while ceria species were converted into oxychlorides. The samples simulating the automobile catalyst were also subjected to magnetic separation after the treatment with FeCl2 vapor; as a result, PGMs were successfully extracted and concentrated in the form of a magnetic powder. Thus, the FeCl2 vapor treatment followed by magnetic separation can be utilized for recovering PGMs directly from spent catalysts as an effective pretreatment for the currently used recycling methods.

Clay-starch combination for micropollutants removal from wastewater treatment plant effluent.

PubMed

Mohd Amin, M F; Heijman, S G J; Rietveld, L C

2016-01-01

In this study, a new, more effective and cost-effective treatment alternative is investigated for the removal of pharmaceuticals from wastewater treatment plant effluent (WWTP-eff). The potential of combining clay with biodegradable polymeric flocculants is further highlighted. Flocculation is viewed as the best method to get the optimum outcome from clay. In addition, flocculation with cationic starch increases the biodegradability and cost of the treatment. Clay is naturally abundantly available and relatively inexpensive compared to conventional adsorbents. Experimental studies were carried out with existing naturally occurring pharmaceutical concentrations found and measured in WWTP-eff with atrazine spiking for comparison between the demineralised water and WWTP-eff matrix. Around 70% of the total measured pharmaceutical compounds were removable by the clay-starch combination. The effect of clay with and without starch addition was also highlighted.

Radiation shielding design of a new tomotherapy facility.

PubMed

Zacarias, Albert; Balog, John; Mills, Michael

2006-10-01

It is expected that intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) will replace a large portion of radiation therapy treatments currently performed with conventional MLC-based 3D conformal techniques. IGRT may become the standard of treatment in the future for prostate and head and neck cancer. Many established facilities may convert existing vaults to perform this treatment method using new or upgraded equipment. In the future, more facilities undoubtedly will be considering de novo designs for their treatment vaults. A reevaluation of the design principles used in conventional vault design is of benefit to those considering this approach with a new tomotherapy facility. This is made more imperative as the design of the TomoTherapy system is unique in several aspects and does not fit well into the formalism of NCRP 49 for a conventional linear accelerator.

Interior noise control prediction study for high-speed propeller-driven aircraft

NASA Technical Reports Server (NTRS)

Rennison, D. C.; Wilby, J. F.; Marsh, A. H.; Wilby, E. G.

1979-01-01

An analytical model was developed to predict the noise levels inside propeller-driven aircraft during cruise at M = 0.8. The model was applied to three study aircraft with fuselages of different size (wide body, narrow body and small diameter) in order to determine the noise reductions required to achieve the goal of an A-weighted sound level which does not exceed 80 dB. The model was then used to determine noise control methods which could achieve the required noise reductions. Two classes of noise control treatments were investigated: add-on treatments which can be added to existing structures, and advanced concepts which would require changes to the fuselage primary structure. Only one treatment, a double wall with limp panel, provided the required noise reductions. Weight penalties associated with the treatment were estimated for the three study aircraft.

Test Statistics and Confidence Intervals to Establish Noninferiority between Treatments with Ordinal Categorical Data.

PubMed

Zhang, Fanghong; Miyaoka, Etsuo; Huang, Fuping; Tanaka, Yutaka

2015-01-01

The problem for establishing noninferiority is discussed between a new treatment and a standard (control) treatment with ordinal categorical data. A measure of treatment effect is used and a method of specifying noninferiority margin for the measure is provided. Two Z-type test statistics are proposed where the estimation of variance is constructed under the shifted null hypothesis using U-statistics. Furthermore, the confidence interval and the sample size formula are given based on the proposed test statistics. The proposed procedure is applied to a dataset from a clinical trial. A simulation study is conducted to compare the performance of the proposed test statistics with that of the existing ones, and the results show that the proposed test statistics are better in terms of the deviation from nominal level and the power.

The European Glaucoma Society Glaucocard project: improved digital documentation of medical data for glaucoma patients based on standardized structured international datasets.

PubMed

Schargus, Marc; Grehn, Franz; Glaucocard Workgroup

2008-12-01

To evaluate existing international IT-based ophthalmological medical data projects, and to define a glaucoma data set based on existing international standards of medical and ophthalmological documentation. To develop the technical environment for easy data mining and data exchange in different countries in Europe. Existing clinical and IT-based projects for documentation of medical data in general medicine and ophthalmology were analyzed to create new data sets for medical documentation in glaucoma patients. Different types of data transfer methods were evaluated to find the best method of data exchange between ophthalmologists in different European countries. Data sets from existing IT projects showed a wide variability in specifications, use of codes, terms and graphical data (perimetry, optic nerve analysis etc.) in glaucoma patients. New standardized digital datasets for glaucoma patients were defined, based on existing standards, which can be used by general ophthalmologists for follow-up examinations and for glaucoma specialists to perform teleconsultation, also across country borders. Datasets are available in different languages. Different types of data exchange methods using secure medical data transfer by internet, USB stick and smartcard were tested for different countries with regard to legal acceptance, practicability and technical realization (e.g. compatibility with EMR systems). By creating new standardized glaucoma specific cross-national datasets, it is now possible to develop an electronic glaucoma patient record system for data storage and transfer based on internet, smartcard or USB stick. The digital data can be used for referrals and for teleconsultation of glaucoma specialists in order to optimize glaucoma treatment. This should lead to an increase of quality in glaucoma care, and prevent expenses in health care costs by unnecessary repeated examinations.

Experimental Treatment for Duchenne Muscular Dystrophy Gets Boost from Existing Medication

MedlinePlus

... Boost from Existing Medication Spotlight on Research Experimental Treatment for Duchenne Muscular Dystrophy Gets Boost from Existing Medication By Colleen Labbe, M.S. | March 1, 2013 A mouse hanging on a wire during a test of muscle strength. Mice with a mutant dystrophin gene, which ...

Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings.

PubMed

Reyes, E Michael; Sharma, Anjali; Thomas, Kate K; Kuehn, Chuck; Morales, José Rafael

2014-09-17

Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs. Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation. Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework. A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.

Potential Linkage Between Cerebrovascular Diseases and Metabolic Syndrome.

PubMed

Jabir, Nasimudeen R; Firoz, Chelapram Kandy; Khan, Mohd Shahnawaz; Zaidi, Syed Kashif; Ashraf, Ghulam Md; Shakil, Shazi; Kamal, Mohammad Amjad; Tabrez, Shams

2017-01-01

Cerebrovascular disease (CD) and metabolic syndrome (MetS) are two devastating health dilemma that continues to be a potential contributor to disability and mortality in human population all across the world. Scientific data clearly shows several mechanistic similarities between these two co-existing and interlinked conditions. The linkage exacerbates ongoing patho-physiological condition towards more lethal events. In view of the presence of modifiable risk factors in both CD and MetS, their management holds potential therapeutic value. Hence, developing common treatment strategies for these diseases could involve common molecular agents. In this communication, we have summarized some of the common pathological conditions viz. abdominal obesity, insulin resistance, dyslipidemia, hypertension, and endothelial dysfunction that further deteriorate existing homeostasis in CD and MetS. Based on our article, it is advocated that substantial improvements in novel multi-targeted drug discovery could provide the effective treatment methods in order to avoid the fatal complications related with CD and MetS. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Field methods for sampling and storing nectar from flowers with low nectar volumes.

PubMed

Morrant, D S; Schumann, R; Petit, S

2009-02-01

Although several methods of sampling and storing floral nectar are available, little information exists on sampling and storing nectar from flowers with low nectar volumes. Methods for sampling and storing nectar from the flowers of species with low floral nectar volumes (<1 microL) were investigated using the flowers of Eucalyptus species. Sampling with microcapillary tubes, blotting up with filter paper, washing and rinsing were compared to determine masses of sugars recovered and differences in sugar ratios. Storage methods included room temperature, refrigeration and freezing treatments; the addition of antimicrobial agents benzyl alcohol or methanol to some of these treatments was also evaluated. Nectar samples were analysed using high-performance liquid chromatography and the masses of sucrose, glucose and fructose in each sample were determined. Masses of sugars varied significantly among sampling treatments, but the highest yielding methods, rinsing and washing, were not significantly different. A washing time of 1 min was as effective as one of 20 min. Storage trials showed that the sugar concentration measurements of nectar solutions changed rapidly, with the best results achieved for refrigeration with no additive (sucrose and fructose were stable for at least 2 weeks). Sugar ratios, however, remained relatively stable in most treatments and did not change significantly across 4 weeks for the methanol plus refrigerator and freezing treatments, and 2 weeks for the refrigeration treatment with no additive. Washing is recommended for nectar collection from flowers with low nectar volumes in the field (with the understanding that one wash underestimates the amounts of sugars present in a flower), as is immediate analysis of sugar mass. In view of the great variation in results depending on nectar collection and storage methods, caution should be exercised in their choice, and their accuracy should be evaluated. The use of pulsed amperometric detection, more specific than refractive index detection, may improve the accuracy of nectar sugar analysis.

Intralesional cryotherapy for hypertrophic scars and keloids: a review

PubMed Central

O’Boyle, Ciaran P; Shayan-Arani, Holleh; Hamada, Maha Wagdy

2017-01-01

Introduction: Hypertrophic and keloid scarring remain notoriously troublesome for patients to tolerate and frustratingly difficult for clinicians to treat. Many different treatment modalities exist, signifying the failure of any method to achieve consistently excellent results. Intralesional cryotherapy is a relatively recent development that uses a double lumen needle, placed through the core of a keloid or hypertrophic scar, to deliver nitrogen vapour, which freezes the scar from its core, outwards. Methods: This article provides a comprehensive review of the literature on intralesional cryotherapy for hypertrophic scars and keloids. A systematic review or meta-analysis was not possible, since the existing articles did not permit this. Results: A search of English language, peer-reviewed literature was carried out. The evidence base was found to be low (level 4). In addition, much of the published evidence comes from a very few groups. Despite this, consistent findings from case series suggest that the technique is safe and achieves good scar reduction with very few treatments. Adverse effects include depigmentation, recurrence and pain. Pain and recurrence appear to be uncommon and depigmentation may be temporary. Discussion: Well-constructed, prospectively recruited comparative trials are absent from the literature. These are strongly encouraged, in order to strengthen general confidence in this technique and in the repeatability of outcomes reported thus far. PMID:29799581

A challenging entanglement: health care providers’ perspectives on caring for ill and injured tourists on Cozumel Island, Mexico

PubMed Central

Crooks, Valorie A.; Snyder, Jeremy

2018-01-01

ABSTRACT Purpose: Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals’ treatment provision experiences on Cozumel Island, Mexico. Methods: 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Results: Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Conclusion: Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island’s health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island’s health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island. PMID:29869593

Role of stereotactic radiosurgery in patients with more than four brain metastases

PubMed Central

Jairam, Vikram; Chiang, Veronica LS; Yu, James B; Knisely, Jonathan PS

2013-01-01

SUMMARY For patients presenting with brain metastases, two methods of radiation treatment currently exist: stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT). SRS is a minimally invasive to noninvasive technique that delivers a high dose of ionizing radiation to a precisely defined focal target volume, whereas WBRT involves multiple smaller doses of radiation delivered to the whole brain. Evidence exists from randomized controlled trials for SRS in the treatment of patients with one to four brain metastases. Patients with more than four brain metastases generally receive WBRT, which can effectively treat undetected metastases and protect against intracranial relapse. However, WBRT has been associated with an increased potential for toxic neurocognitive side effects, including memory loss and early dementia, and does not provide 100% protection against relapse. For this reason, physicians at many medical centers are opting to use SRS as first-line treatment for patients with more than four brain metastases, despite evidence showing an increased rate of intracranial relapse compared with WBRT. In light of the evolving use of SRS, this review will examine the available reports on institutional trials and outcomes for patients with more than four brain metastases treated with SRS alone as first-line therapy. PMID:24273642

Infrastructure optimisation via MBR retrofit: a design guide.

PubMed

Bagg, W K

2009-01-01

Wastewater management is continually evolving with the development and implementation of new, more efficient technologies. One of these is the Membrane Bioreactor (MBR). Although a relatively new technology in Australia, MBR wastewater treatment has been widely used elsewhere for over 20 years, with thousands of MBRs now in operation worldwide. Over the past 5 years, MBR technology has been enthusiastically embraced in Australia as a potential treatment upgrade option, and via retrofit typically offers two major benefits: (1) more capacity using mostly existing facilities, and (2) very high quality treated effluent. However, infrastructure optimisation via MBR retrofit is not a simple or low-cost solution and there are many factors which should be carefully evaluated before deciding on this method of plant upgrade. The paper reviews a range of design parameters which should be carefully evaluated when considering an MBR retrofit solution. Several actual and conceptual case studies are considered to demonstrate both advantages and disadvantages. Whilst optimising existing facilities and production of high quality water for reuse are powerful drivers, it is suggested that MBRs are perhaps not always the most sustainable Whole-of-Life solution for a wastewater treatment plant upgrade, especially by way of a retrofit.

A Potential Treatment for Post-Flight Orthostatic Intolerance in Aero-Space Crews: Autogenic-Feedback Training

NASA Technical Reports Server (NTRS)

Cowings, P. S.; Toscano, W. B.; Miller, N. E.; Pickering, T. G.; Shapiro, D.

1994-01-01

Postflight orthostatic intolerance has been identified as a serious biomedical problem associated with long duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder which are both effective and practical. A considerable body of clinical research has demonstrated that people can be taught to increase their own blood pressure voluntarily and that this is an effective treatment for chronic Orthostatic intolerance in paralyzed patients. The present pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using in operant conditioning procedure, Autogenic-Feedback Training (AFT), three men and two women participated in four to nine (15-30 training sessions). At the end of training ranged between 20 and 50 mm Hg under both supine and 450 head-up tilt conditions. These findings suggest that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight Orthostatic intolerance. Further, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

The convergence of personality disorder diagnoses across different methods among monolingual (Spanish-speaking only) Hispanic patients in substance use treatment.

PubMed

Samuel, Douglas B; Añez, Luis M; Paris, Manuel; Grilo, Carlos M

2014-04-01

Methods for diagnosing personality disorders (PDs) within clinical settings typically diverge from those used in treatment research. Treatment groups in research studies are routinely diagnosed using semistructured interviews or self-report questionnaires, yet these methods show poor agreement with clinical diagnoses recorded in medical charts or assigned by treating clinicians, reducing the potential for evidence-based practice. Furthermore, existing research has been limited by focusing on primarily White and English-speaking participants. Our study extended prior research by comparing 4 independent methods of PD diagnosis, including self-report questionnaire, semistructured interview, chart diagnoses, and ratings by treating clinicians, within a clinical series of 130 monolingual (Spanish only) Hispanic persons (69% male; M age 37.4), in treatment for substance use. The authors examined the convergence of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) PD diagnoses across these methods. PD diagnoses appeared infrequently within medical charts but were diagnosed at higher levels by independent treating clinicians, self-report questionnaires, and semistructured interviews. Nonetheless, diagnostic concordance between clinical diagnoses and the other methods were poor (κ < .20). Convergence of PD diagnoses across diagnostic methods for Spanish-speaking Hispanic persons are comparable to other groups allaying concerns about cross-cultural application of PD diagnoses. Additionally, the results of this study echo previous research in suggesting that clinicians' PD diagnoses overlap little with self-report questionnaires or semistructured diagnostic interviews and suggest that PDs are underdiagnosed using standard diagnostic approaches. Implications for the clinical application of empirically supported research are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved

An Economic comparison of sludge irradiation and alternative methods of municipal sludge treatment

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

Ahlstrom, S.B.; McGuire, H.E.

1977-11-01

The relative economics of radiation treatment and other sludge treatment processes are reported. The desirability of radiation treatment is assessed in terms of cost and the quality of the treated sludge product. The major conclusions of this study are: radiation treatment is a high-level disinfection process. Therefore, it should only be considered if high levels of disinfection are required for widespread reuse of the sludge; the handling, transporting and pathogen growback problems associated with disinfected wet sludge makes it less attractive for reuse than dry sludge; radiation of composted sludge produces a product of similar quality at less cost thanmore » any thermal treatment and/or flash drying treatment option for situations where a high degree of disinfection is required; and heavy metal concerns, especially cadmium, may limit the reuse of sludge despite high disinfection levels. It is recommended that radiation treatment of sludge, particularly dry sludge, continue to be studied. A sensitivity analysis investigating the optimal conditions under which sludge irradiation operates should be instigated. Furthermore, costs of adding sludge irradiation to existing sludge treatment schemes should be determined.« less

Co-liquefaction with acetone and GC analysis of volatile compounds in exhaled breath as lung cancer biomarkers

PubMed Central

Jouyban, Abolghasem; Djozan, Djavanshir; Mohammadandashti, Parastou; Alizadeh-Nabil, Aliakbar; Ghorbanpour, Hooshangh; Khoubnasabjafari, Maryam; Mohammadzadeh, Mohammad

2017-01-01

Introduction: A simple, rapid and low cost method for enrichment of volatile organic compounds (VOCs) from exhaled breath (EB) is presented. Methods: A 1000 mL home-made extraction device was filled with EB. The VOCs were extracted and condensed in 0.5 mL acetone. Recognition of volatiles in the real studied EB samples was performed by a GC-MS. Results: The method displays an extraction efficiency of >86% with the enrichment factor of 1929 for octanal. Limits of detection and quantification, and linear dynamic range were 0.008, 0.026 and 0.026-400 ng/mL respectively. Analysis of real samples showed the existence of more than 100 compounds in EB of healthy volunteers and patients with lung cancer before and after treatment. Exhaled octanal concentration was significantly higher in lung cancer patient than in healthy volunteers and lung cancer patient after treatment. Conclusion: Having used the proposed approach, high extraction recovery (up to 86%) was attained for the lung cancer marker, octanal, as an important biomarker. Our findings on smaples of EB of healthy controls and patients with lung cancer before and after treatment provide complelling evidence upon the effectiveness of the developed method. PMID:28752074

Perturbational treatment of spin-orbit coupling for generally applicable high-level multi-reference methods

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

Mai, Sebastian; Marquetand, Philipp; González, Leticia

2014-08-21

An efficient perturbational treatment of spin-orbit coupling within the framework of high-level multi-reference techniques has been implemented in the most recent version of the COLUMBUS quantum chemistry package, extending the existing fully variational two-component (2c) multi-reference configuration interaction singles and doubles (MRCISD) method. The proposed scheme follows related implementations of quasi-degenerate perturbation theory (QDPT) model space techniques. Our model space is built either from uncontracted, large-scale scalar relativistic MRCISD wavefunctions or based on the scalar-relativistic solutions of the linear-response-theory-based multi-configurational averaged quadratic coupled cluster method (LRT-MRAQCC). The latter approach allows for a consistent, approximatively size-consistent and size-extensive treatment of spin-orbitmore » coupling. The approach is described in detail and compared to a number of related techniques. The inherent accuracy of the QDPT approach is validated by comparing cuts of the potential energy surfaces of acrolein and its S, Se, and Te analoga with the corresponding data obtained from matching fully variational spin-orbit MRCISD calculations. The conceptual availability of approximate analytic gradients with respect to geometrical displacements is an attractive feature of the 2c-QDPT-MRCISD and 2c-QDPT-LRT-MRAQCC methods for structure optimization and ab inito molecular dynamics simulations.« less

Management of Substance Use Disorder in Military Services: A Comprehensive Approach

PubMed Central

Sharbafchi, Mohammad Reza; Heydari, Mostafa

2017-01-01

Background: Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. Materials and Methods: This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. Results: There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. Conclusions: The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army. PMID:28989915

Ethnopharmacological survey of herbal remedies used for treatment of various types of cancer and their methods of preparations in the West Bank-Palestine.

PubMed

Jaradat, Nidal Amin; Al-Ramahi, Rowa; Zaid, Abdel Naser; Ayesh, Ola Ibrahim; Eid, Ahmad Mustafa

2016-03-08

Plants have been the primary source of medicines since life on earth; more than 50 % of existing cancer treatments are derived from plants. An ethnopharmacological survey of herbal remedies used in cancer treatment was carried out in the West Bank/ Palestine. A questionnaire was distributed to one hundred and fifty herbalists, traditional healers and rural dwellers. Collected information included the names of plants, the used parts, types of cancers for which these plants were used and also their methods of preparation. To identify the most important species used, Factor of informant's consensus (F(ic)), Fidelity level (Fl) and the Use-value (UV) were calculated. Collected data has shown that 72 plants are utilized for treatment of cancer, belonging to 44 families; from them Compositae and Lamiaceae were the most common. Leaves and fruits were the most commonly used parts, while decoctions, infusions and syrups were the main methods of preparation. Lung cancer was the most common type of cancer treated with these plants and Ephedra alata was the most commonly used plant for treatment of cancer in Palestine. The Fic was high for all the plants; Fl was 100% for many plants, the highest UV (0.72) was for Ephedra alata. This study showed that many herbal remedies are still used by herbalists in Palestine for treatment of cancer; some of them have been approved scientifically while others are not. A combined effort between informants and scientific institutions working in this field can help in the discovery of new anticancer agents. Moreover, scientists must explore the most suitable method of extraction, formulation and dose determination in order to achieve the best benefits from these herbals.

[Topic identification for cross-sectoral quality assurance in stroke and TIA treatment].

PubMed

Meyer, Sven; Willms, Gerald; Broge, Björn; Szecsenyi, Joachim

2016-10-01

The development of cross-sectoral quality assurance programs usually requires extensive topic identification. Illustrated by the complex processes of care for stroke and transient ischemic attacks (TIAs), a method for comprehensive topic identification is presented. The first step involves a thorough literature search in terms of systematic reviews, health technology assessments, guidelines, studies into healthcare delivery and the use of specific instruments. Routine data as well as epidemiologic studies are used to analyze the reality of service provision. In addition, experts are consulted to gain expertise concerning deficits of care, approaches to quality assurance and experience with existing quality assurance programs. Furthermore individual patient experiences are collected to add the patients' perceptions of care. Because of the limitation on the regulatory scope of Book V of the German Social Code, which, in this case, was necessary, another source of information was the legal framework and its impact on rescue chain, acute treatment and rehabilitation. Existent quality management systems, accreditations and quality assurance programs in prevention, acute treatment and rehabilitation have been searched in order to avoid any overlap with existing measures. After identifying a total of 71 quality targets according to deficits of care, recommendations for care and expert opinions in primary and secondary prevention, rescue chain, acute treatment, rehabilitation and supply of assistive equipment and therapies, respectively, the usability of instruments was tested. These instruments included case documentation, patient surveys and routine data. 14 quality targets proved to be reproducible by these instruments and were included in the recommendations for a cross-sectoral quality assurance program for stroke and TIA. Copyright © 2016. Published by Elsevier GmbH.

One-, two- and three-phase viscosity treatments for basaltic lava flows

PubMed Central

Harris, Andrew J. L.; Allen, John S.

2009-01-01

Lava flows comprise three-phase mixtures of melt, crystals, and bubbles. While existing one-phase treatments allow melt phase viscosity to be assessed on the basis of composition, water content, and/or temperature, two-phase treatments constrain the effects of crystallinity or vesicularity on mixture viscosity. However, three-phase treatments, allowing for the effects of coexisting crystallinity and vesicularity, are not well understood. We investigate existing one- and two-phase treatments using lava flow case studies from Mauna Loa (Hawaii) and Mount Etna (Italy) and compare these with a three-phase treatment that has not been applied previously to basaltic mixtures. At Etna, melt viscosities of 425 ± 30 Pa s are expected for well-degassed (0.1 w. % H2O), and 135 ± 10 Pa s for less well-degassed (0.4 wt % H2O), melt at 1080°C. Application of a three-phase model yields mixture viscosities (45% crystals, 25–35% vesicles) in the range 5600–12,500 Pa s. This compares with a measured value for Etnean lava of 9400 ± 1500 Pa s. At Mauna Loa, the three-phase treatment provides a fit with the full range of field measured viscosities, giving three-phase mixture viscosities, upon eruption, of 110–140 Pa s (5% crystals, no bubble effect due to sheared vesicles) to 850–1400 Pa s (25–30% crystals, 40–60% spherical vesicles). The ability of the three-phase treatment to characterize the full range of melt-crystal-bubble mixture viscosities in both settings indicates the potential of this method in characterizing basaltic lava mixture viscosity. PMID:21691456

Development of a Measure of Asthma-Specific Quality of Life among Adults

PubMed Central

Eberhart, Nicole K.; Sherbourne, Cathy D.; Edelen, Maria Orlando; Stucky, Brian D.; Sin, Nancy L.; Lara, Marielena

2014-01-01

Purpose A key goal in asthma treatment is improvement in quality of life (QoL), but existing measures often confound QoL with symptoms and functional impairment. The current study addresses these limitations and the need for valid patient-reported outcome measures by using state-of-the-art methods to develop an item bank assessing QoL in adults with asthma. This article describes the process for developing an initial item pool for field testing. Methods Five focus group interviews were conducted with a total of 50 asthmatic adults. We used “pile sorting/binning” and “winnowing” methods to identify key QoL dimensions and develop a pool of items based on statements made in the focus group interviews. We then conducted a literature review and consulted with an expert panel to ensure that no key concepts were omitted. Finally, we conducted individual cognitive interviews to ensure that items were well understood and inform final item refinement. Results 661 QoL statements were identified from focus group interview transcripts and subsequently used to generate a pool of 112 items in 16 different content areas. Conclusions Items covering a broad range of content were developed that can serve as a valid gauge of individuals’ perceptions of the effects of asthma and its treatment on their lives. These items do not directly measure symptoms or functional impairment, yet they include a broader range of content than most existent measures of asthma-specific QoL. PMID:24062237

Developmental dysplasia of the hip: a history of innovation.

PubMed

Tarpada, Sandip P; Girdler, Steven J; Morris, Matthew T

2018-05-01

Developmental dysplasia of the hip (DDH) is a relatively common malady that has profound consequences in the infant if left untreated. Effective and early treatment of DDH has been praised as one of the most successful ventures of modern pediatric orthopedics. Yet, before the modern management of DDH came into existence, there were extensive technological developments in the field of harnesses, casts, and traction methods. This paper aims to identify the centuries-old history of advancement in DDH treatment and the many important people involved. Their devices, thoughts, and ideas continue to have a profound impact on the current practice of orthopedic surgery.

Fungal Infections: The Stubborn Cases

PubMed Central

Adam, John E.

1982-01-01

Despite development of numerous antifungal preparations, mycotic infections persist, because of inaccurate diagnosis leading to inappropriate therapy, drug failure, non-compliance or resistance of the organism to antifungal medication. Direct KOH examination is the simplest method of proving the existence of a fungus. Fungal infections tend to be overdiagnosed; disorders which do not improve with three to four weeks of treatment should be reassessed before being labelled ‘stubborn’. Griseofulvin is effective treatment for all dermatophytes, but has certain side effects. Newer topical antifungals are also effective, but no single drug cures all fungal infections. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8 PMID:20469387

Ultimate disposal of scrubber wastes

NASA Technical Reports Server (NTRS)

Cohenour, B. C.

1978-01-01

Part of the initial concern with using the wet scrubbers on the hypergolic propellants was the subsequential disposal of the liquid wastes. To do this, consideration was given to all possible methods to reduce the volume of the wastes and stay within the guidelines established by the state and federal environmental protection agencies. One method that was proposed was the use of water hyacinths in disposal ponds to reduce the waste concentration in the effluent to less than EPA tolerable levels. This method was under consideration and even in use by private industry, municipal governments, and NASA for upgrading existing wastewater treatment facilities to a tertiary system. The use of water hyacinths in disposal ponds appears to be a very cost-effective method for reduction and disposal of hypergolic propellants.

Susceptibility Testing of Medically Important Parasites.

PubMed

Genetu Bayih, Abebe; Debnath, Anjan; Mitre, Edward; Huston, Christopher D; Laleu, Benoît; Leroy, Didier; Blasco, Benjamin; Campo, Brice; Wells, Timothy N C; Willis, Paul A; Sjö, Peter; Van Voorhis, Wesley C; Pillai, Dylan R

2017-07-01

In the last 2 decades, renewed attention to neglected tropical diseases (NTDs) has spurred the development of antiparasitic agents, especially in light of emerging drug resistance. The need for new drugs has required in vitro screening methods using parasite culture. Furthermore, clinical laboratories sought to correlate in vitro susceptibility methods with treatment outcomes, most notably with malaria. Parasites with their various life cycles present greater complexity than bacteria, for which standardized susceptibility methods exist. This review catalogs the state-of-the-art methodologies used to evaluate the effects of drugs on key human parasites from the point of view of drug discovery as well as the need for laboratory methods that correlate with clinical outcomes. Copyright © 2017 American Society for Microbiology.

Decision support systems in water and wastewater treatment process selection and design: a review.

PubMed

Hamouda, M A; Anderson, W B; Huck, P M

2009-01-01

The continuously changing drivers of the water treatment industry, embodied by rigorous environmental and health regulations and the challenge of emerging contaminants, necessitates the development of decision support systems for the selection of appropriate treatment trains. This paper explores a systematic approach to developing decision support systems, which includes the analysis of the treatment problem(s), knowledge acquisition and representation, and the identification and evaluation of criteria controlling the selection of optimal treatment systems. The objective of this article is to review approaches and methods used in decision support systems developed to aid in the selection, sequencing of unit processes and design of drinking water, domestic wastewater, and industrial wastewater treatment systems. Not surprisingly, technical considerations were found to dominate the logic of the developed systems. Most of the existing decision-support tools employ heuristic knowledge. It has been determined that there is a need to develop integrated decision support systems that are generic, usable and consider a system analysis approach.

[Research on Energy Distribution During Osteoarthritis Treatment Using Shock Wave Lithotripsy].

PubMed

Zhang, Shinian; Wang, Xiaofeng; Zhang, Dong

2015-04-01

Extracorporeal shock wave treatment is capable of providing a non-surgical and effective treatment modality for patients suffering from osteoarthritis. The major objective of current works is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Firstly, a model of finite element method (FEM) was developed based on Comsol software in the present study. Then, high-speed photography experiments were performed to record cavitation bubbles with the presence of mimic bone. On the basis of comparing experimental with simulated results, the effectiveness of FEM model could be verified. Finally, the energy distribution during extracorporeal shock wave treatment was predicted. The results showed that the shock wave field was deflected with the presence of bony structure and varying deflection angles could be observed as the bone shifted up in the z-direction relative to shock wave geometric focus. Combining MRI/CT scans to FEM modeling is helpful for better standardizing the treatment dosage and optimizing treatment protocols in the clinic.

Impact of co-existent thyroiditis on clinical outcome in papillary thyroid carcinoma with high preoperative serum antithyroglobulin antibody: a retrospective cohort study.

