Prescription drug abuse: problem, policies, and implications.

PubMed

Phillips, Janice

2013-01-01

This article provides an overview on prescription drug abuse and highlights a number of related legislative bills introduced during the 112th Congress in response to this growing epidemic. Prescription drug abuse has emerged as the nation's fastest growing drug problem. Although prescription drugs have been used effectively and appropriately for decades, deaths from prescription pain medicine in particular have reached epidemic proportions. Bills related to prescription drug abuse introduced during the 112th Congress focus on strengthening provider and consumer education, tracking and monitoring prescription drug abuse, improving data collection on drug overdose fatalities, combating fraud and abuse in Medicare and Medicaid programs, reclassifying drugs to make them more difficult to prescribe and obtain, and enforcing stricter penalties for individuals who operate scam pain clinics and sell pain pills illegitimately. This article underscores the importance of a multifaceted approach to combating prescription drug abuse and concludes with implications for nursing. Copyright © 2013. Published by Mosby, Inc.

Clinical correlates of co-occurring cannabis and tobacco use: a systematic review.

PubMed

Peters, Erica N; Budney, Alan J; Carroll, Kathleen M

2012-08-01

  A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e. concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use.   A systematic review of the literature on clinical diagnoses, psychosocial problems and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users versus cannabis- or tobacco-only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys.   Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be associated consistently with a greater likelihood of tobacco use disorders, more psychosocial problems or poorer tobacco cessation outcomes.   Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Interprofessional collaboration in research, education, and clinical practice: working together for a better future.

PubMed

Green, Bart N; Johnson, Claire D

2015-03-01

Interprofessional collaboration occurs when 2 or more professions work together to achieve common goals and is often used as a means for solving a variety of problems and complex issues. The benefits of collaboration allow participants to achieve together more than they can individually, serve larger groups of people, and grow on individual and organizational levels. This editorial provides an overview of interprofessional collaboration in the areas of clinical practice, education, and research; discusses barriers to collaboration; and suggests potential means to overcome them.

[Metastasis tumors of the central nervous system: molecular biology].

PubMed

Bello, M Josefa; González-Gómez, P; Rey, J A

2004-12-01

Metastases in the nervous system represent an important and growing problem in the clinical practice, being the cause of a great mortality in the developed countries. This article reviews the few data available on the molecular mechanisms involved in the pathogenesis of these tumours, leading to oncogene activation, inactivation of tumour suppressor genes, not only by the classical mechanisms, but also by the tumour cell epigenetic balance alteration. We conclude that all this knowledge will lead in the future to a better diagnosis, treatment and clinic evolution of these patients.

Interprofessional collaboration in research, education, and clinical practice: working together for a better future

PubMed Central

Green, Bart N.; Johnson, Claire D.

2015-01-01

Interprofessional collaboration occurs when 2 or more professions work together to achieve common goals and is often used as a means for solving a variety of problems and complex issues. The benefits of collaboration allow participants to achieve together more than they can individually, serve larger groups of people, and grow on individual and organizational levels. This editorial provides an overview of interprofessional collaboration in the areas of clinical practice, education, and research; discusses barriers to collaboration; and suggests potential means to overcome them. PMID:25594446

Neurobehavioral deficits in premature graduates of intensive care--potential medical and neonatal environmental risk factors.

PubMed

Perlman, J M

2001-12-01

There is growing evidence that a large number of very low birth weight infants are exhibiting neurobehavioral problems in the absence of cerebral palsy at follow-up that has extended into school age and adolescence. Many clinical factors (ie, chronic lung disease, recurrent apnea and bradycardia, transient hypothyroxemia of prematurity, hyperbilirubinemia, nutritional deficiencies, glucocorticoid exposure), as well as stressful environmental conditions, including infant-provider interaction, constant noise, and bright light, may act in combination to impact on the developing brain, even in the absence of overt hemorrhage and/or ischemia. Any potential intervention strategy designed to prevent cognitive and behavioral problems has to account for the numerous biological and clinical conditions and/or interventions, as well as postdischarge social and environmental influences.

Practice databases and their uses in clinical research.

PubMed

Tierney, W M; McDonald, C J

1991-04-01

A few large clinical information databases have been established within larger medical information systems. Although they are smaller than claims databases, these clinical databases offer several advantages: accurate and timely data, rich clinical detail, and continuous parameters (for example, vital signs and laboratory results). However, the nature of the data vary considerably, which affects the kinds of secondary analyses that can be performed. These databases have been used to investigate clinical epidemiology, risk assessment, post-marketing surveillance of drugs, practice variation, resource use, quality assurance, and decision analysis. In addition, practice databases can be used to identify subjects for prospective studies. Further methodologic developments are necessary to deal with the prevalent problems of missing data and various forms of bias if such databases are to grow and contribute valuable clinical information.

Considerations for planning and conducting clinic-based research in physical therapy.

PubMed

Fitzgerald, G K; Delitto, A

2001-08-01

There is growing demand to increase the volume of clinic-based research in physical therapy. Special considerations, unique to the planning and conduct of clinic-based research, need to be addressed to increase the likelihood that these studies will be completed successfully. The purposes of this perspective are to discuss factors affecting clinic-based research and to offer suggestions for addressing these problems when designing and conducting research studies in a clinical setting. This perspective discusses issues such as patient management, determining the availability of target patient populations, acquiring support from physical therapists and physicians, reporting and managing research-related injury or illness, and modifying or terminating projects. Some of the points made in this perspective are illustrated using examples from the authors' experiences in conducting clinical research.

Clinical validity of prototype personality disorder ratings in adolescents.

PubMed

Defife, Jared A; Haggerty, Greg; Smith, Scott W; Betancourt, Luis; Ahmed, Zain; Ditkowsky, Keith

2015-01-01

A growing body of research shows that personality pathology in adolescents is clinically distinctive and frequently stable into adulthood. A reliable and useful method for rating personality pathology in adolescent patients has the potential to enhance conceptualization, dissemination, and treatment effectiveness. The aim of this study is to examine the clinical validity of a prototype matching approach (derived from the Shedler Westen Assessment Procedure-Adolescent Version) for quantifying personality pathology in an adolescent inpatient sample. Sixty-six adolescent inpatients and their parents or legal guardians completed forms of the Child Behavior Checklist (CBCL) assessing emotional and behavioral problems. Clinical criterion variables including suicide history, substance use, and fights with peers were also assessed. Patients' individual and group therapists on the inpatient unit completed personality prototype ratings. Prototype diagnoses demonstrated substantial reliability (median intraclass correlation coefficient =.75) across independent ratings from individual and group therapists. Personality prototype ratings correlated with the CBCL scales and clinical criterion variables in anticipated and meaningful ways. As seen in prior research with adult samples, prototype personality ratings show clinical validity across independent clinician raters previously unfamiliar with the approach, and they are meaningfully related to clinical symptoms, behavioral problems, and adaptive functioning.

Clinical Validity of Prototype Personality Disorder Ratings in Adolescents

PubMed Central

DeFife, Jared A.; Haggerty, Greg; Smith, Scott W.; Betancourt, Luis; Ahmed, Zain; Ditkowsky, Keith

2015-01-01

A growing body of research shows that personality pathology in adolescents is clinically distinctive and frequently stable into adulthood. A reliable and useful method for rating personality pathology in adolescent patients has the potential to enhance conceptualization, dissemination, and treatment effectiveness. The aim of this study is to examine the clinical validity of a prototype matching approach (derived from the Shedler Westen Assessment Procedure – Adolescent Version) for quantifying personality pathology in an adolescent inpatient sample. Sixty-six adolescent inpatients and their parents or legal guardians completed forms of the Child Behavior Checklist (CBCL) assessing emotional and behavioral problems. Clinical criterion variables including suicide history, substance use, and fights with peers were also assessed. Patients’ individual and group therapists on the inpatient unit completed personality prototype ratings. Prototype diagnoses demonstrated substantial reliability (median ICC = .75) across independent ratings from individual and group therapists. Personality prototype ratings correlated with the CBCL scales and clinical criterion variables in anticipated and meaningful ways. As seen in prior research with adult samples, prototype personality ratings show clinical validity across independent clinician raters previously unfamiliar with the approach, and they are meaningfully related to clinical symptoms, behavioral problems, and adaptive functioning. PMID:25457971

An exploration of the properties of the CORE problem list subset and how it facilitates the implementation of SNOMED CT

PubMed Central

Xu, Julia

2015-01-01

Objective Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) is the emergent international health terminology standard for encoding clinical information in electronic health records. The CORE Problem List Subset was created to facilitate the terminology’s implementation. This study evaluates the CORE Subset’s coverage and examines its growth pattern as source datasets are being incorporated. Methods Coverage of frequently used terms and the corresponding usage of the covered terms were assessed by “leave-one-out” analysis of the eight datasets constituting the current CORE Subset. The growth pattern was studied using a retrospective experiment, growing the Subset one dataset at a time and examining the relationship between the size of the starting subset and the coverage of frequently used terms in the incoming dataset. Linear regression was used to model that relationship. Results On average, the CORE Subset covered 80.3% of the frequently used terms of the left-out dataset, and the covered terms accounted for 83.7% of term usage. There was a significant positive correlation between the CORE Subset’s size and the coverage of the frequently used terms in an incoming dataset. This implies that the CORE Subset will grow at a progressively slower pace as it gets bigger. Conclusion The CORE Problem List Subset is a useful resource for the implementation of Systematized Nomenclature of Medicine Clinical Terms in electronic health records. It offers good coverage of frequently used terms, which account for a high proportion of term usage. If future datasets are incorporated into the CORE Subset, it is likely that its size will remain small and manageable. PMID:25725003

[Pregnancy in New World camelids].

PubMed

Gauly, M; Bourke, D

1997-01-01

There is a growing number of llama- and alpacabreeders in Europe. Therefore veterinarians are often asked to intervene in clinical management of different problems, especially reproductive problems. In this review the authors attempt to summarize the different possibilities of pregnancy diagnosis and to give an short overview of reproduction in female llamas and alpacas. South American Camelids are induced ovulators and ovulation will occur within 12 to 24 hours following a single breeding. Llamas and alpacas develop follicular waves. The females will usually not ovulate unless a 7 mm or larger follicle exist on one of the ovaries. Corpus luteum is needed for maintenance of pregnancy.

Education in the workplace for the physician: clinical management states as an organizing framework.

PubMed

Greenes, R A

2000-01-01

Medical educators are interested in approaches to making selected relevant knowledge available in the context of problem-based care. This is of value both during the process of care and as a means of organizing information for offline self-study. Four trends in health information technology are relevant to achieving the goal and can be expected to play a growing role in the future. First, health care enterprises are developing approaches for access to information resources related to the care of a patient, including clinical data and images but also communication tools, referral and other logistic tools, decision support, and educational materials. Second, information for patients and methods for patient-doctor interaction and decision making are becoming available. Third, computer-based methods for representation of practice guidelines are being developed to support applications that can incorporate their logic. Finally, considering patients as being in particular "clinical management states" (or CMSs) for specific problems, approaches are being developed to use guidelines as a kind of "predictive" framework to enable development of interfaces for problem-based clinical encounters. The guidelines for a CMS can be used to identify the kinds of resources specifically needed for clinical encounters of that type. As the above trends converge to produce problem-specific environments, professional specialty organizations and continuing medical education course designers will need to focus energies on organizing and updating medical knowledge to make it available in CMS-specific contexts.

Impact of Growing Up with a Chronically Ill Sibling on Well Siblings' Late Adolescent Functioning

PubMed Central

Fleary, Sasha A.; Heffer, Robert W.

2013-01-01

The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted. PMID:24959574

Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice.

PubMed

Chi, Donald L

2017-07-01

A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Value-Based Medicine and Integration of Tumor Biology.

PubMed

Brooks, Gabriel A; Bosserman, Linda D; Mambetsariev, Isa; Salgia, Ravi

2017-01-01

Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems. Costs of cancer care continue to grow, with targeted therapies responsible for an increasing proportion of spending. Rising costs are bringing the concept of value into sharper focus and challenging the oncology community with implementation of value-based cancer care. This article explores the ways that the genomic revolution is transforming cancer care, describes various frameworks for considering the value of genomically targeted therapies, and outlines key challenges for delivering on the promise of personalized cancer care. It highlights practical solutions for the implementation of value-based care, including investment in biomarker development and clinical trials to improve the efficacy of targeted therapy, the use of evidence-based clinical pathways, team-based care, computerized clinical decision support, and value-based payment approaches.

Obesity and heart failure with preserved ejection fraction: A growing problem.

PubMed

Prenner, Stuart B; Mather, Paul J

2017-12-14

Heart Failure with Preserved Ejection Fraction (HFpEF) is increasing in prevalence due to the aging of the United States population as well as the current obesity epidemic. While obesity is very common in patients with HFpEF, obesity may represent a specific phenotype of HFpEF characterized by unique hemodynamics and structural abnormalities. Obesity induces a systemic inflammatory response that may contribute to myocardial fibrosis and endothelial dysfunction. The most obese patients continue to be excluded from HFpEF clinical trials, and thus ongoing research is needed to determine the role of pharmacologic and interventional approaches in this growing population. Copyright © 2017 Elsevier Inc. All rights reserved.

The anti-vaccination movement and resistance to allergen-immunotherapy: a guide for clinical allergists.

PubMed

Behrmann, Jason

2010-09-15

Despite over a century of clinical use and a well-documented record of efficacy and safety, a growing minority in society questions the validity of vaccination and fear that this common public health intervention is the root-cause of severe health problems. This article questions whether growing public anti-vaccine sentiments might have the potential to spill-over into other therapies distinct from vaccination, namely allergen-immunotherapy. Allergen-immunotherapy shares certain medical vernacular with vaccination (e.g., allergy shots, allergy vaccines), and thus may become "guilty by association" due to these similarities. Indeed, this article demonstrates that anti-vaccine websites have begun unduly discrediting this allergy treatment regimen. Following an explanation of the anti-vaccine movement, the article aims to provide guidance on how clinicians can respond to patient fears towards allergen-immunotherapy in the clinical setting. This guide focuses on the provision of reliable information to patients in order to dispel misconceived associations between vaccination and allergen-immunotherapy, and the discussion of the risks and benefits of both therapies in order to assist patients in making autonomous decisions about their choice of allergy treatment.

Robust parameter extraction for decision support using multimodal intensive care data

PubMed Central

Clifford, G.D.; Long, W.J.; Moody, G.B.; Szolovits, P.

2008-01-01

Digital information flow within the intensive care unit (ICU) continues to grow, with advances in technology and computational biology. Recent developments in the integration and archiving of these data have resulted in new opportunities for data analysis and clinical feedback. New problems associated with ICU databases have also arisen. ICU data are high-dimensional, often sparse, asynchronous and irregularly sampled, as well as being non-stationary, noisy and subject to frequent exogenous perturbations by clinical staff. Relationships between different physiological parameters are usually nonlinear (except within restricted ranges), and the equipment used to measure the observables is often inherently error-prone and biased. The prior probabilities associated with an individual's genetics, pre-existing conditions, lifestyle and ongoing medical treatment all affect prediction and classification accuracy. In this paper, we describe some of the key problems and associated methods that hold promise for robust parameter extraction and data fusion for use in clinical decision support in the ICU. PMID:18936019

Generalist solutions to overprescribing: a joint challenge for clinical and academic primary care.

PubMed

Reeve, Joanne; Bancroft, Rebecca

2014-01-01

Polypharmacy is a phenomenon of modern health care that can offer benefits in terms of patient outcomes. Known risks associated with so-called inappropriate polypharmacy can be reduced through good medicine management and appropriate use of clinical guidelines. However, we now see a growing literature highlighting additional risks to individual well-being and social functioning not recognised within these existing frameworks - the burden of polypharmacy and a problem of overprescribing. We need a new approach to defining and understanding inappropriate polypharmacy from a person-centred perspective. This paper discusses practice-based work exploring the impact of introducing generalist needs assessment for elderly patients with multiple chronic morbidities. The work suggests that generalist care offers something 'different' to current chronic disease management models, but highlights the need for formal evaluation to determine whether it is 'better'. We call for new collaborative research between clinical and academic partners to address the question as to whether generalist care offers solutions to the problems of the burden of polypharmacy.

Nontuberculous Mycobacteria Isolation from Clinical and Environmental Samples in Iran: Twenty Years of Surveillance.

PubMed

Velayati, Ali Akbar; Farnia, Parissa; Mozafari, Mohadese; Mirsaeidi, Mehdi

2015-01-01

Nontuberculous mycobacteria (NTM) are opportunistic pathogens that are widely distributed in the environment. There is a lack of data on species distribution of these organisms from Iran. This study consists of a review of NTM articles published in Iran between the years 1992 and 2014. In this review, 20 articles and 14 case reports were identified. Among the 20 articles, 13 (65%) studies focused on NTM isolates from clinical specimens, 6 (30%) studies examined NTM isolates from environmental samples, and one (5%) article included both clinical and environmental isolates. M. fortuitum (229/997; 23%) was recorded as the most prevalent and rapid growing mycobacteria (RGM) species in both clinical (28%) and environmental (19%) isolated samples (P < 0.05). Among slow growing mycobacteria (SGM), M. simiae (103/494; 21%) demonstrated a higher frequency in clinical samples whereas in environmental samples it was M. flavescens (44/503; 9%). These data represent information from 14 provinces out of 31 provinces of Iran. No information is available in current published data on clinical or environmental NTM from the remaining 17 provinces in Iran. These results emphasize the potential importance of NTM as well as the underestimation of NTM frequency in Iran. NTM is an important clinical problem associated with significant morbidity and mortality in Iran. Continued research is needed from both clinical and environmental sources to help clinicians and researchers better understand and address NTM treatment and prevention.

Nontuberculous Mycobacteria Isolation from Clinical and Environmental Samples in Iran: Twenty Years of Surveillance

PubMed Central

Velayati, Ali Akbar; Farnia, Parissa; Mozafari, Mohadese

2015-01-01

Nontuberculous mycobacteria (NTM) are opportunistic pathogens that are widely distributed in the environment. There is a lack of data on species distribution of these organisms from Iran. This study consists of a review of NTM articles published in Iran between the years 1992 and 2014. In this review, 20 articles and 14 case reports were identified. Among the 20 articles, 13 (65%) studies focused on NTM isolates from clinical specimens, 6 (30%) studies examined NTM isolates from environmental samples, and one (5%) article included both clinical and environmental isolates. M. fortuitum (229/997; 23%) was recorded as the most prevalent and rapid growing mycobacteria (RGM) species in both clinical (28%) and environmental (19%) isolated samples (P < 0.05). Among slow growing mycobacteria (SGM), M. simiae (103/494; 21%) demonstrated a higher frequency in clinical samples whereas in environmental samples it was M. flavescens (44/503; 9%). These data represent information from 14 provinces out of 31 provinces of Iran. No information is available in current published data on clinical or environmental NTM from the remaining 17 provinces in Iran. These results emphasize the potential importance of NTM as well as the underestimation of NTM frequency in Iran. NTM is an important clinical problem associated with significant morbidity and mortality in Iran. Continued research is needed from both clinical and environmental sources to help clinicians and researchers better understand and address NTM treatment and prevention. PMID:26180788

Antibacterial resistance leadership group: open for business.

PubMed

Chambers, Henry F; Bartlett, John G; Bonomo, Robert A; Chiou, Christine; Cosgrove, Sara E; Cross, Heather R; Daum, Robert S; Downing, Michele; Evans, Scott R; Knisely, Jane; Kreiswirth, Barry N; Lautenbach, Ebbing; Mickley, Brenda S; Patel, Robin; Pettigrew, Melinda M; Rodvold, Keith A; Spellberg, Brad; Fowler, Vance G

2014-06-01

Funded by the National Institute of Allergy and Infectious Diseases, the Antibacterial Resistance Leadership Group (ARLG) is tasked with developing a clinical research agenda and conducting clinical studies to address the growing public health threat of antibacterial resistance. The ARLG has identified 4 high-priority areas of research: infections caused by gram-negative bacteria, infections caused by gram-positive bacteria, antimicrobial stewardship and infection prevention, and diagnostics. The ARLG will be accepting proposals from the scientific community for clinical research that addresses 1 or more of these high-priority areas. These studies should have the potential to transform medical practice and be unlikely to occur without ARLG support. The purpose of this article is to make interested parties aware of clinical research opportunities made available by ARLG and to encourage submission of clinical research proposals that address the problem of antibacterial resistance.

Obstructive sleep apnea syndrome: An important piece in the puzzle of cardiovascular risk factors.

PubMed

Costa, Cátia; Santos, Beatriz; Severino, Davide; Cabanelas, Nuno; Peres, Marisa; Monteiro, Isabel; Leal, Margarida

2015-01-01

The obstructive sleep apnea syndrome (OSA) is a clinical entity characterized by recurring episodes of apnea and/or hypopnea during sleep, due to a total or partial collapse, respectively, of the upper airway. This collapse originates a set of pathophysiological changes that determine the appearance of several cardiovascular complications. OSA contributes for the development of hypertension, heart failure, arrhythmias and coronary heart disease. Nowadays it is recognized to be an important public health problem, taking into account not just its repercussions but also its prevalence, since the main risk factor for the disease is obesity, a growing problem worldwide, both in developed and developing countries. The present review summarizes the current knowledge about OSA, as regards its definition, pathophysiology, clinical manifestations, diagnosis, cardiovascular effects and treatment. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

[ANSYS simulation of subcutaneous pustule electrical characteristics].

PubMed

Liu, Baohua; Wang, Xuan; Zhu, Honglian; Wang, Guoyong

2011-12-01

With the growing number of clinical surgery, post-operative surgical wound infection has become a very difficult clinical problem. In the treatments of it, non-invasive test of wound infection and healing status has a significance in clinical medicine practice. In this paper, beginning with the electrical properties of skin tissue structure and on the basis of the electromagnetism and the human anatomy, using the finite element analysis software, we applied safe voltage on the 3D skin model, performed the subcutaneous pustule simulation study and gained the relational curve between depth and radius of the pustule model. The simulation results suggested that the method we put forward could be feasible, and it could provide basis for non-invasive detection of wound healing and wound infection status.

A fast 3D region growing approach for CT angiography applications

NASA Astrophysics Data System (ADS)

Ye, Zhen; Lin, Zhongmin; Lu, Cheng-chang

2004-05-01

Region growing is one of the most popular methods for low-level image segmentation. Many researches on region growing have focused on the definition of the homogeneity criterion or growing and merging criterion. However, one disadvantage of conventional region growing is redundancy. It requires a large memory usage, and the computation-efficiency is very low especially for 3D images. To overcome this problem, a non-recursive single-pass 3D region growing algorithm named SymRG is implemented and successfully applied to 3D CT angiography (CTA) applications for vessel segmentation and bone removal. The method consists of three steps: segmenting one-dimensional regions of each row; doing region merging to adjacent rows to obtain the region segmentation of each slice; and doing region merging to adjacent slices to obtain the final region segmentation of 3D images. To improve the segmentation speed for very large volume 3D CTA images, this algorithm is applied repeatedly to newly updated local cubes. The next new cube can be estimated by checking isolated segmented regions on all 6 faces of the current local cube. This local non-recursive 3D region-growing algorithm is memory-efficient and computation-efficient. Clinical testings of this algorithm on Brain CTA show this technique could effectively remove whole skull, most of the bones on the skull base, and reveal the cerebral vascular structures clearly.

Review of near-infrared methods for wound assessment

NASA Astrophysics Data System (ADS)

Sowa, Michael G.; Kuo, Wen-Chuan; Ko, Alex C.-T.; Armstrong, David G.