PubMed

Nam, H-Y; Lee, H Y; Park, G C

2016-08-01

The aim of this study was to investigate the impact of co-existent chronic lymphocytic thyroiditis (CLT) on changes in serum antithyroglobulin antibody (TgAb) and clinical outcome in papillary thyroid carcinoma (PTC) patients with high preoperative serum TgAb. A retrospective cohort study. University teaching hospital. Thirty-seven PTC patients with high preoperative serum TgAb level (≥100 U/mL) were evaluated. All patients underwent total thyroidectomy followed by high-dose I-131 ablation. Per cent changes of TgAb between pre-treatment and post-treatment, and disease-free survival were calculated. Twenty-two patients (59.5%) had co-existent CLT, and seven had residual/recurrent tumours. There was a higher proportion of females among the patients with CLT compared to those without CLT (95.5% versus 66.7%; P = 0.0306). There were trends towards more aggressive pathologies, such as tumour size, extrathyroidal extension, surgical margin and lymph node stage, in PTC without CLT than in that with co-existent CLT. Pre-treatment and post-treatment TgAb were all higher in PTC with co-existent CLT. But, per cent changes of TgAb between pre-treatment and post-treatment were no significant difference between PTC with and without CLT (P < 0.05). Patients with co-existent CLT showed a significantly lower residual/recurrent tumour rate than those without CLT (4.5% versus 40%; P = 0.0113). Residual/recurrent tumour rate was lower in PTC patients with co-existent CLT than in those without CLT. © 2015 John Wiley & Sons Ltd.

A combination method based on chitosan adsorption and duckweed (Lemna gibba L.) phytoremediation for boron (B) removal from drinking water.

PubMed

Türker, Onur Can; Baran, Talat

2018-01-28

The metalloid boron (B) and its compounds widely exist in the environment, and boron can have hazardous effects on plants, animals, and human beings when it is found in high concentrations in water bodies. It is difficult and costly to remove B with conventional treatment methods from drinking water. Therefore, alternative and cost-effective treatment techniques are necessary. In this study, for the first time, a novel and environmentally friendly method based on the phytoremediation ability of chitosan and duckweed (Lemna gibba L.) combination was evaluated for B removal from drinking water. Our results from batch adsorption experiment indicated that the highest B uptake capacity of chitosan bead was found as 3.18 mg/g, and we determined the optimal B sorption occurs at pH value of 7. The Langmuir isotherm and pseudo-second-order kinetic model better fitted the equilibrium obtained for B removal. B in drinking water could be reduced to less than 2.4 mg L -1 when 0.05 g of plant-based chitosan beads and 12 L. gibba fronds were used in the 4-day treatment period.

Gradient Augmented Level Set Method for Two Phase Flow Simulations with Phase Change

NASA Astrophysics Data System (ADS)

Anumolu, C. R. Lakshman; Trujillo, Mario F.

2016-11-01

A sharp interface capturing approach is presented for two-phase flow simulations with phase change. The Gradient Augmented Levelset method is coupled with the two-phase momentum and energy equations to advect the liquid-gas interface and predict heat transfer with phase change. The Ghost Fluid Method (GFM) is adopted for velocity to discretize the advection and diffusion terms in the interfacial region. Furthermore, the GFM is employed to treat the discontinuity in the stress tensor, velocity, and temperature gradient yielding an accurate treatment in handling jump conditions. Thermal convection and diffusion terms are approximated by explicitly identifying the interface location, resulting in a sharp treatment for the energy solution. This sharp treatment is extended to estimate the interfacial mass transfer rate. At the computational cell, a d-cubic Hermite interpolating polynomial is employed to describe the interface location, which is locally fourth-order accurate. This extent of subgrid level description provides an accurate methodology for treating various interfacial processes with a high degree of sharpness. The ability to predict the interface and temperature evolutions accurately is illustrated by comparing numerical results with existing 1D to 3D analytical solutions.

Botulinum toxin A in the treatment of Raynaud's phenomenon: a systematic review

PubMed Central

Puszczewicz, Mariusz J.

2015-01-01

Introduction The management of Raynaud's phenomenon in its most severe form is challenging, and current medical and surgical treatment methods frequently do not lead to optimal symptom control and prevention of ischemic complications. The aim of the study was to critically evaluate all existing evidence on the use of botulinum toxin A in the management of Raynaud's phenomenon. Material and methods We adopted the PRISMA methodology and searched Cochrane Library, MEDLINE, SCOPUS, EULAR and ACR congresses abstract archives for Raynaud* AND botulinum toxin OR onabotulinum. All studies that contained reports of botulinum toxin A use and its outcome in Raynaud's phenomenon were included in the review. Results Eleven studies met our inclusion criteria and involved a total of 125 patients. Two reviewers extracted data from the studies under review and achieved a consensus in their selection. The main outcomes measured were pain reduction and healing of digital ulcers. The level of evidence across studies was very low to moderate. Conclusions There is insufficient evidence to assess the efficacy of botulinum toxin A in Raynaud's phenomenon. Despite many promising reports, further research in the form of randomized controlled trials is warranted in order to investigate this new treatment method for Raynaud's phenomenon. PMID:27478469

Monitoring post-fire vegetation rehabilitation projects: A common approach for non-forested ecosystems

USGS Publications Warehouse

Wirth, Troy A.; Pyke, David A.

2007-01-01

Emergency Stabilization and Rehabilitation (ES&R) and Burned Area Emergency Response (BAER) treatments are short-term, high-intensity treatments designed to mitigate the adverse effects of wildfire on public lands. The federal government expends significant resources implementing ES&R and BAER treatments after wildfires; however, recent reviews have found that existing data from monitoring and research are insufficient to evaluate the effects of these activities. The purpose of this report is to: (1) document what monitoring methods are generally used by personnel in the field; (2) describe approaches and methods for post-fire vegetation and soil monitoring documented in agency manuals; (3) determine the common elements of monitoring programs recommended in these manuals; and (4) describe a common monitoring approach to determine the effectiveness of future ES&R and BAER treatments in non-forested regions. Both qualitative and quantitative methods to measure effectiveness of ES&R treatments are used by federal land management agencies. Quantitative methods are used in the field depending on factors such as funding, personnel, and time constraints. There are seven vegetation monitoring manuals produced by the federal government that address monitoring methods for (primarily) vegetation and soil attributes. These methods vary in their objectivity and repeatability. The most repeatable methods are point-intercept, quadrat-based density measurements, gap intercepts, and direct measurement of soil erosion. Additionally, these manuals recommend approaches for designing monitoring programs for the state of ecosystems or the effect of management actions. The elements of a defensible monitoring program applicable to ES&R and BAER projects that most of these manuals have in common are objectives, stratification, control areas, random sampling, data quality, and statistical analysis. The effectiveness of treatments can be determined more accurately if data are gathered using an approach that incorporates these six monitoring program design elements and objectives, as well as repeatable procedures to measure cover, density, gap intercept, and soil erosion within each ecoregion and plant community. Additionally, using a common monitoring program design with comparable methods, consistently documenting results, and creating and maintaining a central database for query and reporting, will ultimately allow a determination of the effectiveness of post-fire rehabilitation activities region-wide.

Quantification of Peptides from Immunoglobulin Constant and Variable Regions by Liquid Chromatography-Multiple Reaction Monitoring Mass Spectrometry for Assessment of Multiple Myeloma Patients

PubMed Central

Remily-Wood, Elizabeth R.; Benson, Kaaron; Baz, Rachid C.; Chen, Y. Ann; Hussein, Mohamad; Hartley-Brown, Monique A.; Sprung, Robert W.; Perez, Brianna; Liu, Richard Z.; Yoder, Sean; Teer, Jamie; Eschrich, Steven A.; Koomen, John M.

2014-01-01

Purpose Quantitative mass spectrometry assays for immunoglobulins (Igs) are compared with existing clinical methods in samples from patients with plasma cell dyscrasias, e.g. multiple myeloma. Experimental design Using LC-MS/MS data, Ig constant region peptides and transitions were selected for liquid chromatography-multiple reaction monitoring mass spectrometry (LC-MRM). Quantitative assays were used to assess Igs in serum from 83 patients. Results LC-MRM assays quantify serum levels of Igs and their isoforms (IgG1–4, IgA1–2, IgM, IgD, and IgE, as well as kappa(κ) and lambda(λ) light chains). LC-MRM quantification has been applied to single samples from a patient cohort and a longitudinal study of an IgE patient undergoing treatment, to enable comparison with existing clinical methods. Proof-of-concept data for defining and monitoring variable region peptides are provided using the H929 multiple myeloma cell line and two MM patients. Conclusions and Clinical Relevance LC-MRM assays targeting constant region peptides determine the type and isoform of the involved immunoglobulin and quantify its expression; the LC-MRM approach has improved sensitivity compared with the current clinical method, but slightly higher interassay variability. Detection of variable region peptides is a promising way to improve Ig quantification, which could produce a dramatic increase in sensitivity over existing methods, and could further complement current clinical techniques. PMID:24723328

Quantification of peptides from immunoglobulin constant and variable regions by LC-MRM MS for assessment of multiple myeloma patients.

PubMed

Remily-Wood, Elizabeth R; Benson, Kaaron; Baz, Rachid C; Chen, Y Ann; Hussein, Mohamad; Hartley-Brown, Monique A; Sprung, Robert W; Perez, Brianna; Liu, Richard Z; Yoder, Sean J; Teer, Jamie K; Eschrich, Steven A; Koomen, John M

2014-10-01

Quantitative MS assays for Igs are compared with existing clinical methods in samples from patients with plasma cell dyscrasias, for example, multiple myeloma (MM). Using LC-MS/MS data, Ig constant region peptides, and transitions were selected for LC-MRM MS. Quantitative assays were used to assess Igs in serum from 83 patients. RNA sequencing and peptide-based LC-MRM are used to define peptides for quantification of the disease-specific Ig. LC-MRM assays quantify serum levels of Igs and their isoforms (IgG1-4, IgA1-2, IgM, IgD, and IgE, as well as kappa (κ) and lambda (λ) light chains). LC-MRM quantification has been applied to single samples from a patient cohort and a longitudinal study of an IgE patient undergoing treatment, to enable comparison with existing clinical methods. Proof-of-concept data for defining and monitoring variable region peptides are provided using the H929 MM cell line and two MM patients. LC-MRM assays targeting constant region peptides determine the type and isoform of the involved Ig and quantify its expression; the LC-MRM approach has improved sensitivity compared with the current clinical method, but slightly higher inter-assay variability. Detection of variable region peptides is a promising way to improve Ig quantification, which could produce a dramatic increase in sensitivity over existing methods, and could further complement current clinical techniques. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Quantifying Discipline Practices Using Absolute vs. Relative Frequencies: Clinical and Research Implications for Child Welfare

PubMed Central

Lindhiem, Oliver; Shaffer, Anne; Kolko, David J.

2014-01-01

In the parent intervention outcome literatures, discipline practices are generally quantified as absolute frequencies or, less commonly, as relative frequencies. These differences in methodology warrant direct comparison as they have critical implications for study results and conclusions among treatments targeted at reducing parental aggression and harsh discipline. In this study, we directly compared the absolute frequency method and the relative frequency method for quantifying physically aggressive, psychologically aggressive, and nonaggressive discipline practices. Longitudinal data over a 3-year period came from an existing data set of a clinical trial examining the effectiveness of a psychosocial treatment in reducing parental physical and psychological aggression and improving child behavior (N = 139; Kolko et al., 2009). Discipline practices (both aggressive and nonaggressive) were assessed using the Conflict Tactics Scale (CTS; Straus et al., 1998). The two methods yielded different patterns of results, particularly for nonaggressive discipline strategies. We suggest that each method makes its own unique contribution to a more complete understanding of the association between parental aggression and intervention effects. PMID:24106146

Interpretable inference on the mixed effect model with the Box-Cox transformation.

PubMed

Maruo, K; Yamaguchi, Y; Noma, H; Gosho, M

2017-07-10

We derived results for inference on parameters of the marginal model of the mixed effect model with the Box-Cox transformation based on the asymptotic theory approach. We also provided a robust variance estimator of the maximum likelihood estimator of the parameters of this model in consideration of the model misspecifications. Using these results, we developed an inference procedure for the difference of the model median between treatment groups at the specified occasion in the context of mixed effects models for repeated measures analysis for randomized clinical trials, which provided interpretable estimates of the treatment effect. From simulation studies, it was shown that our proposed method controlled type I error of the statistical test for the model median difference in almost all the situations and had moderate or high performance for power compared with the existing methods. We illustrated our method with cluster of differentiation 4 (CD4) data in an AIDS clinical trial, where the interpretability of the analysis results based on our proposed method is demonstrated. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Physical and numerical sources of computational inefficiency in integration of chemical kinetic rate equations: Etiology, treatment and prognosis

NASA Technical Reports Server (NTRS)

Pratt, D. T.; Radhakrishnan, K.

1986-01-01

The design of a very fast, automatic black-box code for homogeneous, gas-phase chemical kinetics problems requires an understanding of the physical and numerical sources of computational inefficiency. Some major sources reviewed in this report are stiffness of the governing ordinary differential equations (ODE's) and its detection, choice of appropriate method (i.e., integration algorithm plus step-size control strategy), nonphysical initial conditions, and too frequent evaluation of thermochemical and kinetic properties. Specific techniques are recommended (and some advised against) for improving or overcoming the identified problem areas. It is argued that, because reactive species increase exponentially with time during induction, and all species exhibit asymptotic, exponential decay with time during equilibration, exponential-fitted integration algorithms are inherently more accurate for kinetics modeling than classical, polynomial-interpolant methods for the same computational work. But current codes using the exponential-fitted method lack the sophisticated stepsize-control logic of existing black-box ODE solver codes, such as EPISODE and LSODE. The ultimate chemical kinetics code does not exist yet, but the general characteristics of such a code are becoming apparent.

Micro Dot Patterning on the Light Guide Panel Using Powder Blasting.

PubMed

Jang, Ho Su; Cho, Myeong Woo; Park, Dong Sam

2008-02-08

This study is to develop a micromachining technology for a light guidepanel(LGP) mold, whereby micro dot patterns are formed on a LGP surface by a singleinjection process instead of existing screen printing processes. The micro powder blastingtechnique is applied to form micro dot patterns on the LGP mold surface. The optimalconditions for masking, laminating, exposure, and developing processes to form the microdot patterns are first experimentally investigated. A LGP mold with masked micro patternsis then machined using the micro powder blasting method and the machinability of themicro dot patterns is verified. A prototype LGP is test- injected using the developed LGPmold and a shape analysis of the patterns and performance testing of the injected LGP arecarried out. As an additional approach, matte finishing, a special surface treatment method,is applied to the mold surface to improve the light diffusion characteristics, uniformity andbrightness of the LGP. The results of this study show that the applied powder blastingmethod can be successfully used to manufacture LGPs with micro patterns by just singleinjection using the developed mold and thereby replace existing screen printing methods.

Machine learning in heart failure: ready for prime time.

PubMed

Awan, Saqib Ejaz; Sohel, Ferdous; Sanfilippo, Frank Mario; Bennamoun, Mohammed; Dwivedi, Girish

2018-03-01

The aim of this review is to present an up-to-date overview of the application of machine learning methods in heart failure including diagnosis, classification, readmissions and medication adherence. Recent studies have shown that the application of machine learning techniques may have the potential to improve heart failure outcomes and management, including cost savings by improving existing diagnostic and treatment support systems. Recently developed deep learning methods are expected to yield even better performance than traditional machine learning techniques in performing complex tasks by learning the intricate patterns hidden in big medical data. The review summarizes the recent developments in the application of machine and deep learning methods in heart failure management.

Intraoperative imaging-guided cancer surgery: from current fluorescence molecular imaging methods to future multi-modality imaging technology.

PubMed

Chi, Chongwei; Du, Yang; Ye, Jinzuo; Kou, Deqiang; Qiu, Jingdan; Wang, Jiandong; Tian, Jie; Chen, Xiaoyuan

2014-01-01

Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery.

Micro Dot Patterning on the Light Guide Panel Using Powder Blasting

PubMed Central

Jang, Ho Su; Cho, Myeong Woo; Park, Dong Sam

2008-01-01

This study is to develop a micromachining technology for a light guide panel(LGP) mold, whereby micro dot patterns are formed on a LGP surface by a single injection process instead of existing screen printing processes. The micro powder blasting technique is applied to form micro dot patterns on the LGP mold surface. The optimal conditions for masking, laminating, exposure, and developing processes to form the micro dot patterns are first experimentally investigated. A LGP mold with masked micro patterns is then machined using the micro powder blasting method and the machinability of the micro dot patterns is verified. A prototype LGP is test- injected using the developed LGP mold and a shape analysis of the patterns and performance testing of the injected LGP are carried out. As an additional approach, matte finishing, a special surface treatment method, is applied to the mold surface to improve the light diffusion characteristics, uniformity and brightness of the LGP. The results of this study show that the applied powder blasting method can be successfully used to manufacture LGPs with micro patterns by just single injection using the developed mold and thereby replace existing screen printing methods. PMID:27879740

Intraoperative Imaging-Guided Cancer Surgery: From Current Fluorescence Molecular Imaging Methods to Future Multi-Modality Imaging Technology

PubMed Central

Chi, Chongwei; Du, Yang; Ye, Jinzuo; Kou, Deqiang; Qiu, Jingdan; Wang, Jiandong; Tian, Jie; Chen, Xiaoyuan

2014-01-01

Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery. PMID:25250092

An optical method for characterizing carbon content in ceramic pot filters.

PubMed

Goodwin, J Y; Elmore, A C; Salvinelli, C; Reidmeyer, Mary R

2017-08-01

Ceramic pot filter (CPF) technology is a relatively common means of household water treatment in developing areas, and performance characteristics of CPFs have been characterized using production CPFs, experimental CPFs fabricated in research laboratories, and ceramic disks intended to be CPF surrogates. There is evidence that CPF manufacturers do not always fire their products according to best practices and the result is incomplete combustion of the pore forming material and the creation of a carbon core in the final CPFs. Researchers seldom acknowledge the existence of potential existence of carbon cores, and at least one CPF producer has postulated that the carbon may be beneficial in terms of final water quality because of the presence of activated carbon in consumer filters marketed in the Western world. An initial step in characterizing the presence and impact of carbon cores is the characterization of those cores. An optical method which may be more viable to producers relative to off-site laboratory analysis of carbon content has been developed and verified. The use of the optical method is demonstrated via preliminary disinfection and flowrate studies, and the results of these studies indicate that the method may be of use in studying production kiln operation.

[Statistical Process Control (SPC) can help prevent treatment errors without increasing costs in radiotherapy].

PubMed

Govindarajan, R; Llueguera, E; Melero, A; Molero, J; Soler, N; Rueda, C; Paradinas, C

2010-01-01

Statistical Process Control (SPC) was applied to monitor patient set-up in radiotherapy and, when the measured set-up error values indicated a loss of process stability, its root cause was identified and eliminated to prevent set-up errors. Set up errors were measured for medial-lateral (ml), cranial-caudal (cc) and anterior-posterior (ap) dimensions and then the upper control limits were calculated. Once the control limits were known and the range variability was acceptable, treatment set-up errors were monitored using sub-groups of 3 patients, three times each shift. These values were plotted on a control chart in real time. Control limit values showed that the existing variation was acceptable. Set-up errors, measured and plotted on a X chart, helped monitor the set-up process stability and, if and when the stability was lost, treatment was interrupted, the particular cause responsible for the non-random pattern was identified and corrective action was taken before proceeding with the treatment. SPC protocol focuses on controlling the variability due to assignable cause instead of focusing on patient-to-patient variability which normally does not exist. Compared to weekly sampling of set-up error in each and every patient, which may only ensure that just those sampled sessions were set-up correctly, the SPC method enables set-up error prevention in all treatment sessions for all patients and, at the same time, reduces the control costs. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Utilization of communication technology by patients enrolled in substance abuse treatment.

PubMed

McClure, Erin A; Acquavita, Shauna P; Harding, Emily; Stitzer, Maxine L

2013-04-01

Technology-based applications represent a promising method for providing efficacious, widely available interventions to substance abuse treatment patients. However, limited access to communication technology (i.e., mobile phones, computers, internet, and e-mail) could significantly impact the feasibility of these efforts, and little is known regarding technology utilization in substance abusing populations. A survey was conducted to characterize utilization of communication technology in 266 urban, substance abuse treatment patients enrolled at eight drug-free, psychosocial or opioid-replacement therapy clinics. Survey participants averaged 41 years of age and 57% had a yearly household income of less than $15,000. The vast majority reported access to a mobile phone (91%), and to SMS text messaging (79%). Keeping a consistent mobile phone number and yearly mobile contract was higher for White participants, and also for those with higher education, and enrolled in drug-free, psychosocial treatment. Internet, e-mail, and computer use was much lower (39-45%), with younger age, higher education and income predicting greater use. No such differences existed for the use of mobile phones however. Concern regarding the digital divide for marginalized populations appears to be disappearing with respect to mobile phones, but still exists for computer, internet, and e-mail access and use. Results suggest that mobile phone and texting applications may be feasibly applied for use in program-client interactions in substance abuse treatment. Careful consideration should be given to frequent phone number changes, access to technology, and motivation to engage with communication technology for treatment purposes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Therapeutic management of anal eczema: an evidence-based review

PubMed Central

Havlickova, B; Weyandt, G H

2014-01-01

Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

Perceptions of pharmacogenetic research to guide tobacco cessation by patients, providers and leaders in a tribal healthcare setting

PubMed Central

Avey, Jaedon P; Hiratsuka, Vanessa Y; Beans, Julie A; Trinidad, Susan Brown; Tyndale, Rachel F; Robinson, Renee F

2016-01-01

Aim: Describe patients,’ providers’ and healthcare system leaders’ perceptions of pharmacogenetic research to guide tobacco cessation treatment in an American Indian/Alaska Native primary care setting. Materials & methods: This qualitative study used semistructured interviews with 20 American Indian/Alaska Native current or former tobacco users, 12 healthcare providers and nine healthcare system leaders. Results: Participants supported pharmacogenetic research to guide tobacco cessation treatment provided that a community-based participatory research approach be employed, research closely coordinate with existing tobacco cessation services and access to pharmacogenetic test results be restricted to providers involved in tobacco cessation. Conclusion: Despite a history of mistrust toward genetic research in tribal communities, participants expressed willingness to support pharmacogenetic research to guide tobacco cessation treatment. PMID:26871371

A Gender Analysis of the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD): gender and age as predictors of response and treatment-associated changes in body mass index and metabolic measures

PubMed Central

Deligiannidis, Kristina M.; Rothschild, Anthony J.; Barton, Bruce A.; Kroll-Desrosiers, Aimee R.; Meyers, Barnett S.; Flint, Alastair J.; Whyte, Ellen M.; Mulsant, Benoit H.

2014-01-01

Background: Gender differences exist in psychiatric disorders; however gender has not been well studied in psychotic depression. This analysis of the largest clinical trial in psychotic depression examined the effects of age and gender on clinical characteristics and predictors of treatment outcome and treatment-associated changes in body mass index (BMI) and metabolic measures. Methods: Analyses were performed on data from 259 subjects aged 18-93 in the double-blind randomized controlled trial of olanzapine plus sertraline (OLZ/SERT) vs. olanzapine plus placebo (OLZ/PBO) for psychotic depression (STOP-PD). Sociodemographic factors, clinical characteristics, treatment outcome and treatment-associated changes in BMI and metabolic measures were analyzed by gender and age. Results: Female gender was associated with divorced (χ2=5.3, d.f.=1, p=0.03) or widowed (χ2=8.1, d.f.=1, p=<0.01) marital status. Co-morbid anxiety disorders were more common in females than males (χ2=4.9, d.f.=1, p=0.03). Hallucinations(χ2=7.8, d.f.=1, p=0.005) and delusions with disorganization (t-test= −2.10, d.f. =257, p=0.04) were significantly associated with female gender as were higher cholesterol measures( χ2=7.15, d.f.=1, p=0.008).There were no significant interactions between treatment and gender in terms of change in BMI. Gender was not associated with treatment response. Discussion: This is the first analysis of gender and age as predictors of treatment outcome and treatment-associated changes in BMI and metabolic adverse effects in psychotic depression. Gender differences exist in patients with psychotic depression, most notably the presence of hallucinations. Female gender was associated with metabolic measures. Future studies with larger sample sizes may detect small gender differences in treatment outcome and treatment-associated changes in BMI and metabolic measures in psychotic depression. PMID:24229753

[Post-treatment rehabilitation after autologous chondrocyte implantation: State of the art and recommendations of the Clinical Tissue Regeneration Study Group of the German Society for Accident Surgery and the German Society for Orthopedics and Orthopedic Surgery].

PubMed

Pietschmann, M F; Horng, A; Glaser, C; Albrecht, D; Bruns, J; Scheffler, S; Marlovits, S; Angele, P; Aurich, M; Bosch, U; Fritz, J; Frosch, K H; Kolombe, T; Richter, W; Petersen, J P; Nöth, U; Niemeyer, P; Jagodzinsky, M; Kasten, P; Ruhnau, K; Müller, P E

2014-03-01

Over the course of the past two decades autologous chondrocyte implantation (ACI) has become an important surgical technique for treating large cartilage defects. The original method using a periostal flap has been improved by using cell-seeded scaffolds for implantation, the matrix-based autologous chondrocyte implantation (mb-ACI) procedure. Uniform nationwide guidelines for post-ACI rehabilitation do not exist. A survey was conducted among the members of the clinical tissue regeneration study group concerning the current rehabilitation protocols and the members of the study group published recommendations for postoperative rehabilitation and treatment after ACI based on the results of this survey. There was agreement on fundamentals concerning a location-specific rehabilitation protocol (femoral condyle vs. patellofemoral joint). With regard to weight bearing and range of motion a variety of different protocols exist. Similar to this total agreement on the role of magnetic resonance imaging (MRI) for postsurgical care was found but again a great variety of different protocols exist. This manuscript summarizes the recommendations of the members of the German clinical tissue regeneration study group on postsurgical rehabilitation and MRI assessment after ACI (level IVb/EBM).

NEW DEVELOPMENTS IN THE DIAGNOSIS AND TREATMENT OF THYROID CANCER

PubMed Central

Schneider, David F.; Chen, Herbert

2013-01-01

Thyroid cancer exists in several forms. Differentiated thyroid cancers include papillary and follicular histologies. These tumors exist along a spectrum of differentiation, and their incidence continues to climb. A number of advances in the diagnosis and treatment of differentiated thyroid cancers now exist. These include molecular diagnostics and more advanced strategies for risk stratification. Medullary cancer arises from the parafollicular cells and not the follicular cells. Therefore, diagnosis and treatment differs from differentiated thyroid tumors. Genetic testing and newer adjuvant therapies has changed the diagnosis and treatment of medullary thyroid cancer. This review will focus on the epidemiology, diagnosis, work-up, and treatment of both differentiated and medullary thyroid cancers, focusing specifically on newer developments in the field. PMID:23797834

Review of patient-reported outcome measures in chronic hepatitis C

PubMed Central

2012-01-01

Background Chronic hepatitis C (CHC) and its treatment are associated with a variety of patient-reported symptoms and impacts. Some CHC symptoms and impacts may be difficult to evaluate through objective clinical testing, and more easily measured through patient self-report. This literature review identified concepts raised by CHC patients related to symptoms, impacts, and treatment effects, and evaluated integration of these concepts within patient-reported outcome (PRO) measures. The goal of this work was to provide recommendations for incorporation of PRO measurement of concepts that are relevant to the CHC experience into CHC clinical trial design. Methods A three-tiered literature search was conducted. This included searches on concepts of importance, PRO measures used in clinical trials, and existing PRO measures. The PRO Concept Search focused on reviewing issues raised by CHC patients about CHC symptoms, disease impact, and treatment effects. The CHC Trials with PRO Endpoints Search reviewed clinical trials with PRO endpoints to assess differences between treatments over time. The PRO Measure Search reviewed existing PRO measures associated with the concepts of interest. Results This multi-tiered approach identified five key concepts of interest: depression/anxiety, fatigue, flu-like symptoms, cognitive function, insomnia. Comparing these five concepts of interest to the PRO measures in published CHC clinical trials showed that, while treatment of CHC may decrease health-related quality of life in a number of mental and physical domains, the PRO measures that were utilized in published clinical trials inadequately covered the concepts of interest. Further review of 18 existing PRO measures of the concepts of interest showed only four of the 18 were validated in CHC populations. Conclusions This review identified several gaps in the literature regarding assessment of symptoms and outcomes reported as important by CHC patients. Further research is needed to ensure that CHC clinical trials evaluate concepts that are important to patients and include measures that have evidence supporting content validity, reliability, construct validity, and responsiveness. PMID:22871087

TH-EF-BRB-05: 4pi Non-Coplanar IMRT Beam Angle Selection by Convex Optimization with Group Sparsity Penalty

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

O’Connor, D; Nguyen, D; Voronenko, Y

Purpose: Integrated beam orientation and fluence map optimization is expected to be the foundation of robust automated planning but existing heuristic methods do not promise global optimality. We aim to develop a new method for beam angle selection in 4π non-coplanar IMRT systems based on solving (globally) a single convex optimization problem, and to demonstrate the effectiveness of the method by comparison with a state of the art column generation method for 4π beam angle selection. Methods: The beam angle selection problem is formulated as a large scale convex fluence map optimization problem with an additional group sparsity term thatmore » encourages most candidate beams to be inactive. The optimization problem is solved using an accelerated first-order method, the Fast Iterative Shrinkage-Thresholding Algorithm (FISTA). The beam angle selection and fluence map optimization algorithm is used to create non-coplanar 4π treatment plans for several cases (including head and neck, lung, and prostate cases) and the resulting treatment plans are compared with 4π treatment plans created using the column generation algorithm. Results: In our experiments the treatment plans created using the group sparsity method meet or exceed the dosimetric quality of plans created using the column generation algorithm, which was shown superior to clinical plans. Moreover, the group sparsity approach converges in about 3 minutes in these cases, as compared with runtimes of a few hours for the column generation method. Conclusion: This work demonstrates the first non-greedy approach to non-coplanar beam angle selection, based on convex optimization, for 4π IMRT systems. The method given here improves both treatment plan quality and runtime as compared with a state of the art column generation algorithm. When the group sparsity term is set to zero, we obtain an excellent method for fluence map optimization, useful when beam angles have already been selected. NIH R43CA183390, NIH R01CA188300, Varian Medical Systems; Part of this research took place while D. O’Connor was a summer intern at RefleXion Medical.« less

Gear Drive Testing

NASA Technical Reports Server (NTRS)

1982-01-01

Philadelphia Gear Corporation used two COSMIC computer programs; one dealing with shrink fit analysis and the other with rotor dynamics problems in computerized design and test work. The programs were used to verify existing in-house programs to insure design accuracy by checking its company-developed computer methods against procedures developed by other organizations. Its specialty is in custom units for unique applications, such as Coast Guard ice breaking ships, steel mill drives, coal crusher, sewage treatment equipment and electricity.

Review of Smartphone Applications for the Treatment of Eating Disorders

PubMed Central

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

2016-01-01

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

The first experience in estimation of basal cell carcinoma cryoresistence using noninvasive spectrophotometry

NASA Astrophysics Data System (ADS)

Andrukhina, V. V.; Litvinova, K. S.; Nikitin, A. A.; Spiridonova, N. Z.; Rogatkin, D. A.

2009-10-01

The urgency of BCC study affecting maxillofacial area and neck is not only caused by high prevalence of this disease, but also insufficient efficiency of existing treatment methods which lead to full or partial recovery only in 60-80% of cases. We analyzed the results of 198 BCC cases cryosurgical treatment. 33 (16,6%) patients showed continued tumor growth. It has been hypothesized that the behavior and character of microcirculation changes during patient's testing have to correlate with damaging rate of tumors that will allow to develop indications for surgical treatment with local destruction - cryosurgery or cryolaser treatment. We have tested the new group of 33 patients with primary and recurrence types of basal cell carcinoma (BCC) by means of Laser Doppler Flowmetry, Tissues Reflectance Oximetry, Laser Fluorescence Diagnostics before operation. It was shown that the microcirculatory data indicates the presence of cryoresistance.

The first experience in estimation of basal cell carcinoma cryoresistence using noninvasive spectrophotometry

NASA Astrophysics Data System (ADS)

Andrukhina, V. V.; Litvinova, K. S.; Nikitin, A. A.; Spiridonova, N. Z.; Rogatkin, D. A.

2010-02-01

The urgency of BCC study affecting maxillofacial area and neck is not only caused by high prevalence of this disease, but also insufficient efficiency of existing treatment methods which lead to full or partial recovery only in 60-80% of cases. We analyzed the results of 198 BCC cases cryosurgical treatment. 33 (16,6%) patients showed continued tumor growth. It has been hypothesized that the behavior and character of microcirculation changes during patient's testing have to correlate with damaging rate of tumors that will allow to develop indications for surgical treatment with local destruction - cryosurgery or cryolaser treatment. We have tested the new group of 33 patients with primary and recurrence types of basal cell carcinoma (BCC) by means of Laser Doppler Flowmetry, Tissues Reflectance Oximetry, Laser Fluorescence Diagnostics before operation. It was shown that the microcirculatory data indicates the presence of cryoresistance.

Acceptability of a Web-based Community Reinforcement Approach for Substance Use Disorders with Treatment-seeking American Indians/Alaska Natives

PubMed Central

Campbell, Aimee N. C.; Turrigiano, Eva; Moore, Michelle; Miele, Gloria M.; Rieckmann, Traci; Hu, Mei-Chen; Kropp, Frankie; Ringor-Carty, Roz; Nunes, Edward V.

2014-01-01

Longstanding disparities in substance use disorders and treatment access exist among American Indian/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version (Therapeutic Education System [TES]) of the Community Reinforcement Approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N=40) show that TES was acceptable across seven indices (range=7.8 to 9.4 on 0 to 10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted. PMID:25022913

Effluent Treatment Technologies in the Iron and Steel Industry - A State of the Art Review.

PubMed

Das, Pallabi; Mondal, Gautam C; Singh, Siddharth; Singh, Abhay K; Prasad, Bably; Singh, Krishna K

2018-05-01

  Iron and steel industry is the principal driving force propelling economic and technological growth of a nation. However, since its inception this industry is associated with widespread environmental pollution and enormous water consumption. Different units of a steel plant discharge effluents loaded with toxic, hazardous pollutants, and unutilized components which necessitates mitigation. In this paper, pollutant removal efficiency, effluent volume product quality, and economic feasibility of existing treatments are studied vis-à-vis their merits, demerits, and innovations to access their shortcomings which can be overcome with new technology to identify future research directions. While conventional methods are inadequate for complete remediation and water reclamation, the potential of advanced treatments, like membrane separation, remains relatively untapped. It is concluded that integrated systems combining membrane separation with chemical treatments can guarantee a high degree of contaminant removal, reusability of effluents concurrently leading to process intensification ensuring ecofriendliness and commercial viability.

Biological approach to treatment of intra-articular proximal tibial fractures with double osteosynthesis.

PubMed

Singh, Saurabh; Patel, Pankaj R; Joshi, Anil Kumar; Naik, Rajnikant N; Nagaraj, Chethan; Kumar, Sudeep

2009-02-01

The treatment of intra-articular proximal tibial fractures is associated with complications, and much conflicting literature exists concerning the treatment of choice. In our study, an attempt has been made to develop an ideal and adequate treatment protocol for these intra-articular fractures. The principle of double osteosynthesis, i.e., lateral minimally invasive plate osteosynthesis (MIPO), was combined with a medial external fixator to treat 22 intra-articular proximal tibial fractures with soft tissue injury with a mean follow-up of 25 months. Superficial pin track infection was observed in one case, and no soft tissue breakdown was noted. Loss of articular reconstruction was reported in one case. Bridging callus was seen at 12 weeks (8 weeks-7 months). The principle of substitution or double osteosynthesis, i.e., lateral MIPO, was combined with a medial external fixator and proved to be a fairly good method of fixation in terms of results and complications.

Acceptability of a web-based community reinforcement approach for substance use disorders with treatment-seeking American Indians/Alaska Natives.

PubMed

Campbell, Aimee N C; Turrigiano, Eva; Moore, Michelle; Miele, Gloria M; Rieckmann, Traci; Hu, Mei-Chen; Kropp, Frankie; Ringor-Carty, Roz; Nunes, Edward V

2015-05-01

Longstanding disparities in substance use disorders and treatment access exist among American Indians/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version [therapeutic education system (TES)] of the community reinforcement approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N = 40) show that TES was acceptable across seven indices (range 7.8-9.4 on 0-10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted.

A numerical study on dual-phase-lag model of bio-heat transfer during hyperthermia treatment.

PubMed

Kumar, P; Kumar, Dinesh; Rai, K N

2015-01-01

The success of hyperthermia in the treatment of cancer depends on the precise prediction and control of temperature. It was absolutely a necessity for hyperthermia treatment planning to understand the temperature distribution within living biological tissues. In this paper, dual-phase-lag model of bio-heat transfer has been studied using Gaussian distribution source term under most generalized boundary condition during hyperthermia treatment. An approximate analytical solution of the present problem has been done by Finite element wavelet Galerkin method which uses Legendre wavelet as a basis function. Multi-resolution analysis of Legendre wavelet in the present case localizes small scale variations of solution and fast switching of functional bases. The whole analysis is presented in dimensionless form. The dual-phase-lag model of bio-heat transfer has compared with Pennes and Thermal wave model of bio-heat transfer and it has been found that large differences in the temperature at the hyperthermia position and time to achieve the hyperthermia temperature exist, when we increase the value of τT. Particular cases when surface subjected to boundary condition of 1st, 2nd and 3rd kind are discussed in detail. The use of dual-phase-lag model of bio-heat transfer and finite element wavelet Galerkin method as a solution method helps in precise prediction of temperature. Gaussian distribution source term helps in control of temperature during hyperthermia treatment. So, it makes this study more useful for clinical applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

A simple analytical procedure to replace HPLC for monitoring treatment concentrations of chloramine-T on fish culture facilities

USGS Publications Warehouse

Dawson, V.K.; Meinertz, J.R.; Schmidt, L.J.; Gingerich, W.H.

2003-01-01

Concentrations of chloramine-T must be monitored during experimental treatments of fish when studying the effectiveness of the drug for controlling bacterial gill disease. A surrogate analytical method for analysis of chloramine-T to replace the existing high-performance liquid chromatography (HPLC) method is described. A surrogate method was needed because the existing HPLC method is expensive, requires a specialist to use, and is not generally available at fish hatcheries. Criteria for selection of a replacement method included ease of use, analysis time, cost, safety, sensitivity, accuracy, and precision. The most promising approach was to use the determination of chlorine concentrations as an indicator of chloramine-T. Of the currently available methods for analysis of chlorine, the DPD (N,N-diethyl-p-phenylenediamine) colorimetric method best fit the established criteria. The surrogate method was evaluated under a variety of water quality conditions. Regression analysis of all DPD colorimetric analyses with the HPLC values produced a linear model (Y=0.9602 X+0.1259) with an r2 value of 0.9960. The average accuracy (percent recovery) of the DPD method relative to the HPLC method for the combined set of water quality data was 101.5%. The surrogate method was also evaluated with chloramine-T solutions that contained various concentrations of fish feed or selected densities of rainbow trout. When samples were analyzed within 2 h, the results of the surrogate method were consistent with those of the HPLC method. When samples with high concentrations of organic material were allowed to age more than 2 h before being analyzed, the DPD method seemed to be susceptible to interference, possibly from the development of other chloramine compounds. However, even after aging samples 6 h, the accuracy of the surrogate DPD method relative to the HPLC method was within the range of 80-120%. Based on the data comparing the two methods, the U.S. Food and Drug Administration has concluded that the DPD colorimetric method is appropriate to use to measure chloramine-T in water during pivotal efficacy trials designed to support the approval of chloramine-T for use in fish culture. ?? 2003 Elsevier Science B.V. All rights reserved.

A Values-Based Motivational Interviewing (MI) Intervention for Pediatric Obesity: Study Design and Methods for MI Values

PubMed Central

Bean, Melanie K.; Mazzeo, Suzanne E.; Stern, Marilyn; Bowen, Deborah; Ingersoll, Karen

2011-01-01

To reduce pediatric obesity in clinical settings, multidisciplinary behaviorally-based treatment programs are recommended. High attrition and poor compliance are two difficulties frequently encountered in such programs. A brief, empathic and directive clinical intervention, Motivational Interviewing (MI), might help address these motivational and behavioral issues, ultimately resulting in more positive health outcomes. The efficacy of MI as an adjunct in the treatment of pediatric obesity remains relatively understudied. MI Values was developed to implement within an existing multidisciplinary treatment program for obese, ethnically diverse adolescents, the T.E.E.N.S. Program (Teaching, Encouragement, Exercise, Nutrition, Support). T.E.E.N.S. participants who consent to MI Values are randomized to either MI or an education control condition. At weeks 1 and 10 of T.E.E.N.S. participation, the subset of participants assigned to the MI condition engage in individual MI sessions and control participants view health education videos. All MI sessions are audiotaped and coded to monitor treatment fidelity, which has been satisfactory thus far. Participants complete comprehensive assessments at baseline, 3-and 6-month follow-up. We hypothesize that MI participants will demonstrate greater reductions in Body Mass Index (BMI) percentile, improved diet and physical activity behaviors, better compliance with T.E.E.N.S., and lower attrition than participants in the control group. We present study design and methods for MI Values as well as data on feasibility of recruitment methods and treatment integrity. At study completion, findings will contribute to the emerging literature examining the efficacy of MI in the treatment of pediatric obesity. PMID:21554994

Fullerenols as a new therapeutic approach in nanomedicine.

PubMed

Grebowski, Jacek; Kazmierska, Paulina; Krokosz, Anita

2013-01-01

Recently, much attention has been paid to the bioactive properties of water-soluble fullerene derivatives: fullerenols, with emphasis on their pro- and antioxidative properties. Due to their hydrophilic properties and the ability to scavenge free radicals, fullerenols may, in the future, provide a serious alternative to the currently used pharmacological methods in chemotherapy, treatment of neurodegenerative diseases, and radiobiology. Some of the most widely used drugs in chemotherapy are anthracycline antibiotics. Anthracycline therapy, in spite of its effective antitumor activity, induces systemic oxidative stress, which interferes with the effectiveness of the treatment and results in serious side effects. Fullerenols may counteract the harmful effects of anthracyclines by scavenging free radicals and thereby improve the effects of chemotherapy. Additionally, due to the hollow spherical shape, fullerenols may be used as drug carriers. Moreover, because of the existence of the currently ineffective ways for neurodegenerative diseases treatment, alternative compounds, which could prevent the negative effects of oxidative stress in the brain, are still sought. In the search of alternative methods of treatment and diagnosis, today's science is increasingly reaching for tools in the field of nanomedicine, for example, fullerenes and their water-soluble derivatives, which is addressed in the present paper.

Research Thinking of Low-intensity laser For the Treatment of Menopausal Syndrome

NASA Astrophysics Data System (ADS)

Chen, G. Z.; Xu, Y. X.; Wang, X. Y.; Liu, S. H.; Li, L. J.

2011-02-01

Female climacteric syndrome is a clinical syndrome due to autonomic nerve dysfunction occurring in women during climacteric period, which may affect their physical and mental health. Therefore, how to pass climacteric period for women without any problems, avoid or reduce the occurrence of climacteric syndrome, prevent geriatric diseases and improve life quality is a key issue now for great attention. Looking for a convenient, effective, and safer method without toxic-side effects to control the disease is a modern medical problem. By analyzing the relationship between laser technology and traditional acupuncture and moxibustion, the advantage and the existing problems on acupuncture and moxibustion for the treatment of menopausal syndrome, the application of laser methods for the mechanism research on TCM diagnosis and treatment of menopausal syndrome was discussed. It's pointed out that the laser acupuncture is safe and effective to treat menopausal syndrome. Breakthrough will be achieved from the research of the selection of the acupoint prescription and mechanism of Acupuncture and Moxibustion for the treatment of menopausal syndrome by utilizing the advantage of interdisciplinary intersection. Laser technology will make the development of acupuncture and moxibustion science possess an unprecedented field.

Fullerenols as a New Therapeutic Approach in Nanomedicine

PubMed Central

2013-01-01

Recently, much attention has been paid to the bioactive properties of water-soluble fullerene derivatives: fullerenols, with emphasis on their pro- and antioxidative properties. Due to their hydrophilic properties and the ability to scavenge free radicals, fullerenols may, in the future, provide a serious alternative to the currently used pharmacological methods in chemotherapy, treatment of neurodegenerative diseases, and radiobiology. Some of the most widely used drugs in chemotherapy are anthracycline antibiotics. Anthracycline therapy, in spite of its effective antitumor activity, induces systemic oxidative stress, which interferes with the effectiveness of the treatment and results in serious side effects. Fullerenols may counteract the harmful effects of anthracyclines by scavenging free radicals and thereby improve the effects of chemotherapy. Additionally, due to the hollow spherical shape, fullerenols may be used as drug carriers. Moreover, because of the existence of the currently ineffective ways for neurodegenerative diseases treatment, alternative compounds, which could prevent the negative effects of oxidative stress in the brain, are still sought. In the search of alternative methods of treatment and diagnosis, today's science is increasingly reaching for tools in the field of nanomedicine, for example, fullerenes and their water-soluble derivatives, which is addressed in the present paper. PMID:24222914

3. How comprehensive can we be in the economic assessment of vaccines?

PubMed Central

2017-01-01

ABSTRACT In two previous papers we argued on current vaccines economic assessment not fully comprehensive when using the incremental cost-utility analysis normally applied for treatments. Many differences exist between vaccines and drug treatments making vaccines economic evaluation more cumbersome. Four challenges overwhelmingly present in vaccines assessment are less important for treatments: requirements for population, societal perspectives, budget impact evaluation, and time focused objectives (control or elimination). Based on this, economic analysis of vaccines may need to be presented to many different stakeholders with various evaluation preferences, in addition to the current stakeholders involved for drugs treatment assessment. Then, we may need a tool making the inventory of the different vaccines health economic assessment programmes more comprehensive. The cauliflower value toolbox has been developed with that aim, and its use is illustrated here with rotavirus vaccine. Given the broader perspectives for vaccine assessment, it provides better value and cost evaluations. Cost-benefit analysis may be the preferred economic assessment method when considering substitution from treatment to active medical prevention. Other economic evaluation methods can be selected (i.e. optimisation modelling, return on investment) when project prioritisation is the main focus considered and when stakeholders would like to influence the development of the healthcare programme. PMID:29785253

Burning mouth syndrome.

PubMed

Jääskeläinen, Satu K; Woda, Alain

2017-06-01

Objective To review the clinical entity of primary burning mouth syndrome (BMS), its pathophysiological mechanisms, accurate new diagnostic methods and evidence-based treatment options, and to describe novel lines for future research regarding aetiology, pathophysiology, and new therapeutic strategies. Description Primary BMS is a chronic neuropathic intraoral pain condition that despite typical symptoms lacks clear clinical signs of neuropathic involvement. With advanced diagnostic methods, such as quantitative sensory testing of small somatosensory and taste afferents, neurophysiological recordings of the trigeminal system, and peripheral nerve blocks, most BMS patients can be classified into the peripheral or central type of neuropathic pain. These two types differ regarding pathophysiological mechanisms, efficacy of available treatments, and psychiatric comorbidity. The two types may overlap in individual patients. BMS is most frequent in postmenopausal women, with general population prevalence of around 1%. Treatment of BMS is difficult; best evidence exists for efficacy of topical and systemic clonazepam. Hormonal substitution, dopaminergic medications, and therapeutic non-invasive neuromodulation may provide efficient mechanism-based treatments for BMS in the future. Conclusion We present a novel comprehensive hypothesis of primary BMS, gathering the hormonal, neuropathic, and genetic factors presumably required in the genesis of the condition. This will aid in future research on pathophysiology and risk factors of BMS, and boost treatment trials taking into account individual mechanism profiles and subgroup-clusters.

Causal mediation analysis with multiple mediators in the presence of treatment noncompliance.

PubMed

Park, Soojin; Kürüm, Esra

2018-05-20

Randomized experiments are often complicated because of treatment noncompliance. This challenge prevents researchers from identifying the mediated portion of the intention-to-treated (ITT) effect, which is the effect of the assigned treatment that is attributed to a mediator. One solution suggests identifying the mediated ITT effect on the basis of the average causal mediation effect among compliers when there is a single mediator. However, considering the complex nature of the mediating mechanisms, it is natural to assume that there are multiple variables that mediate through the causal path. Motivated by an empirical analysis of a data set collected in a randomized interventional study, we develop a method to estimate the mediated portion of the ITT effect when both multiple dependent mediators and treatment noncompliance exist. This enables researchers to make an informed decision on how to strengthen the intervention effect by identifying relevant mediators despite treatment noncompliance. We propose a nonparametric estimation procedure and provide a sensitivity analysis for key assumptions. We conduct a Monte Carlo simulation study to assess the finite sample performance of the proposed approach. The proposed method is illustrated by an empirical analysis of JOBS II data, in which a job training intervention was used to prevent mental health deterioration among unemployed individuals. Copyright © 2018 John Wiley & Sons, Ltd.

Production of glutinous rice flour from broken rice via ultrasonic assisted extraction of amylose.

PubMed

Setyawati, Yohana Dwi; Ahsan, Sitti Faika; Ong, Lu Ki; Soetaredjo, Felycia Edi; Ismadji, Suryadi; Ju, Yi-Hsu

2016-07-15

In this study, a modified aqueous leaching method by complex formation of amylose with glycerol was employed for reducing the amylose content of starch in broken white rice to less than 2%, so that the resulting starch can be classified to that of glutinous rice flour. By employing ultrasonication in alkaline condition, extraction of amylose could be performed by washing at lower temperature in shorter time compared to the existing aqueous leaching method. The effects of glycerol concentration, alkali concentration, ultrasonication and treatment time on the amylose content of the treated starch were systematically investigated. Under optimum condition, amylose content of broken white rice starch can be reduced from 27.27% to 1.43% with a yield of 80.42%. The changes in the physicochemical properties of the rice flour before and after treatment were studied. Copyright © 2016 Elsevier Ltd. All rights reserved.

Systematic review: conservative treatments for secondary lymphedema

PubMed Central

2012-01-01

Background Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain). Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems. PMID:22216837

Analysis and Modeling of Boundary Layer Separation Method (BLSM).

PubMed

Pethő, Dóra; Horváth, Géza; Liszi, János; Tóth, Imre; Paor, Dávid

2010-09-01

Nowadays rules of environmental protection strictly regulate pollution material emission into environment. To keep the environmental protection laws recycling is one of the useful methods of waste material treatment. We have developed a new method for the treatment of industrial waste water and named it boundary layer separation method (BLSM). We apply the phenomena that ions can be enriched in the boundary layer of the electrically charged electrode surface compared to the bulk liquid phase. The main point of the method is that the boundary layer at correctly chosen movement velocity can be taken out of the waste water without being damaged, and the ion-enriched boundary layer can be recycled. Electrosorption is a surface phenomenon. It can be used with high efficiency in case of large electrochemically active surface of electrodes. During our research work two high surface area nickel electrodes have been prepared. The value of electrochemically active surface area of electrodes has been estimated. The existence of diffusion part of the double layer has been experimentally approved. The electrical double layer capacity has been determined. Ion transport by boundary layer separation has been introduced. Finally we have tried to estimate the relative significance of physical adsorption and electrosorption.

Selective amplification and sequencing of cyclic phosphate-containing RNAs by the cP-RNA-seq method.

PubMed

Honda, Shozo; Morichika, Keisuke; Kirino, Yohei

2016-03-01

RNA digestions catalyzed by many ribonucleases generate RNA fragments that contain a 2',3'-cyclic phosphate (cP) at their 3' termini. However, standard RNA-seq methods are unable to accurately capture cP-containing RNAs because the cP inhibits the adapter ligation reaction. We recently developed a method named cP-RNA-seq that is able to selectively amplify and sequence cP-containing RNAs. Here we describe the cP-RNA-seq protocol in which the 3' termini of all RNAs, except those containing a cP, are cleaved through a periodate treatment after phosphatase treatment; hence, subsequent adapter ligation and cDNA amplification steps are exclusively applied to cP-containing RNAs. cP-RNA-seq takes ∼6 d, excluding the time required for sequencing and bioinformatics analyses, which are not covered in detail in this protocol. Biochemical validation of the existence of cP in the identified RNAs takes ∼3 d. Even though the cP-RNA-seq method was developed to identify angiogenin-generating 5'-tRNA halves as a proof of principle, the method should be applicable to global identification of cP-containing RNA repertoires in various transcriptomes.

Endophytic Phytoaugmentation: Treating Wastewater and Runoff Through Augmented Phytoremediation

PubMed Central

Redfern, Lauren K.

2016-01-01

Abstract Limited options exist for efficiently and effectively treating water runoff from agricultural fields and landfills. Traditional treatments include excavation, transport to landfills, incineration, stabilization, and vitrification. In general, treatment options relying on biological methods such as bioremediation have the ability to be applied in situ and offer a sustainable remedial option with a lower environmental impact and reduced long-term operating expenses. These methods are generally considered ecologically friendly, particularly when compared to traditional physicochemical cleanup options. Phytoremediation, which relies on plants to take up and/or transform the contaminant of interest, is another alternative treatment method which has been developed. However, phytoremediation is not widely used, largely due to its low treatment efficiency. Endophytic phytoaugmentation is a variation on phytoremediation that relies on augmenting the phytoremediating plants with exogenous strains to stimulate associated plant-microbe interactions to facilitate and improve remediation efficiency. In this review, we offer a summary of the current knowledge as well as developments in endophytic phytoaugmentation and present some potential future applications for this technology. There has been a limited number of published endophytic phytoaugmentation case studies and much remains to be done to transition lab-scale results to field applications. Future research needs include large-scale endophytic phytoaugmentation experiments as well as the development of more exhaustive tools for monitoring plant-microbe-pollutant interactions. PMID:27158249

Multicellular Tumour Spheroid as a model for evaluation of [18F]FDG as biomarker for breast cancer treatment monitoring

PubMed Central

Monazzam, Azita; Razifar, Pasha; Simonsson, Martin; Qvarnström, Fredrik; Josephsson, Raymond; Blomqvist, Carl; Långström, Bengt; Bergström, Mats

2006-01-01

Background In order to explore a pre-clinical method to evaluate if [18F]FDG is valid for monitoring early response, we investigated the uptake of FDG in Multicellular tumour spheroids (MTS) without and with treatment with five routinely used chemotherapy agents in breast cancer. Methods The response to each anticancer treatment was evaluated by measurement of the [18F]FDG uptake and viable volume of the MTSs after 2 and 3 days of treatment. Results The effect of Paclitaxel and Docetaxel on [18F]FDG uptake per viable volume was more evident in BT474 (up to 55% decrease) than in MCF-7 (up to 25% decrease). Doxorubicin reduced the [18F]FDG uptake per viable volume more noticeable in MCF-7 (25%) than in BT474 MTSs. Tamoxifen reduced the [18F]FDG uptake per viable volume only in MCF-7 at the highest dose of 1 μM. No effect of Imatinib was observed. Conclusion MTS was shown to be appropriate to investigate the potential of FDG-PET for early breast cancer treatment monitoring; the treatment effect can be observed before any tumour size changes occur. The combination of PET radiotracers and image analysis in MTS provides a good model to evaluate the relationship between tumour volume and the uptake of metabolic tracer before and after chemotherapy. This feature could be used for screening and selecting PET-tracers for early assessment of treatment response. In addition, this new method gives a possibility to assess quickly, and in vitro, a good preclinical profile of existing and newly developed anti-cancer drugs. PMID:16556298

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

PubMed Central

Yatham, Lakshmi; Grunze, Heinz; Vieta, Eduard; Young, Allan; Blier, Pierre; Kasper, Siegfried; Moeller, Hans Jurgen

2017-01-01

Abstract Background: The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. Material and Methods: The PRISMA method was used in the literature search with the combination of the words ‘bipolar,’ ‘manic,’ ‘mania,’ ‘manic depression,’ and ‘manic depressive’ with ‘randomized,’ and ‘algorithms’ with ‘mania,’ ‘manic,’ ‘bipolar,’ ‘manic-depressive,’ or ‘manic depression.’ Relevant web pages and review articles were also reviewed. Results: The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. Conclusions: A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses. PMID:27816941

TH-CD-209-01: A Greedy Reassignment Algorithm for the PBS Minimum Monitor Unit Constraint

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

Lin, Y; Kooy, H; Craft, D

2016-06-15

Purpose: To investigate a Greedy Reassignment algorithm in order to mitigate the effects of low weight spots in proton pencil beam scanning (PBS) treatment plans. Methods: To convert a plan from the treatment planning system’s (TPS) to a deliverable plan, post processing methods can be used to adjust the spot maps to meets the minimum MU constraint. Existing methods include: deleting low weight spots (Cut method), or rounding spots with weight above/below half the limit up/down to the limit/zero (Round method). An alternative method called Greedy Reassignment was developed in this work in which the lowest weight spot in themore » field was removed and its weight reassigned equally among its nearest neighbors. The process was repeated with the next lowest weight spot until all spots in the field were above the MU constraint. The algorithm performance was evaluated using plans collected from 190 patients (496 fields) treated at our facility. The evaluation criteria were the γ-index pass rate comparing the pre-processed and post-processed dose distributions. A planning metric was further developed to predict the impact of post-processing on treatment plans for various treatment planning, machine, and dose tolerance parameters. Results: For fields with a gamma pass rate of 90±1%, the metric has a standard deviation equal to 18% of the centroid value. This showed that the metric and γ-index pass rate are correlated for the Greedy Reassignment algorithm. Using a 3rd order polynomial fit to the data, the Greedy Reassignment method had 1.8 times better metric at 90% pass rate compared to other post-processing methods. Conclusion: We showed that the Greedy Reassignment method yields deliverable plans that are closest to the optimized-without-MU-constraint plan from the TPS. The metric developed in this work could help design the minimum MU threshold with the goal of keeping the γ-index pass rate above an acceptable value.« less

Review: Quantifying animal feeding behaviour with a focus on pigs.

PubMed

Maselyne, Jarissa; Saeys, Wouter; Van Nuffel, Annelies

2015-01-01

The study of animal feeding behaviour is of interest to understand feeding, to investigate the effect of treatments and conditions or to predict illness. This paper reviews the different steps to undertake when studying animal feeding behaviour, with illustrations for group-housed pigs. First, one must be aware of the mechanisms that control feeding and the various influences that can change feeding behaviour. Satiety is shown to largely influence free feeding (ad libitum and without an operant condition) in animals, but 'free' feeding seems a very fragile process, given the many factors that can influence feeding behaviour. Second, a measurement method must be chosen that is compatible with the goal of the research. Several measurement methods exist, which lead to different experimental set-ups and measurement data. Sensors are available for lab conditions, for research on group-housed pigs and also for on-farm use. Most of these methods result in a record of feeding visits. However, these feeding visits are often found to be clustered into meals. Thus, the third step is to choose which unit of feeding behaviour to use for analysis. Depending on the situation, either meals, feeding visits, other raw data, or a combination thereof can be suitable. Meals are more appropriate for analysing short-term feeding behaviour, but this may not be true for disease detection. Further research is therefore needed. To cluster visits into meals, an appropriate analysis method has to be selected. The last part of this paper provides a review and discussion of the existing methods for meal determination. A variety of methods exist, with the most recent methods based on the influence of satiety on feeding. More thorough validation of the recent methods, including validation from a behavioural point of view and uniformity in the applied methods is therefore necessary. Copyright © 2014 Elsevier Inc. All rights reserved.

Executive functions and aphasia treatment outcomes: data from an ortho-phonological cueing therapy for anomia in Chinese.

PubMed

Yeung, Olivia; Law, Sam-Po

2010-12-01

This study examined the existence of a possible relationship between anomic treatment outcomes and executive functions. An ortho-phonological cueing method was used to facilitate object naming in 12 Cantonese-speaking anomic individuals. Treatment effectiveness for each participant was quantified and correlated with the performance of executive functions and language tasks. It was found that 10 participants showed significant improvement in naming treated items. Eight of the participants were able to maintain treatment gains for at least 1 month. Phonological generalization effects were observed in two participants. Performance on the Test of Nonverbal Intelligence (TONI-3) was significantly correlated with effect sizes of treatment, treatment generalization and maintenance and the Attention Network Test (ANT) was significantly correlated with phonological generalization. The result of a simultaneous multiple regression suggested that the performance of the ANT played an important role in phonological generalization. The findings reinforce the current view about the role of executive functions in language rehabilitation. They also shed light on the effect of inhibitory control on treatment generalization.

High Adherence Is Necessary to Realize Health Gains from Water Quality Interventions

PubMed Central

Brown, Joe; Clasen, Thomas

2012-01-01

Background Safe drinking water is critical for health. Household water treatment (HWT) has been recommended for improving access to potable water where existing sources are unsafe. Reports of low adherence to HWT may limit the usefulness of this approach, however. Methods and Findings We constructed a quantitative microbial risk model to predict gains in health attributable to water quality interventions based on a range of assumptions about pre-treatment water quality; treatment effectiveness in reducing bacteria, viruses, and protozoan parasites; adherence to treatment interventions; volume of water consumed per person per day; and other variables. According to mean estimates, greater than 500 DALYs may be averted per 100,000 person-years with increased access to safe water, assuming moderately poor pre-treatment water quality that is a source of risk and high treatment adherence (>90% of water consumed is treated). A decline in adherence from 100% to 90% reduces predicted health gains by up to 96%, with sharpest declines when pre-treatment water quality is of higher risk. Conclusions Results suggest that high adherence is essential in order to realize potential health gains from HWT. PMID:22586491

Connecting Communities to Health Research: Development of the Project CONNECT Minority Research Registry

PubMed Central

Green, Melissa A.; Kim, Mimi M.; Barber, Sharrelle; Odulana, Abedowale A.; Godley, Paul A.; Howard, Daniel L.; Corbie-Smith, Giselle M.