2016-09-01

Wound management is a challenging and costly problem that is growing in importance as people are living longer. Instrumental methods are increasingly being relied upon to provide objective measures of wound assessment to help guide management. Technologies that employ near-infrared (NIR) light form a prominent contingent among the existing and emerging technologies. We review some of these technologies. Some are already established, such as indocyanine green fluorescence angiography, while we also speculate on others that have the potential to be clinically relevant to wound monitoring and assessment. These various NIR-based technologies address clinical wound management needs along the entire healing trajectory of a wound.

It shouldn't happen to a dog … or a veterinarian: clinical paradigms for canine vector-borne diseases.

PubMed

Irwin, Peter J

2014-02-01

Canine vector-borne diseases (CVBDs) comprise a diverse group of viral, bacterial, protozoal, and helminth pathogens, transmitted predominantly by ticks and fleas, and cause significant health problems for dogs worldwide. Growing numbers of reports indicate that CVBDs are emerging in regions where they previously did not exist and this, combined with pathogens that are inherently difficult to detect, is providing companion animal veterinarians with some significant diagnostic challenges. This review discusses six paradigms concerning the diagnosis, treatment, prevention, and zoonotic implications of CVBDs from a veterinary clinical perspective. Copyright © 2013 Elsevier Ltd. All rights reserved.

Laboratory animals as surrogate models of human obesity

PubMed Central

Nilsson, Cecilia; Raun, Kirsten; Yan, Fei-fei; Larsen, Marianne O; Tang-Christensen, Mads

2012-01-01

Obesity and obesity-related metabolic diseases represent a growing socioeconomic problem throughout the world. Great emphasis has been put on establishing treatments for this condition, including pharmacological intervention. However, there are many obstacles and pitfalls in the development process from pre-clinical research to the pharmacy counter, and there is no certainty that what has been observed pre-clinically will translate into an improvement in human health. Hence, it is important to test potential new drugs in a valid translational model early in their development. In the current mini-review, a number of monogenetic and polygenic models of obesity will be discussed in view of their translational character. PMID:22301857

The growing problems of dental caries and obesity: an Australian perspective.

PubMed

Hopcraft, M S; Beaumont, S

2016-10-07

Preventable diet-related diseases such as dental caries and obesity are a growing global problem, causing a significant burden on public health systems. Although there has been good evidence for the links between sugar consumption and dental caries for many decades, we are now seeing stronger links implicating sugar in obesity. There is a growing worldwide movement to tackle these problems by targeting the consumption of sugar-sweetened beverages through a range of public policy measures.

The anti-vaccination movement and resistance to allergen-immunotherapy: a guide for clinical allergists

PubMed Central

2010-01-01

Despite over a century of clinical use and a well-documented record of efficacy and safety, a growing minority in society questions the validity of vaccination and fear that this common public health intervention is the root-cause of severe health problems. This article questions whether growing public anti-vaccine sentiments might have the potential to spill-over into other therapies distinct from vaccination, namely allergen-immunotherapy. Allergen-immunotherapy shares certain medical vernacular with vaccination (e.g., allergy shots, allergy vaccines), and thus may become "guilty by association" due to these similarities. Indeed, this article demonstrates that anti-vaccine websites have begun unduly discrediting this allergy treatment regimen. Following an explanation of the anti-vaccine movement, the article aims to provide guidance on how clinicians can respond to patient fears towards allergen-immunotherapy in the clinical setting. This guide focuses on the provision of reliable information to patients in order to dispel misconceived associations between vaccination and allergen-immunotherapy, and the discussion of the risks and benefits of both therapies in order to assist patients in making autonomous decisions about their choice of allergy treatment. PMID:20843332

Hematologic problems in pediatric patients.

PubMed

Cahill, M

1996-02-01

To provide a review of the common hematologic disorders of childhood: iron deficiency anemia, aplastic anemia, sickle cell disease, and hemophilia. Review articles and book chapters pertaining to the care and treatment of children with hematologic disorders. These common hematologic disorders of childhood have the potential to cause not only acute illness but chronic medical problems, particularly in the growing child. Anticipating and preventing the long-term effects of the illness and treatment are the primary goals of care. Nursing assessment, patient education, and long-term follow-up are major factors in the care of children with hematologic disorders. Nurse-managed comprehensive care clinics have provided successful programs directed at acute care and maintenance care for these children and their families.

A Start-Up Company Grown Up

NASA Astrophysics Data System (ADS)

Zou, Mark

2003-03-01

This is the story of a young Ph.D. from MIT who, after a brief stint at a major MRI company, identified an important need for custom rf coil manufacturing. Beginning with a single order in 1993, he grew his company, USA Instruments, to have 250 employees, $35M in sales, a 65,000-square-foot headquarters, a ranking high on the Inc. 500 list of America's fastest-growing private companies, and many business awards. And most recently, GE Medical Systems has acquired USAI with the intention of growing it even further. Dr. Zou will describe how his physics background has played a pivotal role in solving technical and business problems in the development of pioneering rf coils, most recently multi-channel systems to speed up magnetic resonance clinical imaging.

The existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review.

PubMed

Salmani, Zahra; Zargham-Boroujeni, Ali; Salehi, Mehrdad; K Killeen, Therese; Merghati-Khoei, Effat

2015-07-01

In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, "pearl-growing" techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, "orgasm AND intervention". Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women' sexual problems such as FOD in the Iranian settings.

Cognitive hypnotherapy for pain management.

PubMed

Elkins, Gary; Johnson, Aimee; Fisher, William

2012-04-01

Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.

Fragile X--a challenge to models of the mind and to best clinical practice.

PubMed

Hay, David A

2008-06-01

Cornish et al. (2008, this issue) provide an excellent review of Fragile X a common but very complex cause of intellectual disability. They report on a cohort of such males of normal intelligence quotient (IQ) and socioeconomic status (SES), but who have deficits in selective attention and growing impairment in response inhibition. This paper has theoretical views for our models of the mind and clinical implications for families where Fragile X may never have been considered as a possible cause of some of the problems in male and female family members and possibly as well for other disorders such as attention deficit hyperactivity disorder (ADHD) and autism.

Expanding the PACS archive to support clinical review, research, and education missions

NASA Astrophysics Data System (ADS)

Honeyman-Buck, Janice C.; Frost, Meryll M.; Drane, Walter E.

1999-07-01

Designing an image archive and retrieval system that supports multiple users with many different requirements and patterns of use without compromising the performance and functionality required by diagnostic radiology is an intellectual and technical challenge. A diagnostic archive, optimized for performance when retrieving diagnostic images for radiologists needed to be expanded to support a growing clinical review network, the University of Florida Brain Institute's demands for neuro-imaging, Biomedical Engineering's imaging sciences, and an electronic teaching file. Each of the groups presented a different set of problems for the designers of the system. In addition, the radiologists did not want to see nay loss of performance as new users were added.

Medical service plans in academic medical centers.

PubMed

Siegel, B

1978-10-01

Medical service plans are of major importance to academic medical centers and are becoming increasingly so each year as evidenced by growing dependence of medical schools on resulting funds. How these funds are generated and used varies among schools. The procedures may affect the governance of the institution, modifying the authority of the central administration or the clinical departments. Recent developments in federal legislation, such as health maintenance organizations and amendments (Section 227) to the Social Security Act, and the future development of national health insurance will certainly have an effect on how academic medical centers organize their clinical activities. How successfully various medical schools deal with the dynamic problem may well determine their future survival.

Drug-resistant tuberculosis clinical trials: proposed core research definitions in adults.

PubMed

Furin, J; Alirol, E; Allen, E; Fielding, K; Merle, C; Abubakar, I; Andersen, J; Davies, G; Dheda, K; Diacon, A; Dooley, K E; Dravnice, G; Eisenach, K; Everitt, D; Ferstenberg, D; Goolam-Mahomed, A; Grobusch, M P; Gupta, R; Harausz, E; Harrington, M; Horsburgh, C R; Lienhardt, C; McNeeley, D; Mitnick, C D; Nachman, S; Nahid, P; Nunn, A J; Phillips, P; Rodriguez, C; Shah, S; Wells, C; Thomas-Nyang'wa, B; du Cros, P

2016-03-01

Drug-resistant tuberculosis (DR-TB) is a growing public health problem, and for the first time in decades, new drugs for the treatment of this disease have been developed. These new drugs have prompted strengthened efforts in DR-TB clinical trials research, and there are now multiple ongoing and planned DR-TB clinical trials. To facilitate comparability and maximise policy impact, a common set of core research definitions is needed, and this paper presents a core set of efficacy and safety definitions as well as other important considerations in DR-TB clinical trials work. To elaborate these definitions, a search of clinical trials registries, published manuscripts and conference proceedings was undertaken to identify groups conducting trials of new regimens for the treatment of DR-TB. Individuals from these groups developed the core set of definitions presented here. Further work is needed to validate and assess the utility of these definitions but they represent an important first step to ensure there is comparability in clinical trials on multidrug-resistant TB.

Echinocandin Resistance in Candida Species: a Review of Recent Developments.

PubMed

Wiederhold, Nathan P

2016-12-01

The echinocandins are important agents for the treatment of invasive fungal infections, especially those caused by Candida species. However, as with other antimicrobial agents, microbiologic resistance to this class of antifungal agents has emerged and can result in clinical failure. Several studies have recently reported an increase in echinocandin resistance in Candida glabrata isolates at various medical centers in different geographic regions of the USA. Recent studies have also reported that many of these isolates may also be fluconazole resistant, leaving few treatment options available for clinicians to use in patients with invasive candidiasis caused by this species. Our understanding of the clinical relevance of specific point mutations within the FKS genes that cause echinocandin resistance and risk factors for the development of microbiologic resistance and clinical failure have also increased. The purpose of this review is to discuss echinocandin resistance in Candida species and recent reports that have increased our understanding of this growing clinical problem.

Return of Individual Research Results & Incidental Findings: Facing the Challenges of Translational Science

PubMed Central

Wolf, Susan M.

2014-01-01

The debate over return of individual research results and incidental findings to research participants is a key frontier in research ethics and practice. Fundamentally, this is a problem of translational science, a question of when information about an individual that is generated in research should be communicated for clinical attention, as the technology itself is moving into clinical care. There is growing consensus that investigators should offer participants at least those individual findings of high clinical importance and actionability. Increasing attention to what information biobanks and secondary researchers owe people who provide data and samples offers an opportunity to treat these source individuals as research partners. Cutting-edge issues include return of results in pediatric populations and return to kin and family, including after death of the proband. Progress will require facing the continuum linking research and clinical care and developing standards and models for return. PMID:23875796

Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s.

PubMed

Lewis, Michael D

2016-07-01

Traumatic brain injury (TBI), with its diverse heterogeneity and prolonged secondary pathogenesis, remains a clinical challenge. Clinical studies thus far have failed to identify an effective treatment strategy when a combination of targets controlling aspects of neuroprotection, neuroinflammation, and neuroregeneration is needed. Omega-3 fatty acids (n-3FA) offer the advantage of this approach. Although further clinical trial research is needed, there is a growing body of strong preclinical evidence and clinical experience that suggests that benefits may be possible from aggressively adding substantial amounts of n-3FA to optimize the nutritional foundation of TBI, concussion, and postconcussion syndrome patients. Early and optimal doses of n-3FA, even in a prophylactic setting, have the potential to improve outcomes from this potentially devastating problem. With evidence of unsurpassed safety and tolerability, n-3FA should be considered mainstream, conventional medicine, if conventional medicine can overcome its inherent bias against nutritional, nonpharmacologic therapies.

Fighting infections due to multidrug-resistant Gram-positive pathogens.

PubMed

Cornaglia, G

2009-03-01

Growing bacterial resistance in Gram-positive pathogens means that what were once effective and inexpensive treatments for infections caused by these bacteria are now being seriously questioned, including penicillin and macrolides for use against pneumococcal infections and-in hospitals-oxacillin for use against staphylococcal infections. As a whole, multidrug-resistant (MDR) Gram-positive pathogens are rapidly becoming an urgent and sometimes unmanageable clinical problem. Nevertheless, and despite decades of research into the effects of antibiotics, the actual risk posed to human health by antibiotic resistance has been poorly defined; the lack of reliable data concerning the outcomes resulting from antimicrobial resistance stems, in part, from problems with study designs and the methods used in resistence determination. Surprisingly little is known, too, about the actual effectiveness of the many types of intervention aimed at controlling antibiotic resistance. New antibiotics active against MDR Gram-positive pathogens have been recently introduced into clinical practice, and the antibiotic pipeline contains additional compounds at an advanced stage of development, including new glycopeptides, new anti-methicillin-resistant Staphylococcus aureus (MRSA) beta-lactams, and new diaminopyrimidines. Many novel antimicrobial agents are likely to be niche products, endowed with narrow antibacterial spectra and/or targeted at specific clinical problems. Therefore, an important educational goal will be to change the current, long-lasting attitudes of both physicians and customers towards broad-spectrum and multipurpose compounds. Scientific societies, such as the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), must play a leading role in this process.

[Potential antimicrobial drug interactions in clinical practice: consequences of polypharmacy and multidrug resistance].

PubMed

Martínez-Múgica, Cristina

2015-12-01

Polypharmacy is a growing problem nowadays, which can increase the risk of potential drug interactions, and result in a loss of effectiveness. This is particularly relevant to the anti-infective therapy, especially when infection is produced by resistant bacteria, because therapeutic options are limited and interactions can cause treatment failure. All antimicrobial prescriptions were retrospectively reviewed during a week in the Pharmacy Department, in order to detect potential drug-interactions and analysing their clinical significance. A total of 314 antimicrobial prescriptions from 151 patients were checked. There was at least one potential interaction detected in 40% of patients, being more frequent and severe in those infected with multidrug-resistant microorganisms. Drugs most commonly involved were quinolones, azoles, linezolid and vancomycin. Potential drug interactions with antimicrobial agents are a frequent problem that can result in a loss of effectiveness. This is why they should be detected and avoided when possible, in order to optimize antimicrobial therapy, especially in case of multidrug resistant infections.

High power phased array prototype for clinical high intensity focused ultrasound : applications to transcostal and transcranial therapy.

PubMed

Pernot, M; Aubry, J -F; Tanter, M; Marquet, F; Montaldo, G; Boch, A -L; Kujas, M; Seilhean, D; Fink, M

2007-01-01

Bursts of focused ultrasound energy three orders of magnitude more intense than diagnostic ultrasound became during the last decade a noninvasive option for treating cancer from breast to prostate or uterine fibroid. However, many challenges remain to be addressed. First, the corrections of distortions induced on the ultrasonic therapy beam during its propagation through defocusing obstacles like skull bone or ribs remain today a technological performance that still need to be validated clinically. Secondly, the problem of motion artifacts particularly important for the treatment of abdominal parts becomes today an important research topic. Finally, the problem of the treatment monitoring is a wide subject of interest in the growing HIFU community. For all these issues, the potential of new ultrasonic therapy devices able to work both in Transmit and Receive modes will be emphasized. A review of the work under achievement at L.O.A. using this new generation of HIFU prototypes on the monitoring, motion correction and aberrations corrections will be presented.

Ambiguous genitalia, gender-identity problems, and sex reassignment.

PubMed

Dittmann, R W

1998-01-01

This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.

[Post launch studies].

PubMed

Akaza, Hideyuki; Ohashi, Yasuo; Shimada, Yasuhiro; Ikeda, Tadashi; Saijo, Nagahiro; Isonishi, Seiji; Hirao, Yoshihiko; Tsuruo, Takashi; Tsukagoshi, Shigeru; Sone, Saburo; Nakamura, Seigo; Kato, Masuhiro; Mikami, Osamu; von Euler, Mikael; Blackledge, George; Milsted, Bob; Vose, Brent

2002-11-01

Evidence Based Medicine (EBM) is a growing concept in Japan as it is elsewhere. Central to improving the use of EBM is generation of data through well conducted controlled clinical studies. There are many problems associated with conduct of clinical studies after launch in Japan, and many initiatives are ongoing to improve the situation. Development of Clinical Research Coordinators (CRO) and central Data Management centers are key to improving the quality of clinical research in Japan. Currently Japan has an undeveloped legal system with regard to post-launch trials and off-label use of registered drugs. There is no reimbursement for off-label and various restrictions imposed on the recipients of the Ministry of Health, Labour and Welfare's (MHLW) funds. Maybe the biggest problem is the high cost of post-marketing studies sponsored by pharmaceutical manufacturers. A high quality system to support post launch clinical studies need a solid financial base. There is a need for a suitable review system for investigator initiated multi-centre studies, as the current IRB system is not sufficient. There are also challenges regarding the differences, perceived or real, in treatment practice and available registrations in Japan and in the West, causing problems in choosing suitable comparators and study designs. At the present time it is not clear whether investigator initiated trials will be acceptable for registration purposes in Japan. The agreed first priority is to build a suitable and strong infrastructure within the academic community to support researchers to investigate important questions with or without pharmaceutical company support. Despite all these issues, several groundbreaking projects are under way throughout Japan, in many different areas and by different collaborative groups, some with government support. In fact, researcher-initiated clinical trials achieved a rapid growth in Japan in the past year.

Use of bioreactors in maxillofacial tissue engineering.

PubMed

Depprich, Rita; Handschel, Jörg; Wiesmann, Hans-Peter; Jäsche-Meyer, Janine; Meyer, Ulrich

2008-07-01

Engineering of various oral tissues is a challenging issue in contemporary maxillofacial reconstructive research. In contrast to the classic biomaterial approach, tissue engineering is based on the understanding of cell driven tissue formation, and aims to generate new functional tissues, rather than just to implant non-living space holders. Researchers hope to reach this goal by combining knowledge from biology, physics, materials science, engineering, and medicine in an integrated manner. Several major technical advances have been made in this field during the last decade, and clinical application is at the stage of first clinical trials. A recent limitation of extracorporally engineered cellular substitutes is the problem of growing enlarged tissues ex vivo. One of the main research topics is therefore to scale up artificial tissue constructs for use in extended defect situations. To overcome the monolayer inherent two-dimensional cell assembly, efforts have been made to grow cells in a three-dimensional space. Bioreactors have therefore been in focus for a considerable time to build up enlarged tissues. The shift from the ex vivo approach of cell multiplication to the generation of a real tissue growth is mirrored by the development of bioreactors, enabling scientists to grow more complex tissue constructs. This present review intends to provide an overview of the current state of art in maxillofacial tissue engineering by the use of bioreactors, its limitations and hopes, as well as the future research trends.

The history of COPD.

PubMed

Petty, Thomas L

2006-01-01

The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years. The stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose. Knowledge of the pathogenesis, course and prognosis, and new approaches to therapy have dramatically improved our understanding of this important clinical entity. Smoking cessation improves the early course of disease. Long-term oxygen improves the length and quality of life in selected patients with hypoxemia. Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.

Teens and the Misuse of Prescription Drugs: Evidence-Based Recommendations to Curb a Growing Societal Problem

ERIC Educational Resources Information Center

Twombly, Eric C.; Holtz, Kristen D.

2008-01-01

The misuse of prescription drugs by teens in the United States is a growing public health problem. This article provides a systematic synthesis of multiple strands of literature to recommend effective prevention methods. Using a social-ecological framework, we review the scope of the problem of prescription drug use among teens. Then, we analyze…

Problems in diagnosis and treatment of tuberculosis infection.

PubMed

Tsara, V; Serasli, E; Christaki, P

2009-01-01

Tuberculosis is still a major health problem in industrialized countries due to specific socioeconomic factors and there is the growing need of new rapid and accurate diagnostic methods, in order to achieve higher sensitivity and specificity compared to traditional methods of microscopic sputum examination and culture. Such methods, recently introduced, are nucleic acid amplification (NAA) tests, used directly on clinical specimens and blood tests (QuantiFERON-TB, T-SPOT.TB test), measuring the IFN-gamma released by stimulated T cells. Furthermore, new drugs for the disease need to be developed, aiming to better treatment results and to prevention of Multiple Drug Resistance (MDR) cases. Critical aspects in the management of drug resistance cases should be the careful choices of drugs combination, the close follow up of the patients alongside with the patients adherence to therapy. The role of national and international tuberculosis programs is invaluable in TB control and therapy, as well as the collaboration of all the health system departments. However, most of the clinical problems that may arise are addressed by the International Standards for Tuberculosis Care-ISTC and these guidelines should be taken into consideration, at least until future research provides more promising diagnostic and therapeutic modalities for control of the disease.

Methadone maintenance and the problem with alcohol.

PubMed

Siassi, I; Alston, D C

1976-01-01

There is a growing concern with the rapid pace of physical and psychosocial deterioration of methadone patients who abuse alcohol. The need for a sample method for determining the extent of the problem, as well as the presence of an alcohol problem in individual patients, led the authors to test the validity of the Michigan Alcoholism Sreen Test (MAST) in a small urban methadone maintenance clinic (N = 125). The MAST was administered to every patient by their counselors, and the nursing staff was asked to independently rate each patient according to Keller's definition of alcoholism. The authors compared the patients' MAST scores with the global ratings of the nursing staff. Forty-six percent (n = 58) of the patients scored in the alcoholism range of the MAST questionnaire, while 34% (n = 43) of the patients were diagnosed as alcoholics by the nursing staff. There was 75% (n = 94) agreement between the MAST findings and the nurses' global ratings (p less than .001). The authors suggest that the MAST could be an effective screening tool in the area of alcohol abuse in methadone clinics. Going beyond the data, the authors recommend reexamination by psychiatrists of their peripheral role in the treatment of these difficult and multihandicapped patients.

Privacy enhancing techniques - the key to secure communication and management of clinical and genomic data.

PubMed

De Moor, G J E; Claerhout, B; De Meyer, F

2003-01-01

To introduce some of the privacy protection problems related to genomics based medicine and to highlight the relevance of Trusted Third Parties (TTPs) and of Privacy Enhancing Techniques (PETs) in the restricted context of clinical research and statistics. Practical approaches based on two different pseudonymisation models, both for batch and interactive data collection and exchange, are described and analysed. The growing need of managing both clinical and genetic data raises important legal and ethical challenges. Protecting human rights in the realm of privacy, while optimising research potential and other statistical activities is a challenge that can easily be overcome with the assistance of a trust service provider offering advanced privacy enabling/enhancing solutions. As such, the use of pseudonymisation and other innovative Privacy Enhancing Techniques can unlock valuable data sources.

Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

PubMed Central

Schechner, Vered; Temkin, Elizabeth; Harbarth, Stephan; Carmeli, Yehuda

2013-01-01

SUMMARY Bacterial resistance to antibiotics is a growing clinical problem and public health threat. Antibiotic use is a known risk factor for the emergence of antibiotic resistance, but demonstrating the causal link between antibiotic use and resistance is challenging. This review describes different study designs for assessing the association between antibiotic use and resistance and discusses strengths and limitations of each. Approaches to measuring antibiotic use and antibiotic resistance are presented. Important methodological issues such as confounding, establishing temporality, and control group selection are examined. PMID:23554418

Prophylactic antibiotics in dermatological surgery.

PubMed

Lee, Michael R; Paver, Robert

2016-05-01

This is a review of the common pathogens of surgical site infections, antibiotic coverage for particular anatomical sites, mechanisms by which surgical site infections occur and the latest data and recommendations for prophylactic antibiotics in the prevention of surgical site infections, infective endocarditis and haematogenous joint infections. Recent evidence-based guidelines on surgical prophylaxis is for restricted indications and a shorter duration of antibiotic prophylaxis in situations where no clinical benefit of prolonged therapy has been proven, in order to minimise the potential adverse ecological and clinical effects associated with antibiotic therapy. This review recommends the cautious use of prophylactic antibiotics in dermatological surgery to help prevent the growing problem of bacterial resistance as well as other morbidity and health-care costs. © 2015 The Australasian College of Dermatologists.

A strategy of clinical tolerance for the prevention of HIV and AIDS in China.