2013-01-01

Introduction Prevention and treatment standards are based on evidence obtained in behavioral and clinical research. However, racial and ethnic minorities remain relatively absent from the science that develops these standards. While investigators have successfully recruited participants for individual studies using tailored recruitment methods, these strategies require considerable time and resources. Research registries, typically developed around a disease or condition, serve as a promising model for a targeted recruitment method to increase minority participation in health research. This study assessed the tailored recruitment methods used to populate a health research registry targeting African-American community members. Methods We describe six recruitment methods applied between September 2004 and October 2008 to recruit members into a health research registry. Recruitment included direct (existing studies, public databases, community outreach) and indirect methods (radio, internet, and email) targeting the general population, local universities, and African American communities. We conducted retrospective analysis of the recruitment by method using descriptive statistics, frequencies, and chi-square statistics. Results During the recruitment period, 608 individuals enrolled in the research registry. The majority of enrollees were African American, female, and in good health. Direct and indirect methods were identified as successful strategies for subgroups. Findings suggest significant associations between recruitment methods and age, presence of existing health condition, prior research participation, and motivation to join the registry. Conclusions A health research registry can be a successful tool to increase minority awareness of research opportunities. Multi-pronged recruitment approaches are needed to reach diverse subpopulations. PMID:23340183

Treatment decisions based on scalar and functional baseline covariates.

PubMed

Ciarleglio, Adam; Petkova, Eva; Ogden, R Todd; Tarpey, Thaddeus

2015-12-01

The amount and complexity of patient-level data being collected in randomized-controlled trials offer both opportunities and challenges for developing personalized rules for assigning treatment for a given disease or ailment. For example, trials examining treatments for major depressive disorder are not only collecting typical baseline data such as age, gender, or scores on various tests, but also data that measure the structure and function of the brain such as images from magnetic resonance imaging (MRI), functional MRI (fMRI), or electroencephalography (EEG). These latter types of data have an inherent structure and may be considered as functional data. We propose an approach that uses baseline covariates, both scalars and functions, to aid in the selection of an optimal treatment. In addition to providing information on which treatment should be selected for a new patient, the estimated regime has the potential to provide insight into the relationship between treatment response and the set of baseline covariates. Our approach can be viewed as an extension of "advantage learning" to include both scalar and functional covariates. We describe our method and how to implement it using existing software. Empirical performance of our method is evaluated with simulated data in a variety of settings and also applied to data arising from a study of patients with major depressive disorder from whom baseline scalar covariates as well as functional data from EEG are available. © 2015, The International Biometric Society.

Exploring the Concept of HIV-Related Stigma

PubMed Central

Florom-Smith, Aubrey L.; De Santis, Joseph P.

2013-01-01

BACKGROUND HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS Search engines were employed to review the existing knowledge base of this concept. CONCLUSION After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included. PMID:22861652

Initial Assessment of U.S. Refineries for Purposes of Potential Bio-Based Oil Insertions

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

Freeman, Charles J.; Jones, Susanne B.; Padmaperuma, Asanga B.

2013-04-01

In order to meet U.S. biofuel objectives over the coming decade the conversion of a broad range of biomass feedstocks, using diverse processing options, will be required. Further, the production of both gasoline and diesel biofuels will employ biomass conversion methods that produce wide boiling range intermediate oils requiring treatment similar to conventional refining processes (i.e. fluid catalytic cracking, hydrocracking, and hydrotreating). As such, it is widely recognized that leveraging existing U.S. petroleum refining infrastructure is key to reducing overall capital demands. This study examines how existing U.S. refining location, capacities and conversion capabilities match in geography and processing capabilitiesmore » with the needs projected from anticipated biofuels production.« less

Patellar Tendinopathy

PubMed Central

Schwartz, Aaron; Watson, Jonathan N.; Hutchinson, Mark R.

2015-01-01

Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Conclusion: Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. PMID:26502416

Evaluation of the tratment of metal-EDTA complexes using Ti0{sub 2} photocatalysis

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

Madden, T.; Datyte, A.K.; Prairie, M.R.

1996-03-01

This study has demonstrated the feasibility of TiO{sub 2} photocatalysis to treat EDTA and several metal-EDTA complexes that can be found in industrial wastewaters. For the EDTA complexes of metals capable of photodeposition, such as Cu and Pb, certain reaction conditions were shown to facilitate the simultaneous complex degradation and photodeposition of these metals onto the catalyst. With metals that do not easily photodeposit, such as Ni and Cd, it is shown that the complex degradation is still facilitated, and can enhance other metals removal processes after photocatalytic treatment. Because the treatment of these metal-EDTA complexes typically requires special measures,more » there may exist situations where TiO{sub 2} photocatalysis could actually be the preferred method of treatment. However, its use should be compared economically to other more established advanced oxidation technologies. This necessity is demonstrated in the economic comparison to ozone treatment for EDTA degradation alone, where ozone treatment appears to be the clear choice in this application.« less

Osteopathy for Endometriosis and Chronic Pelvic Pain - a Pilot Study.

PubMed

Sillem, M; Juhasz-Böss, I; Klausmeier, I; Mechsner, S; Siedentopf, F; Solomayer, E

2016-09-01

Introduction: Pelvic pain is a common problem in gynaecological practice. It is often unclear whether definite causality exists between reported symptoms and objective clinical findings of the female genital tract, and medical or operative treatments do not always achieve long-term resolution of symptoms. Methods: This pilot study investigated 28 patients (age 20-65, median 36.5 years) from a gynaecology practice whose only clinical finding was painful pelvic floor muscle tightness. Following standardised gynaecological and physiotherapist examination, all patients received osteopathic treatment. Pain had been present for a median of 3 years (range 1 month to 20 years). 14 patients had previously confirmed endometriosis. Treatment success was evaluated on consultation with patients in person or in writing. Results: 22 of the 28 participants completed the treatment according to plan. Overall, 17 reported symptom improvement, while 10 of the 14 patients with endometriosis did. Conclusion: Osteopathy is well received by women with painful pelvic floor muscle tightness and appears to be an effective treatment option.

Phosphate interference during in situ treatment for arsenic in groundwater.

PubMed

Brunsting, Joseph H; McBean, Edward A

2014-01-01

Contamination of groundwater by arsenic is a problem in many areas of the world, particularly in West Bengal (India) and Bangladesh, where reducing conditions in groundwater are the cause. In situ treatment is a novel approach wherein, by introduction of dissolved oxygen (DO), advantages over other treatment methods can be achieved through simplicity, not using chemicals, and not requiring disposal of arsenic-rich wastes. A lab-scale test of in situ treatment by air sparging, using a solution with approximately 5.3 mg L(-1) ferrous iron and 200 μg L(-1) arsenate, showed removal of arsenate in the range of 59%. A significant obstacle exists, however, due to the interference of phosphate since phosphate competes for adsorption sites on oxidized iron precipitates. A lab-scale test including 0.5 mg L(-1) phosphate showed negligible removal of arsenate. In situ treatment by air sparging demonstrates considerable promise for removal of arsenic from groundwater where iron is present in considerable quantities and phosphates are low.

[Resin infiltration of white spot lesions during the fixed orthodontic appliance therapy].

PubMed

Ogodescu, A; Ogodescu, Emilia; Talpoş, S; Zetu, Irina

2011-01-01

To investigate the evolution of resin infiltrated white spot lesions (WSLs) during 10 month of fixed orthodontic appliance therapy using the photographic examination method. Twelve patients with mild decalcifications prior to the orthodontic treatment were examined once each month. At aggravation of the WSLs, by patients who fail to maintain good oral hygiene, the brackets were taken down, the lesions were infiltrated with resin (ICON) and the brackets were bonded in place. WSLs were evaluated from intraoral photographs taken before and during the treatment. 35.2% of existing lesions aggravated in the first 6 months of treatment. 41.2 % of the W.S.L. were considered severe and were infiltrated. In the next 10 month of orthodontic treatment 92.5% of the infiltrated WSLs were clinically stable. This clinical study showed a positive evolution of the resin infiltrated WSLs during the fixed orthodontic therapy. This is especially important for patients with long periods of treatment like interdisciplinary orthodontic-orthognathic surgery cases or patients that are refractory to oral hygiene measures.

Personality and Differential Treatment Response in Major Depression: A Randomized Controlled Trial Comparing Cognitive-Behavioural Therapy and Pharmacotherapy

PubMed Central

Bagby, R Michael; Quilty, Lena C; Segal, Zindel V; McBride, Carolina C; Kennedy, Sidney H; Costa, Paul T

2008-01-01

Objective Effective treatments for major depressive disorder exist, yet some patients fail to respond, or achieve only partial response. One approach to optimizing treatment success is to identify which patients are more likely to respond best to which treatments. The objective of this investigation was to determine if patient personality characteristics are predictive of response to either cognitive-behavioural therapy (CBT) or pharmacotherapy (PHT). Method Depressed patients completed the Revised NEO Personality Inventory, which measures the higher-order domain and lower-order facet traits of the Five-Factor Model of Personality, and were randomized to receive either CBT or PHT. Result Four personality traits—the higher-order domain neuroticism and 3 lower-order facet traits: trust, straightforwardness, and tendermindedness—were able to distinguish a differential response rate to CBT, compared with PHT. Conclusion The assessment of patient dimensional personality traits can assist in the selection and optimization of treatment response for depressed patients. PMID:18616856

Predictive and preventive strategies to advance the treatments of cardiovascular and cerebrovascular diseases: the Ukrainian context

PubMed Central

2012-01-01

Despite great efforts in treatments of cardiovascular diseases, the field requires innovative strategies because of high rates of morbidity, mortality and disability, indicating evident deficits in predictive vascular diagnosis and individualized treatment approaches. Talking about the vascular system, currently, physicians are not provided with integrated medical approaches to diagnose and treat vascular diseases. Only an individual global approach to the analysis of all segments in the vascular system of a patient allows finding the optimal way for vascular disease treatment. As for the existing methodology, there is a dominance of static methods such as X-ray contrast angiography and magnetic resonance imaging in angiomode. Taking into account the world experience, this article deals with innovative strategies, aiming at predictive diagnosis in vascular system, personalization of the biomedical treatment approaches, and targeted prevention of individual patient cohorts. Clinical examples illustrate the advances in corresponding healthcare sectors. Recommendations are provided to promote the field. PMID:23083430

Decision making tools for selecting sustainable wastewater treatment technologies in Thailand

NASA Astrophysics Data System (ADS)

Wongburi, Praewa; Park, Jae K.

2018-05-01

Wastewater consists of valuable resources that could be recovered or reused. Still it is under threat because of ineffective wastewater management and systems. In Thailand, less than 25% of wastewater generated may be treated while then rest is inadequately treated and sent back directly into waterbodies or the environment. Furthermore, the technologies that have been applied may be inefficient and unsustainable. Efficiency, sustainability, and simplicity are important concepts when designing an appropriate wastewater treatment system in developing countries. The objectives of this study were to review and evaluate wastewater treatment technologies and propose a method to improve or select an appropriate technology. An expert system in Excel® program was developed to determine the best solution. Sensitivity analysis was applied to compare and assess uncertainty factors. Due to the different conditions of each area, the key factor of interest was varied. Furthermore, Robust Decision Making tool was applied to determine the best way to improve existing wastewater treatment facility and to choose the most appropriate wastewater treatment technology.

Divine and rational: the reproductive health of women in ancient Egypt.

PubMed

Sullivan, R

1997-10-01

Analysis of existing evidence indicates that the ancient Egyptians created a systematic medical profession that resorted to divine interventions only when practical treatments failed. Ancient Egyptian women had predetermined roles but high status in society and lived according to strict hierarchial social organization. Inscriptions indicate that monogamous marriage was the norm, and the first year of marriage was probationary. An unspecified interval of months was the known duration of pregnancy, and a number of gods and goddesses were invoked to assist women during pregnancy and delivery. While little is currently known about pregnancy complication suffered by ancient Egyptian women, new techniques of studying mummies will soon yield additional information. The medical papyri yield few references to treatments prescribed for pregnancy complications, and no surgical instruments have been found that have recognizable obstetrical purposes. Accounts of Egyptian sex behavior survive in the writings of ancient historians and erotic texts. There is evidence that both religious (serving the priests) and social prostitution existed. A common theme in ancient texts is the belief that dreams of a sexual nature were ill omens. Medical papyri point to the existence of chlamydia and gonorrhea but not syphilis, various methods of contraception, and treatment for women with symptoms of genitourinary infection. Ancient Egyptians could diagnose pregnancy and even devised a rational pregnancy test. While most known physicians were men, there is evidence that female midwives may have attended births. Examination of Egyptian medical history shows how civilization attempted rational interventions into matters previously believed to be completely controlled by nature.

A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions

PubMed Central

Evans, Marion Willard; Ramcharan, Michael; Floyd, Rod; Globe, Gary; Ndetan, Harrison; Williams, Ronald; Ivie, Ronald

2009-01-01

Abstract Objective By nature, chiropractic is a hands-on profession using manipulation applied to the joints with direct skin-to-skin contacts. Chiropractic tables are designed with a face piece to accommodate the prone patient's head in a neutral position and hand rests to allow for relaxed shoulders and upper spine so treatment is facilitated. The purpose of this article is to present a proposed guideline for hand and treatment table surface sanitizing for the chiropractic profession that is evidence-based and can easily be adopted by teaching institutions and doctors in the field. Methods A review of the chiropractic literature demonstrated that pathogenic microbes are present on treatment tables in teaching clinics at multiple facilities, yet no standardized protocols exist in the United States regarding table sanitizing and hand hygiene in chiropractic clinics or education institutions. This article reviews the scientific literature on the subject by using several search engines, databases, and specific reviews of documents pertaining to the topic including existing general guidelines. Results The literature has several existing guidelines that the authors used to develop a proposed protocol for hand and table sanitizing specific to the chiropractic profession. Recommendations were developed and are presented on hand hygiene and table sanitizing procedures that could lower the risk of infection for both clinical personnel and patients in chiropractic facilities. Conclusion This article offers a protocol for hand and table sanitizing in chiropractic clinics and education institutions. The chiropractic profession should consider adoption of these or similar measures and disseminate them to teaching clinics, institutions, and private practitioners. PMID:19646384

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

PubMed

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

2013-03-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6-10.5 for intermediate-risk patients and 7.8-9.3 for high-risk patients. There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease. RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer. © 2012 BJU International.

The experience of hepatitis C treatment for people with a history of mental health problems: An interpretative phenomenological analysis.

PubMed

Ware, K; Davies, J; Rowse, G; Whittaker, S

2015-07-01

This qualitative study explores the experience of hepatitis C virus treatment for people with pre-existing mental health problems within a large city hospital. Four men and four women with pre-existing mental health problems who had received hepatitis C virus treatment took part in semi-structured interviews which were analysed using interpretative phenomenological analysis. A central theme of 'Self, stigma and change' was identified which interlinked with three other main themes of 'Coping and responding to treatment', 'Connectedness to others' and 'The impact of information'. These themes and their sub-themes are discussed in relation to existing literature and clinical practice guidelines. © The Author(s) 2013.

Evaluation of sites for the location of WEEE recycling plants in Spain.

PubMed

Queiruga, Dolores; Walther, Grit; González-Benito, Javier; Spengler, Thomas

2008-01-01

As a consequence of new European legal regulations for treatment of waste electrical and electronic equipment (WEEE), recycling plants have to be installed in Spain. In this context, this contribution describes a method for ranking of Spanish municipalities according to their appropriateness for the installation of these plants. In order to rank the alternatives, the discrete multi-criteria decision method PROMETHEE (Preference Ranking Organisation METHod for Enrichment Evaluations), combined with a surveys of experts, is applied. As existing plants are located in North and East Spain, a significant concentration of top ranking municipalities can be observed in South and Central Spain. The method does not present an optimal structure of the future recycling system, but provides a selection of good alternatives for potential locations of recycling plants.

Combined surface activated bonding using H-containing HCOOH vapor treatment for Cu/Adhesive hybrid bonding at below 200 °C

NASA Astrophysics Data System (ADS)

He, Ran; Fujino, Masahisa; Akaike, Masatake; Sakai, Taiji; Sakuyama, Seiki; Suga, Tadatomo

2017-08-01

Cu/adhesive hybrid bonding is an attractive approach to three-dimensional (3D) integration because it provides direct Cusbnd Cu vertical interconnects and high mechanical stability. However, Cu/adhesive hybrid bonding at below 200 °C is still challenging because of bonding temperature mismatch between Cusbnd Cu and polymer adhesives and lacking of effective adhesive-compatible Cu surface activation methods. In this paper, we investigate and demonstrate a ;Cu-first; hybrid bonding technique by using hydrogen(H)-containing formic acid (HCOOH) vapor prebonding surface treatment for the first time. In this technique, high-quality Cusbnd Cu bonding is obtained at 180-200 °C that is close to or even lower than the temperature of subsequent adhesive curing. We experimentally investigate the effects of the H-containing HCOOH vapor treatment for Cusbnd Cu bonding and cyclo-olefin polymer adhesive-adhesive bonding. This technique enables Cu/adhesive hybrid bonding at below 200 °C, promising smaller thermal stress, higher throughput, and lower cost comparing to the existing ;adhesive-first; hybrid bonding method.

An online database for plant image analysis software tools.

PubMed

Lobet, Guillaume; Draye, Xavier; Périlleux, Claire

2013-10-09

Recent years have seen an increase in methods for plant phenotyping using image analyses. These methods require new software solutions for data extraction and treatment. These solutions are instrumental in supporting various research pipelines, ranging from the localisation of cellular compounds to the quantification of tree canopies. However, due to the variety of existing tools and the lack of central repository, it is challenging for researchers to identify the software that is best suited for their research. We present an online, manually curated, database referencing more than 90 plant image analysis software solutions. The website, plant-image-analysis.org, presents each software in a uniform and concise manner enabling users to identify the available solutions for their experimental needs. The website also enables user feedback, evaluations and new software submissions. The plant-image-analysis.org database provides an overview of existing plant image analysis software. The aim of such a toolbox is to help users to find solutions, and to provide developers a way to exchange and communicate about their work.

Numerical studies of the Bethe-Salpeter equation for a two-fermion bound state

NASA Astrophysics Data System (ADS)

de Paula, W.; Frederico, T.; Salmè, G.; Viviani, M.

2018-03-01

Some recent advances on the solution of the Bethe-Salpeter equation (BSE) for a two-fermion bound system directly in Minkowski space are presented. The calculations are based on the expression of the Bethe-Salpeter amplitude in terms of the so-called Nakanishi integral representation and on the light-front projection (i.e. the integration of the light-front variable k - = k 0 - k 3). The latter technique allows for the analytically exact treatment of the singularities plaguing the two-fermion BSE in Minkowski space. The good agreement observed between our results and those obtained using other existing numerical methods, based on both Minkowski and Euclidean space techniques, fully corroborate our analytical treatment.

Supercritical water oxidation for the destruction of toxic organic wastewaters: a review.

PubMed

Veriansyah, Bambang; Kim, Jae-Duck

2007-01-01

The destruction of toxic organic wastewaters from munitions demilitarization and complex industrial chemical clearly becomes an overwhelming problem if left to conventional treatment processes. Two options, incineration and supercritical water oxidation (SCWO), exist for the complete destruction of toxic organic wastewaters. Incinerator has associated problems such as very high cost and public resentment; on the other hand, SCWO has proved to be a very promising method for the treatment of many different wastewaters with extremely efficient organic waste destruction 99.99% with none of the emissions associated with incineration. In this review, the concepts of SCWO, result and present perspectives of application, and industrial status of SCWO are critically examined and discussed.

BORDERLINE RESECTABLE PANCREATIC CANCER: Need for Standardization and Methods for Optimal Clinical Trial Design

PubMed Central

Katz, Matthew HG; Marsh, Robert; Herman, Joseph M.; Shi, Qian; Collison, Eric; Venook, Alan; Kindler, Hedy; Alberts, Steven; Philip, Philip; Lowy, Andrew M.; Pisters, Peter; Posner, Mitchell; Berlin, Jordan; Ahmad, Syed A.

2017-01-01

Methodological limitations of prior studies have prevented progress in the treatment of patients with borderline resectable pancreatic adenocarcinoma. Shortcomings have included the absence of staging and treatment standards and pre-existing biases with regard to the use of neoadjuvant therapy and the role of vascular resection at pancreatectomy. In this manuscript, we will review limitations of studies of borderline resectable PDAC reported to date, highlight important controversies related to this disease stage, emphasize the research infrastructure necessary for its future study, and present a recently-approved Intergroup pilot study (Alliance A0201101) that will provide a foundation upon which subsequent well-designed clinical trials can be performed. PMID:23435609

Advances in the treatment of erectile dysfunction: what’s new and upcoming?

PubMed Central

Patel, Chintan K.; Bennett, Nelson

2016-01-01

Erectile dysfunction adversely affects up to 20% of all men and is the most commonly treated sexual disorder. The public health implications of this condition are significant and represent a challenge for our healthcare system. The physiological pathways responsible for erections have been extensively studied, and much advancement has been made since the introduction of phosphodiesterase 5 inhibitors. Newer agents, such as dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, are under investigation. Newer formulations and delivery methods of existing medications such as alprostadil will also be introduced in the near future. Furthermore, low-intensity shockwave lithotripsy and stem cell regenerative techniques are innovative approaches to the treatment of erectile dysfunction. PMID:27516878

Further refinements of the polyp snare for interuterine surgery--a new modality for treatment of myomas and polyps.

PubMed

McLucas, B

1995-01-01

Hysteroscopic treatment of 30 patients suffering from menorrhagia or post-partum complications was accomplished using an electrosurgical polyp snare. Using this method, 18 polyps and 12 myomas were successfully removed in less than twenty minutes without complications. Local anaesthesia was used in 12 patients. Three patients have presented with recurrence of menorrhagia, with a minimum of six months follow-up. Benefits of this technique compared to uterine resectoscopy include shorter operative time, decreased risk of fluid overload, and less risk of uterine perforation. The snare is difficult to use and a learning curve exists. Higher currents than that used for resection are required.

Ultrasonic velocity technique for monitoring property changes in fiber-reinforced ceramic matrix composites

NASA Technical Reports Server (NTRS)

Kautz, Harold E.; Bhatt, Ramakrishna T.

1991-01-01

A technique for measuring ultrasonic velocity was used to monitor changes that occur during processing and heat treatment of a SiC/RBSM composite. Results indicated that correlations exist between the ultrasonic velocity data and elastic modulus and interfacial shear strength data determined from mechanical tests. The ultrasonic velocity data can differentiate strength. The advantages and potential of this nondestructive evaluation method for fiber reinforced ceramic matrix composite applications are discussed.

Methodological challenges to human medical study.

PubMed

Zhong, Yixin; Liu, Baoyan; Qu, Hua; Xie, Qi

2014-09-01

With the transformation of modern medicinal pattern, medical studies are confronted with methodological challenges. By analyzing two methodologies existing in the study of physical matter system and information system, the article points out that traditional Chinese medicine (TCM), especially the treatment based on syndrome differentiation, embodies information conception of methodological positions, while western medicine represents matter conception of methodological positions. It proposes a new way of thinking about combination of TCM and western medicine by combinating two kinds of methodological methods.

Impact of Prehospital Medical Evacuation (MEDEVAC) Transport Time on Combat Mortality in Patients with Non-Compressible Torso Injury and Traumatic Amputations

DTIC Science & Technology

2018-12-28

MED EV AC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations Sb. GRANT NUMBER Sc. PROGRAM...increased morbidity and mortality. Limited data exists on the influence of transport time on patient outcomes with specific injury types. The...treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI). Methods: We

Modeling the effect of blunt impact on mitochondrial function in cartilage: implications for development of osteoarthritis.

PubMed

Kapitanov, Georgi I; Ayati, Bruce P; Martin, James A

2017-01-01

Osteoarthritis (OA) is a disease characterized by degeneration of joint cartilage. It is associated with pain and disability and is the result of either age and activity related joint wear or an injury. Non-invasive treatment options are scarce and prevention and early intervention methods are practically non-existent. The modeling effort presented in this article is constructed based on an emerging biological hypothesis-post-impact oxidative stress leads to cartilage cell apoptosis and hence the degeneration observed with the disease. The objective is to quantitatively describe the loss of cell viability and function in cartilage after an injurious impact and identify the key parameters and variables that contribute to this phenomenon. We constructed a system of differential equations that tracks cell viability, mitochondrial function, and concentrations of reactive oxygen species (ROS), adenosine triphosphate (ATP), and glycosaminoglycans (GAG). The system was solved using MATLAB and the equations' parameters were fit to existing data using a particle swarm algorithm. The model fits well the available data for cell viability, ATP production, and GAG content. Local sensitivity analysis shows that the initial amount of ROS is the most important parameter. The model we constructed is a viable method for producing in silico studies and with a few modifications, and data calibration and validation, may be a powerful predictive tool in the search for a non-invasive treatment for post-traumatic osteoarthritis.

Critical Care Follow-up Clinics: A Scoping Review of Interventions and Outcomes

PubMed Central

Oles, Sylwia K.; Mundell, James; London, Susan; Khan, Babar

2016-01-01

Objective The purpose of this scoping review was to identify evidence describing benefits of interventions provided in ICU-survivor follow-up clinics. Background Advances in intensive care unit (ICU) treatments have increased the number of survivors who require specialized care for ICU-related sequelae. ICU survivor follow-up clinics exist yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken. Method Ten databases were searched yielding one-hundred eleven relevant unique publication titles and abstracts. Sample heterogeneity supported using a scoping review method. After excluding non-related publications, 33 reports were fully reviewed. Twenty international publications were included that described ICU follow-up clinic interventions and/or outcomes. Results Authors discussed very diverse interventions in 15 publications, and 9 reported some level of intervention effectiveness. Evidence was strongest that supported the use of prospective diaries as an intervention to prevent or improve psychological symptoms whereas evidence to support implementation of other interventions was weak. Conclusions Although ICU follow-up clinics exist, evidence for interventions and effectiveness of treatments in these clinics remains under-explored. Implications ICU survivor follow-up clinics provide a venue for further interdisciplinary intervention research that could lead to better health outcomes for ICU survivors. PMID:27309787

Inhibition of Alzheimer’s Amyloid Toxicity with a Tricyclic Pyrone Molecule In Vitro and In Vivo

PubMed Central

Hong, Hyun-Seok; Rana, Sandeep; Barrigan, Lydia; Shi, Aibin; Zhang, Yi; Zhou, Feimeng; Jin, Lee-Way; Hua, Duy H.

2009-01-01

Small amyloid β 1–42 aggregates are toxic to neurons and may be the primary toxic species in Alzheimer’s disease (AD). Methods to reduce the level of Aβ, prevent Aβ aggregation, and eliminate existing Aβ aggregates have been proposed for treatment of AD. A tricyclic pyrone named CP2 is found to prevent cell death associated with Aβ oligomers. We studied the possible mechanisms of neuroprotection by CP2. Surface plasmon resonance spectroscopy shows a direct binding of CP2 with Aβ42 oligomer. Circular dichroism spectroscopy reveals monomeric Aβ42 peptide remains as a random coil/α-helix structure in the presence of CP2 over 48 h. Atomic force microscopy (AFM) studies show CP2 exhibits similar ability to inhibit Aβ42 aggregation as that of Congo Red and curcumin. AFM closed-fluid cell study demonstrates that CP2 disaggregates Aβ42 oligomers and protofibrils. CP2 also blocks Aβ fibrillations using a protein quantification method. Treatment of 5x FAD mice, a robust Aβ42-producing animal model of AD, with a two-week course of CP2 resulted in 40% and 50% decreases in non-fibrillar and fibrillar Aβ species, respectively. Our results suggest that CP2 might be beneficial to AD patients by preventing Aβ aggregation and disaggregating existing Aβ oligomers and protofibrils. PMID:19141069

Autogenic-feedback training: A potential treatment for post-flight orthostatic intolerance in aerospace crews

NASA Technical Reports Server (NTRS)

Cowings, Patricia S.; Toscano, William B.; Miller, Neil E.; Pickering, Thomas G.; Shapiro, David

1993-01-01

Postflight orthostatic intolerance was identified as a serious biomedical problem associated with long duration exposure to microgravity in space. High priority was given to the development of countermeasures for this disorder which are both effective and practical. A considerable body of clinical research demonstrated that people can be taught to increase their own blood pressure voluntarily and that this is an effective treatment for chronic orthostatic intolerance in paralyzed patients. The present pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using an operant conditioning procedure, Autogenic-Feedback Training (AFT), three men and two women participated in four to nine (15-30 training sessions). At the end of training, the average increase in systolic and diastolic pressure, as well as mean arterial pressures that the subjects made, ranged between 20 and 5O mmHg under both supine and 45 deg head-up tilt conditions. These findings suggest that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight orthostatic intolerance. Further, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

Policy Innovation and Policy Pathways: Tuberculosis Control in Sri Lanka, 1948-1990.

PubMed

Jones, Margaret

2016-10-01

This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization's internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance.

Policy Innovation and Policy Pathways: Tuberculosis Control in Sri Lanka, 1948–1990

PubMed Central

Jones, Margaret

2016-01-01

This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization’s internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance. PMID:27628860

PEG spacer gel and adaptive planning vs single plan in external prostate radiotherapy—clinical dosimetry evaluation

PubMed Central

2015-01-01

Objective: Spacer gel is used to reduce the rectal dose in prostate radiotherapy. It is injected to increase the distance between the prostate and rectum. During the course of external radiotherapy treatment, physiological changes in rectal volume exist. When using polyethylene glycol material, such as DuraSeal® (Covidien, Mansfield, MA), gel resorption also occurs. Together, these factors alter the original dose plan distribution. Methods: External dose planning and calculations were simulated using images acquired from 10 patients who were treated with brachytherapy and gel. The CT series was taken relative to gel injection: pre 1 day, post 1 day, post 1 month and post 2 months. Adaptive planning was compared with a single plan. Results: Adaptive planning shows better results compared with the single plan used in the total treatment course; however, the effect is minor. Conclusion: Gel usage is clearly favourable to rectal DVH. Using adaptive planning with gel improves rectal DVH but is not necessary according to this study. Advances in knowledge: Spacer gel is used in prostate radiotherapy to increase distance between the prostate and the rectum, thus reducing the rectal doses. During the treatment course, gel resorption exists which affects the rectal doses. The usefulness of adaptive planning to compensate this resorption effect has not been studied before. PMID:26370300

Autogenic-Feedback Training: A Potential Treatment for Orthostatic Intolerance in Aerospace Crews

NASA Technical Reports Server (NTRS)

Cowings, P. S.; Toscano, W. B.; Miller, N. E.; Pickering, T. G.; Shapiro, D.; Stevenson, J.; Maloney, S.; Knapp, J.

1994-01-01

Postflight orthostatic intolerance has been identified as a serious biomedical problem associated with long-duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder that are both effective and practical. A considerable body of clinical research has demonstrated that people can be taught to increase their own blood pressure voluntarily, and that this is an effective treatment for chronic orthostatic intolerance in paralyzed patients. The current pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using an operant conditioning procedure, autogenic-feedback training (AFT), three men and two women participated in four to nine training (15-30-minute) sessions. At the end of training, the average increase in systolic and diastolic pressure, as well as mean arterial pressures, that the subjects made ranged between 20 and 50 mm Hg under both supine and 45 deg head-up tilt conditions. These findings indicate that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight orthostatic intolerance. Furthermore, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

A comprehensive overview on the structure and comparison of magnetic properties of nanocrystalline synthesized by a thermal treatment method

NASA Astrophysics Data System (ADS)

Naseri, Mahmoud Goodarz; Halimah, M. K.; Dehzangi, Arash; Kamalianfar, Ahmad; Saion, Elias B.; Majlis, Burhanuddin Y.

2014-03-01

This study reports the simple synthesis of MFe2O4 (where M=Zn, Mn and Co) nanostructures by a thermal treatment method, followed by calcination at various temperatures from 723 to 873 K. Poly(vinyl pyrrolidon) (PVP) was used as a capping agent to stabilize the particles and prevent them from agglomeration. The pyrolytic behaviors of the polymeric precursor were analyzed by use of simultaneous thermo-gravimetry analyses (TGA) and derivative thermo-gravimetry (DTG) analyses. The characterization studies were conducted by X-ray diffraction (XRD) and transmission electron microscopy (TEM). Fourier transform infrared spectroscopy (FT-IR) confirmed the presence of metal oxide bands for all the calcined samples. Magnetic properties were demonstrated by a vibrating sample magnetometer (VSM), which displayed that the calcined samples exhibited different types of magnetic behavior. The present study also substantiated that magnetic properties of ferrite nanoparticles prepared by the thermal treatment method, from viewing microstructures of them, can be explained as the results of the two important factors: cation distribution and impurity phase of α-Fe2O3. These two factors are subcategory of the preparation method which is related to macrostructure of ferrite. Electron paramagnetic resonance (EPR) spectroscopy showed the existence of unpaired electrons ZnFe2O4 and MnFe2O4 nanoparticles while it did not exhibit resonance signal for CoFe2O4 nanoparticles.

Asymmetric collimation: Dosimetric characteristics, treatment planning algorithm, and clinical applications

NASA Astrophysics Data System (ADS)

Kwa, William

1998-11-01

In this thesis the dosimetric characteristics of asymmetric fields are investigated and a new computation method for the dosimetry of asymmetric fields is described and implemented into an existing treatment planning algorithm. Based on this asymmetric field treatment planning algorithm, the clinical use of asymmetric fields in cancer treatment is investigated, and new treatment techniques for conformal therapy are developed. Dose calculation is verified with thermoluminescent dosimeters in a body phantom. In this thesis, an analytical approach is proposed to account for the dose reduction when a corresponding symmetric field is collimated asymmetrically to a smaller asymmetric field. This is represented by a correction factor that uses the ratio of the equivalent field dose contributions between the asymmetric and symmetric fields. The same equation used in the expression of the correction factor can be used for a wide range of asymmetric field sizes, photon energies and linear accelerators. This correction factor will account for the reduction in scatter contributions within an asymmetric field, resulting in the dose profile of an asymmetric field resembling that of a wedged field. The output factors of some linear accelerators are dependent on the collimator settings and whether the upper or lower collimators are used to set the narrower dimension of a radiation field. In addition to this collimator exchange effect for symmetric fields, asymmetric fields are also found to exhibit some asymmetric collimator backscatter effect. The proposed correction factor is extended to account for these effects. A set of correction factors determined semi-empirically to account for the dose reduction in the penumbral region and outside the radiated field is established. Since these correction factors rely only on the output factors and the tissue maximum ratios, they can easily be implemented into an existing treatment planning system. There is no need to store either additional sets of asymmetric field profiles or databases for the implementation of these correction factors into an existing in-house treatment planning system. With this asymmetric field algorithm, the computation time is found to be 20 times faster than a commercial system. This computation method can also be generalized to the dose representation of a two-fold asymmetric field whereby both the field width and length are set asymmetrically, and the calculations are not limited to points lying on one of the principal planes. The dosimetric consequences of asymmetric fields on the dose delivery in clinical situations are investigated. Examples of the clinical use of asymmetric fields are given and the potential use of asymmetric fields in conformal therapy is demonstrated. An alternative head and neck conformal therapy is described, and the treatment plan is compared to the conventional technique. The dose distributions calculated for the standard and alternative techniques are confirmed with thermoluminescent dosimeters in a body phantom at selected dose points. (Abstract shortened by UMI.)

The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study: Description and Baseline Characteristics of Participants.

PubMed

Paskett, Electra D; Caan, Bette J; Johnson, Lisa; Bernardo, Brittany M; Young, Gregory S; Pennell, Michael L; Ray, Roberta M; Kroenke, Candyce H; Porter, Peggy L; Anderson, Garnet L

2018-02-01

Background: The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study offers an important opportunity to advance cancer research by extending the original WHI studies to examine survivorship in women diagnosed with cancer during their participation in WHI. Methods: The goals of LILAC are to (i) obtain cancer treatment information and long-term cancer outcomes for women diagnosed with one of eight selected cancers (breast, endometrial, ovarian, lung, and colorectal cancers, and melanoma, lymphoma, and leukemia); (ii) augment the existing WHI biorepository with fixed tumor tissue from the solid tumor sites for cancers diagnosed since 2002; and (iii) develop, refine, and validate methods to use administrative data to capture treatment and recurrence data. Methods for accomplishing these goals are described, as are results from the initial LILAC participant survey. Results: A total of 9,934 WHI participants living with cancer were eligible for LILAC participation, of which 78% ( N = 7,760) agreed to participate. Among the three most prevalent cancer types, 54% are breast cancer survivors, 11% are melanoma survivors, and 10% are survivors of colorectal cancer. Conclusions: In addition to describing this resource, we present pertinent lessons that may assist other investigators interested in embedding survivorship research into existing large epidemiologic cohorts. Impact: The LILAC resource offers a valuable opportunity for researchers to study cancer survivorship and issues pertinent to cancer survivors in future studies. Cancer Epidemiol Biomarkers Prev; 27(2); 125-37. ©2017 AACR . ©2017 American Association for Cancer Research.

Connecting communities to health research: development of the Project CONNECT minority research registry.

PubMed

Green, Melissa A; Kim, Mimi M; Barber, Sharrelle; Odulana, Abedowale A; Godley, Paul A; Howard, Daniel L; Corbie-Smith, Giselle M

2013-05-01

Prevention and treatment standards are based on evidence obtained in behavioral and clinical research. However, racial and ethnic minorities remain relatively absent from the science that develops these standards. While investigators have successfully recruited participants for individual studies using tailored recruitment methods, these strategies require considerable time and resources. Research registries, typically developed around a disease or condition, serve as a promising model for a targeted recruitment method to increase minority participation in health research. This study assessed the tailored recruitment methods used to populate a health research registry targeting African-American community members. We describe six recruitment methods applied between September 2004 and October 2008 to recruit members into a health research registry. Recruitment included direct (existing studies, public databases, community outreach) and indirect methods (radio, internet, and email) targeting the general population, local universities, and African American communities. We conducted retrospective analysis of the recruitment by method using descriptive statistics, frequencies, and chi-square statistics. During the recruitment period, 608 individuals enrolled in the research registry. The majority of enrollees were African American, female, and in good health. Direct and indirect methods were identified as successful strategies for subgroups. Findings suggest significant associations between recruitment methods and age, presence of existing health condition, prior research participation, and motivation to join the registry. A health research registry can be a successful tool to increase minority awareness of research opportunities. Multi-pronged recruitment approaches are needed to reach diverse subpopulations. Copyright © 2013. Published by Elsevier Inc.

Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study

PubMed Central

Malhotra, Shelly; Koeut, Pichenda; Thai, Sopheak; Khun, Kim Eam; Colebunders, Robert; Lynen, Lut

2015-01-01

Background While community-based active case finding (ACF) for tuberculosis (TB) holds promise for increasing early case detection among hard-to-reach populations, limited data exist on the acceptability of active screening. We aimed to identify barriers and explore facilitators on the pathway from diagnosis to care among TB patients and health providers. Methods Mixed-methods study. We administered a survey questionnaire to, and performed in-depth interviews with, TB patients identified through ACF from poor urban settlements in Phnom Penh, Cambodia. Additionally, we conducted focus group discussions and in-depth interviews with community and public health providers involved in ACF, respectively. Results Acceptance of home TB screening was strong among key stakeholders due to perceived reductions in access barriers and in direct and indirect patient costs. Privacy and stigma were not an issue. To build trust and facilitate communication, the participation of community representatives alongside health workers was preferred. Most health providers saw ACF as complementary to existing TB services; however, additional workload as a result of ACF was perceived as straining operating capacity at public sector sites. Proximity to a health facility and disease severity were the strongest determinants of prompt care-seeking. The main reasons reported for delays in treatment-seeking were non-acceptance of diagnosis, high indirect costs related to lost income/productivity and transportation expenses, and anticipated side-effects from TB drugs. Conclusions TB patients and health providers considered home-based ACF complementary to facility-based TB screening. Strong engagement with community representatives was believed critical in gaining access to high risk communities. The main barriers to prompt treatment uptake in ACF were refusal of diagnosis, high indirect costs, and anticipated treatment side-effects. A patient-centred approach and community involvement were essential in mitigating barriers to care in marginalised communities. PMID:26222545

A proven and highly cost-effective method of early detection of breast cancer for developing countries.

PubMed

Rebentisch, D P; Rebentisch, H D; Thomas, K; Karat, S; Jadhav, A J

1995-12-01

Carcinoma of the breast is the third most common cancer in Indian women. With rapid industrialization and effective control of communicable diseases, better diagnostic and treatment facilities, cancer is emerging as a major health problem. Since early detection is the only way to reduce morbidity and mortality from breast cancer, we undertook a pilot project to evaluate efficacy of using existing manpower and resources for screening women in the high risk group. Methodology pros and cons, results, and recommendations are presented. Our method can be adopted by any developing country interested in a screening programme for malignant disease.

Patient safety, quality of care, and knowledge translation in the intensive care unit.

PubMed

Needham, Dale M

2010-07-01

A large gap exists between the completion of clinical research demonstrating the benefit of new treatment interventions and improved patient outcomes resulting from implementation of these interventions as part of routine clinical practice. This gap clearly affects patient safety and quality of care. Knowledge translation is important for addressing this gap, but evaluation of the most appropriate and effective knowledge translation methods is still ongoing. Through describing one model for knowledge translation and an example of its implementation, insights can be gained into systematic methods for advancing the implementation of evidence-based interventions to improve safety, quality, and patient outcomes.

Ultrasound-assisted oxidative desulfurization of bitumen

NASA Astrophysics Data System (ADS)

Kamal, Wan Mohamad Ikhwan bin Wan; Okawa, Hirokazu; Kato, Takahiro; Sugawara, Katsuyasu

2017-07-01

Bitumen contains a high percentage of sulfur (about 4.6 wt %). A hydrodesulfurization method is used to remove sulfur from bitumen. The drawback of this method is the requirement for a high temperature of >300 °C. Most of the sulfur in bitumen exists as thiophene. Oxidative desulfurization (ODS), involving oxidizing sulfur using H2O2, then removing it using NaOH, allows the removal of sulfur in thiophene at low temperatures. We removed sulfur from bitumen using ODS treatment under ultrasound irradiation, and 52% of sulfur was successfully removed. Additionally, the physical action of ultrasound assisted the desulfurization of bitumen, even at low H2O2 concentrations.

Imaging metabolic heterogeneity in cancer.

PubMed

Sengupta, Debanti; Pratx, Guillem

2016-01-06

As our knowledge of cancer metabolism has increased, it has become apparent that cancer metabolic processes are extremely heterogeneous. The reasons behind this heterogeneity include genetic diversity, the existence of multiple and redundant metabolic pathways, altered microenvironmental conditions, and so on. As a result, methods in the clinic and beyond have been developed in order to image and study tumor metabolism in the in vivo and in vitro regimes. Both regimes provide unique advantages and challenges, and may be used to provide a picture of tumor metabolic heterogeneity that is spatially and temporally comprehensive. Taken together, these methods may hold the key to appropriate cancer diagnoses and treatments in the future.

Towards better environmental performance of wastewater sludge treatment using endpoint approach in LCA methodology.

PubMed

Alyaseri, Isam; Zhou, Jianpeng

2017-03-01

The aim of this study is to use the life cycle assessment method to measure the environmental performance of the sludge incineration process in a wastewater treatment plant and to propose an alternative that can reduce the environmental impact. To show the damages caused by the treatment processes, the study aimed to use an endpoint approach in evaluating impacts on human health, ecosystem quality, and resources due to the processes. A case study was taken at Bissell Point Wastewater Treatment Plant in Saint Louis, Missouri, U.S. The plant-specific data along with literature data from technical publications were used to build an inventory, and then analyzed the environmental burdens from sludge handling unit in the year 2011. The impact assessment method chosen was ReCipe 2008. The existing scenario (dewatering-multiple hearth incineration-ash to landfill) was evaluated and three alternative scenarios (fluid bed incineration and anaerobic digestion with and without land application) with energy recovery from heat or biogas were proposed and analyzed to find the one with the least environmental impact. The existing scenario shows that the most significant impacts are related to depletion in resources and damage to human health. These impacts mainly came from the operation phase (electricity and fuel consumption and emissions related to combustion). Alternatives showed better performance than the existing scenario. Using ReCipe endpoint methodology, and among the three alternatives tested, the anaerobic digestion had the best overall environmental performance. It is recommended to convert to fluid bed incineration if the concerns were more about human health or to anaerobic digestion if the concerns were more about depletion in resources. The endpoint approach may simplify the outcomes of this study as follows: if the plant is converted to fluid bed incineration, it could prevent an average of 43.2 DALYs in human life, save 0.059 species in the area from extinction, and make a 62% reduction in the plant's current expenses needed by future generations to extract resources per year. At the same time it may prevent 36.1 DALYs in humans, save 0.157 species, and make a 101% reduction in current expenses on resources per year, if converting to anaerobic digestion.

Review of methods to probe single cell metabolism and bioenergetics

PubMed Central

Vasdekis, Andreas E.; Stephanopoulos, Gregory

2015-01-01

Single cell investigations have enabled unexpected discoveries, such as the existence of biological noise and phenotypic switching in infection, metabolism and treatment. Herein, we review methods that enable such single cell investigations specific to metabolism and bioenergetics. Firstly, we discuss how to isolate and immobilize individuals from a cell suspension, including both permanent and reversible approaches. We also highlight specific advances in microbiology for its implications in metabolic engineering. Methods for probing single cell physiology and metabolism are subsequently reviewed. The primary focus therein is on dynamic and high-content profiling strategies based on label-free and fluorescence microspectroscopy and microscopy. Non-dynamic approaches, such as mass spectrometry and nuclear magnetic resonance, are also briefly discussed. PMID:25448400

In vivo THz sensing of the cornea of the eye

NASA Astrophysics Data System (ADS)

Ozheredov, Ilya; Prokopchuk, Mikhail; Mischenko, Mikhail; Safonova, Tatiana; Solyankin, Petr; Larichev, Andrey; Angeluts, Andrey; Balakin, Alexei; Shkurinov, Alexander

2018-05-01

Measurement of the absolute value of the humidity of the cornea of the human eye and its dynamics is of paramount importance for the preservation of eyesight. In the present paper we have demonstrated that terahertz technologies can be practically applied for quantitative measurement of the physiological dynamics of tear film and sensing of corneal tissue hydration. We suggest uses of the equipment for application in clinics and a method for absolute calibration of the values for measurement. The proposed method is fundamentally different from existing and currently available methods of ophthalmological diagnosis. This suggests that the developed technique may have high diagnostic significance and can be used in the study and treatment of several diseases of the ocular surface.

42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2017-10-01 2017-10-01 false Treatment of incentive programs or add-on payments...

42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

Code of Federal Regulations, 2010 CFR

2016-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2016-10-01 2016-10-01 false Treatment of incentive programs or add-on payments...

Costing bias in economic evaluations.

PubMed

Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

2015-01-01

Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.

Spasticity in multiple sclerosis and role of glatiramer acetate treatment

PubMed Central

Meca-Lallana, Jose Eustasio; Hernández-Clares, Rocío; Carreón-Guarnizo, Ester

2015-01-01

Introduction Spasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes. Methods We performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs. Results Added to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored. Conclusions This literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice. PMID:26445705

Work-related asthma: diagnosis and prognosis of immunological occupational asthma and work-exacerbated asthma.

PubMed

Muñoz, X; Cruz, M J; Bustamante, V; Lopez-Campos, J L; Barreiro, E

2014-01-01

The incidence and prevalence of asthma are increasing. One reason for this trend is the rise in adult-onset asthma, especially occupational asthma, which is 1 of the 2 forms of work-related asthma. Occupational asthma is defined as asthma caused by agents that are present exclusively in the workplace. The presence of pre-existing asthma does not rule out the possibility of developing occupational asthma. A distinction has traditionally been made between immunological occupational asthma (whether IgE-mediated or not) and nonimmunological occupational asthma caused by irritants, the most characteristic example of which is reactive airway dysfunction syndrome. The other form of work-related asthma is known as work-exacerbated asthma, which affects persons with pre-existing or concurrent asthma that is worsened by work-related factors. It is important to differentiate between the 2 entities because their treatment, prognosis, and medical and social repercussions can differ widely. In this review, we discuss diagnostic methods, treatment, and avoidance/nonavoidance of the antigen in immunological occupational asthma and work-exacerbated asthma. Key words: Specific inhalation challenge. Peak expiratory flow. Workplace. Irritants.

Effect of Thyrotropin Suppression Therapy on Bone in Thyroid Cancer Patients

PubMed Central

Hawley, Sarah T.; Haymart, Megan R.

2016-01-01

Background. The thyroid cancer incidence is rising. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy. Also, its potential skeletal effects remain a concern to physicians caring for thyroid cancer patients. We conducted a review of published data to evaluate existing studies focusing on the skeletal effects of thyrotropin suppression therapy in thyroid cancer patients. Materials and Methods. A systematic search of the PubMed, Ovid/Medline, and Cochrane Central Register of Controlled Trials databases was conducted. The retained studies were evaluated for methodological quality, and the study populations were categorized into premenopausal women, postmenopausal women, and men. Results. Twenty-five pertinent studies were included. Seven studies were longitudinal and 18 were cross-sectional. Of the 25 included studies, 13 were assigned an excellent methodological quality score. Three of 5 longitudinal studies and 3 of 13 cross-sectional studies reported decreased bone mineral density (BMD) in premenopausal women; 2 of 4 longitudinal studies and 5 of 13 cross-sectional studies reported decreased BMD in postmenopausal women. The remaining studies showed no effect on BMD. The only longitudinal study of men showed bone mass loss; however, cross-sectional studies of men did not demonstrate a similar effect. Conclusion. Studies to date have yielded conflicting results on the skeletal effects of thyrotropin suppression therapy and a knowledge gap remains, especially for older adults and men. Existing data should be cautiously interpreted because of the variable quality and heterogeneity. Identifying groups at risk of adverse effects from thyrotropin suppression therapy will be instrumental to providing focused and tailored thyroid cancer treatment. Implications for Practice: The standard treatment for thyroid cancer includes total thyroidectomy with or without radioactive iodine ablation, often followed by thyrotropin suppression therapy. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy, and discordant results have been reported on its adverse effects on bone. The present review provides physicians with existing data on the skeletal effects of thyrotropin suppression therapy, highlighting the need for further research to identify the groups at risk of adverse skeletal effects. This knowledge will aid in developing tailored thyroid cancer treatment. PMID:26659220

A Bayesian adaptive design for biomarker trials with linked treatments

PubMed Central

Wason, James M S; Abraham, Jean E; Baird, Richard D; Gournaris, Ioannis; Vallier, Anne-Laure; Brenton, James D; Earl, Helena M; Mander, Adrian P

2015-01-01

Background: Response to treatments is highly heterogeneous in cancer. Increased availability of biomarkers and targeted treatments has led to the need for trial designs that efficiently test new treatments in biomarker-stratified patient subgroups. Methods: We propose a novel Bayesian adaptive randomisation (BAR) design for use in multi-arm phase II trials where biomarkers exist that are potentially predictive of a linked treatment's effect. The design is motivated in part by two phase II trials that are currently in development. The design starts by randomising patients to the control treatment or to experimental treatments that the biomarker profile suggests should be active. At interim analyses, data from treated patients are used to update the allocation probabilities. If the linked treatments are effective, the allocation remains high; if ineffective, the allocation changes over the course of the trial to unlinked treatments that are more effective. Results: Our proposed design has high power to detect treatment effects if the pairings of treatment with biomarker are correct, but also performs well when alternative pairings are true. The design is consistently more powerful than parallel-groups stratified trials. Conclusions: This BAR design is a powerful approach to use when there are pairings of biomarkers with treatments available for testing simultaneously. PMID:26263479

Preferences for 'New' Treatments Diminish in the Face of Ambiguity.

PubMed

Harrison, Mark; Marra, Carlo A; Bansback, Nick

2017-06-01

New products usually offer advantages over existing products, but in health care, most new drugs are 'me-too', comparable in effectiveness and side effects to existing drugs, but with a more ambiguous evidence base around adverse effects. Despite this, new treatments drive increased health care spending, suggesting a preference for 'newness' in this setting. We explore (1) whether preferences for treatments labeled 'new' exist and (2) persist once the ambiguity in the evidence base reflecting newness is described. We use a Canadian general population sample (n = 2837) characterized by their innovativeness in adopting new products in normal markets. We found that innovators/early adopters (n = 173) had significant preferences for 'newer' treatments (B = 0.162, p = 0.038) irrespective of comparable benefits and side effects and all respondents had significant preferences for less ambiguity in benefit/side effect estimates. Notably, when 'newness' was combined with ambiguity, no significant preferences for new treatments were observed regardless of respondent innovativeness. We conclude that preferences for new products exist for some people in health care markets but disappear when the implication of ambiguity in the evidence base for new treatments is communicated. Physicians should avoid describing treatments as 'new' or be mindful to qualify the implications of 'new' treatments in terms of evidence ambiguity. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Clinical application of decellularized and lyophilized human amnion/chorion membrane grafts for closing post‐laryngectomy pharyngocutaneous fistulas

PubMed Central

Mardaleishvili, Konstantine; Loladze, George; Javakhishvili, Ivane; Chakhunasvili, Konstantine; Karalashvili, Lika; Sukhitashvili, Natia; Chutkerashvili, Gocha; Kakabadze, Ann; Chakhunasvili, David

2016-01-01

Background and Objectives Squamous cell carcinoma is the most common pathological type among the cancers of the larynx. Standard treatment for squamous cell carcinoma of the larynx is the combination of chemotherapy, radiotherapy, and laryngectomy. Pharyngocutaneous fistula is a common complication of laryngectomy. We hypothesized that decellularized and lyophilized human amnion/chorion membrane can be an effective, non‐invasive method of treating pharyngocutaneous fistula. Methods A total of 67 patients with laryngeal squamous cell carcinoma were retrospectively analyzed after treatment in a prospective trial. After preoperative chemotherapy, radiotherapy, and total or extended laryngectomy, primary wound healing occurred in 42 (62.7%) patients. Pharyngocutaneous fistula developed in 8 (11.9%) patients. Decellularized and lyophilized human amnion/chorion membrane grafts were used to reconstruct the fistulas. Results The average time for the full healing of the wound in all patients after transplantation of these grafts was 18 days. Conclusion The advantages of using these grafts over other existing methods of pharyngocutaneous fistula treatment are that they are non‐invasive, prevent donor morbidity, and enable management of the wound without using classical wound gauze. J. Surg. Oncol. 2016;113:538–543. © 2016 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. PMID:26791912

Validity of palatal superimposition of 3-dimensional digital models in cases treated with rapid maxillary expansion and maxillary protraction headgear

PubMed Central

Choi, Jin-Il; Jost-Brinkmann, Paul-Georg; Choi, Dong-Soon; Jang, In-San

2012-01-01

Objective The purpose of this study was to evaluate the validity of the 3-dimensional (3D) superimposition method of digital models in patients who received treatment with rapid maxillary expansion (RME) and maxillary protraction headgear. Methods The material consisted of pre- and post-treatment maxillary dental casts and lateral cephalograms of 30 patients, who underwent RME and maxillary protraction headgear treatment. Digital models were superimposed using the palate as a reference area. The movement of the maxillary central incisor and the first molar was measured on superimposed cephalograms and 3D digital models. To determine whether any difference existed between the 2 measuring techniques, intra-class correlation (ICC) and Bland-Altman plots were analyzed. Results The measurements on the 3D digital models and cephalograms showed a very high correlation in the antero-posterior direction (ICC, 0.956 for central incisor and 0.941 for first molar) and a moderate correlation in the vertical direction (ICC, 0.748 for central incisor and 0.717 for first molar). Conclusions The 3D model superimposition method using the palate as a reference area is as clinically reliable for assessing antero-posterior tooth movement as cephalometric superimposition, even in cases treated with orthopedic appliances, such as RME and maxillary protraction headgear. PMID:23173116

A Systematic Map of Systematic Reviews in Pediatric Dentistry—What Do We Really Know?

PubMed Central

Mejàre, Ingegerd A.; Klingberg, Gunilla; Mowafi, Frida K.; Stecksén-Blicks, Christina; Twetman, Svante H. A.; Tranæus, Sofia H.

2015-01-01

Objectives To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. Methods A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Results Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. Conclusion There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry. PMID:25706629

Interactive Dose Shaping - efficient strategies for CPU-based real-time treatment planning

NASA Astrophysics Data System (ADS)

Ziegenhein, P.; Kamerling, C. P.; Oelfke, U.

2014-03-01

Conventional intensity modulated radiation therapy (IMRT) treatment planning is based on the traditional concept of iterative optimization using an objective function specified by dose volume histogram constraints for pre-segmented VOIs. This indirect approach suffers from unavoidable shortcomings: i) The control of local dose features is limited to segmented VOIs. ii) Any objective function is a mathematical measure of the plan quality, i.e., is not able to define the clinically optimal treatment plan. iii) Adapting an existing plan to changed patient anatomy as detected by IGRT procedures is difficult. To overcome these shortcomings, we introduce the method of Interactive Dose Shaping (IDS) as a new paradigm for IMRT treatment planning. IDS allows for a direct and interactive manipulation of local dose features in real-time. The key element driving the IDS process is a two-step Dose Modification and Recovery (DMR) strategy: A local dose modification is initiated by the user which translates into modified fluence patterns. This also affects existing desired dose features elsewhere which is compensated by a heuristic recovery process. The IDS paradigm was implemented together with a CPU-based ultra-fast dose calculation and a 3D GUI for dose manipulation and visualization. A local dose feature can be implemented via the DMR strategy within 1-2 seconds. By imposing a series of local dose features, equal plan qualities could be achieved compared to conventional planning for prostate and head and neck cases within 1-2 minutes. The idea of Interactive Dose Shaping for treatment planning has been introduced and first applications of this concept have been realized.

Patients’ Reasons for Choosing Office-based Buprenorphine: Preference for Patient-Centered Care

PubMed Central

Korthuis, P. Todd; Gregg, Jessica; Rogers, Wendy E.; McCarty, Dennis; Nicolaidis, Christina; Boverman, Joshua

2010-01-01

Objectives To explore HIV-infected patients’ attitudes about buprenorphine treatment in office-based and opioid treatment program (OTP) settings. Methods We conducted in-depth qualitative interviews with 29 patients with co-existing HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes. Results Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient-provider relationships underpinning their preference for office-based care. This was manifest as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in office-based settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was partly due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach, but also due to the perception that the office-based settings were “safer” for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings. Conclusions HIV-infected patients with opioid dependence preferred office-based buprenorphine because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with co-existing opioid dependence and HIV infection. PMID:21170143

BAYESIAN META-ANALYSIS ON MEDICAL DEVICES: APPLICATION TO IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

PubMed Central

Youn, Ji-Hee; Lord, Joanne; Hemming, Karla; Girling, Alan; Buxton, Martin

2012-01-01

Objectives: The aim of this study is to describe and illustrate a method to obtain early estimates of the effectiveness of a new version of a medical device. Methods: In the absence of empirical data, expert opinion may be elicited on the expected difference between the conventional and modified devices. Bayesian Mixed Treatment Comparison (MTC) meta-analysis can then be used to combine this expert opinion with existing trial data on earlier versions of the device. We illustrate this approach for a new four-pole implantable cardioverter defibrillator (ICD) compared with conventional ICDs, Class III anti-arrhythmic drugs, and conventional drug therapy for the prevention of sudden cardiac death in high risk patients. Existing RCTs were identified from a published systematic review, and we elicited opinion on the difference between four-pole and conventional ICDs from experts recruited at a cardiology conference. Results: Twelve randomized controlled trials were identified. Seven experts provided valid probability distributions for the new ICDs compared with current devices. The MTC model resulted in estimated relative risks of mortality of 0.74 (0.60–0.89) (predictive relative risk [RR] = 0.77 [0.41–1.26]) and 0.83 (0.70–0.97) (predictive RR = 0.84 [0.55–1.22]) with the new ICD therapy compared to Class III anti-arrhythmic drug therapy and conventional drug therapy, respectively. These results showed negligible differences from the preliminary results for the existing ICDs. Conclusions: The proposed method incorporating expert opinion to adjust for a modification made to an existing device may play a useful role in assisting decision makers to make early informed judgments on the effectiveness of frequently modified healthcare technologies. PMID:22559753

[New approaches to the treatment of keratoconjunctivitis sicca].

PubMed

Safonova, T N; Gladkova, O V; Novikov, I A; Boev, V I; Fedorov, A A

A new method has been developed for the treatment of severe forms of keratoconjunctivitis sicca (KCS) that involves the use of an original cyclosporine A (CyA) saturated soft contact lens (SCL) together with preservative-free artificial tears therapy. to evaluate the effectiveness of the newly developed treatment for KCS based on the use of medical SCL saturated with 0.05% CyA. The patients (43 men, 60 eyes) with severe KCS were divided into 2 groups. Group 1 included 21 patients (30 eyes), who received artificial tears and wore 0.05% CyA-saturated silicone-hydrogel SCLs. Group 2 included 22 patients (30 eyes), who wore unsaturated original SCLs and received CyA instillations 2 times daily and, also, artificial tears. Apart from a standard ophthalmic examination, the assessment included Schirmer's test, Norn's test, vital eye stain tests, tear osmometry, laser confocal tomography of the cornea, optical coherence tomography of the anterior segment with meniscometry, impression cytology of the conjunctiva, tear pH measurement, plating of the content of the conjunctival cavity, measurement of the width of the palpebral fissure, and calculation of the ocular surface disease index. Treatment results were followed up at 1, 3, 6, and 12 months. The use of 0.05% CyA-saturated SCLs allows to halve treatment time for patients with severe KSC (down to 1 week - 1 month) as compared to unsaturated original SCLs in combination with 0.05% CyA instillations and to reduce it 5 times as compared to 0.05% CyA instillations only. The new method of KSC treatment that involves the use of medical SCL of original design (ensures even distribution of 0.05% CyA across the ocular surface) and preservative-free artificial tears has demonstrated high therapeutic effectiveness as compared to existing methods.

A values-based Motivational Interviewing (MI) intervention for pediatric obesity: study design and methods for MI Values.