PubMed

Wang, Y

2000-02-01

HIV infection and AIDS create many dilemmas in Chinese AIDS/HIV prevention policy. A strategy of clinical tolerance is proposed to address these dilemmas. The immediate purpose of the strategy of clinical tolerance is to win the cooperation of members of stigmatized groups at high risk for contracting HIV infection and AIDS, which occurs as a result of acts done in private and thus beyond the reach of regulation. The strategy of clinical tolerance differs from both tolerance as liberal tolerance and tolerance as a moral ideal of tolerance. A strategy of clinical tolerance does not ask the government, health worker, health official or the public to change either laws or the disapproval of prostitution, homosexuality and drug use. A strategy of clinical tolerance asks, instead, that we weigh what we may regard as the wrong involved in prostitution, homosexuality, and drug use against the greater evil of an HIV/AIDS epidemic. A strategy of clinical tolerance offers the most effective and practical way to confront a growing and significant public health problem in China.

What Should We Tell Our Patients About Marijuana (Cannabis indica and Cannabis sativa)?

PubMed

Pizzorno, Joseph

2016-12-01

With several states allowing medicinal use of marijuana and a growing number decriminalizing recreational use, many of our patients are using this herbal drug. Approximately 43% of US adults have tried marijuana, with 13% using it regularly. These users are seeking help from integrative medicine practitioners regarding safety. They are looking for advice based on research and clinical experience, not politics or philosophical bias. The major health problems caused by marijuana appear to be bronchial irritation, decreased motivation, learning difficulties, and injuries. However, less well appreciated are the toxicity problems caused by contamination with pesticides and solvent residues. We have important guidance to help prevent unnecessary toxicity in our patients who choose to use marijuana. This editorial reviews toxicity and safety. Medicinal use will be addressed in the future.

What critical care nurses need to know about health care access when caring for elders in acute care settings.

PubMed

Jennings, Bonnie Mowinski; Lamb, Gerri

2007-09-01

Health care system issues, in general, and access to care, in particular, are not problems typically studied by critical care nurses. Rather, initial and continuing education focuses on clinical aspects of care. This focus is necessary to assure that critical care nurses have the expertise to care for patients who need astute surveillance for complicated physical problems and their emotional sequelae, as well as in-depth knowledge and skills related to care coordination for patient stabilization and transfer. However, evidence is growing that patients benefit when critical care nurses expand their knowledge about access to care. This article provides insights regarding access to health care and how it relates to many of the admission and readmission patterns that critical care nurses observe.

SHEPHERD CREEK, CINCINNATI, OH: USING TRADABLE CREDITS TO CONTROL EXCESS STORMWATER RUNOFF

EPA Science Inventory

The problem of managing stormwater runoff grows apace with continued urbanization, yet the management tools for this growing non-point source problem have not fully kept up. The rapid growth of stormwater utilities around the nation is an important step toward providing an ef...

Cochrane Lecture 1997. What evidence do we need for evidence based medicine?

PubMed Central

Hart, J T

1997-01-01

As presently understood, evidence based medicine aims to advance practice from its traditional unverifiable mix of art and science to rational use of measurable inputs and outputs. In practice, however, its advocates accept uncritically a desocialised definition of science, assume that major clinical decisions are taken at the level of secondary specialist rather than primary generalist care, and ignore the multiple nature of most clinical problems, as well as the complexity of social problems within which clinical problems arise and have to be solved. These reductionist assumptions derive from the use of evidence based medicine as a tool for managed care in a transactional model for consultations. If these assumptions persist, they will strengthen reification of disease and promote the episodic output of process regardless of health outcome. We need to work within a different paradigm based on development of patients as co-producers rather than consumers, promoting continuing output of health gain through shared decisions using all relevant evidence, within a broader, socialised definition of science. Adoption of this model would require a major social and cultural shift for health professionals. This shift has already begun, promoted by changes in public attitudes to professional authority, changes in the relation of professionals to managers, and pressures for improved effectiveness and efficiency which, contrary to received wisdom, seem more likely to endorse cooperative than transactional clinical production. Progress on these lines is resisted by rapidly growing and extremely powerful economic and political interests. Health professionals and strategists have yet to recognise and admit the existence of this choice. PMID:9519124

The laboratory workforce shortage: a managerial perspective.

PubMed

Cortelyou-Ward, Kendall; Ramirez, Bernardo; Rotarius, Timothy

2011-01-01

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

A hyaluronic acid membrane delivery system for cultured keratinocytes: clinical "take" rates in the porcine kerato-dermal model.

PubMed

Myers, S R; Grady, J; Soranzo, C; Sanders, R; Green, C; Leigh, I M; Navsaria, H A

1997-01-01

The clinical take rates of cultured keratinocyte autografts are poor on a full-thickness wound unless a dermal bed is provided. Even under these circumstances two important problems are the time delay in growing autografts and the fragility of the grafts. A laser-perforated hyaluronic acid membrane delivery system allows grafting at early confluence without requiring dispase digestion to release grafts from their culture dishes. We designed this study to investigate the influence of this membrane on clinical take rates in an established porcine kerato-dermal grafting model. The study demonstrated a significant reduction in take as a result of halving the keratinocyte seeding density onto the membrane. The take rates, however, of grafts grown on the membrane at half or full conventional seeding density and transplanted to a dermal wound bed were comparable, if not better, than those of keratinocyte sheet grafts.

Enterococci from artisanal dairy products show high levels of adaptability.

PubMed

Carlos, Ana Rita; Santos, Jorge; Semedo-Lemsaddek, Teresa; Barreto-Crespo, Maria Teresa; Tenreiro, Rogério

2009-02-15

Enterococci are ubiquitous organisms able to promote both health (fermented food/probiotics) and illness (human/animal infections). Disturbingly, several enterococcal species commonly found in artisanal cheeses, such as Enterococcus faecalis and E. faecium, are being increasingly established as causes of infection, posing a problem for food safety. In this study enterococci from ewe's milk and cheese were compared to clinical and reference strains by growth in media simulating environmental colonization and infection sites: 2YT, BHI, skim milk, urine and rabbit serum at different pHs, NaCl concentrations and temperatures. Growth curves were obtained with Microbiology Workstation Bioscreen C and used to calculate relative indexes--RIs--(based on absorbance, lag phase and specific growth rate) for each strain and environmental condition. Similar or higher RIs were obtained for food strains growing in infection-related environments when compared to clinical ones, revealing their ability to adapt and grow in these conditions. A dendrogram built using Pearson's correlation coefficient and a PCA analysis clustered the strains regardless of their origin or species allocation, suggesting a strain-specific mode of growth and a high environmental adaptability of enterococcal strains. These evidences turn essential the evaluation of strains to be used as starters or probiotics.

[The environment as a reservoir for antimicrobial resistance : A growing problem for public health?

PubMed

Westphal-Settele, Kathi; Konradi, Sabine; Balzer, Frederike; Schönfeld, Jens; Schmithausen, Ricarda

2018-05-01

Antimicrobial resistance (AMR) is a threat to public and animal health on the global scale. The origin of the genes associated with resistance has long been unknown. Recently, there is a growing body of evidence demonstrating that environmental bacteria are resistant to a multitude of antibiotic substances and that this environmental reservoir of AMR is still growing. The analysis of the genomes of bacterial pathogens indicates that they have acquired their resistance profiles by incorporating different genetic elements through horizontal gene transfer. The ancestors of pathogenic bacteria, as well as the origin of resistance determinants, lay most likely in the environmental microbiota. Indeed, there is some evidence that at least some clinically relevant resistance genes have originated in environmental bacterial species. Thus, feasible measures are required to reduce the risks posed by AMR genes and resistant bacteria that occur in the environment. It has been shown that a concurrence of factors, such as high concentrations of antibiotics or heavy metals used as biocides and high bacterial densities, promote development and spread of antimicrobial resistance. For this purpose, it is essential to restrict the use of antibiotics for the treatment of livestock and humans to medical necessity, as well as to reduce the application of biocides and heavy metals in animal husbandry. Moreover, it is important to further develop sanitary measures at the interface between the environment and clinical settings or livestock farming.

The CROWN initiative: journal editors invite researchers to develop core outcomes in women’s health

PubMed Central

2014-01-01

Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a "core outcomes set" - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women's health have come together to support The CROWN (CoRe Outcomes in WomeN's health) Initiative. PMID:25048583

The CROWN initiative: journal editors invite researchers to develop core outcomes in women’s health

PubMed Central

2014-01-01

Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a “core outcomes set” - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women’s health have come together to support The CROWN (CoRe Outcomes in WomeN’s health) Initiative. PMID:24957208

The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health

PubMed Central

2014-01-01

Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a "core outcomes set" - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women's health have come together to support The CROWN (CoRe Outcomes in WomeN's health) Initiative. PMID:25050130

An update on anesthetics and impact on the brain.

PubMed

Fodale, Vincenzo; Tripodi, Vincenzo F; Penna, Olivia; Famà, Fausto; Squadrito, Francesco; Mondello, Epifanio; David, Antonio

2017-09-01

While anesthetics are indispensable clinical tools and generally considered safe and effective, a growing concern over the potential neurotoxicity of anesthesia or specific anesthetic agents has called into question the safety of general anesthetics, especially when administered at extremes of age. Areas covered: This article reviews and updates research findings on the safety of anesthesia and anesthetics in terms of long-term neurotoxicity, with particular focus on postoperative cognitive dysfunctions, Alzheimer's disease and dementias, developing brain, post-operative depression and autism spectrum disorder. Expert opinion: Exposure to general anesthetics is potentially harmful to the human brain, and the consequent long-term cognitive deficits should be classified as an iatrogenic pathology, and considered a public health problem. The fact that in laboratory and clinical research only certain anesthetic agents and techniques, but not others, appear to be involved, raises the problem on what is the safest and the least safe anesthetic to maximize anesthesia efficiency, avoid occurrence of adverse events, and ensure patient safety. New trends in research are moving toward the theory that neuroinflammation could be the hallmark of, or could have a pivotal role in, several neurological disorders.

Role of the pharmacist in reducing healthcare costs: current insights

PubMed Central

Dalton, Kieran; Byrne, Stephen

2017-01-01

Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists’ work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets. PMID:29354549

Co-occurring Disordered Gambling Among Treatment-Seekers at a Community Outpatient Addiction Clinic.

PubMed

Elman, Igor; Borodovsky, Jacob; Howard, Margaret; Scoglio, Arielle; Steinkamp, Jackson; Sobieszczyk, Amy; Mysels, David; Albanese, Mark

2016-01-01

Parallel to the ongoing expansion of legalized gambling activities is a growing concern about rising occurrence of uncontrollable gambling. People with preexisting gambling and/or chemical addictions may be particularly vulnerable, but the extent of such co-occurring conditions and their demographic and clinical characteristics have not been sufficiently elucidated. To that end, the present study attempted to both, quantify the presence and to characterize co-occurring pathological or problem gambling (ie, respectively, at least 1- or at least 5 pathological gambling criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) among treatment-seeking patients at a community outpatient addiction program. The patients were assessed with the South Oaks Gambling Screen and their charts were reviewed for the extraction of demographic and clinical information according to a predetermined template. Data from 183 subjects withstood quality control procedures and were included. The prevalence rates of co-occurring problem- (18.6%) and pathological (10.9%) gambling were strikingly higher than those found in the general population (2% and 0.5%, respectively). No increase in the clinical severity indices was observed across the gambling groups. Our data replicate those of prior studies reporting heightened prevalence of problematic gambling in patients with substance use disorders and extend the prior findings by including a subject population of treatment-seekers. In the era of the gambling industry growth, these results call for creation and/or adjustment of clinical addiction services to meet emerging preventive and therapeutic needs.

Nodular Fasciitis in the Axillary Tail of the Breast

PubMed Central

Samardzic, Dejan; Chetlen, Alison; Malysz, Jozef

2014-01-01

Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass. PMID:25426226

Prevention and early identification of elder abuse.

PubMed

Burnett, Jason; Achenbaum, W Andrew; Murphy, Kathleen Pace

2014-11-01

Elder abuse is a public health problem growing more pervasive despite being grossly underreported and underdetected. Annually, many vulnerable older adults suffer various forms of abuse threatening their overall health, quality of life, and survival. To better protect our aging population, we must overcome obstacles such as ageism, lack of geriatric health professional training, and low screening practices in clinical settings. Addressing these challenges is not sufficient for eliminating the abuse of older adults, but it is necessary for diminishing the potential for abuse and the associated negative health outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Tuberous Sclerosis

MedlinePlus

... on where the tumors grow. They could include Skin problems, such as light patches and thickened skin Seizures Behavior problems Intellectual disabilities Kidney problems Some people have signs ...

Facts about Texas Children. Excerpted from Children, Choice, and Change.

ERIC Educational Resources Information Center

Harris, Lorwen Connie

The environment in which Texas children grow up is crucial to their future and to the future of the state. Almost 500,000 Texas families were poor in 1985. Poverty sets the stage for numerous childhood maladies: infant mortality, health problems, child abuse, learning disabilities, malnutrition, and mental health problems. As poor children grow up…

Bariatric amputee: A growing problem?

PubMed

Kulkarni, Jai; Hannett, Dominic P; Purcell, Steven

2015-06-01

This study reviewed prevalence of patients with lower limb amputations with above normal weight profile, with body mass index over 25, in seven disablement services centres managing their amputee rehabilitation in the United Kingdom. To review two clinical standards of practice in amputee rehabilitation. Ambulant lower limb amputees should have their body weight recorded on an electronic information system, with identification of cohort with body weight >100 kg. Lower limb amputees to be provided with suitable weight-rated prosthesis. Observational study of clinical practice. Data were collected from the Clinical Information Management Systems. Inclusion criteria--subjects were ambulant prosthetic users with some prosthetic intervention in the last 5 years and had at least one lower limb amputation. In 96% of patients, the weight record profile was maintained. In addition, 86% were under 100 kg, which is the most common weight limit of prosthetic componentry. Of 15,204 amputation levels, there were 1830 transfemoral and transtibial sites in users with body weight over 100 kg. In 60 cases, the prosthetic limb build was rated to be below the user body weight. In 96% of our patients, body weight was documented, and in 97%, the prosthetic limb builds were within stated body weight limits, but this may not be the case in all the other disablement services centres in the United Kingdom. Also, the incidence of obesity in the United Kingdom is a growing problem, and the health issues associated with obesity are further compounded in the amputee population. Prosthetic componentry has distinct weight limits which must be considered during prescription. As people with amputation approach the limits of specific components, clinicians are faced with the challenge of continued provision in a safe and suitable manner. This article reviews the amputee population and the current national profile to consider trends in provision and the incidence of these challenges. © The International Society for Prosthetics and Orthotics 2014.

Assessing life stressors and social resources: applications to alcoholic patients.

PubMed

Moos, R H; Fenn, C B; Billings, A G; Moos, B S

A growing body of evidence points to the importance of life stressors and social resources in the development and course of alcoholism and other substance abuse disorders. This article describes the Life Stressors and Social Resources Inventory (LISRES), which provides an integrated assessment of life stressors and social resources in eight domains: physical health, home/neighborhood, financial, work, spouse/partner, children, extended family, and friends. The indices were developed on data obtained at two points in time 18 months apart from four demographically comparable groups: alcoholic patients, depressed patients, arthritic patients, and non-problem-drinking adults. As expected, alcoholic patients reported more acute and chronic stressors and fewer social resources than did non-problem-drinking adults. More important, the indices were predictively related to changes in alcohol consumption, drinking problems, depression, and self-confidence. Procedures such as the LISRES have some potential clinical and research applications and may be helpful in examining the process of recovery and relapse in substance abuse disorders.

What Should We Tell Our Patients About Marijuana (Cannabis indica and Cannabis sativa)?

PubMed Central

Pizzorno, Joseph

2016-01-01

With several states allowing medicinal use of marijuana and a growing number decriminalizing recreational use, many of our patients are using this herbal drug. Approximately 43% of US adults have tried marijuana, with 13% using it regularly. These users are seeking help from integrative medicine practitioners regarding safety. They are looking for advice based on research and clinical experience, not politics or philosophical bias. The major health problems caused by marijuana appear to be bronchial irritation, decreased motivation, learning difficulties, and injuries. However, less well appreciated are the toxicity problems caused by contamination with pesticides and solvent residues. We have important guidance to help prevent unnecessary toxicity in our patients who choose to use marijuana. This editorial reviews toxicity and safety. Medicinal use will be addressed in the future. PMID:28223891

Dementia Research: Populations, Progress, Problems, and Predictions.

PubMed

Hunter, Sally; Smailagic, Nadja; Brayne, Carol

2018-05-16

Alzheimer's disease (AD) is a clinicopathologically defined syndrome leading to cognitive impairment. Following the recent failures of amyloid-based randomized controlled trials to change the course of AD, there are growing calls for a re-evaluation of basic AD research. Epidemiology offers one approach to integrating the available evidence. Here we examine relationships between evidence from population-based, clinicopathological studies of brain aging and a range of hypotheses from all areas of AD research. We identify various problems, including a lack of systematic approach to measurement of clinical and neuropathological factors associated with dementia in experimental and clinical settings, poor understanding of the strengths and weaknesses of different observational and experimental designs, a lack of clarity in relation to disease definitions from the clinical, neuropathological, and molecular perspectives, inadequate characterization of brain aging in the human population, difficulties in translation between laboratory-based and population-based evidence bases, and a lack of communication between different sections of the dementia research community. Population studies highlight complexity and predict that therapeutic approaches based on single disease features will not be successful. Better characterization of brain aging in the human population is urgently required to select biomarkers and therapeutic targets that are meaningful to human disease. The generation of detailed and reliable evidence must be addressed before progress toward therapeutic interventions can be made.

Addressing mental health epidemic among university students via web-based, self-screening, and referral system: a preliminary study.

PubMed

Kim, Eung-Hun; Coumar, Anil; Lober, William B; Kim, Yongmin

2011-03-01

The prevalence and severity of mental health problems in college and university communities are alarming. However, the majority of students with mental disorders do not seek help from professionals. To help students assess their mental conditions and encourage them to take an active role in seeking care, we developed a web-based self-screening, referral, and secure communication system and evaluated it at the University of Washington for 17 months. The system handled more than 1000 screenings during the study period. Of the subjects who used the system, 75% noted that the system helped them to make a decision to receive help from professionals. The system was able to provide outreach to students with mental health concerns effectively, allow them to self-screen their conditions, and encourage them to receive professional assistance. The system provided students with 24/7 web-based access to the clinic, and more than 50% of the system use was made during off-hours. The system was well received by patients, referral managers, and care providers, and it was transferred to the clinic for daily clinical use. We believe that a web-based system like ours could be used as one way to tackle the growing epidemic of mental health problems among college and university students.

Clinical Research Informatics for Big Data and Precision Medicine.

PubMed

Weng, C; Kahn, M G

2016-11-10

To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI. We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research. The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges. The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors.

Clinical Research Informatics for Big Data and Precision Medicine

PubMed Central

Kahn, M. G.

2016-01-01

Summary Objectives To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI. Methods We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research. Results The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges. Conclusion The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors. PMID:27830253

Maximising the potential of part-time clinical teachers.

PubMed

Patston, Philip; Holmes, David; Maalhagh-Fard, Ahmad; Ting, Kang; Ziccardi, Vincent B

2010-12-01

A problem faced by health professions education throughout the world is a lack of full-time clinical teachers. This is particularly serious in dentistry and nursing, but is increasingly also true in medicine. To make up for this shortfall there is a growing reliance on part-time clinical teachers. Part-time clinical teachers are essential for the education of students. However, compared with their full-time counterparts, the part-time teachers are often not adequately prepared for their roles as educators within the context of the clinical curriculum. They might not be trained in the latest educational practices, and may be unprepared for the time needed to excel as teachers and mentors. As part-time teachers take on more responsibility, it is important that they take part in orientation and training sessions to assist them in developing the skills they need to succeed. This will require a significant commitment from the institution as well as the part-time teacher, but is critical for maintaining the academic quality of the clinical training programmes. This also represents an untapped area for research into how to ensure the success of part-time clinical teachers. © Blackwell Publishing Ltd 2010.

Perspective: Transforming science into medicine: how clinician-scientists can build bridges across research's "valley of death".

PubMed

Roberts, Scott F; Fischhoff, Martin A; Sakowski, Stacey A; Feldman, Eva L

2012-03-01

Significant increases in National Institutes of Health (NIH) spending on medical research have not produced corresponding increases in new treatments and cures. Instead, laboratory discoveries remain in what has been termed the "valley of death," the gap between bench research and clinical application. Recently, there has been considerable discussion in the literature and scientific community about the causes of this phenomenon and how to bridge the abyss. In this article, the authors examine one possible explanation: Clinician-scientists' declining role in the medical research enterprise has had a dilatory effect on the successful translation of laboratory breakthroughs into new clinical applications. In recent decades, the percentage of MDs receiving NIH funding has drastically decreased compared with PhDs. The growing gap between the research and clinical enterprises has resulted in fewer scientists with a true understanding of clinical problems as well as scientists who are unable to or uninterested in gleaning new basic research hypotheses from failed clinical trials. The NIH and many U.S. medical schools have recognized the decline of the clinician-scientist as a major problem and adopted innovative programs to reverse the trend. However, more radical action may be required, including major changes to the NIH peer-review process, greater funding for translational research, and significantly more resources for the training, debt relief, and early career support of potential clinician-scientists. Such improvements are required for clinician-scientists to conduct translational research that bridges the valley of death and transforms biomedical research discoveries into tangible clinical treatments and technologies.

U.S. healthcare fix: leveraging the lessons from the food supply chain.

PubMed

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Is the malpractice crisis filtering down to family planning?

PubMed

1986-06-01

Evidence now exists that the insurance industry is including contraceptive researchers and family planning clinics in its crackdown on malpractice and liability policies. Family planning practioners have been lumped together with private physicians under the category "Profit-buster" for most major insurers, and the effects are just beginning to show. The liability problems of family planning clinics overlap those of physicians and drug companies. Essentially, they, too, can be held responsible for the products they prescribe and dispense to their clients. When the family planning clinic of NEWCAP, Inc., a community action program in Wisconsin, was abruptly dropped by its insurer in November, the staff was puzzled. NEWCAP had a spotless record and had experienced no previous insurance problems. The insurance company justified its actions by explaining it was getting out of the malpractice field altogether. Although NEWCAP's dilemma seems to be unique at this time, family planning organizations are concerned about the future. The malpractice crackdown also is causing problems for contraceptive researchers. Over the past few years, research and development programs have suffered because of difficulty in obtaining product liability insurance. Due to insurance costs, the Popuation Council's US clinical trials of the promising NORPLANT contraceptive implant were pared down to the minimum number required for Food and Drug Administration approval. Family Planning International's clinical trials of the biodegradable contraceptive implant Capronor have been postponed because an insurer could not be found. Acquiring insurance does not put the researcher over the hurdle, according to Richard Lincoln, senior vice president of the Alan Guttmacher Institute. There are more problems ahead after the research is completed. Dr. Harold Nash, New York's Population Council, has some suggestions for alleviating what seems to be a growing problem. If interest rates increase and insurers raise rates across the board, "they will start seeing a good return on their investments, and the problem will just go away," he said. "But if that doesn't happen, and maybe even if it does, some legislative remedies are needed to control all this litigation." Several different ideas now are being considered by state legislatures and by Congress. One suggestion is to limit the contingency fees that lawyers can charge. Another is to limit the amount of damages that can be levied based on pain and suffering. A third considers the problem of frivolous suits and would require a plantiff entering into a trivial suit to pay the expenses incurred by the defendant.

Senior Alcohol Services Revisited: Elderly Alcoholism--Current State of the Art.

ERIC Educational Resources Information Center

Dunlop, Jean D.