PubMed

Bean, Melanie K; Mazzeo, Suzanne E; Stern, Marilyn; Bowen, Deborah; Ingersoll, Karen

2011-09-01

To reduce pediatric obesity in clinical settings, multidisciplinary behaviorally-based treatment programs are recommended. High attrition and poor compliance are two difficulties frequently encountered in such programs. A brief, empathic and directive clinical intervention, Motivational Interviewing (MI), might help address these motivational and behavioral issues, ultimately resulting in more positive health outcomes. The efficacy of MI as an adjunct in the treatment of pediatric obesity remains relatively understudied. MI Values was developed to implement within an existing multidisciplinary treatment program for obese, ethnically diverse adolescents, the T.E.E.N.S. Program (Teaching, Encouragement, Exercise, Nutrition, Support). T.E.E.N.S. participants who consent to MI Values are randomized to either MI or an education control condition. At weeks 1 and 10 of T.E.E.N.S. participation, the subset of participants assigned to the MI condition engages in individual MI sessions and control participants view health education videos. All MI sessions are audiotaped and coded to monitor treatment fidelity, which has been satisfactory thus far. Participants complete comprehensive assessments at baseline, 3- and 6-month follow-ups. We hypothesize that MI participants will demonstrate greater reductions in Body Mass Index (BMI) percentile, improved diet and physical activity behaviors, better compliance with T.E.E.N.S., and lower attrition than participants in the control group. We present study design and methods for MI Values as well as data on feasibility of recruitment methods and treatment integrity. At study completion, findings will contribute to the emerging literature examining the efficacy of MI in the treatment of pediatric obesity. Copyright © 2011 Elsevier Inc. All rights reserved.

Management of Substance Use Disorder in Military Services: A Comprehensive Approach.

PubMed

Sharbafchi, Mohammad Reza; Heydari, Mostafa

2017-01-01

Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army.

Estimating drug treatment needs among state prison inmates.

PubMed

Belenko, Steven; Peugh, Jordon

2005-03-07

Growing prison populations in the U.S. are largely due to drug-related crime and drug abuse. Yet, relatively few inmates receive treatment, existing interventions tend to be short-term or non-clinical, and better methods are needed to match drug-involved inmates to level of care. Using data from the 1997 Survey of Inmates in State Correctional Facilities, a nationally representative sample of 14,285 inmates from 275 state prisons, we present a framework for estimating their levels of treatment need. The framework is drawn partly from the American Society of Addiction Medicine Patient Placement Criteria and other client matching protocols, incorporating drug use severity, drug-related behavioral consequences, and other social and health problems. The results indicate high levels of drug involvement, but considerable variation in severity/recency of use and health and social consequences. We estimate that one-third of male and half of female inmates need residential treatment, but that half of male and one-third of female inmates may need no treatment or short-term interventions. Treatment capacity in state prisons is quite inadequate relative to need, and improvements in assessment, treatment matching, and inmate incentives are needed to conserve scarce treatment resources and facilitate inmate access to different levels of care.

Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

PubMed Central

Liakakos, Theodore; Karamanolis, George; Patapis, Paul; Misiakos, Evangelos P.

2009-01-01

Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases. PMID:20069112

Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach

PubMed Central

Chie, Qiu Ting; Tam, Cai Lian; Bonn, Gregory; Dang, Hoang Minh; Khairuddin, Rozainee

2016-01-01

This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18–69 years; n = 30) and staff (ages 30–72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive–behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support. PMID:27303313

National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment

PubMed Central

Campopiano, Melinda; Baldwin, Grant; McCance-Katz, Elinore

2015-01-01

Objectives. We estimated national and state trends in opioid agonist medication-assisted treatment (OA-MAT) need and capacity to identify gaps and inform policy decisions. Methods. We generated national and state rates of past-year opioid abuse or dependence, maximum potential buprenorphine treatment capacity, number of patients receiving methadone from opioid treatment programs (OTPs), and the percentage of OTPs operating at 80% capacity or more using Substance Abuse and Mental Health Services Administration data. Results. Nationally, in 2012, the rate of opioid abuse or dependence was 891.8 per 100 000 people aged 12 years or older compared with national rates of maximum potential buprenorphine treatment capacity and patients receiving methadone in OTPs of, respectively, 420.3 and 119.9. Among states and the District of Columbia, 96% had opioid abuse or dependence rates higher than their buprenorphine treatment capacity rates; 37% had a gap of at least 5 per 1000 people. Thirty-eight states (77.6%) reported at least 75% of their OTPs were operating at 80% capacity or more. Conclusions. Significant gaps between treatment need and capacity exist at the state and national levels. Strategies to increase the number of OA-MAT providers are needed. PMID:26066931

Upgrading of the STP Uithoorn: treatment of nutrient rich wastewater from horticulture.

PubMed

Piekema, P; Neef, R

2005-01-01

The STP Uithoorn will be upgraded to accommodate the treatment of wastewater from a growing population and to meet more stringent nutrient discharge limits in 2006. In 2003 a system choice and preliminary design was made for the upgrading. A special feature is the nutrient rich wastewater flow from the rapidly developing horticulture in the area. Since the future loads from horticulture are highly uncertain, flexibility of the STP after upgrading is an important issue. A three stage system was selected: improved physical-chemical primary treatment, secondary treatment by activated sludge, and tertiary treatment by denitrifying filters. In this way an important part of the existing infrastructure can be reused, and flexibility is assured by constructing the tertiary treatment in modules and by providing a wide range of operational control possibilities. In this paper the process of system choice and selection of type of tertiary treatment are described, as well as the optimisation of the existing treatment. In order to determine the feasibility of allowing a high loading rate on the existing secondary clarifiers, a two-dimensional hydraulic model of the clarification process was used.

TH-E-BRF-06: Kinetic Modeling of Tumor Response to Fractionated Radiotherapy

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

Zhong, H; Gordon, J; Chetty, I

2014-06-15

Purpose: Accurate calibration of radiobiological parameters is crucial to predicting radiation treatment response. Modeling differences may have a significant impact on calibrated parameters. In this study, we have integrated two existing models with kinetic differential equations to formulate a new tumor regression model for calibrating radiobiological parameters for individual patients. Methods: A system of differential equations that characterizes the birth-and-death process of tumor cells in radiation treatment was analytically solved. The solution of this system was used to construct an iterative model (Z-model). The model consists of three parameters: tumor doubling time Td, half-life of dying cells Tr and cellmore » survival fraction SFD under dose D. The Jacobian determinant of this model was proposed as a constraint to optimize the three parameters for six head and neck cancer patients. The derived parameters were compared with those generated from the two existing models, Chvetsov model (C-model) and Lim model (L-model). The C-model and L-model were optimized with the parameter Td fixed. Results: With the Jacobian-constrained Z-model, the mean of the optimized cell survival fractions is 0.43±0.08, and the half-life of dying cells averaged over the six patients is 17.5±3.2 days. The parameters Tr and SFD optimized with the Z-model differ by 1.2% and 20.3% from those optimized with the Td-fixed C-model, and by 32.1% and 112.3% from those optimized with the Td-fixed L-model, respectively. Conclusion: The Z-model was analytically constructed from the cellpopulation differential equations to describe changes in the number of different tumor cells during the course of fractionated radiation treatment. The Jacobian constraints were proposed to optimize the three radiobiological parameters. The developed modeling and optimization methods may help develop high-quality treatment regimens for individual patients.« less

Standard methods for sampling freshwater fishes: Opportunities for international collaboration

USGS Publications Warehouse

Bonar, Scott A.; Mercado-Silva, Norman; Hubert, Wayne A.; Beard, Douglas; Dave, Göran; Kubečka, Jan; Graeb, Brian D. S.; Lester, Nigel P.; Porath, Mark T.; Winfield, Ian J.

2017-01-01

With publication of Standard Methods for Sampling North American Freshwater Fishes in 2009, the American Fisheries Society (AFS) recommended standard procedures for North America. To explore interest in standardizing at intercontinental scales, a symposium attended by international specialists in freshwater fish sampling was convened at the 145th Annual AFS Meeting in Portland, Oregon, in August 2015. Participants represented all continents except Australia and Antarctica and were employed by state and federal agencies, universities, nongovernmental organizations, and consulting businesses. Currently, standardization is practiced mostly in North America and Europe. Participants described how standardization has been important for management of long-term data sets, promoting fundamental scientific understanding, and assessing efficacy of large spatial scale management strategies. Academics indicated that standardization has been useful in fisheries education because time previously used to teach how sampling methods are developed is now more devoted to diagnosis and treatment of problem fish communities. Researchers reported that standardization allowed increased sample size for method validation and calibration. Group consensus was to retain continental standards where they currently exist but to further explore international and intercontinental standardization, specifically identifying where synergies and bridges exist, and identify means to collaborate with scientists where standardization is limited but interest and need occur.

Treatment alternatives of slaughterhouse wastes, and their effect on the inactivation of different pathogens: a review.

PubMed

Franke-Whittle, Ingrid H; Insam, Heribert

2013-05-01

Slaughterhouse wastes are a potential reservoir of bacterial, viral, prion and parasitic pathogens, capable of infecting both animals and humans. A quick, cost effective and safe disposal method is thus essential in order to reduce the risk of disease following animal slaughter. Different methods for the disposal of such wastes exist, including composting, anaerobic digestion (AD), alkaline hydrolysis (AH), rendering, incineration and burning. Composting is a disposal method that allows a recycling of the slaughterhouse waste nutrients back into the earth. The high fat and protein content of slaughterhouse wastes mean however, that such wastes are an excellent substrate for AD processes, resulting in both the disposal of wastes, a recycling of nutrients (soil amendment with sludge), and in methane production. Concerns exist as to whether AD and composting processes can inactivate pathogens. In contrast, AH is capable of the inactivation of almost all known microorganisms. This review was conducted in order to compare three different methods of slaughterhouse waste disposal, as regards to their ability to inactivate various microbial pathogens. The intention was to investigate whether AD could be used for waste disposal (either alone, or in combination with another process) such that both energy can be obtained and potentially hazardous materials be disposed of.

Treatment alternatives of slaughterhouse wastes, and their effect on the inactivation of different pathogens: A review

PubMed Central

2013-01-01

Slaughterhouse wastes are a potential reservoir of bacterial, viral, prion and parasitic pathogens, capable of infecting both animals and humans. A quick, cost effective and safe disposal method is thus essential in order to reduce the risk of disease following animal slaughter. Different methods for the disposal of such wastes exist, including composting, anaerobic digestion (AD), alkaline hydrolysis (AH), rendering, incineration and burning. Composting is a disposal method that allows a recycling of the slaughterhouse waste nutrients back into the earth. The high fat and protein content of slaughterhouse wastes mean however, that such wastes are an excellent substrate for AD processes, resulting in both the disposal of wastes, a recycling of nutrients (soil amendment with sludge), and in methane production. Concerns exist as to whether AD and composting processes can inactivate pathogens. In contrast, AH is capable of the inactivation of almost all known microorganisms. This review was conducted in order to compare three different methods of slaughterhouse waste disposal, as regards to their ability to inactivate various microbial pathogens. The intention was to investigate whether AD could be used for waste disposal (either alone, or in combination with another process) such that both energy can be obtained and potentially hazardous materials be disposed of. PMID:22694189

Evaluation and application of an innovative method based on various chitosan composites and Lemna gibba for boron removal from drinking water.

PubMed

Türker, Onur Can; Baran, Talat

2017-06-15

Boron exists in various types of water environments, and it is difficult and costly to remove B with conventional treatment methods from drinking water. Clearly, alternative and cost effective treatment techniques are imperative. In the present study, an innovative and environment friendly method based on hybrid systems consisting of various chitosan composite beads and Lemna gibba were evaluated for removal of B from drinking water. Our results from batch adsorption experiment indicated that a plant-based chitosan composite bead has a higher capacity of B removal than mineral-based chitosan composite beads. Almost 50% of total B removal was achieved using the hybrid system based on dried Lemna-chitosan composite beads and Lemna gibba combination in 4 days. Even at the high B concentration (8mgBL -1 ), B in drinking water could be reduced to less than 2.4mgL -1 when 0.05g plant-based chitosan composite beads and 12 Lemna fronds were used for 50mL test solution. Copyright © 2017 Elsevier Ltd. All rights reserved.

Uses of virtual reality for diagnosis, rehabilitation and study of unilateral spatial neglect: review and analysis.

PubMed

Tsirlin, Inna; Dupierrix, Eve; Chokron, Sylvie; Coquillart, Sabine; Ohlmann, Theophile

2009-04-01

Unilateral spatial neglect is a disabling condition frequently occurring after stroke. People with neglect suffer from various spatial deficits in several modalities, which in many cases impair everyday functioning. A successful treatment is yet to be found. Several techniques have been proposed in the last decades, but only a few showed long-lasting effects and none could completely rehabilitate the condition. Diagnostic methods of neglect could be improved as well. The disorder is normally diagnosed with pen-and-paper methods, which generally do not assess patients in everyday tasks and do not address some forms of the disorder. Recently, promising new methods based on virtual reality have emerged. Virtual reality technologies hold great opportunities for the development of effective assessment and treatment techniques for neglect because they provide rich, multimodal, and highly controllable environments. In order to stimulate advancements in this domain, we present a review and an analysis of the current work. We describe past and ongoing research of virtual reality applications for unilateral neglect and discuss the existing problems and new directions for development.

Ozone Gas as a Benign Sterilization Treatment for PLGA Nanofiber Scaffolds

PubMed Central

de Jesus Andreoli Pinto, Terezinha; Bou-Chacra, Nadia Araci; Galante, Raquel; de Araújo, Gabriel Lima Barros; do Nascimento Pedrosa, Tatiana; Maria-Engler, Silvya Stuchi

2016-01-01

The use of electrospun nanofibers for tissue engineering and regenerative medicine applications is a growing trend as they provide improved support for cell proliferation and survival due, in part, to their morphology mimicking that of the extracellular matrix. Sterilization is a critical step in the fabrication process of implantable biomaterial scaffolds for clinical use, but many of the existing methods used to date can negatively affect scaffold properties and performance. Poly(lactic-co-glycolic acid) (PLGA) has been widely used as a biodegradable polymer for 3D scaffolds and can be significantly affected by current sterilization techniques. The aim of this study was to investigate pulsed ozone gas as an alternative method for sterilizing PLGA nanofibers. The morphology, mechanical properties, physicochemical properties, and response of cells to PLGA nanofiber scaffolds were assessed following different degrees of ozone gas sterilization. This treatment killed Geobacillus stearothermophilus spores, the most common biological indicator used for validation of sterilization processes. In addition, the method preserved all of the characteristics of nonsterilized PLGA nanofibers at all degrees of sterilization tested. These findings suggest that ozone gas can be applied as an alternative method for sterilizing electrospun PLGA nanofiber scaffolds without detrimental effects. PMID:26757850

Ozone Gas as a Benign Sterilization Treatment for PLGA Nanofiber Scaffolds.

PubMed

Rediguieri, Carolina Fracalossi; Pinto, Terezinha de Jesus Andreoli; Bou-Chacra, Nadia Araci; Galante, Raquel; de Araújo, Gabriel Lima Barros; Pedrosa, Tatiana do Nascimento; Maria-Engler, Silvya Stuchi; De Bank, Paul A

2016-04-01

The use of electrospun nanofibers for tissue engineering and regenerative medicine applications is a growing trend as they provide improved support for cell proliferation and survival due, in part, to their morphology mimicking that of the extracellular matrix. Sterilization is a critical step in the fabrication process of implantable biomaterial scaffolds for clinical use, but many of the existing methods used to date can negatively affect scaffold properties and performance. Poly(lactic-co-glycolic acid) (PLGA) has been widely used as a biodegradable polymer for 3D scaffolds and can be significantly affected by current sterilization techniques. The aim of this study was to investigate pulsed ozone gas as an alternative method for sterilizing PLGA nanofibers. The morphology, mechanical properties, physicochemical properties, and response of cells to PLGA nanofiber scaffolds were assessed following different degrees of ozone gas sterilization. This treatment killed Geobacillus stearothermophilus spores, the most common biological indicator used for validation of sterilization processes. In addition, the method preserved all of the characteristics of nonsterilized PLGA nanofibers at all degrees of sterilization tested. These findings suggest that ozone gas can be applied as an alternative method for sterilizing electrospun PLGA nanofiber scaffolds without detrimental effects.

Development of an iterative reconstruction method to overcome 2D detector low resolution limitations in MLC leaf position error detection for 3D dose verification in IMRT.

PubMed

Visser, R; Godart, J; Wauben, D J L; Langendijk, J A; Van't Veld, A A; Korevaar, E W

2016-05-21

The objective of this study was to introduce a new iterative method to reconstruct multi leaf collimator (MLC) positions based on low resolution ionization detector array measurements and to evaluate its error detection performance. The iterative reconstruction method consists of a fluence model, a detector model and an optimizer. Expected detector response was calculated using a radiotherapy treatment plan in combination with the fluence model and detector model. MLC leaf positions were reconstructed by minimizing differences between expected and measured detector response. The iterative reconstruction method was evaluated for an Elekta SLi with 10.0 mm MLC leafs in combination with the COMPASS system and the MatriXX Evolution (IBA Dosimetry) detector with a spacing of 7.62 mm. The detector was positioned in such a way that each leaf pair of the MLC was aligned with one row of ionization chambers. Known leaf displacements were introduced in various field geometries ranging from  -10.0 mm to 10.0 mm. Error detection performance was tested for MLC leaf position dependency relative to the detector position, gantry angle dependency, monitor unit dependency, and for ten clinical intensity modulated radiotherapy (IMRT) treatment beams. For one clinical head and neck IMRT treatment beam, influence of the iterative reconstruction method on existing 3D dose reconstruction artifacts was evaluated. The described iterative reconstruction method was capable of individual MLC leaf position reconstruction with millimeter accuracy, independent of the relative detector position within the range of clinically applied MU's for IMRT. Dose reconstruction artifacts in a clinical IMRT treatment beam were considerably reduced as compared to the current dose verification procedure. The iterative reconstruction method allows high accuracy 3D dose verification by including actual MLC leaf positions reconstructed from low resolution 2D measurements.

Geochemical Data for Upper Mineral Creek, Colorado, Under Existing Ambient Conditions and During an Experimental pH Modification, August 2005

USGS Publications Warehouse

Runkel, Robert L.; Kimball, Briant A.; Steiger, Judy I.; Walton-Day, Katherine

2009-01-01

Mineral Creek, an acid mine drainage stream in south-western Colorado, was the subject of a water-quality study that employed a paired synoptic approach. Under the paired synoptic approach, two synoptic sampling campaigns were conducted on the same study reach. The initial synoptic campaign, conducted August 22, 2005, documented stream-water quality under existing ambient conditions. A second synoptic campaign, conducted August 24, 2005, documented stream-water quality during a pH-modification experiment that elevated the pH of Mineral Creek. The experimental pH modification was designed to determine the potential reductions in dissolved constituent concentrations that would result from the implementation of an active treatment system for acid mine drainage. During both synoptic sampling campaigns, a solution containing lithium bromide was injected continuously to allow for the calculation of streamflow using the tracer-dilution method. Synoptic water-quality samples were collected from 30 stream sites and 11 inflow locations along the 2-kilometer study reach. Data from the study provide spatial profiles of pH, concentration, and streamflow under both existing and experimentally-altered conditions. This report presents the data obtained August 21-24, 2005, as well as the methods used for sample collection and data analysis.

Critical review of real-time methods for solid waste characterisation: Informing material recovery and fuel production.

PubMed

Vrancken, C; Longhurst, P J; Wagland, S T

2017-03-01

Waste management processes generally represent a significant loss of material, energy and economic resources, so legislation and financial incentives are being implemented to improve the recovery of these valuable resources whilst reducing contamination levels. Material recovery and waste derived fuels are potentially valuable options being pursued by industry, using mechanical and biological processes incorporating sensor and sorting technologies developed and optimised for recycling plants. In its current state, waste management presents similarities to other industries that could improve their efficiencies using process analytical technology tools. Existing sensor technologies could be used to measure critical waste characteristics, providing data required by existing legislation, potentially aiding waste treatment processes and assisting stakeholders in decision making. Optical technologies offer the most flexible solution to gather real-time information applicable to each of the waste mechanical and biological treatment processes used by industry. In particular, combinations of optical sensors in the visible and the near-infrared range from 800nm to 2500nm of the spectrum, and different mathematical techniques, are able to provide material information and fuel properties with typical performance levels between 80% and 90%. These sensors not only could be used to aid waste processes, but to provide most waste quality indicators required by existing legislation, whilst offering better tools to the stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparative Effectiveness of STEMI Regionalization Strategies

PubMed Central

Concannon, Thomas W.; Kent, David M.; Normand, Sharon-Lise; Newhouse, Joseph P.; Griffith, John L.; Cohen, Joshua; Beshansky, Joni R.; Wong, John B.; Aversano, Thomas; Selker, Harry P.

2010-01-01

BACKGROUND Primary percutaneous coronary intervention (PCI) is more effective on average than fibrinolytic therapy (FT) in the treatment of ST-segment elevation myocardial infarction (STEMI). Yet most U.S. hospitals are not equipped for PCI and FT is still widely used. This study evaluated the comparative effectiveness of STEMI regionalization strategies to increase the use of PCI against standard emergency transport and care. METHODS AND RESULTS We estimated incremental treatment costs and quality-adjusted life expectancies of 2,000 patients with STEMI who received PCI or FT in simulations of emergency care in a regional hospital system. To increase access to PCI across the system, we compared a base case strategy to 12 hospital-based strategies of building new PCI labs or extending the hours of existing labs, and one emergency medical services (EMS)-based strategy of transporting all patients with STEMI to existing PCI-capable hospitals. The base case resulted in 609 (569, 647) patients getting PCI. Hospital-based strategies increased the number of patients receiving PCI, the costs of care, and quality-adjusted life years (QALYs) saved, and were cost effective under a variety of conditions. An EMS-based strategy of transporting every patient to an existing PCI facility was less costly and more effective than all hospital expansion options. CONCLUSION Our results suggest that new construction and staffing of PCI labs may not be warranted if an EMS strategy is both available and feasible. PMID:20664025

Remote ballistic fractures in a gelatine model - aetiology and surgical implications

PubMed Central

2013-01-01

Background Remote ballistic femoral fractures are rare fractures reported in the literature but still debated as to their existence and, indeed, their treatment. This study aimed to prove their existence, understand how they occur and determine which ammunition provides the greatest threat. In addition, fracture patterns, soft tissue disruption and contamination were assessed to aid in treatment planning. Method We filmed 42 deer femora embedded in ballistic gelatine and shot with four different military (5.56 × 45 mm, 7.62 × 39 mm) and civilian (9 × 19 mm, .44 in.) bullets, at varying distances off the bone (0–10 cm). Results Two remote ballistic fractures occurred, both with .44 in. hollow-point bullets shot 3 cm off the bone. These fractures occurred when the leading edge of the expanding temporary cavity impacted the femur's supracondylar region, producing a wedge-shaped fracture with an undisplaced limb, deceivingly giving the appearance of a spiral fracture. No communication was seen between the fracture and permanent cavity, despite the temporary cavity encasing the fracture and stripping periosteum from its base. Conclusion These fractures occur with civilian ammunition, but cannot prove their existence with military rounds. They result from the expanding temporary cavity affecting the weakest part of the bone, creating a potentially contaminated wedge-shaped fracture, important for surgeons considering operative intervention. PMID:23721113

A selective review of the first 20 years of instrumental variables models in health-services research and medicine.

PubMed

Cawley, John

2015-01-01

The method of instrumental variables (IV) is useful for estimating causal effects. Intuitively, it exploits exogenous variation in the treatment, sometimes called natural experiments or instruments. This study reviews the literature in health-services research and medical research that applies the method of instrumental variables, documents trends in its use, and offers examples of various types of instruments. A literature search of the PubMed and EconLit research databases for English-language journal articles published after 1990 yielded a total of 522 original research articles. Citations counts for each article were derived from the Web of Science. A selective review was conducted, with articles prioritized based on number of citations, validity and power of the instrument, and type of instrument. The average annual number of papers in health services research and medical research that apply the method of instrumental variables rose from 1.2 in 1991-1995 to 41.8 in 2006-2010. Commonly-used instruments (natural experiments) in health and medicine are relative distance to a medical care provider offering the treatment and the medical care provider's historic tendency to administer the treatment. Less common but still noteworthy instruments include randomization of treatment for reasons other than research, randomized encouragement to undertake the treatment, day of week of admission as an instrument for waiting time for surgery, and genes as an instrument for whether the respondent has a heritable condition. The use of the method of IV has increased dramatically in the past 20 years, and a wide range of instruments have been used. Applications of the method of IV have in several cases upended conventional wisdom that was based on correlations and led to important insights about health and healthcare. Future research should pursue new applications of existing instruments and search for new instruments that are powerful and valid.

The utilization of information technology in biomedicine

NASA Astrophysics Data System (ADS)

Isaev, E. A.; Tarasov, P. A.

2017-01-01

Biomedicine is a branch of medicine that studies the human body, its structure and function in health and disease, pathological condition, methods of diagnosis, treatment and correction [1]. At the moment, to solve their diverse problems associated with the collection, storage, and data analysis, process modeling, biomedicine extensively uses modern technical equipment. The goal of this article - to make a brief analysis of existing technologies (big data, mobile and cloud technologies), in terms of their applicability to the needs of biomedicine.

Optimization of dental implantation

NASA Astrophysics Data System (ADS)

Dol, Aleksandr V.; Ivanov, Dmitriy V.

2017-02-01

Modern dentistry can not exist without dental implantation. This work is devoted to study of the "bone-implant" system and to optimization of dental prostheses installation. Modern non-invasive methods such as MRI an 3D-scanning as well as numerical calculations and 3D-prototyping allow to optimize all of stages of dental prosthetics. An integrated approach to the planning of implant surgery can significantly reduce the risk of complications in the first few days after treatment, and throughout the period of operation of the prosthesis.

Biological enhancement of hydrocarbon extraction

DOEpatents

Brigmon, Robin L [North Augusta, SC; Berry, Christopher J [Aiken, SC

2009-01-06

A method of microbial enhanced oil recovery for recovering oil from an oil-bearing rock formation is provided. The methodology uses a consortium of bacteria including a mixture of surfactant producing bacteria and non-surfactant enzyme producing bacteria which may release hydrocarbons from bitumen containing sands. The described bioprocess can work with existing petroleum recovery protocols. The consortium microorganisms are also useful for treatment of above oil sands, ground waste tailings, subsurface oil recovery, and similar materials to enhance remediation and/or recovery of additional hydrocarbons from the materials.

Modeling Aromatic Liquids:  Toluene, Phenol, and Pyridine.

PubMed

Baker, Christopher M; Grant, Guy H

2007-03-01

Aromatic groups are now acknowledged to play an important role in many systems of interest. However, existing molecular mechanics methods provide a poor representation of these groups. In a previous paper, we have shown that the molecular mechanics treatment of benzene can be improved by the incorporation of an explicit representation of the aromatic π electrons. Here, we develop this concept further, developing charge-separation models for toluene, phenol, and pyridine. Monte Carlo simulations are used to parametrize the models, via the reproduction of experimental thermodynamic data, and our models are shown to outperform an existing atom-centered model. The models are then used to make predictions about the structures of the liquids at the molecular level and are tested further through their application to the modeling of gas-phase dimers and cation-π interactions.

Should compulsive sexual behavior be considered an addiction?

PubMed Central

Kraus, Shane W.; Voon, Valerie; Potenza, Marc N.

2016-01-01

Aims To review the evidence base for classifying compulsive sexual behavior (CSB) as a non-substance or “behavioral” addiction. Methods Data from multiple domains (e.g., epidemiological, phenomenological, clinical, biological) are reviewed and considered with respect to data from substance and gambling addictions. Results Overlapping features exist between CSB and substance-use disorders. Common neurotransmitter systems may contribute to CSB and substance-use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist. Conclusions Despite the growing body of research linking compulsive sexual behavior to substance addictions, significant gaps in understanding continue to complicate classification of compulsive sexual behaviour as an addiction. PMID:26893127

Cross-sectoral optimization and visualization of transformation processes in urban water infrastructures in rural areas.

PubMed

Baron, S; Kaufmann Alves, I; Schmitt, T G; Schöffel, S; Schwank, J

2015-01-01

Predicted demographic, climatic and socio-economic changes will require adaptations of existing water supply and wastewater disposal systems. Especially in rural areas, these new challenges will affect the functionality of the present systems. This paper presents a joint interdisciplinary research project with the objective of developing an innovative software-based optimization and decision support system for the implementation of long-term transformations of existing infrastructures of water supply, wastewater and energy. The concept of the decision support and optimization tool is described and visualization methods for the presentation of results are illustrated. The model is tested in a rural case study region in the Southwest of Germany. A transformation strategy for a decentralized wastewater treatment concept and its visualization are presented for a model village.

Is there a specific hemodynamic effect in reflexology? A systematic review of randomized controlled trials.

PubMed

Jones, Jenny; Thomson, Patricia; Irvine, Kathleen; Leslie, Stephen J

2013-04-01

Reflexology claims that the feet are representative of the body and that massage to specific points of the feet increases blood supply to "mapped" organs in the body. This review provides the first systematic evaluation of existing reflexology randomized controlled trials (RCTs) to determine whether there is any evidence to suggest the existence of a reflexology treatment-related hemodynamic effect; to examine whether reflexology researchers used study designs that systematically controlled for nonspecific effects in order to isolate this specific component; and to highlight some of the methodological challenges that need to be overcome to demonstrate specific and beneficial hemodynamic effects. Fifty-two RCTs of reflexology published from 1990 to September 2011 were initially retrieved. Cardiorespiratory Department, Highland Heartbeat Centre, Raigmore Hospital, Inverness. Adult subjects. Studies using reflexology foot massage techniques as the intervention versus sham reflexology treatment, simple foot massage, conventional treatment, or no treatment as the control were then selected. OUTCOME MEASURES included any hemodynamic parameter potentially involved in the regulation of circulating blood volume and flow, including heart rate and systolic and diastolic arterial blood pressure. Seven RCTs suggested that reflexology has an effect on selected cardiovascular parameters; however, five of these delivered the reflexology intervention as a whole complex treatment, with the data collector often delivering the intervention themselves. This systematic review found that although reflexology has been shown to have an effect on selected hemodynamic variables, the lack of methodological control for nonspecific general massage effects means that there is little convincing evidence at this time to suggest the existence of a specific treatment-related hemodynamic effect. Furthermore, the review found that few studies of reflexology controlled for nonspecific effects in order to isolate any specific active component, despite the hemodynamic claim being a key part of the therapeutic value of reflexology. Therefore, further research approaches using more innovative designs and robust methods that can allow a treatment-induced, therapeutically beneficial hemodynamic effect to reveal itself are needed to help reflexology purchasers make a more informed decision about the safety and product quality of the reflexology hemodynamic claim and for reflexologists to be able to guarantee minimum product quality, validity, and safety standards in their practice.

Repeated addiction treatment use in Sweden: a National Register Database study.

PubMed

Grahn, Robert; Chassler, Deborah; Lundgren, Lena

2014-11-01

Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

A Community Based Study on the Mode of Transmission, Prevention and Treatment of Buruli Ulcers in Southwest Cameroon: Knowledge, Attitude and Practices

PubMed Central

Akoachere, Jane-Francis K. T.; Nsai, Frankline S.; Ndip, Roland N.