This report notes the growing awareness of alcohol problems among the elderly during the past 5 to 10 years, and reviews the final conclusions of the federal demonstration project, Senior Alcohol Services. Five basic concepts are included: (1) there are a growing number of elderly persons with alcohol problems (10-15% of all persons over age 60);…

Statistical challenges in a regulatory review of cardiovascular and CNS clinical trials.

PubMed

Hung, H M James; Wang, Sue-Jane; Yang, Peiling; Jin, Kun; Lawrence, John; Kordzakhia, George; Massie, Tristan

2016-01-01

There are several challenging statistical problems identified in the regulatory review of large cardiovascular (CV) clinical outcome trials and central nervous system (CNS) trials. The problems can be common or distinct due to disease characteristics and the differences in trial design elements such as endpoints, trial duration, and trial size. In schizophrenia trials, heavy missing data is a big problem. In Alzheimer trials, the endpoints for assessing symptoms and the endpoints for assessing disease progression are essentially the same; it is difficult to construct a good trial design to evaluate a test drug for its ability to slow the disease progression. In CV trials, reliance on a composite endpoint with low event rate makes the trial size so large that it is infeasible to study multiple doses necessary to find the right dose for study patients. These are just a few typical problems. In the past decade, adaptive designs were increasingly used in these disease areas and some challenges occur with respect to that use. Based on our review experiences, group sequential designs (GSDs) have borne many successful stories in CV trials and are also increasingly used for developing treatments targeting CNS diseases. There is also a growing trend of using more advanced unblinded adaptive designs for producing efficacy evidence. Many statistical challenges with these kinds of adaptive designs have been identified through our experiences with the review of regulatory applications and are shared in this article.

Privacy protection for clinical and genomic data. The use of privacy-enhancing techniques in medicine.

PubMed

Claerhout, B; DeMoor, G J E

2005-03-01

Privacy includes the right of individuals and organisations to determine for themselves when, how and to what extent information about them is communicated to others. The growing need of managing large amounts of both clinical and genetic data raises important legal and ethical challenges. This paper introduces some of the privacy-protection problems related to classical and genomic medicine, and highlights the relevance of trusted third parties and of privacy-enhancing techniques (PETs) in the context of data collection, e.g., for research. Practical approaches based on two pseudonymisation models, for both batch data collection and interactive data storage, are presented. The actual application of the described techniques today proves the possible benefits for medicine that innovative privacy-enhancing techniques can provide. Technical PET solutions can unlock valuable data sources, otherwise not available.

Rapid bacterial antibiotic susceptibility test based on simple surface-enhanced Raman spectroscopic biomarkers

NASA Astrophysics Data System (ADS)

Liu, Chia-Ying; Han, Yin-Yi; Shih, Po-Han; Lian, Wei-Nan; Wang, Huai-Hsien; Lin, Chi-Hung; Hsueh, Po-Ren; Wang, Juen-Kai; Wang, Yuh-Lin

2016-03-01

Rapid bacterial antibiotic susceptibility test (AST) and minimum inhibitory concentration (MIC) measurement are important to help reduce the widespread misuse of antibiotics and alleviate the growing drug-resistance problem. We discovered that, when a susceptible strain of Staphylococcus aureus or Escherichia coli is exposed to an antibiotic, the intensity of specific biomarkers in its surface-enhanced Raman scattering (SERS) spectra drops evidently in two hours. The discovery has been exploited for rapid AST and MIC determination of methicillin-susceptible S. aureus and wild-type E. coli as well as clinical isolates. The results obtained by this SERS-AST method were consistent with that by the standard incubation-based method, indicating its high potential to supplement or replace existing time-consuming methods and help mitigate the challenge of drug resistance in clinical microbiology.

Self-growing neural network architecture using crisp and fuzzy entropy

NASA Technical Reports Server (NTRS)

Cios, Krzysztof J.

1992-01-01

The paper briefly describes the self-growing neural network algorithm, CID2, which makes decision trees equivalent to hidden layers of a neural network. The algorithm generates a feedforward architecture using crisp and fuzzy entropy measures. The results of a real-life recognition problem of distinguishing defects in a glass ribbon and of a benchmark problem of differentiating two spirals are shown and discussed.

Lowering Student Loan Default Rates: What One Consortium of Historically Black Institutions Did to Succeed. Education Sector Reports

ERIC Educational Resources Information Center

Dillon, Erin; Smiles, Robin V.

2010-01-01

Colleges across the nation are struggling to confront a growing problem in higher education: student debt. As more students borrow more money than ever before, and recent graduates enter the worst job market in a generation, students are increasingly unable to pay back their loans. This report discusses the growing problem of students defaulting…

Enabling an Open Data Ecosystem for the Neurosciences.

PubMed

Wiener, Martin; Sommer, Friedrich T; Ives, Zachary G; Poldrack, Russell A; Litt, Brian

2016-11-02

As the pace and complexity of neuroscience data grow, an open data ecosystem must develop and grow with it to allow neuroscientists the ability to reach for new heights of discovery. However, the problems and complexities of neuroscience data sharing must first be addressed. Among the challenges facing data sharing in neuroscience, the problem of incentives, discoverability, and sustainability may be the most pressing. We here describe these problems and provide potential future solutions to help cultivate an ecosystem for data sharing. Copyright © 2016 Elsevier Inc. All rights reserved.

Prevalence of orthorexia nervosa is less than 1 %: data from a US sample.

PubMed

Dunn, Thomas M; Gibbs, Josh; Whitney, Noelle; Starosta, Amy

2017-03-01

Orthorexia nervosa, or pathological dieting based on being "healthy," has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample. The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health. While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category. As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition.

Impact of Genetics on the Clinical Management of Channelopathies

PubMed Central

Schwartz, Peter J.; Ackerman, Michael J.; George, Alfred L.; Wilde, Arthur A.M.

2013-01-01

There are few areas in cardiology where the impact of genetics and of genetic testing on clinical management has been as great as in cardiac channelopathies, arrhythmic disorders of genetic origin related to the ionic control of the cardiac action potential. Among the growing number of diseases identified as channelopathies, three are sufficiently prevalent to represent significant clinical and societal problems and to warrant adequate understanding by practicing cardiologists: long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome. This review will focus selectively on the impact of genetic discoveries on clinical management of these three diseases. For each disorder, we will discuss to what extent genetic knowledge and clinical genetic test results modify the way cardiologists should approach and manage affected patients. We will also address the optimal use of genetic testing including its potential limitations and the potential medico-legal implications when such testing is not performed. We will highlight how important can be to understand the ways by which genotype can impact clinical manifestations, risk stratification, and responses to the therapy. We will also illustrate the close bridge between molecular biology and clinical medicine, and will emphasize that consideration of the genetic basis for these hereditable arrhythmia syndromes, as well as the proper use and interpretation of clinical genetic testing, should remain the standard-of-care. PMID:23684683

Late gastrointestinal effects of pelvic radiation: a nurse-led service.

PubMed

Ludlow, Helen; Green, John; Turner, Jeff

2017-02-23

There are currently at least 2 million people in the UK living with and following a cancer diagnosis. Typically four out of every ten people with cancer will receive radiotherapy, but a large proportion of people who have pelvic radiotherapy may go on to develop gastrointestinal (GI) symptoms. This includes rectal bleeding and faecal incontinence, which can have a huge impact on quality of life. These problems often go under-reported by patients and are also under-recognised or under-treated by health professionals. Cancer survivorship is a growing topic that is likely to have a major impact on the NHS, with increasing numbers of patients presenting. A late GI effects of pelvic radiotherapy clinic was set up to address these growing needs of patients with GI symptoms following radiotherapy. This article also shares insights from a doctoral study that is underway looking at people's experiences of living with symptoms following their treatment, in order to improve awareness of the major impact that this can have.

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

PubMed

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

2015-12-01

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

Making big data useful for health care: a summary of the inaugural mit critical data conference.

PubMed

Badawi, Omar; Brennan, Thomas; Celi, Leo Anthony; Feng, Mengling; Ghassemi, Marzyeh; Ippolito, Andrea; Johnson, Alistair; Mark, Roger G; Mayaud, Louis; Moody, George; Moses, Christopher; Naumann, Tristan; Pimentel, Marco; Pollard, Tom J; Santos, Mauro; Stone, David J; Zimolzak, Andrew

2014-08-22

With growing concerns that big data will only augment the problem of unreliable research, the Laboratory of Computational Physiology at the Massachusetts Institute of Technology organized the Critical Data Conference in January 2014. Thought leaders from academia, government, and industry across disciplines-including clinical medicine, computer science, public health, informatics, biomedical research, health technology, statistics, and epidemiology-gathered and discussed the pitfalls and challenges of big data in health care. The key message from the conference is that the value of large amounts of data hinges on the ability of researchers to share data, methodologies, and findings in an open setting. If empirical value is to be from the analysis of retrospective data, groups must continuously work together on similar problems to create more effective peer review. This will lead to improvement in methodology and quality, with each iteration of analysis resulting in more reliability.

The specificity of maternal parenting behavior and child adjustment difficulties: a study of inner-city African American families.

PubMed

Jones, Deborah J; Forehand, Rex; Rakow, Aaron; Colletti, Christina J M; McKee, Laura; Zalot, Alecia

2008-04-01

The specificity of the association between 2 parenting behaviors (warmth and supervision) and 2 indicators, aggressive behavior and depressive symptoms, of major child outcomes (externalizing problems and internalizing problems) was examined among 196 inner-city African American mothers and their school age children. Given the growing number of African American families affected by HIV/AIDS and demonstrated compromises in parenting associated with maternal infection, the moderating role of maternal HIV/AIDS was also examined. Findings from longitudinal analyses supported the specificity of maternal warmth but not of maternal supervision. Maternal warmth was a stronger predictor of decreases in child aggressive behavior than of decreases in depressive symptoms. In addition, maternal warmth was a stronger predictor of decreases in aggressive behavior than was maternal supervision. Parenting specificity was not moderated by maternal HIV/AIDS. Clinical implications and future research directions are discussed. (c) 2008 APA, all rights reserved.

Making Big Data Useful for Health Care: A Summary of the Inaugural MIT Critical Data Conference

PubMed Central

2014-01-01

With growing concerns that big data will only augment the problem of unreliable research, the Laboratory of Computational Physiology at the Massachusetts Institute of Technology organized the Critical Data Conference in January 2014. Thought leaders from academia, government, and industry across disciplines—including clinical medicine, computer science, public health, informatics, biomedical research, health technology, statistics, and epidemiology—gathered and discussed the pitfalls and challenges of big data in health care. The key message from the conference is that the value of large amounts of data hinges on the ability of researchers to share data, methodologies, and findings in an open setting. If empirical value is to be from the analysis of retrospective data, groups must continuously work together on similar problems to create more effective peer review. This will lead to improvement in methodology and quality, with each iteration of analysis resulting in more reliability. PMID:25600172

Bridging semantics and syntax with graph algorithms—state-of-the-art of extracting biomedical relations

PubMed Central

Uzuner, Özlem; Szolovits, Peter

2017-01-01

Research on extracting biomedical relations has received growing attention recently, with numerous biological and clinical applications including those in pharmacogenomics, clinical trial screening and adverse drug reaction detection. The ability to accurately capture both semantic and syntactic structures in text expressing these relations becomes increasingly critical to enable deep understanding of scientific papers and clinical narratives. Shared task challenges have been organized by both bioinformatics and clinical informatics communities to assess and advance the state-of-the-art research. Significant progress has been made in algorithm development and resource construction. In particular, graph-based approaches bridge semantics and syntax, often achieving the best performance in shared tasks. However, a number of problems at the frontiers of biomedical relation extraction continue to pose interesting challenges and present opportunities for great improvement and fruitful research. In this article, we place biomedical relation extraction against the backdrop of its versatile applications, present a gentle introduction to its general pipeline and shared resources, review the current state-of-the-art in methodology advancement, discuss limitations and point out several promising future directions. PMID:26851224

An evaluation of US patent 2015065565 (A1) for a new class of SGLT2 inhibitors for treatment 1 of type II diabetes mellitus.

PubMed

Jiang, Meiyan; Steyger, Peter S

2015-01-01

Type 2 diabetes mellitus (T2DM) is a growing and serious global health problem. Pharmacological inhibition of the sodium-glucose cotransporter-2 (SGLT2; SLC5A2) increases urinary glucose excretion, decreasing plasma glucose levels in an insulin-independent manner. Agents that inhibit SGLT2 have recently become available for clinical therapy of T2DM. The patent claims a new class of SGLT2 inhibitors: derivatives of dioxa-bicyclo[3.2.1]octane-2,3,4-triol (including ertugliflozin; PF-04971729). The invention describes the design, synthesis and pharmacological tests related to ertugliflozin, which could ultimately lead to efficacious therapy for T2DM alone or in combination with other anti-diabetic agents. Ertugliflozin is likely to be of great clinical significance in the near future. Continued analysis of ertugliflozin derivatives to now validate safe and efficacious treatment of T2DM in a larger number of clinical subjects over an extended period is needed to further support clinical utility. Identification, and discussion, of likely contra-indications is also needed.

Not Your Same Old Story: New Rules for Thematic Apperceptive Techniques (TATs).

PubMed

Jenkins, Sharon Rae

2017-01-01

Stories told about pictures have been used for both research and clinical practice since the beginning of modern personality assessment. However, with the growing science-practice gap, these thematic apperceptive techniques (TATs) have been used differently in those 2 venues. Scientific validation is presumptively general, but clinical application is idiographic and situation-specific. A bridge is needed. The manualized human-scored narrative analysis systems discussed here are valuable scientist-practitioner tools, but they require a validation literature to support further research publication, maintain their role in clinical training, and justify clinicians' reimbursement by third-party payers. To facilitate wider understanding of manualized TAT methodologies, this article addresses long-standing criticisms of TAT reliability and proposes some strategic solutions to the measurement error problem for both researchers and clinicians, including analyzing person-situation interactions, purposeful situation sampling for within-storyteller comparisons, and uses of small samples. The new rules for TATs include conceptual and methodological standards that researchers should aim to meet and report, reviewers should apply to manuscripts, and clinical assessors can use to analyze their own data and justify third-party payment.

Current update on portable dental equipment.

PubMed

Charlton, David G; Ehrlich, A D; Miniotis, Nicholas J

2007-02-01

The dental care needs of the elderly are increasing as their population grows. For some of the elderly (eg, the nonambulatory, homebound, institutionalized), accessing dental care is a problem because they are unable to visit a traditional dental clinic. In the past, dental care has been taken to the homebound or institutionalized elderly by dentists using portable dental equipment. However, the perception that such equipment is difficult or impossible to obtain has limited the availability of on-site care. The purpose of this article is to describe various types of portable dental equipment and their features so that dentists interested in providing care to this group of patients are aware of them.

Pay attention to serendipity.

PubMed

Haidrani, Layla

2017-03-22

When and why did you develop an interest in research? My first nursing job was as a staff nurse in an oncology intensive care unit and a bone marrow transplant unit taking care of patients who were participating in high intensity clinical trials. During my master's degree, I worked as a research assistant for two faculty members whose research was making an impact at state and national levels, and I was able to lead a small research project of my own. During my doctoral and post-doctoral studies, my research interests continued to grow. I find great meaning and purpose in identifying and solving difficult problems through research.

Nanosensors and nanomaterials for monitoring glucose in diabetes

PubMed Central

Cash, Kevin J.; Clark, Heather A.

2010-01-01

Worldwide, diabetes is a rapidly growing problem that is managed at the individual level by monitoring and controlling blood glucose levels to minimize the negative effects of the disease. Because of limitations in diagnostic methods, significant research efforts are focused on developing improved methods to measure glucose. Nanotechnology has impacted these efforts by increasing the surface area of sensors, improving the catalytic properties of electrodes and providing nanoscale sensors. Herein, we discuss developments in the past several years on both nanosensors that directly measure glucose as well as nanomaterials that improve glucose sensor function. Finally, we discuss challenges that must be overcome to apply these developments in the clinic. PMID:20869318

Clinical Challenges in the Growing Medical Marijuana Field.

PubMed

Barker, Jonathan

2018-03-01

Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients. [Full article available at http://rimed.org/rimedicaljournal-2018-03.asp].

Clinical Challenges in the Growing Medical Marijuana Field.

PubMed

Barker, Jonathan

2018-02-02

Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].

Harassment and Discrimination of Women in Employment. Working Paper Prepared for the Conference on Harassment in the Workplace (Washington, DC, July 7-9, 1981).

ERIC Educational Resources Information Center

Chapman, Gordon R., Ed.; And Others

The problem of harassment of women in the workplace has received increasing attention from government agencies, Congress, and the courts in recent years. This growing general awareness of the problem of harassment and sex discrimination by both employers and employees is being made more acute by women's growing demands for career opportunities…

An open trial of 'grief-help': a cognitive-behavioural treatment for prolonged grief in children and adolescents.

PubMed

Spuij, Mariken; Dekovic, Maja; Boelen, Paul A

2015-01-01

In the past years, there is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). Although mostly studied in adults, clinically significant PGD symptoms have also been observed in children and adolescents. To date, no effective treatment for childhood PGD yet exists. We recently developed a nine-session cognitive-behavioural treatment for childhood PGD combined with five sessions of parental counselling. In the current article, we present outcomes of treatment of 10 consecutive children and adolescents turning to our university clinic with elevated PGD symptoms as their primary problem and main reason to seek therapy. Patients were significantly improved at post-treatment, with large improvements in self-rated PGD and post-traumatic stress (effect sizes > 0.8) and small to moderate improvement in depression and parent-rated internalizing and externalizing problems (0.2 < effect sizes < 0.8). Additional predictor analysis of outcomes suggested that, among other things, this treatment approach is less efficacious for children and adolescents further removed from loss and those confronted with suicidal loss. That said, the treatment appears promising, and controlled evaluation is clearly indicated. Copyright © 2013 John Wiley & Sons, Ltd.

Machine Learning Approaches in Cardiovascular Imaging.

PubMed

Henglin, Mir; Stein, Gillian; Hushcha, Pavel V; Snoek, Jasper; Wiltschko, Alexander B; Cheng, Susan

2017-10-01

Cardiovascular imaging technologies continue to increase in their capacity to capture and store large quantities of data. Modern computational methods, developed in the field of machine learning, offer new approaches to leveraging the growing volume of imaging data available for analyses. Machine learning methods can now address data-related problems ranging from simple analytic queries of existing measurement data to the more complex challenges involved in analyzing raw images. To date, machine learning has been used in 2 broad and highly interconnected areas: automation of tasks that might otherwise be performed by a human and generation of clinically important new knowledge. Most cardiovascular imaging studies have focused on task-oriented problems, but more studies involving algorithms aimed at generating new clinical insights are emerging. Continued expansion in the size and dimensionality of cardiovascular imaging databases is driving strong interest in applying powerful deep learning methods, in particular, to analyze these data. Overall, the most effective approaches will require an investment in the resources needed to appropriately prepare such large data sets for analyses. Notwithstanding current technical and logistical challenges, machine learning and especially deep learning methods have much to offer and will substantially impact the future practice and science of cardiovascular imaging. © 2017 American Heart Association, Inc.

The vexing problem of thrombosis in long-term mechanical circulatory support.

PubMed

Mehra, Mandeep R; Stewart, Garrick C; Uber, Patricia A

2014-01-01

Durable left ventricular assist devices (LVADs) have not only enhanced longevity but also conferred sustained improvements in quality of life, symptom control, and functional capacity in patients with medically refractory advanced heart failure. Problems with device-related infection, bleeding, neurologic events, right-sided heart failure, and device malfunction have dominated the clinical care of patients living on mechanical support. Even as adoption of durable LVADs accelerated globally, we began to encounter a growing dilemma of pump malfunction caused by thrombosis. In early 2011, clinicians began to notice a spike in the incidence of pump thrombosis with the HeartMate II (Thoratec Corp, Pleasanton, CA) LVAD. By 2012, the problem of thrombosis in LVADs began to consume most of the scientific direction as centers and collaborative groups began to dissect this nascent phenomenon. In this perspective, we describe the magnitude and implications of pump thrombosis, discuss secular and management trends in this unique population, attempt to dissect the problem at its root, offer guidance on surveillance and therapeutic principles, and outline issues that deserve our immediate and collaborative attention. © 2014 International Society for Heart and Lung Transplantation Published by International Society for the Heart and Lung Transplantation All rights reserved.

[How to assess mindfulness? Problems and future].

PubMed

Trousselard, M; Steiler, D; Claverie, D; Canini, F

2016-02-01

The concept of mindfulness is characterized by awareness and acceptance of experiences; flexible regulation of attention; an objective receptivity to experience and an orientation to the here-and-now. Interest in 'mindfulness' and 'mindfulness meditation' is recent and growing both at the levels of research and of clinical practice in the West as mindfulness is associated with health and well-being. It (mindfulness) is attained by the practice of certain types of meditation. One of the current key challenges is to evaluate and measure the level of mindfulness of a subject and its evolution. The paper proposes a reflexion on the concept of mindfulness with a view to improving the operational evaluation of mindfulness level for clinical and non-clinical subjects. First, the problems with the use of existing self-report questionnaires assessing mindfulness level are discussed. Second, an analysis of the cognitive processes that come into play in mindfulness acquisition (by meditation) can highlight the significance of certain cognitive tools in a more accurate evaluation of the level of mindfulness of individuals. Self-regulation of attention, and orientation to lived experience could be operational candidates for assessing the level of mindfulness. The pertinence of well-known paradigms evaluating self-regulation of attention and orientation to experience are discussed. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Preparing the nursing student for internship in a pre-registration nursing program: developing a problem based approach with the use of high fidelity simulation equipment.

PubMed

Nevin, M; Neill, F; Mulkerrins, J

2014-03-01

This paper aims to explore the development and evaluation results of a simulated skills package designed using a problem based learning approach with general nursing students. Internationally, the use of high fidelity simulated learning environments has escalated. This has occurred as a result of growing concerns relating to patient safety, patient litigation, lack of clinical opportunities for student nurses to gain experience and integration of new teaching methods into nursing curricula. There are however both proponents and opponents to the value of simulation and high fidelity simulation within nursing education. This study was conducted in an Irish school of nursing. A simulated learning support package was developed by nurse educators and piloted with 134 third year nursing students. This was evaluated using a questionnaire in which 87 students responded. Students generally found the simulation sessions realistic and useful in developing clinical skills, knowledge and confidence for clinical practice. However student issues regarding support with preparation for the session were highlighted. Also, the need for a more formalised structure for debriefing following the simulation sessions were identified. It is hoped that this paper will provide nurse educators with some guidance to aid future development of innovative and interactive teaching and learning strategies. Copyright © 2013 Elsevier Ltd. All rights reserved.

Health IT for Patient Safety and Improving the Safety of Health IT.

PubMed

Magrabi, Farah; Ong, Mei-Sing; Coiera, Enrico

2016-01-01

Alongside their benefits health IT applications can pose new risks to patient safety. Problems with IT have been linked to many different types of clinical errors including prescribing and administration of medications; as well as wrong-patient, wrong-site errors, and delays in procedures. There is also growing concern about the risks of data breach and cyber-security. IT-related clinical errors have their origins in processes undertaken to design, build, implement and use software systems in a broader sociotechnical context. Safety can be improved with greater standardization of clinical software and by improving the quality of processes at different points in the technology life cycle, spanning design, build, implementation and use in clinical settings. Oversight processes can be set up at a regional or national level to ensure that clinical software systems meet specific standards. Certification and regulation are two mechanisms to improve oversight. In the absence of clear standards, guidelines are useful to promote safe design and implementation practices. Processes to identify and mitigate hazards can be formalised via a safety management system. Minimizing new patient safety risks is critical to realizing the benefits of IT.

Changing patterns of thalassemia worldwide.

PubMed

Vichinsky, Elliott P

2005-01-01

Thalassemia is a growing global public health problem with an estimated 900,000 births of clinically significant thalassemia disorders expected to occur in the next 20 years. This growth will occur in disorders previously uncommon in many parts of the world. In particular, hemoglobin (Hb) E-beta-thalassemia and Hb H disease account for much of the projected increases in thalassemia. Worldwide, Hb E-beta-thalassemia is one of the most frequent hemoglobinopathies. The incidence of Hb E approaches 60% of the populations in many regions of Southeast Asia. In coastal regions of North America, its prevalence is rapidly growing. The severity of Hb E-beta-thalassemia ranges from a complete lack of symptoms to transfusion dependence. alpha-Thalassemia diseases, often considered benign, are now recognized to be more severe than originally reported. Hb H, Hb H-Constant Spring (CS), and homozygous alpha-thalassemia affect at least a million people worldwide. California considers Hb H disease a public health problem and has initiated a neonatal screening program for Hb H and particularly Hb H-CS. Homozygous alpha-thalassemia, usually fatal, is also being more commonly detected. Several regions have initiated universal prenatal screening programs to address homozygous alpha-thalassemia. In summary, the prognosis for thalassemia disorders is improving, but prenatal diagnosis and neonatal screenings are needed. Comprehensive services that address language and social barriers as well as access to Hb F-enhancing agents and transfusions are needed.

Enhancing US-Japan Cooperation to Combat Antimicrobial Resistance

PubMed Central

2014-01-01

The Global Health Security Agenda (GHSA) is aimed at preventing, detecting, and responding to infectious disease threats. To move toward these goals, the United States has committed to partner with at least 30 countries around the world. One of the objectives of the GHSA includes “[p]reventing the emergence and spread of antimicrobial drug resistant organisms.” Antimicrobial resistance (AMR) has become a growing global health security problem, with inappropriate use of antimicrobial medications in humans and animals and a lack of new antimicrobial medications contributing to this problem. While AMR is a growing global concern, working on it regionally can make this multifaceted problem more manageable. The United States and Japan, both world leaders in the life sciences, are close allies that have established cooperative programs in medical research and global health that can be used to work on combating AMR and advance the GHSA. Although the United States and Japan have cooperated on health issues in the past, their cooperation on the growing problem of AMR has been limited. Their existing networks, cooperative programs, and close relationships can and should be used to work on combating this expanding problem. PMID:25470465

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

Strietelmeier, E. A.; Nuttall, H. Eric; Hatzinger, Paul

Nitrate and perchlorate are growing worldwide problems as mobile anionic groundwater contaminants. Biological rduction of nitrate and perchlorate in groundwater is under development as a technology to address these problems.

Aging in HIV-Infected Subjects: A New Scenario and a New View.

PubMed

Negredo, Eugenia; Back, David; Blanco, José-Ramón; Blanco, Julià; Erlandson, Kristine M; Garolera, Maite; Guaraldi, Giovanni; Mallon, Patrick; Moltó, José; Serra, José Antonio; Clotet, Bonaventura

2017-01-01

The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts. However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.

The Aging Cardiovascular System: Understanding It at the Cellular and Clinical Levels.

PubMed

Paneni, Francesco; Diaz Cañestro, Candela; Libby, Peter; Lüscher, Thomas F; Camici, Giovanni G

2017-04-18

Cardiovascular disease (CVD) presents a great burden for elderly patients, their caregivers, and health systems. Structural and functional alterations of vessels accumulate throughout life, culminating in increased risk of developing CVD. The growing elderly population worldwide highlights the need to understand how aging promotes CVD in order to develop new strategies to confront this challenge. This review provides examples of some major unresolved clinical problems encountered in daily cardiovascular practice as we care for elderly patients. Next, the authors summarize the current understanding of the mechanisms implicated in cardiovascular aging, and the potential for targeting novel pathways implicated in endothelial dysfunction, mitochondrial oxidative stress, chromatin remodeling, and genomic instability. Lastly, the authors consider critical aspects of vascular repair, including autologous transplantation of bone marrow-derived stem cells in elderly patients. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Potential biomarkers in psychiatry: focus on the cholesterol system

PubMed Central

Woods, Alisa G; Sokolowska, Izabela; Taurines, Regina; Gerlach, Manfred; Dudley, Edward; Thome, Johannes; Darie, Costel C

2012-01-01

Abstract Measuring biomarkers to identify and assess illness is a strategy growing in popularity and relevance. Although already in clinical use for treating and predicting cancer, no biological measurement is used clinically for any psychiatric disorder. Biomarkers could predict the course of a medical problem, and aid in determining how and when to treat. Several studies have indicated that of candidate psychiatric biomarkers detected using proteomic techniques, cholesterol and associated proteins, specifically apolipoproteins (Apos), may be of interest. Cholesterol is necessary for brain development and its synthesis continues at a lower rate in the adult brain. Apos are the protein component of lipoproteins responsible for lipid transport. There is extensive evidence that the levels of cholesterol and Apos may be disturbed in psychiatric disorders, including autistic spectrum disorders (ASD). Here, we describe putative serum biomarkers for psychiatric disorders, and the role of cholesterol and Apos in central nervous system (CNS) disorders. PMID:22304330

Pitfalls in the psychoeducational assessment of adolescents with learning and school adjustment problems.

PubMed

Pollak, J M

1985-01-01

Over the past decade there has been a growing interest on the part of educators, medical specialists, mental health personnel, and the lay public in the diagnosis, evaluation, and remediation of specific learning disabilities in the school-age child. This paper attempts to show through case illustrations of five high school-age adolescents how parents can seek from clinical evaluators a diagnostic impression of primary learning disability for their nonlearning disabled children; how this otherwise legitimate diagnostic category can be inappropriately used in the service of denying the salient individual, emotional, and family system factors at work in the school-related difficulties; and how the label of learning disability can work as a formidable resistance on the part of the family when, following comprehensive, in-depth assessment, professional recommendations focus less on specific educational remediation and more on the need for individual or family psychotherapy. Suggestions are made for dealing with this clinical issue.

Crowdsourcing in biomedicine: challenges and opportunities

PubMed Central

Khare, Ritu; Good, Benjamin M.; Leaman, Robert; Su, Andrew I.

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. PMID:25888696

The problems of urinary tract infections with Candida spp. aetiology in women.

PubMed

Tomczak, Hanna; Szałek, Edyta; Grześkowiak, Edmund

2014-08-29

Urinary tract infections (UTIs) in women are a growing clinical concern. The most frequent risk factors of UTIs with fungal aetiology in women are: antibiotic therapy (especially broad-spectrum antibiotics), immunosuppressive therapy, diabetes, malnutrition, pregnancy, and frequent intercourse. The aim of the study was to analyse urinary tract infections with Candida spp. aetiology in women hospitalised at the Clinical Hospital in Poznań, Poland, between 2009 and 2011. The investigations revealed that as many as 71% of positive urine cultures with Candida fungi came from women. The following fungi were most frequently isolated from the patients under analysis: C. albicans (47%), C. glabrata (31%), C. tropicalis (6%), C. krusei (3%). In order to diagnose a UTI the diagnosis cannot be based on a single result of a urine culture. Due to the small number of antifungal drugs and high costs of treatment, antifungal drugs should be applied with due consideration and care.

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

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

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

Revenge Pornography: Mental Health Implications and Related Legislation.

PubMed

Kamal, Mudasir; Newman, William J

2016-09-01

Revenge pornography, also known as nonconsensual pornography, is a subtype of cyberharassment/cyberstalking, and a serious problem facing society in the Internet age. Revenge pornography can result in lifelong mental health consequences for victims, damaged relationships, and social isolation. Recently, a growing number of states have recognized the importance of this phenomenon and have enacted legislation that criminalizes it. The technology industry has also taken steps to assist victims of revenge pornography by creating web forms to request removal of links leading to the explicit content. The Cyber Civil Rights Initiative (CCRI) has been instrumental in promoting public awareness of this often overlooked problem and in providing services for victims. Although important steps have been made, greater recognition of the gravity of this problem and the mental health implications of revenge pornography is needed to expand legislation criminalizing such acts. A federal criminal law, in particular, is much overdue. Mental health professionals must understand the dimensions of revenge pornography to be able to identify and address the consequences in both forensic and clinical settings. © 2016 American Academy of Psychiatry and the Law.

Quantum Entanglement Growth under Random Unitary Dynamics

NASA Astrophysics Data System (ADS)

Nahum, Adam; Ruhman, Jonathan; Vijay, Sagar; Haah, Jeongwan

2017-07-01

Characterizing how entanglement grows with time in a many-body system, for example, after a quantum quench, is a key problem in nonequilibrium quantum physics. We study this problem for the case of random unitary dynamics, representing either Hamiltonian evolution with time-dependent noise or evolution by a random quantum circuit. Our results reveal a universal structure behind noisy entanglement growth, and also provide simple new heuristics for the "entanglement tsunami" in Hamiltonian systems without noise. In 1D, we show that noise causes the entanglement entropy across a cut to grow according to the celebrated Kardar-Parisi-Zhang (KPZ) equation. The mean entanglement grows linearly in time, while fluctuations grow like (time )1/3 and are spatially correlated over a distance ∝(time )2/3. We derive KPZ universal behavior in three complementary ways, by mapping random entanglement growth to (i) a stochastic model of a growing surface, (ii) a "minimal cut" picture, reminiscent of the Ryu-Takayanagi formula in holography, and (iii) a hydrodynamic problem involving the dynamical spreading of operators. We demonstrate KPZ universality in 1D numerically using simulations of random unitary circuits. Importantly, the leading-order time dependence of the entropy is deterministic even in the presence of noise, allowing us to propose a simple coarse grained minimal cut picture for the entanglement growth of generic Hamiltonians, even without noise, in arbitrary dimensionality. We clarify the meaning of the "velocity" of entanglement growth in the 1D entanglement tsunami. We show that in higher dimensions, noisy entanglement evolution maps to the well-studied problem of pinning of a membrane or domain wall by disorder.

Positive and Negative Peer Influence in Residential Care.

PubMed

Huefner, Jonathan C; Smith, Gail L; Stevens, Amy L

2017-10-13

The potential for negative peer influence has been well established in research, and there is a growing interest in how positive peer influence also impacts youth. No research, however, has concurrently examined positive and negative peer influence in the context of residential care. Clinical records for 886 residential care youth were used in a Hierarchical Linear Model analysis to examine the impact of negative and positive peer influence on naturally occurring patterns of serious problem behavior over time. Negative peer influence, where the majority of youth in a home manifested above the average number of serious behavior problems, occurred 13.7% of the time. Positive peer influence, where the majority of youth manifested no serious problem behaviors for the month, occurred 47.7% of the time. Overall, youth problem behavior improved over time. There were significantly lower rates of serious problem behavior in target youth during positive peer influence months. Conversely, there were significantly higher rates of serious problem behaviors in target youth during negative peer influence months. Negative peer influence had a relatively greater impact on target peers' serious behavior problems than did positive peer influence. Caregiver experience significantly reduced the impact of negative peer influence, but did not significantly augment positive peer influence. Months where negative peer influence was combined with inexperienced caregivers produced the highest rates of serious problem behavior. Our results support the view that residential programs for troubled youth need to create circumstances that promote positive and control for negative peer influence.

Recycled concrete aggregate (RCA) for infrastructure elements.

DOT National Transportation Integrated Search

2014-02-01

With a growing demand for new construction and the need to replace infrastructure stretched beyond its service life, society : faces the problem of an ever-growing production of construction and demolition waste. The Federal Highway Administration : ...

Chronic oedema: a prevalent health care problem for UK health services.

PubMed

Moffatt, Christine J; Keeley, Vaughan; Franks, Peter J; Rich, Anna; Pinnington, Lorraine L

2017-10-01

Chronic oedema (CO) is a major clinical problem worldwide, which has many important secondary consequences for health, activity and participation. Effective treatment planning and organisation of services is dependent on an understanding of the condition and its epidemiology. This cross-sectional study was designed to estimate the point prevalence of CO within the health services of one UK urban population and to determine the proportions that have concurrent leg ulceration. Patients with CO in all anatomic sites were ascertained by health care professionals in one acute and one community hospital, all relevant outpatient and community nursing services, general practices and all nursing/residential homes in one urban catchment area (Derby City). The presence and distribution of oedema was confirmed through a brief clinical examination. A battery of demographic and clinical details was recorded for each case. Within the study population of Derby City residents, 971 patients were identified with CO [estimated crude prevalence 3·93 per 1000, 95% confidence interval (CI) 3·69-4·19]. The prevalence was the highest among those aged 85 or above (28·75 per 1000) and was higher among women (5·37 per 1000) than men (2·48 per 1000). The prevalence among hospital inpatients was 28·5%. Only five (3%) patients in the community population had oedema related to cancer or cancer treatment. Of the 304 patients identified with oedema from the Derby hospitals or community health services, 121 (40%) had a concurrent leg ulcer. Prevalence statistics and current demographic trends indicate that CO is a major and growing health care problem. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Recycled concrete aggregate (RCA) for infrastructure elements.

DOT National Transportation Integrated Search

2014-07-01

With a growing demand for new construction and the need to replace infrastructure stretched beyond its service life, society faces the : problem of an ever-growing production of construction and demolition waste. The Federal Highway Administration (F...

Young Australian Indigenous Students' Growing Pattern Generalisations: The Role of Gesture When Generalising

ERIC Educational Resources Information Center

Miller, Jodie

2014-01-01

This paper explores how young Indigenous students' (Year 2 and 3) generalise growing patterns. Piagetian clinical interviews were conducted to determine how students articulated growing pattern generalisations. Two case studies are presented displaying how students used gesture to support and articulate their generalisations of growing patterns.…

Antimicrobial Octapeptin C4 Analogues Active against Cryptococcus Species.

PubMed

Chitty, Jessica L; Butler, Mark S; Suboh, Azzah; Edwards, David J; Cooper, Matthew A; Fraser, James A; Robertson, Avril A B

2018-02-01

Resistance to antimicrobials is a growing problem in both developed and developing countries. In nations where AIDS is most prevalent, the human fungal pathogen Cryptococcus neoformans is a significant contributor to mortality, and its growing resistance to current antifungals is an ever-expanding threat. We investigated octapeptin C4, from the cationic cyclic lipopeptide class of antimicrobials, as a potential new antifungal. Octapeptin C4 was a potent, selective inhibitor of this fungal pathogen with an MIC of 1.56 μg/ml. Further testing of octapeptin C4 against 40 clinical isolates of C. neoformans var. grubii or neoformans showed an MIC of 1.56 to 3.13 μg/ml, while 20 clinical isolates of C. neoformans var. gattii had an MIC of 0.78 to 12.5 μg/ml. In each case, the MIC values for octapeptin C4 were equivalent to, or better than, current antifungal drugs fluconazole and amphotericin B. The negatively charged polysaccharide capsule of C. neoformans influences the pathogen's sensitivity to octapeptin C4, whereas the degree of melanization had little effect. Testing synthetic octapeptin C4 derivatives provided insight into the structure activity relationships, revealing that the lipophilic amino acid moieties are more important to the activity than the cationic diaminobutyric acid groups. Octapeptins have promising potential for development as anticryptococcal therapeutic agents. Copyright © 2018 Chitty et al.

Antimicrobial Octapeptin C4 Analogues Active against Cryptococcus Species

PubMed Central

Chitty, Jessica L.; Butler, Mark S.; Suboh, Azzah; Edwards, David J.; Cooper, Matthew A.; Fraser, James A.

2017-01-01

ABSTRACT Resistance to antimicrobials is a growing problem in both developed and developing countries. In nations where AIDS is most prevalent, the human fungal pathogen Cryptococcus neoformans is a significant contributor to mortality, and its growing resistance to current antifungals is an ever-expanding threat. We investigated octapeptin C4, from the cationic cyclic lipopeptide class of antimicrobials, as a potential new antifungal. Octapeptin C4 was a potent, selective inhibitor of this fungal pathogen with an MIC of 1.56 μg/ml. Further testing of octapeptin C4 against 40 clinical isolates of C. neoformans var. grubii or neoformans showed an MIC of 1.56 to 3.13 μg/ml, while 20 clinical isolates of C. neoformans var. gattii had an MIC of 0.78 to 12.5 μg/ml. In each case, the MIC values for octapeptin C4 were equivalent to, or better than, current antifungal drugs fluconazole and amphotericin B. The negatively charged polysaccharide capsule of C. neoformans influences the pathogen's sensitivity to octapeptin C4, whereas the degree of melanization had little effect. Testing synthetic octapeptin C4 derivatives provided insight into the structure activity relationships, revealing that the lipophilic amino acid moieties are more important to the activity than the cationic diaminobutyric acid groups. Octapeptins have promising potential for development as anticryptococcal therapeutic agents. PMID:29158283

An integrative review on coping skills in nursing students: implications for policymaking.

PubMed

Labrague, L J; McEnroe-Petitte, D M; Al Amri, M; Fronda, D C; Obeidat, A A

2018-06-01

This study critically appraised both quantitative and qualitative studies describing coping strategies utilized by nursing students when faced with stress. Stress in nursing students during clinical training is well documented in the nursing literature. The need to utilize positive-coping strategies is necessary to effectively deal with stress and its accompanying stressors. An integrative review method was used in this review. PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and Scopus were the databases used in searching for relevant literature using the following search terms; 'coping', 'nursing students', clinical training', 'ways of coping' and 'clinical practice'. A total of 27 studies published from 2001 to 2016 were included in this review. Findings demonstrated that nursing students utilized problem-focused coping strategies rather than emotion-focused coping strategies. Specific coping behaviours utilized included problem-solving behaviours, self-confident approaches and seeking of support from family and friends. The review contributes to the growing literature on coping strategies in nursing students and may have implications on nursing education and nursing policy. This review also demonstrated a scarcity of studies that links specific coping strategies to nursing school stressors and examines predictors of coping skills in nursing students. Institutionalization of structured student orientation programme, implementation of well-planned mentoring programmes and establishment of support unit/centres may be helpful in supporting nursing students during their clinical placement. By developing empirically based interventions, nursing faculty can assist nursing students in strengthening their positive-coping skills to effectively deal with various stressors encountered. © 2017 International Council of Nurses.

Imaging Virus-Associated Cancer

PubMed Central

Fu, De-Xue; Foss, Catherine A.; Nimmagadda, Sridhar; Ambinder, Richard F.; Pomper, Martin G.

2012-01-01

Cancer remains an important and growing health problem. Researchers have made great progress in defining genetic and molecular alterations that contribute to cancer formation and progression. Molecular imaging can identify appropriate patients for targeted cancer therapy and may detect early biochemical changes in tumors during therapy, some of which may have important prognostic implications. Progress in this field continues largely due to a union between molecular genetics and advanced imaging technology. This review details uses of molecular-genetic imaging in the context of tumor-associated viruses. Under certain conditions, and particularly during pharmacologic stimulation, gammaherpesviruses will express genes that enable imaging and therapy in vivo. The techniques discussed are readily translatable to the clinic. PMID:18991718

[Asperger syndrome - a fashionable diagnosis?].

PubMed

Haker, Helene

2014-10-01

The Asperger Syndrome is - in contrast to early childhood autism - a disorder at the lighter end of the autism spectrum. Although first described in 1943, it was included in the ICD-10 not before 1992. The knowledge about this lighter autistic disorder spread only slowly. The increasing prevalence rates can be explained by the increased knowledge about this disorder and the growing clinical experience. In contrast to the public that gives repeated medial attention to it, and to would-be affected who seem to see an attractive excuse for social problems in an Asperger diagnosis, many psychiatrists appear cautious to state a diagnosis with which they are not familiar and which is discredited as a fashionable diagnosis.

Obesity and cancer: inflammation bridges the two

PubMed Central

Kolb, Ryan; Sutterwala, Fayyaz S.; Zhang, Weizhou

2016-01-01

Obesity is a growing public health problem and affects 35% US adults. Obesity increases the risk of many cancer types and is associated with poor outcomes. Clinical management of cancer patients has been essentially the same between normal weight and obese individuals. Understanding causal mechanisms by which obesity drives cancer initiation and progression is essential for the development of novel precision therapy for obese cancer patients. One caveat is that various mechanisms have been proposed for different cancer types for their progression under obesity. Since obesity is known to have global impact on inflammation, here we will summarize recent literature and discuss the potential of inflammation being the common causal mechanism to promote cancer promotion across cancer types. PMID:27429211

Multidimensional treatment foster care as a preventive intervention to promote resiliency among youth in the child welfare system.

PubMed

Leve, Leslie D; Fisher, Philip A; Chamberlain, Patricia

2009-12-01

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from 4 randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed.

Nanosensors and nanomaterials for monitoring glucose in diabetes.

PubMed

Cash, Kevin J; Clark, Heather A

2010-12-01

Worldwide, diabetes is a rapidly growing problem that is managed at the individual level by monitoring and controlling blood glucose levels to minimize the negative effects of the disease. Because of limitations in diagnostic methods, significant research efforts are focused on developing improved methods to measure glucose. Nanotechnology has impacted these efforts by increasing the surface area of sensors, improving the catalytic properties of electrodes and providing nanoscale sensors. Here, we discuss developments in the past several years on both nanosensors that directly measure glucose and nanomaterials that improve glucose sensor function. Finally, we discuss challenges that must be overcome to apply these developments in the clinic. Copyright © 2010 Elsevier Ltd. All rights reserved.

Internet addiction, sleep and health-related life quality among obese individuals: a comparison study of the growing problems in adolescent health.

PubMed

Eliacik, Kayi; Bolat, Nurullah; Koçyiğit, Cemil; Kanik, Ali; Selkie, Ellen; Yilmaz, Huseyin; Catli, Gonul; Dundar, Nihal Olgac; Dundar, Bumin Nuri

2016-12-01

The rapid rise in the global prevalence of obesity suggests that environmental factors may be responsible. The increased use of technology is associated with increased rates of obesity due to declines in physical activity and significant sedentary life style. Internet addiction is also a growing health issue associated with diminished physical activity and poor sleep quality as well as various health problems. The purpose of this study was to determine associations between Internet addiction and adolescent obesity-related problems. In this case-control study, 71 adolescents with obesity were recruited from the outpatient clinic at Tepecik Teaching Hospital and Katip Celebi University Hospital, Department of Pediatric Endocrinology in Izmir, Turkey. The control group consisted of 64 non-obese adolescents that were matched with patients in the study group by age and gender. All subjects completed socio-demographic forms, an Internet addiction scale, the Pediatric Quality of Life Inventory, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. Adolescents with obesity were significantly more likely to have Internet addiction (p = 0.002), lower quality of life (p < 0.001), and higher daytime sleepiness (p = 0.008). Moreover, binary regression analysis showed that Internet addiction and less physical activity were associated with increased odds of obesity. The results indicated a significant association between Internet addiction and obesity. Health practitioners should take possible Internet addiction, online activities, and physical activities into consideration in follow-up of obese adolescents. In addition to pharmacologic therapies and dietary interventions, providing behavioral therapy targeting healthy Internet use may be promising to reduce the effects of obesity in adolescence.

Late-adoptions in adolescence: Can attachment and emotion regulation influence behaviour problems? A controlled study using a moderation approach.