2016-01-01

Background Buruli ulcer (BU) is a neglected tropical disease affecting the skin, tissues and in some cases the bones, caused by the environmental pathogen Mycobacterium ulcerans (M. ulcerans). Its mode of transmission is still elusive. Delayed treatment may cause irreversible disabilities with consequent social and economic impacts on the victim. Socio-cultural beliefs, practices and attitudes in endemic communities have been shown to influence timely treatment causing disease management, prevention and control a great challenge. An assessment of these factors in endemic localities is important in designing successful intervention strategies. Considering this, we assessed the knowledge, attitude and practices regarding BU in three endemic localities in the South West region, Cameroon to highlight existing misconceptions that need to be addressed to enhance prompt treatment and facilitate effective prevention and control. Methods and Findings A cross-sectional study was executed in three BU endemic health districts. Using qualitative and quantitative approaches we surveyed 320 randomly selected household heads, interviewed BU patients and conducted three focus group discussions (FGDs) to obtain information on awareness, beliefs, treatment, and attitudes towards victims. The influence of socio-demographic factors on these variables was investigated. Results Respondents (84.4%) had a good knowledge of BU though only 65% considered it a health problem while 49.4% believed it is contagious. Socio-demographic factors significantly (P<0.05) influenced awareness of BU, knowledge and practice on treatment and attitudes towards victims. Although the majority of respondents stated the hospital as the place for appropriate treatment, FGDs and some BU victims preferred witchdoctors/herbalists and prayers, and considered the hospital as the last option. We documented beliefs about the disease which could delay treatment. Conclusion Though we are reporting a high level of knowledge of BU, there exist fallacies about BU and negative attitudes towards victims in communities studied. Efforts towards disease eradication must first of all target these misconceptions. PMID:27227429

Gait Analysis Methods for Rodent Models of Osteoarthritis

PubMed Central

Jacobs, Brittany Y.; Kloefkorn, Heidi E.; Allen, Kyle D.

2014-01-01

Patients with osteoarthritis (OA) primarily seek treatment due to pain and disability, yet the primary endpoints for rodent OA models tend to be histological measures of joint destruction. The discrepancy between clinical and preclinical evaluations is problematic, given that radiographic evidence of OA in humans does not always correlate to the severity of patient-reported symptoms. Recent advances in behavioral analyses have provided new methods to evaluate disease sequelae in rodents. Of particular relevance to rodent OA models are methods to assess rodent gait. While obvious differences exist between quadrupedal and bipedal gait sequences, the gait abnormalities seen in humans and in rodent OA models reflect similar compensatory behaviors that protect an injured limb from loading. The purpose of this review is to describe these compensations and current methods used to assess rodent gait characteristics, while detailing important considerations for the selection of gait analysis methods in rodent OA models. PMID:25160712

Surrogacy Assessment Using Principal Stratification and a Gaussian Copula Model

PubMed Central

Taylor, J.M.G.; Elliott, M.R.

2014-01-01

In clinical trials, a surrogate outcome (S) can be measured before the outcome of interest (T) and may provide early information regarding the treatment (Z) effect on T. Many methods of surrogacy validation rely on models for the conditional distribution of T given Z and S. However, S is a post-randomization variable, and unobserved, simultaneous predictors of S and T may exist, resulting in a non-causal interpretation. Frangakis and Rubin1 developed the concept of principal surrogacy, stratifying on the joint distribution of the surrogate marker under treatment and control to assess the association between the causal effects of treatment on the marker and the causal effects of treatment on the clinical outcome. Working within the principal surrogacy framework, we address the scenario of an ordinal categorical variable as a surrogate for a censored failure time true endpoint. A Gaussian copula model is used to model the joint distribution of the potential outcomes of T, given the potential outcomes of S. Because the proposed model cannot be fully identified from the data, we use a Bayesian estimation approach with prior distributions consistent with reasonable assumptions in the surrogacy assessment setting. The method is applied to data from a colorectal cancer clinical trial, previously analyzed by Burzykowski et al..2 PMID:24947559

Surrogacy assessment using principal stratification and a Gaussian copula model.

PubMed

Conlon, Asc; Taylor, Jmg; Elliott, M R

2017-02-01

In clinical trials, a surrogate outcome ( S) can be measured before the outcome of interest ( T) and may provide early information regarding the treatment ( Z) effect on T. Many methods of surrogacy validation rely on models for the conditional distribution of T given Z and S. However, S is a post-randomization variable, and unobserved, simultaneous predictors of S and T may exist, resulting in a non-causal interpretation. Frangakis and Rubin developed the concept of principal surrogacy, stratifying on the joint distribution of the surrogate marker under treatment and control to assess the association between the causal effects of treatment on the marker and the causal effects of treatment on the clinical outcome. Working within the principal surrogacy framework, we address the scenario of an ordinal categorical variable as a surrogate for a censored failure time true endpoint. A Gaussian copula model is used to model the joint distribution of the potential outcomes of T, given the potential outcomes of S. Because the proposed model cannot be fully identified from the data, we use a Bayesian estimation approach with prior distributions consistent with reasonable assumptions in the surrogacy assessment setting. The method is applied to data from a colorectal cancer clinical trial, previously analyzed by Burzykowski et al.

An objective Bayesian analysis of a crossover design via model selection and model averaging.

PubMed

Li, Dandan; Sivaganesan, Siva

2016-11-10

Inference about the treatment effect in a crossover design has received much attention over time owing to the uncertainty in the existence of the carryover effect and its impact on the estimation of the treatment effect. Adding to this uncertainty is that the existence of the carryover effect and its size may depend on the presence of the treatment effect and its size. We consider estimation and testing hypothesis about the treatment effect in a two-period crossover design, assuming normally distributed response variable, and use an objective Bayesian approach to test the hypothesis about the treatment effect and to estimate its size when it exists while accounting for the uncertainty about the presence of the carryover effect as well as the treatment and period effects. We evaluate and compare the performance of the proposed approach with a standard frequentist approach using simulated data, and real data. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Recovering Wood and McCarthy's ERP-prototypes by means of ERP-specific procrustes-rotation.

PubMed

Beauducel, André

2018-02-01

The misallocation of treatment-variance on the wrong component has been discussed in the context of temporal principal component analysis of event-related potentials. There is, until now, no rotation-method that can perfectly recover Wood and McCarthy's prototypes without making use of additional information on treatment-effects. In order to close this gap, two new methods: for component rotation were proposed. After Varimax-prerotation, the first method identifies very small slopes of successive loadings. The corresponding loadings are set to zero in a target-matrix for event-related orthogonal partial Procrustes- (EPP-) rotation. The second method generates Gaussian normal distributions around the peaks of the Varimax-loadings and performs orthogonal Procrustes-rotation towards these Gaussian distributions. Oblique versions of this Gaussian event-related Procrustes- (GEP) rotation and of EPP-rotation are based on Promax-rotation. A simulation study revealed that the new orthogonal rotations recover Wood and McCarthy's prototypes and eliminate misallocation of treatment-variance. In an additional simulation study with a more pronounced overlap of the prototypes GEP Promax-rotation reduced the variance misallocation slightly more than EPP Promax-rotation. Comparison with Existing Method(s): Varimax- and conventional Promax-rotations resulted in substantial misallocations of variance in simulation studies when components had temporal overlap. A substantially reduced misallocation of variance occurred with the EPP-, EPP Promax-, GEP-, and GEP Promax-rotations. Misallocation of variance can be minimized by means of the new rotation methods: Making use of information on the temporal order of the loadings may allow for improvements of the rotation of temporal PCA components. Copyright © 2017 Elsevier B.V. All rights reserved.

Selective amplification and sequencing of cyclic phosphate-containing RNAs by the cP-RNA-seq method

PubMed Central

Honda, Shozo; Morichika, Keisuke; Kirino, Yohei

2016-01-01

RNA digestions catalyzed by many ribonucleases generate RNA fragments containing a 2′,3′-cyclic phosphate (cP) at their 3′-termini. However, standard RNA-seq methods are unable to accurately capture cP-containing RNAs because the cP inhibits the adapter ligation reaction. We recently developed a method named “cP-RNA-seq” that is able to selectively amplify and sequence cP-containing RNAs. Here we describe the cP-RNA-seq protocol in which the 3′-termini of all RNAs, except those containing a cP, are cleaved through a periodate treatment after phosphatase treatment, hence subsequent adapter ligation and cDNA amplification steps are exclusively applied to cP-containing RNAs. cP-RNA-seq takes ~6 d, excluding the time required for sequencing and bioinformatics analyses, such downstream assays are not covered in detail in this protocol. Biochemical validation of the existence of cP in the identified RNAs takes ~3 d. Even though the cP-RNA-seq method was developed to identify angiogenin-generating 5′-tRNA halves as a proof of principle, the method should be applicable to global identification of cP-containing RNA repertoires in various transcriptomes. PMID:26866791

Differentiation of organic and non-organic winter wheat cultivars from a controlled field trial by crystallization patterns.

PubMed

Kahl, Johannes; Busscher, Nicolaas; Mergardt, Gaby; Mäder, Paul; Torp, Torfinn; Ploeger, Angelika

2015-01-01

There is a need for authentication tools in order to verify the existing certification system. Recently, markers for analytical authentication of organic products were evaluated. Herein, crystallization with additives was described as an interesting fingerprint approach which needs further evidence, based on a standardized method and well-documented sample origin. The fingerprint of wheat cultivars from a controlled field trial is generated from structure analysis variables of crystal patterns. Method performance was tested on factors such as crystallization chamber, day of experiment and region of interest of the patterns. Two different organic treatments and two different treatments of the non-organic regime can be grouped together in each of three consecutive seasons. When the k-nearest-neighbor classification method was applied, approximately 84% of Runal samples and 95% of Titlis samples were classified correctly into organic and non-organic origin using cross-validation. Crystallization with additive offers an interesting complementary fingerprint method for organic wheat samples. When the method is applied to winter wheat from the DOK trial, organic and non-organic treated samples can be differentiated significantly based on pattern recognition. Therefore crystallization with additives seems to be a promising tool in organic wheat authentication. © 2014 Society of Chemical Industry.

Development of a simple and sensitive method for the characterization of odorous waste gas emissions by means of solid-phase microextraction (SPME) and GC-MS/olfactometry.

PubMed

Kleeberg, K K; Liu, Y; Jans, M; Schlegelmilch, M; Streese, J; Stegmann, R

2005-01-01

A solid-phase microextraction (SPME) method has been developed for the extraction of odorous compounds from waste gas. The enriched compounds were characterized by gas chromatography-mass spectrometry (GC-MS) and gas chromatography followed by simultaneous flame ionization detection and olfactometry (GC-FID/O). Five different SPME fiber coatings were tested, and the carboxen/polydimethylsiloxane (CAR/PDMS) fiber showed the highest ability to extract odorous compounds from the waste gas. Furthermore, parameters such as exposure time, desorption temperature, and desorption time have been optimized. The SPME method was successfully used to characterize an odorous waste gas from a fat refinery prior to and after waste gas treatment in order to describe the treatment efficiency of the used laboratory scale plant which consisted of a bioscrubber/biofilter combination and an activated carbon adsorber. The developed method is a valuable approach to provide detailed information of waste gas composition and complements existing methods for the determination of odors. However, caution should be exercised if CAR/PDMS fibers are used for the quantification of odorous compounds in multi-component matrices like waste gas emissions since the relative affinity of each analyte was shown to differ according to the total amount of analytes present in the sample.

Testing the effects of brief intervention in primary care for problem drug use in a randomized controlled trial: rationale, design, and methods.

PubMed

Krupski, Antoinette; Joesch, Jutta M; Dunn, Chris; Donovan, Dennis; Bumgardner, Kristin; Lord, Sarah Peregrine; Ries, Richard; Roy-Byrne, Peter

2012-12-14

A substantial body of research has established the effectiveness of brief interventions for problem alcohol use. Following these studies, national dissemination projects of screening, brief intervention (BI), and referral to treatment (SBIRT) for alcohol and drugs have been implemented on a widespread scale in multiple states despite little existing evidence for the impact of BI on drug use for non-treatment seekers. This article describes the design of a study testing the impact of SBIRT on individuals with drug problems, its contributions to the existing literature, and its potential to inform drug policy. The study is a randomized controlled trial of an SBIRT intervention carried out in a primary care setting within a safety net system of care. Approximately 1,000 individuals presenting for scheduled medical care at one of seven designated primary care clinics who endorse problematic drug use when screened are randomized in a 1:1 ratio to BI versus enhanced care as usual (ECAU). Individuals in both groups are reassessed at 3, 6, 9, and 12 months after baseline. Self-reported drug use and other psychosocial measures collected at each data point are supplemented by urine analysis and public health-related data from administrative databases. This study will contribute to the existing literature by providing evidence for the impact of BI on problem drug use based on a broad range of measures including self-reported drug use, urine analysis, admission to drug abuse treatment, and changes in utilization and costs of health care services, arrests, and death with the intent of informing policy and program planning for problem drug use at the local, state, and national levels. ClinicalTrials.gov NCT00877331.

Controversies in Oral and Maxillofacial Pathology.

PubMed

Peacock, Zachary S

2017-11-01

Several benign pathologic entities that are commonly encountered by the oral and maxillofacial surgeon remain controversial. From etiology to treatment, no consensus exists in the literature regarding the best treatment of benign lesions, such as the keratocystic odontogenic tumor, giant cell lesion, or ameloblastoma. Given the need for often-morbid treatment to prevent recurrence of these lesions, multiple less-invasive treatments exist in the literature for each entity with little agreement. As the molecular and genomic pathogenesis of these lesions are better understood, directed treatments will hopefully lessen the contention in management. Copyright © 2017 Elsevier Inc. All rights reserved.

[Home treatment: systematic review and implementation in Germany].

PubMed

Gühne, Uta; Weinmann, Stefan; Arnold, Katrin; Atav, Esra-Sultan; Becker, Thomas; Riedel-Heller, Steffi

2011-04-01

To report about existing evidence of effectiveness of home treatment for severely mentally ill adults and implementation in Germany. Systematic electronic and manual literature search. Compared to standard care, home treatment was equally or more efficacious with respect to general state of health and mental health. Home treatment was superior with regard to other outcomes. So far, implementation in Germany is limited. Home treatment can be seen as an effective addition to existing approaches of psychiatric care. It may be cost-effective also in Germany. Reasons for limited implementation in routine care are discussed. © Georg Thieme Verlag KG Stuttgart · New York.

What’s Important to the Patient?: Informational Needs of Patients Making Decisions about Hepatitis C Treatment

PubMed Central

Evon, Donna M.; Golin, Carol E.; Stoica, Teodora; Jones, Rachel; Willis, Sarah; Galanko, Joseph; Fried, Michael W.

2017-01-01

Background & Objectives Multiple treatment options with direct-acting antivirals (DAAs) are now available for hepatitis C virus (HCV). Study aims were to understand (1) The informational topics patients want to have to make informed treatment decisions; (2) The importance patients place on each topic; and (3) The topics patients prioritize as most important. Methods Mixed methods study utilizing two samples recruited from an academic liver center. Participants were not currently on treatment. Sample I (n=45) free-listed all informational topics deemed important to decision-making. Raw responses were coded into several broad and subcategories. Sample II (n=38) rated the importance of the subcategories from Sample I and ranked their highest priorities on two surveys, one containing topics for which sufficient research existed to inform patients (“static”), and the other containing topics that would require additional research. Results The topics listed by Sample I fell into 6 broad categories with 17 total subcategories. The most oft-cited informational topics were harms of treatment (100%), treatment benefits (62%) and treatment regimen details (84%). Sample II rated 16 of 17 subcategories as “pretty important’ or “extremely important.” Sample II prioritized (1) viral cure, (2) long-term survival, and (3) side effects on the survey of topics requiring additional research, and (1) liver disease, (2) lifestyle changes, and (3) medication details on the second survey of the most important static topics patients needed. Conclusions Patients weighed several informational topics to make an informed decision about HCV treatment. These findings lay the groundwork for future patient-centered outcomes research in HCV and patient-provider communication to enhance patients’ informed decision-making regarding DAA treatment options. PMID:27882509

Skin permeation and retention of topical bead formulation containing tranexamic acid.

PubMed

Vijayakumar, Ajay; Baskaran, Rengarajan; Yoo, Bong Kyu

2017-02-01

The objective of this study is to develop a topical bead formulation of tranexamic acid (TA) which can be used concomitantly with laser treatment. The bead formulation of TA (TAB) was successfully prepared by fluidized bed drying method. Physicochemical properties of the TAB were evaluated in terms of chemical stability of TA and differential scanning calorimetry. TA in the bead was stable up to six months at 25°C and existed as amorphous state. In vitro skin permeation and in vivo skin retention of TA in the beads were significantly higher compared to a commercial product. When the bead was dissolved into distilled water and applied concomitantly with laser treatment, the amount of TA retained in the skin in the in vivo study was inversely proportional to the energy levels of laser treatment, indicating absorption into subcutaneous tissue and drainage to systemic circulation. Therefore, when laser treatment is used concomitantly with TAB, energy level should be very carefully monitored to avoid possible adverse events associated with systemic side effects of TA.

[The gold standard in diabetic foot treatment: total contact cast].

PubMed

Lozano-Platonoff, Adriana; Florida Mejía-Mendoza, Melissa Desireé; Ibáñez-Doria, Mónica; Contreras-Ruiz, José

2014-01-01

In patients with diabetes, foot complications remain one of the main health issues, with ulcers representing one of the most common. These ulcerations originate from repetitive trauma on a foot with neuropathy. Inadequate care of the diabetic foot may lead to one of the gravest complications of the diabetic foot: amputation. The key to the treatment of the diabetic foot is the control of comorbidities (glucose levels and vascular disease), debridement, exudate control with the available modern dressings, treatment of infection, and offloading the affected foot. A common error in this basic treatment is the method used for offloading, leading to delayed healing as a result, and maybe even amputation. For this purpose we propose the total contact cast considered the "gold standard" in diabetic foot offloading. The objective of the present review is to present the existing evidence in the medical literature on the effectiveness of its use for healing diabetic foot ulcers and hence preventing amputations.

Targeting HER2 in the treatment of non-small cell lung cancer.

PubMed

Mar, Nataliya; Vredenburgh, James J; Wasser, Jeffrey S

2015-03-01

Oncogenic driver mutations have emerged as major treatment targets for molecular therapies in a variety of cancers. HER2 positivity has been well-studied in breast cancer, but its importance is still being explored in non-small cell lung cancer (NSCLC). Laboratory methods for assessment of HER2 positivity in NSCLC include immunohistochemistry (IHC) for protein overexpression, fluorescent in situ hybridization (FISH) for gene amplification, and next generation sequencing (NGS) for gene mutations. The prognostic and predictive significance of these tests remain to be validated, with an emerging association between HER2 gene mutations and response to HER2 targeted therapies. Despite the assay used to determine the HER2 status of lung tumors, all patients with advanced HER2 positive lung adenocarcinoma should be evaluated for treatment with targeted agents. Several clinical approaches for inclusion of these drugs into patient treatment plans exist, but there is no defined algorithm specific to NSCLC. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effect of ultrasonic treatment of palygorskite on the catalytic performance of Pd-Cu/palygorskite catalyst for room temperature CO oxidation in humid circumstances.

PubMed

Wang, Yongzhao; Wang, Yongning; Li, Xiao; Liu, Zhaotie; Zhao, Yongxiang

2018-03-01

Pd-Cu/palygorskite catalysts were prepared by a wet impregnation method using palygorskite (PC/N-Pal) and ultrasonic-treated palygorskite (PC/U-Pal) as the support. Their catalytic activities toward CO oxidation at room temperature and in humid circumstances were investigated. PC/U-Pal exhibits much higher catalytic activity and stability than PC/N-Pal under the conditions of 1.0 vol.% CO and 3.3 vol.% H 2 O in the feed gas. The X-ray diffraction results indicate that quartz impurities were eliminated from the Pal after the ultrasonic treatment, and more copper species exist in the form of Cu 2 Cl(OH) 3 in PC/U-Pal. The temperature-programmed reduction results suggest that there is an enhanced reducibility of PC/U-Pal after ultrasonic treatment. Furthermore, the ultrasonic treatment can properly decrease the hydrophilicity of the support and catalyst, which may also contribute to the excellent catalytic performance.

[Multidisciplinary approach of hip fractures based on Hungarian data].

PubMed

Juhász, Krisztina; Turchányi, Béla; Mintál, Tibor; Somogyi, Péter

2016-09-01

Hip fractures are described by increased mortality, loss of quality of life, functional decline and burden of diseases. They show a growing number worldwide. The aim of the present study is to summarise the existing data on the incidence, mortality, complications and rehabilitation of hip fractures, which relevance is reported only by few studies. To reduce mortality and complications of hip fractures the authors emphasize the importance of primary treatment within 12 hours, appropriate selection of surgical methods corresponding to the fracture type after the assessment of femoral head viability, vitamin D supplementation, same conditions for primary treatment during everyday of the week, and an adequate acute treatment and rehabilitation for patient's general health status. In the future integrated processing of multidisciplinary results of hip fractures based on Hungarian data can support the development of efficient treatment and prevention strategies, which can be advantageous for the patient, families, health care system, and the society, too, by the reduction of costly complications of hip fracture healing and mortality. Orv. Hetil., 2016, 157(37), 1469-1475.

Class III orthognathic surgical cases facilitated by accelerated osteogenic orthodontics: a preliminary report.

PubMed

Wu, JiaQi; Xu, Li; Liang, Cheng; Jiang, JiuHui

2015-11-01

To describe a multidisciplinary treatment approach that includes corticotomy, orthodontic force and orthognathic surgery for the management of skeletal Class III surgical cases. The main advantage of the combined techniques is a reduction in treatment time for young adult patients. Accelerated Osteogenic Orthodontics (AOO) was delivered to three young adult patients during their pre-surgical orthodontic treatment. After aligning and levelling the dental arches, a piezosurgical corticotomy was performed to the buccal aspect of the alveolar bone. Bone graft materials were used to cover the decorticated area and soft tissue flaps were replaced. The mean time for extraction space closure was 5.4 ± 1.3 months and the mean time for pre-surgical orthodontic treatment was 12.0 ± 0.9 months. The average total treatment time was 20.4 ± 2.4 months. A pre-existing bony fenestration in the buccal cortex adjacent to the right lateral incisor root apex of Case 1 was corrected. The facial aesthetics of three patients improved following multidisciplinary treatment. This approach may be an efficient method for the orthognathic patient who desires a reduced treatment time, but further clinical research is required.

Estimation of wildfire size and risk changes due to fuels treatments

USGS Publications Warehouse

Cochrane, M.A.; Moran, C.J.; Wimberly, M.C.; Baer, A.D.; Finney, M.A.; Beckendorf, K.L.; Eidenshink, J.; Zhu, Z.

2012-01-01

Human land use practices, altered climates, and shifting forest and fire management policies have increased the frequency of large wildfires several-fold. Mitigation of potential fire behaviour and fire severity have increasingly been attempted through pre-fire alteration of wildland fuels using mechanical treatments and prescribed fires. Despite annual treatment of more than a million hectares of land, quantitative assessments of the effectiveness of existing fuel treatments at reducing the size of actual wildfires or how they might alter the risk of burning across landscapes are currently lacking. Here, we present a method for estimating spatial probabilities of burning as a function of extant fuels treatments for any wildland fire-affected landscape. We examined the landscape effects of more than 72 000 ha of wildland fuel treatments involved in 14 large wildfires that burned 314 000 ha of forests in nine US states between 2002 and 2010. Fuels treatments altered the probability of fire occurrence both positively and negatively across landscapes, effectively redistributing fire risk by changing surface fire spread rates and reducing the likelihood of crowning behaviour. Trade offs are created between formation of large areas with low probabilities of increased burning and smaller, well-defined regions with reduced fire risk.

Early Maladaptive Schemas in a Sample of Airline Pilots seeking Residential Substance Use Treatment: An Initial Investigation

PubMed Central

Shorey, Ryan C.; Brasfield, Hope; Anderson, Scott; Stuart, Gregory L.

2014-01-01

Background Recent research has begun to examine the early maladaptive schemas of substance abusers, as it is believed that targeting these core beliefs in treatment may result in improved substance use outcomes. One special population that has received scant attention in the research literature, despite high levels of substance use, is airline pilots. Aims The current study examined the early maladaptive schemas of a sample of airline pilots (n = 64) who were seeking residential treatment for alcohol dependence and whether they differed in early maladaptive schemas from non-pilot substance abusers who were also seeking residential treatment for alcohol dependence (n = 45). Method Pre-existing medical records from patients of a residential substance abuse treatment facility were reviewed for the current study. Results Of the 18 early maladaptive schemas, results demonstrated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards (high internalized standards of behavior), whereas non-pilots scored higher on insufficient self-control (low frustration tolerance and self-control). Conclusions Early maladaptive schemas may be a relevant treatment target for substance abuse treatment seeking pilots and non-pilots. PMID:24701252

Benchmark results and theoretical treatments for valence-to-core x-ray emission spectroscopy in transition metal compounds

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

Mortensen, D. R.; Seidler, G. T.; Kas, Joshua J.

We report measurement of the valence-to-core (VTC) region of the K-shell x-ray emission spectra from several Zn and Fe inorganic compounds, and their critical comparison with several existing theoretical treatments. We find generally good agreement between the respective theories and experiment, and in particular find an important admixture of dipole and quadrupole character for Zn materials that is much weaker in Fe-based systems. These results on materials whose simple crystal structures should not, a prior, pose deep challenges to theory, will prove useful in guiding the further development of DFT and time-dependent DFT methods for VTC-XES predictions and their comparisonmore » to experiment.« less

Physiology-driven adaptive virtual reality stimulation for prevention and treatment of stress related disorders.

PubMed

Cosić, Kresimir; Popović, Sinisa; Kukolja, Davor; Horvat, Marko; Dropuljić, Branimir

2010-02-01

The significant proportion of severe psychological problems related to intensive stress in recent large peacekeeping operations underscores the importance of effective methods for strengthening the prevention and treatment of stress-related disorders. Adaptive control of virtual reality (VR) stimulation presented in this work, based on estimation of the person's emotional state from physiological signals, may enhance existing stress inoculation training (SIT). Physiology-driven adaptive VR stimulation can tailor the progress of stressful stimuli delivery to the physiological characteristics of each individual, which is indicated for improvement in stress resistance. Following an overview of physiology-driven adaptive VR stimulation, its major functional subsystems are described in more detail. A specific algorithm of stimuli delivery applicable to SIT is outlined.

Therapeutic Properties and Biological Benefits of Marine-Derived Anticancer Peptides

PubMed Central

Kang, Hee Kyoung; Choi, Moon-Chang; Seo, Chang Ho; Park, Yoonkyung

2018-01-01

Various organisms exist in the oceanic environment. These marine organisms provide an abundant source of potential medicines. Many marine peptides possess anticancer properties, some of which have been evaluated for treatment of human cancer in clinical trials. Marine anticancer peptides kill cancer cells through different mechanisms, such as apoptosis, disruption of the tubulin-microtubule balance, and inhibition of angiogenesis. Traditional chemotherapeutic agents have side effects and depress immune responses. Thus, the research and development of novel anticancer peptides with low toxicity to normal human cells and mechanisms of action capable of avoiding multi-drug resistance may provide a new method for anticancer treatment. This review provides useful information on the potential of marine anticancer peptides for human therapy. PMID:29558431

TU-C-201-02: Clinical Implementation of HDR: Afterloader and Applicator Selection

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

Esthappan, J.

2015-06-15

Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for eachmore » institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program.« less

TU-C-201-01: Clinical Implementation of HDR: A New User’s Perspective

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

Al-Hallaq, H.

2015-06-15

Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for eachmore » institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program.« less

TU-C-201-00: Clinical Implementation of HDR Brachytherapy

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

NONE

2015-06-15

Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for eachmore » institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program.« less

TU-C-201-03: The Use of Checklists and Audit Tools for Safety and QA

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

Prisciandaro, J.

Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for eachmore » institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program.« less

Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder

PubMed Central

Kessler, R.C.; van Loo, H.M.; Wardenaar, K.J.; Bossarte, R.M.; Brenner, L.A.; Ebert, D.D; de Jonge, P.; Nierenberg, A.A.; Rosellini, A.J.; Sampson, N.A.; Schoevers, R.A.; Wilcox, M.A.; Zaslavsky, A.M.

2016-01-01

Aims Clinicians need guidance to address the heterogeneity of treatment responses of patients with major depressive disorder (MDD). While prediction schemes based on symptom clustering and biomarkers have so far not yielded results of sufficient strength to inform clinical decision-making, prediction schemes based on big data predictive analytic models might be more practically useful. Methods We review evidence suggesting that prediction equations based on symptoms and other easily-assessed clinical features found in previous research to predict MDD treatment outcomes might provide a foundation for developing predictive analytic clinical decision support models that could help clinicians select optimal (personalized) MDD treatments. These methods could also be useful in targeting patient subsamples for more expensive biomarker assessments. Results Approximately two dozen baseline variables obtained from medical records or patient reports have been found repeatedly in MDD treatment trials to predict overall treatment outcomes (i.e., intervention versus control) or differential treatment outcomes (i.e., intervention A versus intervention B). Similar evidence has been found in observational studies of MDD persistence-severity. However, no treatment studies have yet attempted to develop treatment outcome equations using the full set of these predictors. Promising preliminary empirical results coupled with recent developments in statistical methodology suggest that models could be developed to provide useful clinical decision support in personalized treatment selection. These tools could also provide a strong foundation to increase statistical power in focused studies of biomarkers and MDD heterogeneity of treatment response in subsequent controlled trials. Conclusions Coordinated efforts are needed to develop a protocol for systematically collecting information about established predictors of heterogeneity of MDD treatment response in large observational treatment studies, applying and refining these models in subsequent pragmatic trials, carrying out pooled secondary analyses to extract the maximum amount of information from these coordinated studies, and using this information to focus future discovery efforts in the segment of the patient population in which continued uncertainty about treatment response exists. PMID:26810628

Infertility in public health: the case of Norway

PubMed Central

Sundby, J.

2010-01-01

Infertility is a health issue that demonstrates how unequal access to health care is at a global level. In the poorer segments of the world, and in poor parts of wealthy societies, access is often minimal or non-existent. Public and lay attitudes to modern infertility treatment have been heavily debated alongside development of methods. I have looked at the changes in the public discourse in modern media, legislation, politics, and among professionals. The paper seeks to present and discuss some of these changes as they have evolved in one of the countries that have had one of the more strict laws regulating access to treatment, namely Norway. It is a country that nevertheless offers treatment in the public health system. The paper also tries to connect this discussion to the difficulties faced in every attempt to expand infertility services to the developing world. PMID:25013709

Treatment of Infants Identified by Newborn Screening for Severe Combined Immunodeficiency

PubMed Central

Dorsey, Morna J.; Dvorak, Christopher C.; Cowan, Morton J.; Puck, Jennifer M.