PubMed

Pace, Cecilia Serena; Di Folco, Simona; Guerriero, Viviana

2018-03-01

A growing body of research suggests that, compared to normative adolescence, adoptive adolescence could be considered a specific risk condition characterized by more psychiatric problems, attachment insecurity, and emotional regulation difficulties as consequences of negative experiences in preadoption relationships. The current study explores (a) a moderation model of adoption status on the association between attachment representations (secure, dismissing, preoccupied, and disorganized) and behavioural problems and (b) a moderation model of adoption status on the association between emotion regulation processes (cognitive reappraisal and expressive suppression) and behavioural problems. Both the moderation models were controlled for verbal skills. Forty-six adopted adolescents and a control group of 34 nonadopted peers (12-16 years old) living with both their biological parents were assessed using the Friends and Family Interview, the Emotion Regulation Questionnaire for Children and Adolescents, the Child Behaviour Check List 6-18, and the verbal subtests of the Wechsler Intelligence Scale for Children, the latter as control measure. Results showed that adoption status (but not attachment) positively predicted externalizing and total behaviour problems, whereas attachment disorganization (but not adoption status) positively predicted internalizing problems in both group. Moreover, low cognitive reappraisal had a negative impact on externalizing problems only for adopted adolescents, but not for nonadopted youths. The clinical implications of these findings are discussed in order to enhance effective intervention with adopted adolescents and their parents. Copyright © 2017 John Wiley & Sons, Ltd.

Clinical application of 3D imaging for assessment of treatment outcomes

PubMed Central

Cevidanes, Lucia H.C.; Oliveira, Ana Emilia Figueiredo; Grauer, Dan; Styner, Martin; Proffit, William R.

2011-01-01

This paper outlines the clinical application of CBCT for assessment of treatment outcomes, and discusses current work to superimpose digital dental models and 3D photographs. Superimposition of CBCTs on stable structures of reference now allow assessment of 3D dental, skeletal and soft tissue changes for both growing and non-growing patients. Additionally, we describe clinical findings from CBCT superimpositions in assessment of surgery and skeletal anchorage treatment. PMID:21516170

Computational Issues in Damping Identification for Large Scale Problems

NASA Technical Reports Server (NTRS)

Pilkey, Deborah L.; Roe, Kevin P.; Inman, Daniel J.

1997-01-01

Two damping identification methods are tested for efficiency in large-scale applications. One is an iterative routine, and the other a least squares method. Numerical simulations have been performed on multiple degree-of-freedom models to test the effectiveness of the algorithm and the usefulness of parallel computation for the problems. High Performance Fortran is used to parallelize the algorithm. Tests were performed using the IBM-SP2 at NASA Ames Research Center. The least squares method tested incurs high communication costs, which reduces the benefit of high performance computing. This method's memory requirement grows at a very rapid rate meaning that larger problems can quickly exceed available computer memory. The iterative method's memory requirement grows at a much slower pace and is able to handle problems with 500+ degrees of freedom on a single processor. This method benefits from parallelization, and significant speedup can he seen for problems of 100+ degrees-of-freedom.

Glogs as Non-Routine Problem Solving Tools in Mathematics

ERIC Educational Resources Information Center

Devine, Matthew T.

2013-01-01

In mathematical problem solving, American students are falling behind their global peers because of a lack of foundational and reasoning skills. A specific area of difficulty with problem solving is working non-routine, heuristic-based problems. Many students are not provided with effective instruction and often grow frustrated and dislike math.…

Syphilitic punctate inner retinitis in immunocompetent gay men.

PubMed

Wickremasinghe, Sanjeewa; Ling, Cecilia; Stawell, Richard; Yeoh, Jonathan; Hall, Anthony; Zamir, Ehud

2009-06-01

To describe the features of an unusual syphilitic uveitis syndrome in a cluster of homosexual patients. Retrospective case series. Five consecutive patients diagnosed with syphilitic retinitis in our Melbourne uveitis clinic over a period of 8 months. The case notes of patients diagnosed with syphilitic retinitis were reviewed and the clinical features are presented and discussed. Description of retinal findings and documentation of any associated sequelae. All patients were homosexual men. Two were human immunodeficiency virus positive. None of the patients had been previously diagnosed with syphilis, although 3 presented with systemic symptoms and signs of secondary syphilis. All patients had marked anterior uveitis and vitritis. All patients had acute retinal arteriolitis and inner retinitis, with distinctive, inner retinal and preretinal white dots. These retinal findings were remarkably similar in all patients, and resolved with little or no sequelae after standard systemic treatment for syphilis, combined with oral prednisolone. Syphilitic retinitis may be an increasingly common clinical problem, reflecting the growing incidence of syphilis among homosexual men in Australia. Our patients showed stereotypical ocular and systemic features, which are useful in differentiating this condition clinically from other types of acute posterior uveitis, such as necrotizing viral retinitis. Proprietary or commercial disclosure may be found after the references.

Big Data and Machine Learning in Plastic Surgery: A New Frontier in Surgical Innovation.

PubMed

Kanevsky, Jonathan; Corban, Jason; Gaster, Richard; Kanevsky, Ari; Lin, Samuel; Gilardino, Mirko

2016-05-01

Medical decision-making is increasingly based on quantifiable data. From the moment patients come into contact with the health care system, their entire medical history is recorded electronically. Whether a patient is in the operating room or on the hospital ward, technological advancement has facilitated the expedient and reliable measurement of clinically relevant health metrics, all in an effort to guide care and ensure the best possible clinical outcomes. However, as the volume and complexity of biomedical data grow, it becomes challenging to effectively process "big data" using conventional techniques. Physicians and scientists must be prepared to look beyond classic methods of data processing to extract clinically relevant information. The purpose of this article is to introduce the modern plastic surgeon to machine learning and computational interpretation of large data sets. What is machine learning? Machine learning, a subfield of artificial intelligence, can address clinically relevant problems in several domains of plastic surgery, including burn surgery; microsurgery; and craniofacial, peripheral nerve, and aesthetic surgery. This article provides a brief introduction to current research and suggests future projects that will allow plastic surgeons to explore this new frontier of surgical science.

New DEA rules expand options for controlled substance disposal.

PubMed

Peterson, David M

2015-03-01

Prescription drug abuse and overdose are rapidly growing problems in the United States. The United States federal Disposal of Controlled Substances Rule became effective 9 October 2014, implementing the Secure and Responsible Drug Disposal Act of 2010 (Disposal Act). These regulations target escalating prescription drug misuse by reducing accumulation of unused controlled substances that may be abused, diverted or accidentally ingested. Clinical areas that can now participate in collecting unused controlled substances include retail pharmacies, hospitals or clinics with an onsite pharmacy, and narcotic treatment programs. Collection methods include placing a controlled substance collection receptacle or instituting a mail-back program. Because prompt onsite destruction of collected items is required of mail-back programs, collection receptacles are more likely to be used in clinical areas. Retail pharmacies and hospitals or clinics with an onsite pharmacy may also place and maintain collection receptacles at long-term care facilities. The Act and Rule are intended to increase controlled substance disposal methods and expand local involvement in collection of unused controlled substances. Potential barriers to participating in controlled substance collection include acquisition of suitable collection receptacles and liners, lack of available space meeting the necessary criteria, lack of employee time for verification and inventory requirements, and program costs.

Pulmonary thromboembolic disease. Clinical management of acute and chronic disease.

PubMed

Torbicki, Adam

2010-07-01

Pulmonary thromboembolism falls between the areas of pulmonology and cardiology, internal medicine and intensive care, radiology and nuclear medicine, and hematology and cardiothoracic surgery. Depending on their clinical background, physicians faced with a patient with a pulmonary thromboembolism may speak different languages and adopt different treatment approaches. Now, however, there is an opportunity to end the Tower of Babel surrounding pulmonary thromboembolism. There is a growing acknowledgement that the key clinical problems in both acute pulmonary embolism and chronic thromboembolic pulmonary hypertension are linked to right ventricular pressure overload and right ventricular failure. As a result, cardiologists and cardiac intensive care specialists are taking an increasing interest in understanding and combating these conditions. The European Society of Cardiology was the first to elaborate comprehensive clinical practice guidelines for pulmonary thromboembolism and chronic thromboembolic pulmonary hypertension. The task forces involved in producing these guidelines included radiologists, pulmonologists, hematologists, intensive care physicians and surgeons, which ensured that the final document was universally acceptable. The aim of this article was to provide an overview of the epidemiology, risk factors, diagnosis, treatment, prognosis and prevention of acute pulmonary thromboembolism and chronic thromboembolic pulmonary hypertension, while taking into account European Society of Cardiology guidelines and incorporating new evidence where necessary.

Clinical measurement of tooth wear: Tooth wear indices

PubMed Central

López-Frías, Francisco J.; Castellanos-Cosano, Lizett; Martín-González, Jenifer; Llamas-Carreras, José M.

2012-01-01

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification corresponds to a different process with specific clinical features. Classifications made so far have no accurate prevalence data because the indexes do not necessarily measure a specific etiology, or because the study populations can be diverse in age and characteristics. Tooth wears (attrition, erosion and abrasion) is perceived internationally as a growing problem. However, the interpretation and comparison of clinical and epidemiological studies, it is increasingly difficult because of differences in terminology and the large number of indicators/indices that have been developed for the diagnosis, classification and monitoring of the loss of dental hard tissue. These indices have been designed to identify increasing severity and are usually numerical, none have universal acceptance, complicating the evaluation of the true increase in prevalence reported. This article considers the ideal requirements for an erosion index. A literature review is conducted with the aim of analyzing the evolution of the indices used today and discuss whether they meet the clinical needs and research in dentistry. Key words:Tooth wear, tooth wear indices, attrition, erosion, abrasion, abfraction. PMID:24558525

[Good agricultural practice (GAP) of Chinese materia medica (CMM) for ten years: achievements, problems and proposals].

PubMed

Guo, Lan-Ping; Zhang, Yan; Zhu, Shou-Dong; Wang, Gui-Hua; Wang, Xiu; Zhang, Xiao-Bo; Chen, Mei-Lan; He, Ya-Li; Han, Bang-Xing; Chen, Nai-Fu; Huang, Lu-Qi

2014-04-01

This paper aims to summarize the achievements during the implementation process of good agricultural practice (GAP) in Chinese Materia Medica (CMM), and on basis of analyzing the existing problems of GAP, to propose further implementation of GAP in TCM growing. Since the launch of GAP in CMM growing ten years ago, it has acquired great achievements, including: (1) The promulgation of a series of measures for the administration of the GAP approval in the CMM growing; (2) The expanded planting area of CMM; (3) The increased awareness of standardized CMM growing among farmers and enterprises; (4) The establishment of GAP implementation bases for CMM growing; (5) The improvement of theory and methodology for CMM growing; (6) The development of a large group of experts and scholars in GAP approval for CMM production. The problems existing in the production include: (1) A deep understanding of GAP and its certification is still needed; (2) The distribution of the certification base is not reasonable; (3) The geo-economics effect and the backward farming practices are thought to be the bottlenecks in the standardization of CMM growing and the scale production of CMM; (4) Low comparative effectiveness limits the development of the GAP; (5) The base of breeding improved variety is blank; (6) The immature of the cultivation technique lead to the risk of production process; (7) The degradation of soil microbial and the continuous cropping obstacle restrict the sustainable development of the GAP base. To further promote the health and orderly GAP in the CMM growing, the authors propose: (1) To change the mode of production; (2) To establish a sound standard system so as to ensure quality products for fair prices; (3) To fully consider the geo-economic culture and vigorously promote the definite cultivating of traditional Chinese medicinal materials; (4) To strengthen the transformation and generalization of basic researches and achievements, in order to provide technical support for the CMM production; (5) To deepen the understanding of GAP, to vigorously promote ecological planting and precision agriculture, in order to overcome the continuous cropping obstacle. The authors think that despite the fact that we are still facing with a huge array of management and technological problems, the GAP in the CMM growing has already enjoyed widespread support and showed great potential. In the future, with people's deeper understanding of GAP and the great progress of the science and technology, the GAP will constantly be fused with the theory, methodology and technology in the modern agriculture like precision agriculture, eco-agriculture and etc.

Vitamin B12 among Vegetarians: Status, Assessment and Supplementation.

PubMed

Rizzo, Gianluca; Laganà, Antonio Simone; Rapisarda, Agnese Maria Chiara; La Ferrera, Gioacchina Maria Grazia; Buscema, Massimo; Rossetti, Paola; Nigro, Angela; Muscia, Vincenzo; Valenti, Gaetano; Sapia, Fabrizio; Sarpietro, Giuseppe; Zigarelli, Micol; Vitale, Salvatore Giovanni

2016-11-29

Cobalamin is an essential molecule for humans. It acts as a cofactor in one-carbon transfers through methylation and molecular rearrangement. These functions take place in fatty acid, amino acid and nucleic acid metabolic pathways. The deficiency of vitamin B12 is clinically manifested in the blood and nervous system where the cobalamin plays a key role in cell replication and in fatty acid metabolism. Hypovitaminosis arises from inadequate absorption, from genetic defects that alter transport through the body, or from inadequate intake as a result of diet. With the growing adoption of vegetarian eating styles in Western countries, there is growing focus on whether diets that exclude animal foods are adequate. Since food availability in these countries is not a problem, and therefore plant foods are sufficiently adequate, the most delicate issue remains the contribution of cobalamin, which is poorly represented in plants. In this review, we will discuss the status of vitamin B12 among vegetarians, the diagnostic markers for the detection of cobalamin deficiency and appropriate sources for sufficient intake, through the description of the features and functions of vitamin B12 and its absorption mechanism.

Organ donation as transition work: Policy discourse and clinical practice in The Netherlands.

PubMed

Paul, Katharina T; Avezaat, Cees J J; Ijzermans, Jan N; Friele, Roland D; Bal, Roland A

2014-07-01

An increasing number of patients become eligible for organ transplants. In the Netherlands, at the level of policy discourse, growing waiting lists are often referred to as a persistent "shortage" of organs, producing a "public health crisis." In this way, organ donation is presented as an ethical, social, and medical necessity. Likewise, policy discourse offers a range of seemingly unambiguous solutions: improving logistical infrastructure at the level of hospitals, developing organizational and legal protocols, as well as public information campaigns. Instead of taking these problem and solution definitions as given, we critically examine the relationship between policy discourse and clinical practice. Based on a historical review, first, we trace the key moments of transformation where organ donation became naturalized in Dutch policy discourse, particularly in its altruistic connotation. Second, based on in-depth interviews with medical professionals, we show how those involved in organ donation continue to struggle with the controversial nature of their clinical practice. More specifically, we highlight their use of different forms of knowledge that underlie clinicians' "transition work": from losing a patient to "gaining" a donor. © The Author(s) 2013.

Progress in the Discovery of Treatments for C. difficile Infection: A Clinical and Medicinal Chemistry Review

PubMed Central

Tsutsumi, Lissa S.; Owusu, Yaw B.; Hurdle, Julian G.; Sun, Dianqing

2014-01-01

Clostridium difficile is an anaerobic, Gram-positive pathogen that causes C. difficile infection, which results in significant morbidity and mortality. The incidence of C. difficile infection in developed countries has become increasingly high due to the emergence of newer epidemic strains, a growing elderly population, extensive use of broad spectrum antibiotics, and limited therapies for this diarrheal disease. Because treatment options currently available for C. difficile infection have some drawbacks, including cost, promotion of resistance, and selectivity problems, new agents are urgently needed to address these challenges. This review article focuses on two parts: the first part summarizes current clinical treatment strategies and agents under clinical development for C. difficile infection; the second part reviews newly reported anti-difficile agents that have been evaluated or reevaluated in the last five years and are in the early stages of drug discovery and development. Antibiotics are divided into natural product inspired and synthetic small molecule compounds that may have the potential to be more efficacious than currently approved treatments. This includes potency, selectivity, reduced cytotoxicity, and novel modes of action to prevent resistance. PMID:24236721

Disrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.

PubMed

Garland, Eric L

2014-06-01

Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. As such, novel, nonpharmacologic interventions are needed to complement pharmacotherapy and interrupt the cycle of behavioral escalation. The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.

A New Clinical Instrument for The Early Detection of Cataract Using Dynamic Light Scattering and Corneal Topography

NASA Technical Reports Server (NTRS)

Ansari, Rafat R.; Datiles, Manuel B., III; King, James F.

2000-01-01

A growing cataract can be detected at the molecular level using the technique of dynamic light scattering (DLS). However, the success of this method in clinical use depends upon the precise control of the scattering volume inside a patient's eye and especially during patient's repeat visits. This is important because the scattering volume (cross-over region between the scattered fight and incident light) inside the eye in a high-quality DLS set-up is very small (few microns in dimension). This precise control holds the key for success in the longitudinal studies of cataract and during anti-cataract drug screening. We have circumvented these problems by fabricating a new DLS fiber optic probe with a working distance of 40 mm and by mounting it inside a cone of a corneal analyzer. This analyzer is frequently used in mapping the corneal topography during PRK (photorefractive keratectomy) and LASIK (laser in situ keratomileusis) procedures in shaping of the cornea to correct myopia. This new instrument and some preliminary clinical tests on one of us (RRA) showing the data reproducibility are described.

New clinical instrument for the early detection of cataract using dynamic light scattering and corneal topography

NASA Astrophysics Data System (ADS)

Ansari, Rafat R.; Datiles, Manuel B., III; King, James F.

2000-06-01

A growing cataract can be detected at the molecular level using the technique of dynamic light scattering (DLS). However, the success of this method in clinical use depends upon the precise control of the scattering volume inside a patient's eye and especially during patient's repeat visits. This is important because the scattering volume (cross-over region between the scattered light and incident light) inside the eye in a high-quality DLS set-up is very small (few microns in dimension). This precise control holds the key for success in the longitudinal studies of cataract and during anti-cataract drug screening. We have circumvented these problems by fabricating a new DLS fiber optic probe with a working distance of 40 mm and by mounting it inside a cone of a corneal analyzer. This analyzer is frequently used in mapping the corneal topography during PRK (photorefractive keratectomy) and LASIK (laser in situ keratomileusis) procedures in shaping of the cornea to correct myopia. This new instrument and some preliminary clinical tests on one of us (RRA) showing the data reproducibility are described.

Honey in wound care: effects, clinical application and patient benefit.

PubMed

Lay-flurrie, Karen

The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibiotic-resistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with methicillin-resistant Staphylococcus aureus or Pseudomonas. The associated costs of treating such wounds are escalating as a result. While the use of honey as a wound dressing has been recognized, at least since Egyptian times circa 2000 BC, it is only more recently, due to the development and licensing of modern honey wound dressings, that such dressings have become more widely available and used in wound management. This article focuses on the use of honey in the treatment of infected wounds and burns. It will examine the effects of honey at the wound bed and its clinical applications, along with the current dressings available. Also discussed are the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.

The Clinical Problem of Symptomatic Alzheimer Disease and Mild Cognitive Impairment

PubMed Central

Tarawneh, Rawan; Holtzman, David M.

2012-01-01

Alzheimer disease (AD) is the most common cause of dementia in the elderly. Clinicopathological studies support the presence of a long preclinical phase of the disease, with the initial deposition of AD pathology estimated to begin approximately 10–15 years prior to the onset of clinical symptoms. The hallmark clinical phenotype of AD is a gradual and progressive decline in two or more cognitive domains, most commonly involving episodic memory and executive functions, that is sufficient to cause social or occupational impairment. Current diagnostic criteria can accurately identify AD in the majority of cases. As disease-modifying therapies are being developed, there is growing interest in the identification of individuals in the earliest symptomatic, as well as presymptomatic, stages of disease, because it is in this population that such therapies may have the greatest chance of success. The use of informant-based methods to establish cognitive and functional decline of an individual from previously attained levels of performance best allows for the identification of individuals in the very mildest stages of cognitive impairment. PMID:22553492

Flood inundation extent mapping based on block compressed tracing

NASA Astrophysics Data System (ADS)

Shen, Dingtao; Rui, Yikang; Wang, Jiechen; Zhang, Yu; Cheng, Liang

2015-07-01

Flood inundation extent, depth, and duration are important factors affecting flood hazard evaluation. At present, flood inundation analysis is based mainly on a seeded region-growing algorithm, which is an inefficient process because it requires excessive recursive computations and it is incapable of processing massive datasets. To address this problem, we propose a block compressed tracing algorithm for mapping the flood inundation extent, which reads the DEM data in blocks before transferring them to raster compression storage. This allows a smaller computer memory to process a larger amount of data, which solves the problem of the regular seeded region-growing algorithm. In addition, the use of a raster boundary tracing technique allows the algorithm to avoid the time-consuming computations required by the seeded region-growing. Finally, we conduct a comparative evaluation in the Chin-sha River basin, results show that the proposed method solves the problem of flood inundation extent mapping based on massive DEM datasets with higher computational efficiency than the original method, which makes it suitable for practical applications.

I Collect Therefore I am--Autonoetic Consciousness and Hoarding in Asperger Syndrome.

PubMed

Skirrow, Paul; Jackson, Paul; Perry, Ewan; Hare, Dougal Julian

2015-01-01

A growing number of studies have highlighted impairments in the ability of individuals with autism spectrum disorders to recall specific, personally experienced material. These difficulties have been related to underlying problems with autonoetic consciousness, namely the subjective awareness of one's own existence in subjective time. The current paper describes the manifestation of these difficulties in three individuals diagnosed with Asperger syndrome. For the people described, lifelong collecting and hoarding behaviours appeared to serve the function of constituting and maintaining aspects of their sense of self, particularly the sense of continuity and agency over time. On the basis of this clinical information and previous research into self-related processes in people with autism spectrum disorders, an initial model of collecting and hoarding behaviours amongst individuals with Asperger syndrome was formulated. The implications of this formulation for both clinical practice and future research are discussed. People with Asperger syndrome can have problems in developing a functional sense of self. Collecting and hoarding behaviour by people with Asperger syndrome may reflect such underlying difficulties in their sense of self rather than being symptoms of comorbid mental illness. Interventions need to take account of the function of such behaviours rather than solely regarding them as discrete pathological signs. Copyright © 2014 John Wiley & Sons, Ltd.

In vitro models.

PubMed

Mather, Jennie Powell

2012-02-01

The current resurgence of interest in the cancer stem cell (CSC) hypothesis as possibly providing a unifying theory of cancer biology is fueled by the growing body of work on normal adult tissue stem cells and the promise that CSC may hold the key to one of the central problems of clinical oncology: tumor recurrence. Many studies suggest that the microenvironment plays a role, perhaps a seminal one, in cancer development and progression. In addition, the possibility that the stem cell-like component of tumors is capable of rapid and reversible changes of phenotype raises questions concerning studies with these populations and the application of what we learn to the clinical situation. These types of questions are extremely difficult to study using in vivo models or freshly isolated cells. Established cell lines grown in defined conditions provide important model systems for these studies. There are three types of in vitro models for CSCs: (a) selected subpopulations of existing tumor lines (derived from serum-containing medium; (b) creation of lines from tumor or normal cells by genetic manipulation; or (c) direct in vitro selection of CSC from tumors or sorted tumor cells using defined serum-free conditions. We review the problems associated with creating and maintaining in vitro cultures of CSCs and the progress to date on the establishment of these important models. Copyright © 2011 AlphaMed Press.

The global diversion of pharmaceutical drugs: opiate treatment and the diversion of pharmaceutical opiates: a clinician's perspective.

PubMed

Bell, James

2010-09-01

To provide a clinician's perspective on the problem of diversion of prescribed pharmaceuticals. The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986-2006, Australia 1996-2008 and the United States and France from the mid-1990s. Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long-term opioid prescribing. All long-term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements--including dilution of methadone take-aways, supervision of administration for high-risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines. Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels.

Research capacity building in midwifery: Case study of an Australian Graduate Midwifery Research Intern Programme.

PubMed

Hauck, Yvonne L; Lewis, Lucy; Bayes, Sara; Keyes, Louise

2015-09-01

Having the research capacity to identify problems, create new knowledge and most importantly translate this knowledge into practice is essential within health care. Midwifery, as well as other health professions in Australia, is challenged in building its research capacity to contribute evidence to inform clinical practice. The aim of this project was to evaluate an innovative Graduate Midwifery Research Intern Programme offered at a tertiary obstetric hospital in Western Australia, to determine what was working well and how the programme could be improved. A case study approach was used to gain feedback from graduate midwives within a Graduate Research Intern (GRI) Programme. In addition outcomes were compiled of all projects the GRI midwives contributed to. Six GRI midwives participated in a survey comprising of four open ended questions to provide feedback about the programme. Findings confirm that the GRI programme increased the graduates understanding of how research works, its capacity to define a problem, generate new knowledge and inform clinical practice. The GRI midwives' feedback suggested the programme opened their thinking to future study and gave them enhanced insight into women's experiences around childbirth. To grow our knowledge as a professional group, midwives must develop and promote programmes to build our pool of research capable midwives. By sharing our programme evaluation we hope to entice other clinical settings to consider the value in replicating such a programme within their context. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Adolescent developmental issues in Hong Kong: Relevance to positive youth development programs in Hong Kong.

PubMed

Shek, Daniel T L

2006-01-01

Several adolescent developmental issues and problems in Hong Kong are examined in this paper. First, the changing adolescent substance abuse patterns are described. Second, although the overall youth crime trend was relatively stable in the past decade, shoplifting and stealing crimes deserve our concern. Third, adolescent mental health problem is a growing problem. Fourth, statistics show that unhealthy life styles, such as smoking, early sex and moral confusion are issues of concern. Fifth, the proportion of adolescents experiencing economic disadvantage has increased. Sixth, youth unemployment and non-engaged youth are growing problems when the economy of Hong Kong is undergoing re-structuring. Seventh, family and parenting problems in families with adolescents deserve our attention. Finally, the Social Development Index showed that the development of young people has gradually deteriorated in the past decade. These adolescent issues and problems provide useful pointers for designing the positive youth development program financially sponsored by the Hong Kong Jockey Club Charities Trust.

Growth Problems

MedlinePlus

... hormones needed to grow and develop. For example, Turner syndrome is a genetic condition (due to a problem ... a missing or abnormal X chromosome. Girls with Turner syndrome tend to be short and don't usually ...

Specificity of Problem-Solving Skills Training in Mothers of Children Newly Diagnosed With Cancer: Results of a Multisite Randomized Clinical Trial

PubMed Central

Sahler, Olle Jane Z.; Dolgin, Michael J.; Phipps, Sean; Fairclough, Diane L.; Askins, Martha A.; Katz, Ernest R.; Noll, Robert B.; Butler, Robert W.

2013-01-01

Purpose Diagnosis of cancer in a child can be extremely stressful for parents. Bright IDEAS, a problem-solving skills training (PSST) intervention, has been shown to decrease negative affectivity (anxiety, depression, post-traumatic stress symptoms) in mothers of newly diagnosed patients. This study was designed to determine the specificity of PSST by examining its direct and indirect (eg, social support) effects compared with a nondirective support (NDS) intervention. Patients and Methods This randomized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment. Participants completed assessments prerandomization (T1), immediately postintervention (T2), and at 3-month follow-up (T3). Both PSST and NDS consisted of eight weekly 1-hour individual sessions. Outcomes included measures of problem-solving skill and negative affectivity. Results There were no significant between-group differences at baseline (T1). Except for level of problem-solving skill, which was directly taught in the PSST arm, outcome measures improved equally in both groups immediately postintervention (T2). However, at the 3-month follow-up (T3), mothers in the PSST group continued to show significant improvements in mood, anxiety, and post-traumatic stress; mothers in the NDS group showed no further significant gains. Conclusion PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends. In contrast, NDS is an effective intervention while it is being administered, but its benefits plateau when active support is removed. Therefore, teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment. PMID:23358975

An initial study of behavioral addiction symptom severity and demand for indoor tanning.

PubMed

Becirevic, Amel; Reed, Derek D; Amlung, Michael; Murphy, James G; Stapleton, Jerod L; Hillhouse, Joel J

2017-10-01

Indoor tanning remains a popular activity in Western cultures despite a growing body of literature suggesting its link to skin cancer and melanoma. Advances in indoor tanning research have illuminated problematic patterns of its use. With problems such as difficulty quitting, devoting resources toward its use at the expense of healthy activities, and excessive motivation and urges to tan, symptoms of excessive indoor tanning appear consistent with behavioral addiction. The present study bridges the gap between clinical approaches to understanding indoor tanning problems and behavioral economic considerations of unhealthy habits and addiction. Eighty undergraduate females completed both the Behavioral Addiction Indoor Tanning Screener and the Tanning Purchase Task. Results suggest that behavioral economic demand for tanning significantly differs between risk classification groups, providing divergent validity to the Behavioral Addiction Indoor Tanning Screener and offering additional evidence of the sensitivity of the Tanning Purchase Task to differentiating groups according to tanning profiles. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Can probiotics benefit children with autism spectrum disorders?

PubMed Central

Navarro, Fernando; Liu, Yuying; Rhoads, Jon Marc

2016-01-01

Children with autism are commonly affected by gastrointestinal problems such as abdominal pain, constipation and diarrhea. In recent years, there has been a growing interest in the use of probiotics in this population, as it hypothetically may help to improve bowel habits and the behavioral and social functioning of these individuals. The gut microbiome plays an important role in the pathophysiology of organic as well as functional gastrointestinal disorders. Microbial modification with the use of antibiotics, probiotics, and fecal transplantation have been effective in the treatment of conditions such as recurrent Clostridium difficile infection, pouchitis, and irritable bowel syndrome. The present review presents a number of reported clinical, immunological and microbiome-related changes seen in children with autism compared to normally developed children. It also discusses gut inflammation, permeability concerns, and absorption abnormalities that may contribute to these problems. Most importantly, it discusses evidence, from human and animal studies, of a potential role of probiotics in the treatment of gastrointestinal symptoms in children with autism. PMID:28028357

Child-to-Child programme in the Philippine setting.

PubMed

Rabor, I F; Santos Ocampo, P D

1982-09-01

The Philippines is an archipelago with a growing population, largely rural, 50% of which is in the 0-14 years old age group. As noted by WHO (1978), the leading health problems are communicable diseases, malnutrition, poor environmental sanitation, malaria and schistosomiasis, rapid population growth, drug abuse and dependence. Health care delivery is hampered by insufficient number and maldistribution of personnel, health clinics and hospitals. The predominant attitude of curative rather than preventive approach to health problems shared by consumers and care givers alike, passive and meager participation if at all on the part of recipients also contribute to deficient health care delivery. Child-to-Child health programmes would be most useful in depressed areas of the country, especially in the rural setting and should be widely implemented if feasible. Data concerning the community involved will include resources, strengths and weaknesses, and degree of commitment from its members. We hope to have in the Philippines more experience in Child-to-Child programmes-health care delivery in the future.

Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013–20141

PubMed Central

Esposito, Douglas H.; Gaines, Joanna; Ridpath, Alison; Barry, M. Anita; Feldman, Katherine A.; Mullins, Jocelyn; Burns, Rachel; Ahmad, Nina; Nyangoma, Edith N.; Nguyen, Duc B.; Perz, Joseph F.; Moulton-Meissner, Heather A.; Jensen, Bette J.; Lin, Ying; Posivak-Khouly, Leah; Jani, Nisha; Morgan, Oliver W.; Brunette, Gary W.; Pritchard, P. Scott; Greenbaum, Adena H.; Rhee, Susan M.; Blythe, David; Sotir, Mark

2016-01-01

During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment. PMID:27434822

Bioprosthetic tissue matrices in complex abdominal wall reconstruction.

PubMed

Broyles, Justin M; Abt, Nicholas B; Sacks, Justin M; Butler, Charles E

2013-12-01

Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction. We reviewed the peer-reviewed literature on the use of bioprosthetic mesh in human subjects. Basic science articles and large retrospective and prospective reviews were included in author's analysis. The clinical performance and characteristics of 13 bioprosthetic tissue matrices were evaluated. The majority of the products evaluated perform well in contaminated fields, where the risk of wound-healing difficulties is high. Clinical outcomes, which included infection, reherniation, and bulge formation, were variable, and the majority of the studies had a mean follow-up of less than 24 months. Although bioprosthetic matrix has a multitude of indications within the growing field of abdominal wall reconstruction, the functionality, regenerative capacity, and long-term fate of these products have yet to be fully established. Furthermore, the clinical performance, indications, and contraindications for each type of matrix need to be fully evaluated in long-term outcome studies.

Bioprosthetic Tissue Matrices in Complex Abdominal Wall Reconstruction

PubMed Central

Broyles, Justin M.; Abt, Nicholas B.; Sacks, Justin M.

2013-01-01

Background: Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction. Methods: We reviewed the peer-reviewed literature on the use of bioprosthetic mesh in human subjects. Basic science articles and large retrospective and prospective reviews were included in author’s analysis. The clinical performance and characteristics of 13 bioprosthetic tissue matrices were evaluated. Results: The majority of the products evaluated perform well in contaminated fields, where the risk of wound-healing difficulties is high. Clinical outcomes, which included infection, reherniation, and bulge formation, were variable, and the majority of the studies had a mean follow-up of less than 24 months. Conclusions: Although bioprosthetic matrix has a multitude of indications within the growing field of abdominal wall reconstruction, the functionality, regenerative capacity, and long-term fate of these products have yet to be fully established. Furthermore, the clinical performance, indications, and contraindications for each type of matrix need to be fully evaluated in long-term outcome studies. PMID:25289285

Toward an Emerging Role for Motivational Interviewing in Primary Care.

PubMed

Keeley, Robert; Engel, Matthew; Reed, Alex; Brody, David; Burke, Brian L

2018-05-18

Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care. Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.

Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis.

PubMed

Rigato, Mauro; Pizzol, Damiano; Tiago, Armindo; Putoto, Giovanni; Avogaro, Angelo; Fadini, Gian Paolo

2018-05-26

Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluating Writing Programs: Paradigms, Problems, Possibilities.

ERIC Educational Resources Information Center

McLeod, Susan H.

1992-01-01

Describes two methodological approaches (qualitative and quantitative) that grow out of two different research examples. Suggests the problems these methods present. Discusses the ways in which an awareness of these problems can help teachers to understand how to work with researchers in designing useful evaluations of writing programs. (PRA)

Traveling Salesman Problem: A Foveating Pyramid Model

ERIC Educational Resources Information Center

Pizlo, Zygmunt; Stefanov, Emil; Saalweachter, John; Li, Zheng; Haxhimusa, Yll; Kropatsch, Walter G.

2006-01-01

We tested human performance on the Euclidean Traveling Salesman Problem using problems with 6-50 cities. Results confirmed our earlier findings that: (a) the time of solving a problem is proportional to the number of cities, and (b) the solution error grows very slowly with the number of cities. We formulated a new version of a pyramid model. The…

Alcohol Problems Prevention/Intervention Programs: Guidelines for College Campuses. Revised.

ERIC Educational Resources Information Center

Harding, Frances M.; Connor, Leslie S.

This manual is designed to respond to the growing interest among colleges in technical assistance for dealing with alcohol-related problems. Part One provides an overview of the dimensions of alcohol related problems and delves into the causes and prevention of alcohol problems. It outlines the Public Health Model approach to dealing with alcohol…

Occupational necessity and educational invention: resident teaching of radiologic technologists.

PubMed

Gunderman, Richard B; Fraley, Ronald; Jackson, Valerie; Robinson, Susan; Williamson, Kenneth

2003-04-01

Radiology faces a severe and growing shortage of radiologic technologists. One way of redressing this problem is to improve the quality of education provided to radiologic technology students. Yet growing clinical demands increasingly erode faculty time for teaching. This study examined whether radiology residents could provide equivalent instruction in radiologic technology at lower cost, and whether such experience could enhance residents' interest in teaching as part of their careers. Course evaluation forms completed by the students in a required radiologic pathology course were reviewed, and student-reported faculty and resident performances in teaching were compared. Residents also were surveyed for their reactions to the experience of teaching this course. Ninety percent of students (27 of 30) either agreed or strongly agreed that the course was well taught by radiology faculty members, and 97% (29 of 30) either agreed or strongly agreed that the course was well taught by radiology residents. The total direct cost of instruction by radiology residents was 73% lower than the cost of instruction by faculty. Residents who participated in teaching found the experience worthwhile, and they described a wide variety of personal and educational benefits. Involving radiology residents in teaching can help redress the growing shortage of radiologic technologists, relieve some of the pressure on faculty time, and contribute to the professional development of the next generation of radiologists.

Implementation issues relevant to outpatient neurology palliative care.

PubMed

Kluger, Benzi M; Persenaire, Michael J; Holden, Samantha K; Palmer, Laura T; Redwine, Hannah; Berk, Julie; Anderson, C Alan; Filley, Christopher M; Kutner, Jean; Miyasaki, Janis; Carter, Julie

2017-11-29

There is growing interest in the application of palliative care principles to improve care for patients and families affected by neurologic diseases. We developed an interdisciplinary outpatient clinic for patients and families affected by neurologic disorders to better address the problems faced by our highest need patients. We have developed and improved this program over the past three years and share several of our most important lessons as well as ongoing challenges and areas where we see our clinic evolving in the future. We provide a description of our clinic logistics, including key steps in the initiation of the clinic, and provide descriptions from similar clinics at other institutions to demonstrate some of the variability in this growing field. We also provide results from a formal one-year quality improvement project and a one-year retrospective study of patients attending this clinic. Our clinic has grown steadily since its inception and maintains high satisfaction ratings from patients, caregivers, and referring providers. To maintain standardized and efficient care we have developed materials for patients and referring physicians as well as checklists and other processes used by our interdisciplinary team. Feedback from our quality improvement project helped define optimal visit duration and refine communication among team members and with patients and families. Results from our chart review suggest our clinic influences advance care planning and place of death. Common referral reasons include psychosocial support, complex symptom management, and advance care planning. Current challenges for our clinic include developing a strategy for continued growth, creating a sustainable financial model for interdisciplinary care, integrating our services with disease-specific sections, improving primary palliative care knowledge and skills within our referral base, and building effective alliances with community neurologists, geriatrics, primary care, nursing homes, and hospices. Specialized outpatient palliative care for neurologic disorders fills several important gaps in care for this patient population, provides important educational opportunities for trainees, and creates opportunities for patient and caregiver-centered research. Educational initiatives are needed to train general neurologists in primary palliative care, to train neurologists in specialist palliative care, and to train palliative medicine specialists in neurology. Research is needed to build an evidence base to identify patient and caregiver needs, support specific interventions, and to build more efficient models of care in both academic and community settings.

Designing a Forcenet Information Topology

DTIC Science & Technology

2004-12-01

and limitations, but one consistent problem is that by tagging data the amount of bits needed to represent the data grows proportionately. As a...40 Frank Morning, Jr., “Smallsats Grow Up,” Aviation Week & Space Technology, December 8, 2003 41 Ibid. 32 (such as emails home or...Below are a few important points concerning a huge field of work. a. Dissimilar Redundancy and Reconstitution A growing concern within the DoD is

Legal highs: staying on top of the flood of novel psychoactive substances

PubMed Central

Baumeister, David; Tojo, Luis M.

2015-01-01

There has been growing clinical, public, and media awareness and concern about the availability and potential harmfulness of so-called ‘legal highs’, which are more appropriately called new or novel psychoactive substances (NPS). A cat-and-mouse process has emerged wherein unknown chemists and laboratories are producing new, and as yet nonproscribed, compounds for human consumption; and as soon as they are banned, which they inevitably are, slightly modified analogues are produced to circumvent new laws. This rapidly changing environment, 81 new substances were identified in 2013 alone, has led to confusion for clinicians, psychopharmacologists, and the public at large. Our difficulties in keeping up with the process has had a two-fold negative effect: the danger of ignoring what is confusing; and the problem that some of the newer synthesized compounds appear ever more potent. This review aims to circumscribe a quick moving and growing field, and to categorize NPS into five major groups based upon their ‘parent’ compounds: stimulants similar to cocaine, amphetamines and ecstasy; cannabinoids; benzodiazepine based drugs; dissociatives similar to ketamine and phencyclidine (PCP); and those modelled after classic hallucinogens such as LSD and psilocybin. Pharmacodynamic actions, subjective and physical effects, harmfulness, risk of dependency and, where appropriate, putative clinical potentials are described for each class. Clinicians might encounter NPS in various ways: anecdotal reportage; acute intoxication; as part of a substance misuse profile; and as a precipitant or perpetuating factor for longer-term physical and psychological ill health. Current data are overall limited, and much of our knowledge and treatment strategies are based upon those of the ‘parent’ compound. There is a critical need for more research in this field, and for professionals to make themselves more aware of this growing issue and how it might affect those we see clinically and try to help: a brave new world of so-called ‘psychonauts’ consuming NPS will also need informed ‘psychotherapeutonauts’. The paper should serve as a primer for clinicians and interested readers, as well as provide a framework into which to place the new substances that will inevitably be synthesized in the future. PMID:26240749

Research, empiricism and clinical practice in low-income countries.

PubMed

Isaac, Mohan; Chand, Prabhat; Murthy, Pratima

2007-10-01

Mental health problems are relevant for every country. They are particularly important for low-income countries which face a high burden of illness due to infectious disease, greater socio-economic disparities, and have limited resources for mental health care. There is a great mismatch in the areas of mental health research, practice, policy and services in comparison to developed countries. There have been a few studies that have investigated major mental health problems prevailing in these countries but missed out significant health problems. Studies have tended to be more donor driven and conducted in tertiary centres. The low priority accorded to mental health by the policy makers, scarcity of human resources, lack of culture-specific study instruments, lack of support from scientific journals have been some of the impediments to mental health research in these countries. In addition, lack of community participation and absence of sound mental health policies have deprived the vast majority of the benefit of modern psychiatric treatments. Recently, with increase in collaboration in research, availability of treatment including low-priced psychotropics, and a growing emphasis on the need for mental health policy in some low-income countries, the bleak scenario is expected to change.

Hospital discharge queues in Massachusetts.

PubMed

Gruenberg, L W; Willemain, T R

1982-02-01

There is growing concern over the inappropriate utilization of health care facilities. The high cost of hospital care and the apparent shortage of nursing home beds have focused attention on one aspect of this problem: the clinically unnecessary days (sometimes called "administrative days" or "ADs") spent in hospitals by patients who are awaiting placement in long-term care facilities. In this study, data from a 1976 Massachusetts Department of Public Health survey of patients backed up in hospitals were analyzed to determine the magnitude of the problem and to examine the influence of several major factors that had been hypothesized in previous studies to contribute to the backup. We demonstrate that the average delay of a patient found waiting in a "snapshot" survey (which is often used to estimate the magnitude of the problem) is significantly greater than the average delay experienced by a typical discharged patient. We show that there are at least two major factors that influence the delay time: nursing home preferences in accepting certain types of patients and nursing home occupancy rates in the hospital service area. Neither medical-surgical occupancy rate nor the number of AD patients waiting in the hospital was significantly correlated with the delay time.

Massively multiplayer online role-playing game-induced seizures: a neglected health problem in Internet addiction.

PubMed

Chuang, Yao-Chung

2006-08-01

As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing psychosocial problem. However, epileptic seizure, another out-of-the-ordinary health problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games -- Massively Multiplayer Online Role-Playing Games (MMORPGs) -- were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game-induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the software. While the prevalence of MMORPG-induced seizures remains unknown, it may exceed our expectations and impact our society. Not only for clinical neurologists but also for the primary physicians, educators, sociologists, and global online game publishers, there should be an awareness of this special form of reflex seizures in order to provide an appropriate health warning to MMORPG players.

Current Social Problem Novels.

ERIC Educational Resources Information Center

Kenney, Donald J.

This review of social problem novels for young adults opens with a brief background of the genre, then lists the dominant themes of social problem fiction and nonfiction novels that have been published in the last two years, such as alcoholism, alienation, death, growing up and self-awarness, drugs, and divorce. Other themes mentioned are…

Geriatric gambling disorder: challenges in clinical assessment.

PubMed

Smith, Mara; Hategan, Ana; Bourgeois, James A

2017-12-01

To the Editor: The gaming industry is growing rapidly, as is the proportion of older adults aged 65 years or older who participate in gambling (Tse et al., 2012). With casinos tailoring their venues and providing incentives to attract older adults, and with the increasing popularity of "pleasure trips" to casinos organized by retirement homes, plus active promotion of government-operated lotteries in many countries, this trend is likely to continue. Gambling disorder (GD) or "pathological" or "problem" gambling presents a public health concern in the geriatric population. However, ascertainment of its prevalence and diagnostic accuracy have proven challenging. This is largely due to the absence of diagnostic criteria specific to the geriatric age and rating scales validated for use in this population.

Multidimensional Treatment Foster Care as a Preventive Intervention to Promote Resiliency Among Youth in the Child Welfare System

PubMed Central

Leve, Leslie D.; Fisher, Philip A.; Chamberlain, Patricia

2009-01-01

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well-studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from four randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed. PMID:19807861

Sex Trafficking of Women and Girls

PubMed Central

Deshpande, Neha A; Nour, Nawal M

2013-01-01

Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a significant and growing problem in both the United States and the larger global community. The costs to society include the degradation of human and women’s rights, poor public health, disrupted communities, and diminished social development. Victims of sex trafficking acquire adverse physical and psychological health conditions and social disadvantages. Thus, sex trafficking is a critical health issue with broader social implications that requires both medical and legal attention. Healthcare professionals can work to improve the screening, identification, and assistance of victims of sex trafficking in a clinical setting and help these women and girls access legal and social services. PMID:23687554

The prescription opioid epidemic: an overview for anesthesiologists.

PubMed

Alam, Asim; Juurlink, David N

2016-01-01

The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem. We searched PubMed, Google Scholar, and EMBASE™ for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest. In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem. Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.

Self-Organization and the Self-Assembling Process in Tissue Engineering

PubMed Central

Eswaramoorthy, Rajalakshmanan; Hadidi, Pasha; Hu, Jerry C.

2015-01-01

In recent years, the tissue engineering paradigm has shifted to include a new and growing subfield of scaffoldless techniques which generate self-organizing and self-assembling tissues. This review aims to provide a cogent description of this relatively new research area, with special emphasis on applications toward clinical use and research models. Particular emphasis is placed on providing clear definitions of self-organization and the self-assembling process, as delineated from other scaffoldless techniques in tissue engineering and regenerative medicine. Significantly, during formation, self-organizing and self-assembling tissues display biological processes similar to those that occur in vivo. These help lead to the recapitulation of native tissue morphological structure and organization. Notably, functional properties of these tissues also approach native tissue values; some of these engineered tissues are already in clinical trials. This review aims to provide a cohesive summary of work in this field, and to highlight the potential of self-organization and the self-assembling process to provide cogent solutions to current intractable problems in tissue engineering. PMID:23701238

Postpartum mental illness: perspectives from an Arabian Gulf population.

PubMed

Ghubash, Rafia; Eapen, Valsamma

2009-08-01

There is growing awareness of the importance of mental health issues in the perinatal period in Western societies, but very little information is available from Muslim and Arab countries. Qualitative information gathered using focus group discussions of women of childbearing age is presented along with additional information obtained from key informant interviews with grandmothers, husbands, and health care professionals in the United Arab Emirates. The participants were women attending a public sector clinic in Al Ain, Abu Dhabi, and a private clinic in Dubai on a particular day. There were 19 women in the age range 17 to 46 years (M age = 29 yr.). The majority of the women who took part in the study did not recognize postnatal depression as a psychological issue but considered the problems a result of "evil eye" or "Jinn." The present findings suggest the need for initiating awareness programs among women and training of health professionals on the detection and management of postnatal depression.

Clinical efficacy of a herbal dentifrice on dentinal hypersensitivity: a randomized controlled clinical trial.