2017-01-01

Background Severe combined immunodeficiency (SCID) is characterized by severely impaired T cell development and is fatal without treatment. Newborn screening (NBS) for SCID permits identification of affected infants before development of opportunistic infections and other complications. Substantial variation exists between treatment centers with regard to pre-transplant care and transplant protocols for NBS identified SCID infants, as well as for infants with other T lymphopenic disorders detected by NBS. Methods We developed approaches to management based on the study of infants identified by SCID NBS who received care at UCSF. Results From August 2010 through October 2016, 32 NBS SCID and leaky SCID cases from California and other states were treated and 42 NBS identified non-SCID T cell lymphopenia (TCL) cases were followed. Conclusions Our center’s approach supports successful outcomes; systematic review of our practice provides a framework for diagnosis and management, recognizing that more data will continue to shape best practices. PMID:28270365

[Radiotherapy phase I trials' methodology: Features].

PubMed

Rivoirard, R; Vallard, A; Langrand-Escure, J; Guy, J-B; Ben Mrad, M; Yaoxiong, X; Diao, P; Méry, B; Pigne, G; Rancoule, C; Magné, N

2016-12-01

In clinical research, biostatistical methods allow the rigorous analysis of data collection and should be defined from the trial design to obtain the appropriate experimental approach. Thus, if the main purpose of phase I is to determine the dose to use during phase II, methodology should be finely adjusted to experimental treatment(s). Today, the methodology for chemotherapy and targeted therapy is well known. For radiotherapy and chemoradiotherapy phase I trials, the primary endpoint must reflect both effectiveness and potential treatment toxicities. Methodology should probably be complex to limit failures in the following phases. However, there are very few data about methodology design in the literature. The present study focuses on these particular trials and their characteristics. It should help to raise existing methodological patterns shortcomings in order to propose new and better-suited designs. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Exercise as Treatment for Anxiety: Systematic Review and Analysis

PubMed Central

Stonerock, Gregory L.; Hoffman, Benson M.; Smith, Patrick J.; Blumenthal, James A.

2015-01-01

Background Exercise has been shown to reduce symptoms of anxiety, but few studies have studied exercise in individuals pre-selected because of their high anxiety. Purpose To review and critically evaluate studies of exercise training in adults with either high levels of anxiety or an anxiety disorder. Methods We conducted a systematic review of randomized clinical trials (RCTs) in which anxious adults were randomized to an exercise or non-exercise control condition. Data were extracted concerning anxiety outcomes and study design. Existing meta-analyses were also reviewed. Results Evidence from 12 RCTs suggested benefits of exercise, for select groups, similar to established treatments and greater than placebo. However, most studies had significant methodological limitations, including small sample sizes, concurrent therapies, and inadequate assessment of adherence and fitness levels. Conclusions Exercise may be a useful treatment for anxiety, but lack of data from rigorous, methodologically sound RCTs precludes any definitive conclusions about its effectiveness. PMID:25697132

[Stimulation of wound healing by tetrachlordecaoxide. Results of a randomized double-blind study].

PubMed

Hinz, J; Hautzinger, H; Helling, J; Schirren, G; Sell, G; Stahl, K W; Kühne, F W

1984-05-10

In 38 patients with chronic therapeutically resistant wounds, which, in 25 cases, had been existing for more than one year, Tetrachlorodecaoxide ( TCDO ) in a water solution containing glycerin was analyzed for its capacity to induce wound healing and compared in this respect to the standard in moist wound treatment, physiological sodium chloride. The results of the clinical trial demonstrate that the TCDO solution is significantly superior to physiological saline in local wound treatment regarding the degree of wound smear reduction, the formation of wound granulation tissue, the stimulation of epithelisation on the wound borders and the shrinking of the wound surface. The differences in therapeutic efficiency are so large that, in spite of the relatively small patient samples (21 + 17) it was possible to verify the superiority of a method for wound treatment in a randomized double blind clinical trial.

[Non-pharmacologic treatment of arterial hypertension in hemodialysis patients].

PubMed

Chazot, C; Charra, B

2007-10-01

High blood pressure in dialysis patients is related to extracellular volume excess and the related increase of systemic vascular resistances. Scribner has early described the treatment of hypertension with ultrafiltration and low salt diet, without any drugs. The dry weight method relies on the progressive reduction of the postdialysis body weight until blood pressure is normalized. Additional measures are needed such as low salt diet, neutral sodium balance during dialysis treatment, stop of antihypertensive drugs, adequate length of the dialysis session, and patient education. It may exist a lag time between the normalization of the extracellular volume and blood pressure. It is related to the correction of the hemodynamic consequences of the extracellular volume overload. Moreover, the dry weight may potentially vary in patients undergoing catabolic intercurrent events. The complications of these changes (severe hypertension, pulmonary oedema) must be anticipated by the nephrologist and the staff to avoid additional morbidity to the patient.

Influence of electrodes on the 448 kHz electric currents created by radiofrequency: A finite element study.

PubMed

Spottorno, J; Gonzalez de Vega, C; Buenaventura, M; Hernando, A

2017-01-01

Radiofrequency is a technology used in physical rehabilitation by physicians and physiotherapists for more than fifteen years, although there exist doubts on how it works. Indiba is a particular method that applies a voltage difference of 448 KHz between two electrodes, creating an electric current between them. These electrodes are an active one that is placed on different areas of the body and a passive one that is left on the same position during the treatment. There are two different types of active electrodes: the capacitive one and the resistive one. In this paper, it has been studied how the different electrodes affect the current density inside the body and thus how they affect the efficacy of the treatment. It shows how finite element calculations should help physicians in order to better understand its behavior and improve the treatments.

The Response to Conjugal Violence in Substance Abuse Treatment Settings.

ERIC Educational Resources Information Center

Brown, Thomas G.; Caplan, Thomas; Seraganian, Peter; Werk, Annette

The linkage between conjugal violence and substance abuse is well established. The evidence suggests that little coordination exists among the therapeutic communities positioned to treat co-existing problems. A survey was conducted in Quebec with professionals representing 57 substance abuse treatment centers, 38 of which were public. Questions…

Brief Behavioral Therapy for Pediatric Anxiety and Depression: Piloting an Integrated Treatment Approach

ERIC Educational Resources Information Center

Weersing, V. Robin; Gonzalez, Araceli; Campo, John V.; Lucas, Amanda N.

2008-01-01

Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral…

40 CFR 407.84 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... publicly owned treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by any existing point source subject...

40 CFR 407.64 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by any existing point source subject to the...

40 CFR 407.74 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... publicly owned treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by any existing point source subject...

Dual diagnosis clients' treatment satisfaction - a systematic review

PubMed Central

2011-01-01

Background The aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD). Methods We examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings. Results Across the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed. Conclusions High satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients. PMID:21501510

Mass-flow-rate-controlled fluid flow in nanochannels by particle insertion and deletion.

PubMed

Barclay, Paul L; Lukes, Jennifer R

2016-12-01

A nonequilibrium molecular dynamics method to induce fluid flow in nanochannels, the insertion-deletion method (IDM), is introduced. IDM inserts and deletes particles within distinct regions in the domain, creating locally high and low pressures. The benefits of IDM are that it directly controls a physically meaningful quantity, the mass flow rate, allows for pressure and density gradients to develop in the direction of flow, and permits treatment of complex aperiodic geometries. Validation of IDM is performed, yielding good agreement with the analytical solution of Poiseuille flow in a planar channel. Comparison of IDM to existing methods indicates that it is best suited for gases, both because it intrinsically accounts for compressibility effects on the flow and because the computational cost of particle insertion is lowest for low-density fluids.

Augmented reality system

NASA Astrophysics Data System (ADS)

Lin, Chien-Liang; Su, Yu-Zheng; Hung, Min-Wei; Huang, Kuo-Cheng

2010-08-01

In recent years, Augmented Reality (AR)[1][2][3] is very popular in universities and research organizations. The AR technology has been widely used in Virtual Reality (VR) fields, such as sophisticated weapons, flight vehicle development, data model visualization, virtual training, entertainment and arts. AR has characteristics to enhance the display output as a real environment with specific user interactive functions or specific object recognitions. It can be use in medical treatment, anatomy training, precision instrument casting, warplane guidance, engineering and distance robot control. AR has a lot of vantages than VR. This system developed combines sensors, software and imaging algorithms to make users feel real, actual and existing. Imaging algorithms include gray level method, image binarization method, and white balance method in order to make accurate image recognition and overcome the effects of light.

A time-implicit numerical method and benchmarks for the relativistic Vlasov–Ampere equations

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

Carrie, Michael; Shadwick, B. A.

2016-01-04

Here, we present a time-implicit numerical method to solve the relativistic Vlasov–Ampere system of equations on a two dimensional phase space grid. The time-splitting algorithm we use allows the generalization of the work presented here to higher dimensions keeping the linear aspect of the resulting discrete set of equations. The implicit method is benchmarked against linear theory results for the relativistic Landau damping for which analytical expressions using the Maxwell-Juttner distribution function are derived. We note that, independently from the shape of the distribution function, the relativistic treatment features collective behaviors that do not exist in the non relativistic case.more » The numerical study of the relativistic two-stream instability completes the set of benchmarking tests.« less

A time-implicit numerical method and benchmarks for the relativistic Vlasov–Ampere equations

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

Carrié, Michael, E-mail: mcarrie2@unl.edu; Shadwick, B. A., E-mail: shadwick@mailaps.org

2016-01-15

We present a time-implicit numerical method to solve the relativistic Vlasov–Ampere system of equations on a two dimensional phase space grid. The time-splitting algorithm we use allows the generalization of the work presented here to higher dimensions keeping the linear aspect of the resulting discrete set of equations. The implicit method is benchmarked against linear theory results for the relativistic Landau damping for which analytical expressions using the Maxwell-Jüttner distribution function are derived. We note that, independently from the shape of the distribution function, the relativistic treatment features collective behaviours that do not exist in the nonrelativistic case. The numericalmore » study of the relativistic two-stream instability completes the set of benchmarking tests.« less

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

PubMed Central

Bergh, Cecilia; Brodin, Ulf; Lindberg, Greger; Södersten, Per

2002-01-01

Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n = 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9–26.5) of treatment, but only one patient went into remission while waiting for treatment (P = 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 ≥ 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6–36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover. PMID:12082182

Sparse distance-based learning for simultaneous multiclass classification and feature selection of metagenomic data.

PubMed

Liu, Zhenqiu; Hsiao, William; Cantarel, Brandi L; Drábek, Elliott Franco; Fraser-Liggett, Claire

2011-12-01

Direct sequencing of microbes in human ecosystems (the human microbiome) has complemented single genome cultivation and sequencing to understand and explore the impact of commensal microbes on human health. As sequencing technologies improve and costs decline, the sophistication of data has outgrown available computational methods. While several existing machine learning methods have been adapted for analyzing microbiome data recently, there is not yet an efficient and dedicated algorithm available for multiclass classification of human microbiota. By combining instance-based and model-based learning, we propose a novel sparse distance-based learning method for simultaneous class prediction and feature (variable or taxa, which is used interchangeably) selection from multiple treatment populations on the basis of 16S rRNA sequence count data. Our proposed method simultaneously minimizes the intraclass distance and maximizes the interclass distance with many fewer estimated parameters than other methods. It is very efficient for problems with small sample sizes and unbalanced classes, which are common in metagenomic studies. We implemented this method in a MATLAB toolbox called MetaDistance. We also propose several approaches for data normalization and variance stabilization transformation in MetaDistance. We validate this method on several real and simulated 16S rRNA datasets to show that it outperforms existing methods for classifying metagenomic data. This article is the first to address simultaneous multifeature selection and class prediction with metagenomic count data. The MATLAB toolbox is freely available online at http://metadistance.igs.umaryland.edu/. zliu@umm.edu Supplementary data are available at Bioinformatics online.

Stroke rehabilitation at home using virtual reality, haptics and telemedicine.

PubMed

Rydmark, Martin; Broeren, Jörgen; Pascher, Ragnar

2002-01-01

The objective of this pilot study is to identify the level of difficulty in which subjects with left hemisphere damage in the acute phase after stroke can start practicing in a virtual environment. Second, to test an application of Virtual Reality technology to existing occupational treatment methods in stroke rehabilitation and develop a platform for home rehabilitation controlled telemedically. The findings indicate that the system shows potential as an assessment and training device. The feasibility study setup is working well likewise the assessment method. Developing and increasing the complexity of the tasks must be based on the patient individual neurology, and that the cinematic motion patterns of the patient's are the basis for exercise design.

Ensemble of single quadrupolar nuclei in rotating solids: sidebands in NMR spectrum.

PubMed

Kundla, Enn

2006-07-01

A novel way is proposed to describe the evolution of nuclear magnetic polarization and the induced NMR spectrum. In this method, the effect of a high-intensity external static magnetic field and the effects of proper Hamiltonian left over interaction components, which commute with the first, are taken into account simultaneously and equivalently. The method suits any concrete NMR problem. This brings forth the really existing details in the registered spectra, evoked by Hamiltonian secular terms, which may be otherwise smoothed due to approximate treatment of the effects of the secular terms. Complete analytical expressions are obtained describing the NMR spectra including the rotational sideband sets of single quadrupolar nuclei in rotating solids.

Soldering and brazing safety guide: A handbook on space practice for those involved in soldering and brazing

NASA Astrophysics Data System (ADS)

This manual provides those involved in welding and brazing with effective safety procedures for use in performance of their jobs. Hazards exist in four types of general soldering and brazing processes: (1) cleaning; (2) application of flux; (3) application of heat and filler metal; and (4) residue cleaning. Most hazards during those operations can be avoided by using care, proper ventilation, protective clothing and equipment. Specific process hazards for various methods of brazing and soldering are treated. Methods to check ventilation are presented as well as a check of personal hygiene and good maintenance practices are stressed. Several emergency first aid treatments are described.

Comparative quantification of oxygen release by wetland plants: electrode technique and oxygen consumption model.

PubMed

Wu, Haiming; Liu, Jufeng; Zhang, Jian; Li, Cong; Fan, Jinlin; Xu, Xiaoli

2014-01-01

Understanding oxygen release by plants is important to the design of constructed wetlands for wastewater treatment. Lab-scale systems planted with Phragmites australis were studied to evaluate the amount of oxygen release by plants using electrode techniques and oxygen consumption model. Oxygen release rate (0.14 g O2/m(2)/day) measured using electrode techniques was much lower than that (3.94-25.20 gO2/m(2)/day) calculated using the oxygen consumption model. The results revealed that oxygen release by plants was significantly influenced by the oxygen demand for the degradation of pollutants, and the oxygen release rate increased with the rising of the concentration of degradable materials in the solution. The summary of the methods in qualifying oxygen release by wetland plants demonstrated that variations existed among different measuring methods and even in the same measuring approach. The results would be helpful for understanding the contribution of plants in constructed wetlands toward actual wastewater treatment.

The use of clinical trials in comparative effectiveness research on mental health.

PubMed

Blanco, Carlos; Rafful, Claudia; Olfson, Mark

2013-08-01

A large body of comparative effectiveness research (CER) focuses on the use of observational and quasi-experimental approaches. We sought to examine the use of clinical trials as a tool for CER, particularly in mental health. Examination of three ongoing randomized clinical trials in psychiatry addressing issues that would pose difficulties for nonexperimental CER methods. Existing statistical approaches to nonexperimental data appear insufficient to compensate for biases that may arise when the pattern of missing data cannot be properly modeled such as when there are no standards for treatment, when affected populations have limited access to treatment, or when there are high rates of treatment dropout. Clinical trials should retain an important role in CER, particularly in cases of high disorder prevalence, large expected effect sizes, difficult-to-reach populations, or when examining sequential treatments or stepped-care algorithms. Progress in CER on mental health will require careful consideration of appropriate selection between clinical trials and nonexperimental designs and on allocation of research resources to optimally inform key treatment decisions for each patient. Copyright © 2013 Elsevier Inc. All rights reserved.

Prism adaptation for spatial neglect after stroke: translational practice gaps.

PubMed

Barrett, A M; Goedert, Kelly M; Basso, Julia C

2012-10-01

Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor 'aiming', prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50-75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose-response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.

Healing of chronic wounds with adjunctive ablative fractional laser resurfacing in two pediatric patients.

PubMed

Krakowski, Andrew C; Diaz, Lucia; Admani, Shehla; Uebelhoer, Nathan S; Shumaker, Peter R

2016-02-01

The development of chronic non-healing wounds is multifactorial and can lead to increased patient morbidity. When traditional wound care methods fail, alternative treatments are needed to prevent chronic ulcer complications. Ablative fractional laser resurfacing (AFR) is an emerging therapy for chronic wounds. We report the successful use of AFR to facilitate the healing of chronic wounds in two pediatric patients. This is a case series including two patients with chronic wounds within scars that were treated with a micro-fractionated carbon dioxide (CO2 ) laser in a single pass at a pulse energy of 50 mJ and a treatment density of 5%. One patient had one treatment and the other had two treatments 1 month apart. AFR led to rapid healing of chronic wounds in both pediatric patients. The wounds remained epithelialized after 9 months in one patient and 4 months in the other. There were no complications. The combination of tolerability and efficacy observed in these cases introduces AFR as a potential promising adjunct to existing treatments for chronic, non-healing wounds in the pediatric population. © 2015 Wiley Periodicals, Inc.

Publication bias in obesity treatment trials?

PubMed

Allison, D B; Faith, M S; Gorman, B S

1996-10-01

The present investigation examined the extent of publication bias (namely the tendency to publish significant findings and file away non-significant findings) within the obesity treatment literature. Quantitative literature synthesis of four published meta-analyses from the obesity treatment literature. Interventions in these studies included pharmacological, educational, child, and couples treatments. To assess publication bias, several regression procedures (for example weighted least-squares, random-effects multi-level modeling, and robust regression methods) were used to regress effect sizes onto their standard errors, or proxies thereof, within each of the four meta-analysis. A significant positive beta weight in these analyses signified publication bias. There was evidence for publication bias within two of the four published meta-analyses, such that reviews of published studies were likely to overestimate clinical efficacy. The lack of evidence for publication bias within the two other meta-analyses might have been due to insufficient statistical power rather than the absence of selection bias. As in other disciplines, publication bias appears to exist in the obesity treatment literature. Suggestions are offered for managing publication bias once identified or reducing its likelihood in the first place.

Prism adaptation for spatial neglect after stroke: translational practice gaps

PubMed Central

Barrett, A. M.; Goedert, Kelly M.; Basso, Julia C.

2012-01-01

Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor ‘aiming’, prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50–75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose–response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied. PMID:22926312

Combining biofeedback and Narrative Exposure Therapy for persistent pain and PTSD in refugees: a pilot study

PubMed Central

Morina, Naser; Maier, Thomas; Bryant, Richard; Knaevelsrud, Christine; Wittmann, Lutz; Rufer, Michael; Schnyder, Ulrich; Müller, Julia

2012-01-01

Objective Many traumatised refugees suffer from both persistent pain and posttraumatic stress disorder (PTSD). To date, no specific guidelines exist for treatment of this group of patients. This paper presents data on a pilot treatment study conducted with 15 traumatised refugees with persistent pain and PTSD. Methods Participants received 10 sessions of pain-focused treatment with biofeedback (BF) followed by 10 sessions of Narrative Exposure Therapy (NET). Structured interviews and standardised questionnaires were used to assess symptoms of pain intensity, pain disability, PTSD and quality of life directly before and after treatment and at 3 months follow-up. Results Following the combined intervention, participants showed a significant reduction in both pain and PTSD symptoms, as well as improved quality of life. Additionally, biofeedback increased motivation for subsequent trauma-focused therapy, which in turn was related to larger PTSD treatment gains. Conclusion This pilot study provides initial evidence that combining BF and NET is safe, acceptable, and feasible in patients with co-morbid persistent pain and PTSD. PMID:22893834

Airsickness Prevention in Helicopter Passengers: A Comparison of Four Countermeasures

DTIC Science & Technology

2006-03-01

many existing treatments , airsickness remains an issue of concern in today’s military. This study used a double-blind, between groups, placebo...and 4) ReliefBand. Each individual participated twice, once with the treatment and once with placebo. The findings indicate that only the combination...target areas (Armstrong, 1961). Despite many existing treatments , airsickness is still an issue of concern in today’s military. The symptoms exhibited.by

Comparative analysis of salivary zinc level in recurrent herpes labialis

PubMed Central

Khozeimeh, Faezeh; Jafari, Nasim; Attar, Ahmad Movahedian; Jafari, Shahram; Ataie, Masoud

2012-01-01

Background: Recurrent Herpes Labialis (RHL) is one of most common infective vesiculoulcerative lesions. According to some studies administration of topical and/or systemic zinc compositions has been effective in treatment and prevention. This article aims to comparison of zinc level in healthy subjects and RHL patients in acute and convalescent phases. Materials and Methods: This was a retrospective case – control study, carried on 80 individuals (40 normal and 40 RHL patients) mean age=34.5 and 34.4, respectively. Saliva samples were taken in patients in acute phase once and after healing of lesions in convalescent phase (averagely 21 days later) and in normal individuals. Salivary zinc level concentration was measured by flame atomic absorption spectrophotometer by dry digestion method. The results were statistically analyzed with SPSS software by t-test (α=0.05). Results: Results showed that salivary zinc level in case group in acute and convalescent phases were 160.8 ngr/mland 205.7 ngr/ml respectivly and significant differences between them were existed (P <0.05). Also significant differences were existed between zinc concentration in healthy subjects and patient groups (in both phases) (P=.001 and .002 for acute and convalescent phases respectively). Conclusion: According to the results, zinc level is significantly lower in acute phase than in convalescent phase and significantly lower in both phases compared to healthy individuals,so determination of serum zinc level and prescribing zinc complement in low serum status has both treatmental and preventive effects in RHL patients. PMID:22363358

Development of a measure of asthma-specific quality of life among adults.

PubMed

Eberhart, Nicole K; Sherbourne, Cathy D; Edelen, Maria Orlando; Stucky, Brian D; Sin, Nancy L; Lara, Marielena

2014-04-01

A key goal in asthma treatment is improvement in quality of life (QoL), but existing measures often confound QoL with symptoms and functional impairment. The current study addresses these limitations and the need for valid patient-reported outcome measures by using state-of-the-art methods to develop an item bank assessing QoL in adults with asthma. This article describes the process for developing an initial item pool for field testing. Five focus group interviews were conducted with a total of 50 asthmatic adults. We used "pile sorting/binning" and "winnowing" methods to identify key QoL dimensions and develop a pool of items based on statements made in the focus group interviews. We then conducted a literature review and consulted with an expert panel to ensure that no key concepts were omitted. Finally, we conducted individual cognitive interviews to ensure that items were well understood and inform final item refinement. Six hundred and sixty-one QoL statements were identified from focus group interview transcripts and subsequently used to generate a pool of 112 items in 16 different content areas. Items covering a broad range of content were developed that can serve as a valid gauge of individuals' perceptions of the effects of asthma and its treatment on their lives. These items do not directly measure symptoms or functional impairment, yet they include a broader range of content than most existent measures of asthma-specific QoL.

Modeling for waste management associated with environmental-impact abatement under uncertainty.

PubMed

Li, P; Li, Y P; Huang, G H; Zhang, J L

2015-04-01

Municipal solid waste (MSW) treatment can generate significant amounts of pollutants, and thus pose a risk on human health. Besides, in MSW management, various uncertainties exist in the related costs, impact factors, and objectives, which can affect the optimization processes and the decision schemes generated. In this study, a life cycle assessment-based interval-parameter programming (LCA-IPP) method is developed for MSW management associated with environmental-impact abatement under uncertainty. The LCA-IPP can effectively examine the environmental consequences based on a number of environmental impact categories (i.e., greenhouse gas equivalent, acid gas emissions, and respiratory inorganics), through analyzing each life cycle stage and/or major contributing process related to various MSW management activities. It can also tackle uncertainties existed in the related costs, impact factors, and objectives and expressed as interval numbers. Then, the LCA-IPP method is applied to MSW management for the City of Beijing, the capital of China, where energy consumptions and six environmental parameters [i.e., CO2, CO, CH4, NOX, SO2, inhalable particle (PM10)] are used as systematic tool to quantify environmental releases in entire life cycle stage of waste collection, transportation, treatment, and disposal of. Results associated with system cost, environmental impact, and the related policy implication are generated and analyzed. Results can help identify desired alternatives for managing MSW flows, which has advantages in providing compromised schemes under an integrated consideration of economic efficiency and environmental impact under uncertainty.

Portable Raman monitoring of modern cleaning and consolidation operations of artworks on mineral supports.

PubMed

Martínez-Arkarazo, I; Sarmiento, A; Maguregui, M; Castro, K; Madariaga, J M

2010-08-01

Any restoration performed on cultural heritage artworks must guarantee a low impact on the treated surfaces. Although completely risk-free methods do not exist, the use of tailor-made procedures and the continuous monitoring by portable instrumentation is surely one of the best approaches to conduct a modern restoration process. In this work, a portable Raman monitoring, combined sometimes with spectroscopic techniques providing the elemental composition, is the key analysis technique in the three-step restoration protocol proposed: (a) in situ analysis of the surface to be treated (original composition and degradation products/pollutants) and the cleaning agents used as extractants, (b) the thermodynamic study of the species involved in the treatment in order to design a suitable restoration method and (c) application and monitoring of the treatment. Two cleaning operations based on new technologies were studied and applied to two artworks on mineral supports: a wall painting affected by nitrate impact, and a black crusted stone (chalk) altarpiece. Raman bands of nitrate and gypsum, respectively, decreased after the step-by-step operations in each case, which helped restorers to decide when the treatment was concluded, thus avoiding any further damage to the treated surface of the artworks.

Tuberculosis incidence and treatment completion among Ugandan prison inmates

PubMed Central

Schwitters, A.; Kaggwa, M.; Omiel, P.; Nagadya, G.; Kisa, N.; Dalal, S.

2016-01-01

SUMMARY BACKGROUND The Uganda Prisons Service (UPS) is responsible for the health of approximately 32 500 inmates in 233 prisons. In 2008 a rapid UPS assessment estimated TB prevalence at 654/100 000, three times that of the general population (183/100 000). Although treatment programs exist, little is known about treatment completion in sub-Saharan African prisons. METHODS We conducted a retrospective study of Ugandan prisoners diagnosed with TB from June 2011 to November 2012. We analyzed TB diagnosis, TB-HIV comorbidity and treatment completion from national registers and tracked prison transfers and releases. RESULTS A total of 469 prisoners were diagnosed with TB over the 1.5-year period (incidence 955/100 000 person-years). Of 466 prisoners starting treatment, 48% completed treatment, 43% defaulted, 5% died and 4% were currently on treatment. During treatment, 12% of prisoners remaining in the same prison defaulted, 53% of transfers defaulted and 81% of those released were lost to follow-up. The odds of defaulting were 8.36 times greater among prisoners who were transferred during treatment. CONCLUSIONS TB incidence and treatment default are high among Ugandan prisoners. Strategies to improve treatment completion and prevent multidrug resistance could include avoiding transfer of TB patients, improving communications between prisons to ensure treatment follow-up after transfer and facilitating transfer to community clinics for released prisoners. PMID:24902552

Validity of therapist self-report ratings of fidelity to evidence-based practices for adolescent behavior problems: correspondence between therapists and observers.

PubMed

Hogue, Aaron; Dauber, Sarah; Lichvar, Emily; Bobek, Molly; Henderson, Craig E

2015-03-01

Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases (n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT.

Comparison of Reflexology and Connective Tissue Manipulation in Participants with Primary Dysmenorrhea.

PubMed

Demirtürk, Funda; Erkek, Zümrüt Yilar; Alparslan, Özgür; Demirtürk, Fazlı; Demir, Osman; Inanir, Ahmet

2016-01-01

The aim of this interventional correlational study is to compare the effects of foot reflexology (FR) and connective tissue manipulation (CTM) in subjects with primary dysmenorrhea. A total of 30 participants having primary dysmenorrhea completed the study. Data, including demographics (age, body-mass index), menstrual cycle (age at menarche, menstrual cycle duration, time since menarche, bleeding duration), and menstrual pain characteristics (intensity and duration of pain, type and amount of analgesics), were recorded. Effect of dysmenorrhea on participants' concentration in lessons and in sports and social activities was assessed by using the visual analog scale. Participants rated their menstruation-related symptom intensity through the Likert-type scale. FR was applied to 15 participants for 3 days a week and CTM was performed on 15 participants for 5 days a week. Treatments were performed during one cycle, which started at the third or fourth day of menstruation and continued till the onset of next menstruation. Assessments were performed before treatment (first menstruation), then after termination of the treatment because of the next menstruation's onset (second menstruation), and ∼1 month after at the consecutive menstrual period (third menstrual cycle). Time-dependent changes in duration and intensity of pain along with analgesic amount show that both treatments provided significant improvements (p < 0.05) and no superiority existed between the groups (p > 0.05). A similar result was obtained in terms of time-dependent changes in concentration in lessons and difficulty in sports and social activities due to dysmenorrhea. Menstruation-related symptoms were found to be decreased after treatment and in the following cycle with both treatments (p < 0.05) where no difference existed between the groups (p > 0.05). Both FR and CTM can be used in the treatment of primary dysmenorrhea and menstruation-related symptoms as these methods are free from the potentially adverse effects of analgesics, noninvasive, and easy to perform.

Effects of antiviral treatment on influenza-related complications over four influenza seasons: 2006-2010.

PubMed

Spagnuolo, Philip J; Zhang, Mengxi; Xu, Yaping; Han, Jian; Liu, Shuqian; Liu, Jinan; Lichtveld, Maureen; Shi, Lizheng

2016-08-01

The objective of the study is to evaluate the effect of antiviral treatment, pre-existing diseases, and sociodemographic factors on the risk of influenza-related complications and healthcare utilization. Case data was obtained from U.S. MarketScan Research Databases. Cases had a clinical diagnosis of influenza between 2006 and 2010 and continuous healthcare insurance from 90 days before to 30 days after diagnosis. Logistic regression models were applied to explore the impact of antiviral treatment on complications and healthcare utilization. Modified generalized estimating equation regression models in propensity score matched samples were used to address the robustness of the study. Analyses included 1,557,437 cases from four influenza seasons. In each season, 34.82%-43.42% of patients received antiviral treatment, mostly oseltamivir. On average, 1.86% of patients were hospitalized, 9.56% visited the emergency room and 41.14% made ≥2 outpatient visits. The incidence of complications ranged from 17.62 to 19.67 per 100 patient-months. The relative risk of complications was increased in patients aged 0-4 years and those with pre-existing diseases, including asthma, Parkinson's disease, and cystic fibrosis. Overall, patients receiving antiviral treatment had an 11% reduction in the risk of complications. Among oseltamivir-treated patients, the risk of complications was significantly reduced by 81% in those treated ≤2 days after diagnosis compared with later. Antiviral treatment significantly reduced the risk of hospitalization, emergency room visits and need for ≥2 outpatient visits by 29%, 24% and 11%, respectively. The propensity score matching method improved the strength of the study. Early treatment with antivirals, and specifically oseltamivir, significantly reduced the risk of influenza-related complications and healthcare utilization. However, lacking information about disease severity and the time from onset of symptoms to fulfillment of a prescription may bias the outcomes.