PubMed

Kumari, M; Naik, S B; Rao, N S; Martande, S S; Pradeep, A R

2013-12-01

Dentinal hypersensitivity is a common problem and there is a growing interest in herbal based formulations for the treatment of oral diseases. This study was conducted to assess the efficacy of a commercially available novel herbal dentifrice in reduction of dentinal hypersensitivity. A total of 73 subjects (38 males and 35 females; aged 25-60 years) were randomly divided into two groups: Group 1 - a placebo dentifrice (The Himalaya Drug Company Research and Development, Makali, Bangalore) and Group 2 - (test group), a commercially available herbal dentifrice (Hi Ora K, The Himalaya Drug Company Research and Development, Makali, Bangalore). Sensitivity scores for controlled air stimulus and cold water were recorded at baseline, 6 weeks and 12 weeks. The test group was found to be significantly better compared to the placebo group at the end of 6 and 12 weeks in reduction of dentinal hypersensitivity. The novel herbal dentifrice can be recommended for treatment of dentinal hypersensitivity. © 2013 Australian Dental Association.

Crowdsourcing in biomedicine: challenges and opportunities.

PubMed

Khare, Ritu; Good, Benjamin M; Leaman, Robert; Su, Andrew I; Lu, Zhiyong

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. Published by Oxford University Press 2015. This work is written by US Government employees and is in the public domain in the US.

Use of Gaming in Self-Management of Diabetes in Teens.

PubMed

Swartwout, Ellen; El-Zein, Ashley; Deyo, Patricia; Sweenie, Rachel; Streisand, Randi

2016-07-01

With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change.

Hyperspectral small animal fluorescence imaging: spectral selection imaging

NASA Astrophysics Data System (ADS)

Leavesley, Silas; Jiang, Yanan; Patsekin, Valery; Hall, Heidi; Vizard, Douglas; Robinson, J. Paul

2008-02-01

Molecular imaging is a rapidly growing area of research, fueled by needs in pharmaceutical drug-development for methods for high-throughput screening, pre-clinical and clinical screening for visualizing tumor growth and drug targeting, and a growing number of applications in the molecular biology fields. Small animal fluorescence imaging employs fluorescent probes to target molecular events in vivo, with a large number of molecular targeting probes readily available. The ease at which new targeting compounds can be developed, the short acquisition times, and the low cost (compared to microCT, MRI, or PET) makes fluorescence imaging attractive. However, small animal fluorescence imaging suffers from high optical scattering, absorption, and autofluorescence. Much of these problems can be overcome through multispectral imaging techniques, which collect images at different fluorescence emission wavelengths, followed by analysis, classification, and spectral deconvolution methods to isolate signals from fluorescence emission. We present an alternative to the current method, using hyperspectral excitation scanning (spectral selection imaging), a technique that allows excitation at any wavelength in the visible and near-infrared wavelength range. In many cases, excitation imaging may be more effective at identifying specific fluorescence signals because of the higher complexity of the fluorophore excitation spectrum. Because the excitation is filtered and not the emission, the resolution limit and image shift imposed by acousto-optic tunable filters have no effect on imager performance. We will discuss design of the imager, optimizing the imager for use in small animal fluorescence imaging, and application of spectral analysis and classification methods for identifying specific fluorescence signals.

Perceived Social Support and Mental Health Problems Among Pakistani University Students.

PubMed

Jibeen, Tahira

2016-11-01

Despite the growing number of cross-cultural studies focusing on psychological problems, little is known about social support outside of western civilization, particularly among people in South Asian cultures. This study examined the cultural orientation regarding perceived social support and psychological problems among 912 undergraduate students (age 19-26) studying at COMSATS Institute of Information Technology, Lahore, Pakistan. The present study supported variance in cultural values regarding the relative prominence of sources of support in collectivist culture indicating that low levels of family support were related to various psychological problems. Further, low levels of peer support were related to depression, anxiety, and interpersonal sensitivity. While familial support played a bigger role than peer support in affecting psychological problems, peer support also had a role to play. The results may help counsellors and researchers to identify more effectively the population of students at high risk for mental illness and develop culturally effective interventions to address this significant and growing public health issue.

Cases of Lyme disease reported in a military community.

PubMed

Underwood, P K; Armour, V M

1993-02-01

Lyme disease, a growing public health problem in the United States, is also an increasing threat in Europe. Cases identified in a military community in West Germany are presented and problems of diagnosis and treatment discussed.

The Solutionaries Education for a Better World: What Is Schooling for?

ERIC Educational Resources Information Center

Weil, Zoe

2012-01-01

People are confronted with escalating, interrelated global problems: climate change, growing extinction rates, economic instability, a looming energy catastrophe, depletion of resources, and an ever-growing population of people, each of whom requires food, water, shelter, and a job. Clearly, people need to create better, sustainable, and…

Sexual Harassment a Growing Problem as Some Donors Make Overtures to People Seeking Gifts from Them.

ERIC Educational Resources Information Center

McMillen, Liz

1991-01-01

Most college fundraisers are women and most donors are men. The conditions of fundraising may make sexual harassment an important issue by creating opportunities for confusion and abuse. A growing need for colleges to address the issue is seen. (MSE)

Writing the New West: A Critical Review

ERIC Educational Resources Information Center

Robbins, Paul; Meehan, Katharine; Gosnell, Hannah; Gilbertz, Susan J.

2009-01-01

A vast and growing interdisciplinary research effort has focused on the rise of the so-called New West, purportedly the product of regional socioeconomic, political, and ecological upheavals in states like Montana and Colorado. Reviewing the growing research on this problem in sociology, economics, geography, and conservation science, this article…

Growth patterns for shape-shifting elastic bilayers.

PubMed

van Rees, Wim M; Vouga, Etienne; Mahadevan, L

2017-10-31

Inspired by the differential-growth-driven morphogenesis of leaves, flowers, and other tissues, there is increasing interest in artificial analogs of these shape-shifting thin sheets made of active materials that respond to environmental stimuli such as heat, light, and humidity. But how can we determine the growth patterns to achieve a given shape from another shape? We solve this geometric inverse problem of determining the growth factors and directions (the metric tensors) for a given isotropic elastic bilayer to grow into a target shape by posing and solving an elastic energy minimization problem. A mathematical equivalence between bilayers and curved monolayers simplifies the inverse problem considerably by providing algebraic expressions for the growth metric tensors in terms of those of the final shape. This approach also allows us to prove that we can grow any target surface from any reference surface using orthotropically growing bilayers. We demonstrate this by numerically simulating the growth of a flat sheet into a face, a cylindrical sheet into a flower, and a flat sheet into a complex canyon-like structure.

Growth patterns for shape-shifting elastic bilayers

PubMed Central

van Rees, Wim M.; Vouga, Etienne; Mahadevan, L.

2017-01-01

Inspired by the differential-growth-driven morphogenesis of leaves, flowers, and other tissues, there is increasing interest in artificial analogs of these shape-shifting thin sheets made of active materials that respond to environmental stimuli such as heat, light, and humidity. But how can we determine the growth patterns to achieve a given shape from another shape? We solve this geometric inverse problem of determining the growth factors and directions (the metric tensors) for a given isotropic elastic bilayer to grow into a target shape by posing and solving an elastic energy minimization problem. A mathematical equivalence between bilayers and curved monolayers simplifies the inverse problem considerably by providing algebraic expressions for the growth metric tensors in terms of those of the final shape. This approach also allows us to prove that we can grow any target surface from any reference surface using orthotropically growing bilayers. We demonstrate this by numerically simulating the growth of a flat sheet into a face, a cylindrical sheet into a flower, and a flat sheet into a complex canyon-like structure. PMID:29078336

Representations of minimum unit pricing for alcohol in UK newspapers: a case study of a public health policy debate.

PubMed

Patterson, Chris; Katikireddi, Srinivasa Vittal; Wood, Karen; Hilton, Shona

2015-03-01

Mass media influence public acceptability, and hence feasibility, of public health interventions. This study investigates newsprint constructions of the alcohol problem and minimum unit pricing (MUP). Quantitative content analysis of 901 articles about MUP published in 10 UK and Scottish newspapers between 2005 and 2012. MUP was a high-profile issue, particularly in Scottish publications. Reporting increased steadily between 2008 and 2012, matching the growing status of the debate. The alcohol problem was widely acknowledged, often associated with youths, and portrayed as driven by cheap alcohol, supermarkets and drinking culture. Over-consumption was presented as a threat to health and social order. Appraisals of MUP were neutral, with supportiveness increasing slightly over time. Arguments focused on health impacts more frequently than more emotive perspectives or business interests. Health charities and the NHS were cited slightly more frequently than alcohol industry representatives. Emphases on efficacy, evidence and experts are positive signs for evidence-based policymaking. The high profile of MUP, along with growing support within articles, could reflect growing appetite for action on the alcohol problem. Representations of the problem as structurally driven might engender support for legislative solutions, although cultural explanations remain common. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health.

Representations of minimum unit pricing for alcohol in UK newspapers: a case study of a public health policy debate

PubMed Central

Patterson, Chris; Katikireddi, Srinivasa Vittal; Wood, Karen; Hilton, Shona

2015-01-01

Background Mass media influence public acceptability, and hence feasibility, of public health interventions. This study investigates newsprint constructions of the alcohol problem and minimum unit pricing (MUP). Methods Quantitative content analysis of 901 articles about MUP published in 10 UK and Scottish newspapers between 2005 and 2012. Results MUP was a high-profile issue, particularly in Scottish publications. Reporting increased steadily between 2008 and 2012, matching the growing status of the debate. The alcohol problem was widely acknowledged, often associated with youths, and portrayed as driven by cheap alcohol, supermarkets and drinking culture. Over-consumption was presented as a threat to health and social order. Appraisals of MUP were neutral, with supportiveness increasing slightly over time. Arguments focused on health impacts more frequently than more emotive perspectives or business interests. Health charities and the NHS were cited slightly more frequently than alcohol industry representatives. Conclusion Emphases on efficacy, evidence and experts are positive signs for evidence-based policymaking. The high profile of MUP, along with growing support within articles, could reflect growing appetite for action on the alcohol problem. Representations of the problem as structurally driven might engender support for legislative solutions, although cultural explanations remain common. PMID:25312002

Massively Scalable Near Duplicate Detection in Streams of Documents using MDSH

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

Bogen, Paul Logasa; Symons, Christopher T; McKenzie, Amber T

2013-01-01

In a world where large-scale text collections are not only becoming ubiquitous but also are growing at increasing rates, near duplicate documents are becoming a growing concern that has the potential to hinder many different information filtering tasks. While others have tried to address this problem, prior techniques have only been used on limited collection sizes and static cases. We will briefly describe the problem in the context of Open Source Intelligence (OSINT) along with our additional constraints for performance. In this work we propose two variations on Multi-dimensional Spectral Hash (MDSH) tailored for working on extremely large, growing setsmore » of text documents. We analyze the memory and runtime characteristics of our techniques and provide an informal analysis of the quality of the near-duplicate clusters produced by our techniques.« less

New Toronto clinic for men may be sign of growing entrepreneurship within medicine.

PubMed Central

Lowry, F

1995-01-01

A Toronto physician has opened a new clinic for male patients, particularly highly stressed executives, who pay to have their physical, mental and nutritional health assessed. The Health Institute for Men, which opened in January, is located close to the Toronto Stock Exchange. It charges $450 for the initial visit, which includes a complete history, mental-assessment exam and thorough physical. The chair of the CMA Board of Directors considers the clinic a sign of growing entrepreneurship within Canadian medicine. Images p204-a p204-b PMID:7600471

Gambling in Ethnic Adolescent Populations: An Exploratory Study of the Utility of Problem Behaviour Theory as an Explanatory Framework

ERIC Educational Resources Information Center

Zangeneh, Masood; Mann, Robert E.; McCready, John; Oseni, Lola

2010-01-01

Problem gambling is a growing concern among adolescents today. According to recent studies, rates of problem gambling among youth are higher than those reported by adults. Though few in number, studies have also shown certain ethnic communities to be prone to gambling-related problems and related problematic behaviours. As yet, there is no…

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group.

PubMed

Anderson, Michelle A; Akshintala, Venkata; Albers, Kathryn M; Amann, Stephen T; Belfer, Inna; Brand, Randall; Chari, Suresh; Cote, Greg; Davis, Brian M; Frulloni, Luca; Gelrud, Andres; Guda, Nalini; Humar, Abhinav; Liddle, Rodger A; Slivka, Adam; Gupta, Rachelle Stopczynski; Szigethy, Eva; Talluri, Jyothsna; Wassef, Wahid; Wilcox, C Mel; Windsor, John; Yadav, Dhiraj; Whitcomb, David C

2016-01-01

Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care. Copyright © 2015 IAP and EPC. All rights reserved.

Respiratory dysfunction in patients with chronic neck pain: What is the current evidence?

PubMed

Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

2016-10-01

Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. The effect size of the respiratory dysfunction regarding these respiratory parameters can be approximately described as moderate. These findings not only suggest a more thoughtful drug prescription, but they may lead to consideration of incorporation of respiratory assessment and treatment into routine physiotherapy practice. Indeed preliminary studies exploring the incorporation of such a treatment into usual practice have provided very promising results not only in relation to respiratory function, but also for other parameters of clinical interest. There remains however imminent need for randomized controlled trials to confirm the evidence base for such an approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mechanism, Assessment and Management of Pain in Chronic Pancreatitis: Recommendations of a Multidisciplinary Study Group

PubMed Central

Anderson, Michelle A; Akshintala, Venkata; Albers, Kathryn M; Amann, Stephen T.; Belfer, Inna; Brand, Randall; Chari, Suresh; Cote, Greg; Davis, Brian M.; Frulloni, Luca; Gelrud, Andres; Guda, Nalini; Humar, Abhinav; Liddle, Rodger A.; Slivka, Adam; Gupta, Rachelle Stopczynski; Szigethy, Eva; Talluri, Jyothsna; Wassef, Wahid; Wilcox, C Mel; Windsor, John; Yadav, Dhiraj; Whitcomb, David C.

2015-01-01

Description Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Methods Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Results Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. Management: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Conclusions Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care. PMID:26620965

[Patient-related complexity in nursing care - Collective case studies in the acute care hospital].

PubMed

Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn

2018-06-04

Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

Current progress in tissue engineering of heart valves: multiscale problems, multiscale solutions.

PubMed

Cheung, Daniel Y; Duan, Bin; Butcher, Jonathan T

2015-01-01

Heart valve disease is an increasingly prevalent and clinically serious condition. There are no clinically effective biological diagnostics or treatment strategies. The only recourse available is replacement with a prosthetic valve, but the inability of these devices to grow or respond biologically to their environments necessitates multiple resizing surgeries and life-long coagulation treatment, especially in children. Tissue engineering has a unique opportunity to impact heart valve disease by providing a living valve conduit, capable of growth and biological integration. This review will cover current tissue engineering strategies in fabricating heart valves and their progress towards the clinic, including molded scaffolds using naturally derived or synthetic polymers, decellularization, electrospinning, 3D bioprinting, hybrid techniques, and in vivo engineering. Whereas much progress has been made to create functional living heart valves, a clinically viable product is not yet realized. The next leap in engineered living heart valves will require a deeper understanding of how the natural multi-scale structural and biological heterogeneity of the tissue ensures its efficient function. Related, improved fabrication strategies must be developed that can replicate this de novo complexity, which is likely instructive for appropriate cell differentiation and remodeling whether seeded with autologous stem cells in vitro or endogenously recruited cells.

Current Progress in Tissue Engineering of Heart Valves: Multiscale Problems, Multiscale Solutions

PubMed Central

Cheung, Daniel Y; Duan, Bin; Butcher, Jonathan T.

2016-01-01

Introduction Heart valve disease is an increasingly prevalent and clinically serious condition. There are no clinically effective biological diagnostics or treatment strategies. The only recourse available is replacement with a prosthetic valve, but the inability of these devices to grow or respond biologically to their environments necessitates multiple resizing surgeries and life-long coagulation treatment, especially in children. Tissue engineering has a unique opportunity to impact heart valve disease by providing a living valve conduit, capable of growth and biological integration. Areas covered This review will cover current tissue engineering strategies in fabricating heart valves and their progress towards the clinic, including molded scaffolds using naturally-derived or synthetic polymers, decellularization, electrospinning, 3D bioprinting, hybrid techniques, and in vivo engineering. Expert opinion While much progress has been made to create functional living heart valves, a clinically viable product is not yet realized. The next leap in engineered living heart valves will require a deeper understanding of how the natural multi-scale structural and biological heterogeneity of the tissue ensures its efficient function. Related, improved fabrication strategies must be developed that can replicate this de novo complexity, which is likely instructive for appropriate cell differentiation and remodeling whether seeded with autologous stem cells in vitro or endogenously recruited cells. PMID:26027436

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home.

PubMed

McClement, Susan; Lobchuk, Michelle; Chochinov, Harvey Max; Dean, Ruth

2010-01-01

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.

Improved Leg Tracking Considering Gait Phase and Spline-Based Interpolation during Turning Motion in Walk Tests.

PubMed

Yorozu, Ayanori; Moriguchi, Toshiki; Takahashi, Masaki

2015-09-04

Falling is a common problem in the growing elderly population, and fall-risk assessment systems are needed for community-based fall prevention programs. In particular, the timed up and go test (TUG) is the clinical test most often used to evaluate elderly individual ambulatory ability in many clinical institutions or local communities. This study presents an improved leg tracking method using a laser range sensor (LRS) for a gait measurement system to evaluate the motor function in walk tests, such as the TUG. The system tracks both legs and measures the trajectory of both legs. However, both legs might be close to each other, and one leg might be hidden from the sensor. This is especially the case during the turning motion in the TUG, where the time that a leg is hidden from the LRS is longer than that during straight walking and the moving direction rapidly changes. These situations are likely to lead to false tracking and deteriorate the measurement accuracy of the leg positions. To solve these problems, a novel data association considering gait phase and a Catmull-Rom spline-based interpolation during the occlusion are proposed. From the experimental results with young people, we confirm   that the proposed methods can reduce the chances of false tracking. In addition, we verify the measurement accuracy of the leg trajectory compared to a three-dimensional motion analysis system (VICON).

Advanced Computing Methods for Knowledge Discovery and Prognosis in Acoustic Emission Monitoring

ERIC Educational Resources Information Center

Mejia, Felipe

2012-01-01

Structural health monitoring (SHM) has gained significant popularity in the last decade. This growing interest, coupled with new sensing technologies, has resulted in an overwhelming amount of data in need of management and useful interpretation. Acoustic emission (AE) testing has been particularly fraught by the problem of growing data and is…

Do People Grow on Family Trees? Genealogy for Kids & Other Beginners. Teacher's Guide.

ERIC Educational Resources Information Center

Wolfman, Ira

This teacher's guide to "Do People Grow on Family Trees?" provides the classroom teacher with thought-provoking discussion topics and questions and curriculum-enhancing activities. It presents objective-based, action learning strategies that involve students in the following: simulation situations that lead to problem solving and other…

Cybernation and Man--A Course Development Project; Report Number 2. Final Report.

ERIC Educational Resources Information Center

Dionne, Edward A.; Parkman, Ralph

Transportation, Agriculture, and Art are used as examples to establish how technology, especially computer-based technology, is involved in the life of man. Cities grow in population very rapidly; motor vehicles grow in number even more rapidly; both citcumstances raise problems--traffic congestion, economic loss, air pollution, urban…

An Analysis of Learning To Plan as a Search Problem.

ERIC Educational Resources Information Center

Gratch, Jonathan; DeJong, Gerald

Increasingly, machine learning is entertained as a mechanism for improving the efficiency of planning systems. Research in this area has generated an impressive battery of techniques and a growing body of empirical successes. Unfortunately the formal properties of these systems are not well understood. This is highlighted by a growing corpus of…

[The good and the bad. The abuse of mass-media. Tasks in child care].

PubMed

Rodé, Magdolna

2004-10-24

People would like to spend their increasing spare-time with entertainment and, therefore, the use of media has been growing. This has both advantages and disadvantages (physical and mental disturbances in their growing). Pediatricians need to know this problems and to recognize it in time to avert.

The New, the Newly Reborn and the Growing

ERIC Educational Resources Information Center

Reese, Susan

2005-01-01

A growing school population and deteriorating facilities are among the problems faced by the nation's educational system. Finding solutions to both the overcrowding and the crumbling condition of this nation's schools has fueled a bit of a construction boom, first among colleges and now in the nation's school districts. Within different states and…

Students' Perceptions of Cheating and Plagiarism in Higher Institutions

ERIC Educational Resources Information Center

Owunwanne, Daniel; Rustagi, Narendra; Dada, Remi

2010-01-01

There is a growing body of evidence that cheating and plagiarism are prominent problems in many universities. In informal conversations, it seems that different students perceive plagiarism differently. In this paper, we conducted a survey at Howard University to examine or to follow up with this growing trend. Specifically, team leaders in school…

Values-based practice in mental health and psychiatry.

PubMed

Woodbridge-Dodd, Kim

2012-11-01

Values-based practice (VBP) challenges traditions of clinical practice and moral decision-making and the literature published over the last 18 months demonstrates a growing momentum for its use. The VBP model has become part of the narrative of health and social care practice. It features in a range of publications and has been subject to philosophical analysis in relation to its theoretical rigour, and applied to clinical practice through education and training, implementation in the field and policy development. From a philosophical perspective the model faces several challenges; from a practice perspective it is welcomed as a necessary partner to Evidence-Based Practice. Both perspectives suggest VBP requires significant adjustment to professional ideas of good practice, expectations of the clinician service user relationship and notions of what constitutes good care. VBP is both a solution and a problem for clinicians. Whether VBP is seen as providing a much needed clinical skill for working with the complexity of mental health and psychiatry which is steeped in values or a solution to a dominant sociopolitical neoliberal ideology demand for choice and personalization of care, VBP will require clinicians to make personal changes to their values base that reach to the depths of their professional identity.

Human embryonic stem cell lines: socio-legal concerns and therapeutic promise.

PubMed

McLaren, Anne

2002-10-01

Stem cell lines would be very valuable for the repair of diseased or damaged organs. Stem cells derived from adult tissues raise few ethical problems, and would not be rejected if derived from the patient. They show considerable plasticity and might be appropriate for some clinical conditions, but they tend not to grow well in culture. Stem cells derived from the early human embryo proliferate indefinitely in culture and can give rise to many different tissues, but their derivation requires destruction of the embryo, which is not ethically acceptable in some countries. Other countries allow strictly regulated destructive research on human embryos, usually those that have been produced for infertile couples in infertility clinics. Embryos that are no longer required for the couple's own reproductive project could be donated for research rather than just discarded. Different approaches are being developed to avoid immunological rejection of embryonic stem cells used for therapy. Derivation of embryonic stem cell lines by somatic cell nuclear transfer ('cloning') from the patients themselves might be one possible approach, but is unlikely to be used in routine clinical practice if more cost-effective methods are available.

The assessment of skin picking in adolescence: psychometric properties of the Skin Picking Scale-Revised (German version).

PubMed

Gallinat, Christina; Keuthen, Nancy J; Stefini, Annette; Backenstrass, Matthias

2017-02-01

Skin picking disorder has received growing attention since the release of DSM-5, yet there are no evidence-based assessment instruments for adolescent samples. The present study examines the psychometric properties of the Skin Picking Scale-Revised (SPS-R, German version) in adolescents. A total of 76 adolescents (96% female) completed the SPS-R, the Clinical Psychological Diagnostic System (KPD-38), and a questionnaire assessing demographics and clinical characteristics online. The SPS-R had high internal consistency (α = 0.89) and significant small-to-medium correlations with reduced competence skills, psychological impairment, general life satisfaction, social support, and social problems on the KPD-38. Similar to prior findings for adults, an exploratory factor analysis suggested a two-factor model for the SPS-R in adolescents. Group comparisons failed to show significant differences on SPS-R scores between participants with and without dermatological conditions. The current results suggest that the SPS-R can be useful in adolescent samples as a reliable and valid instrument for the assessment of skin picking severity. Future research investigating scale validity and factor structure in a clinical sample of adolescent skin pickers is warranted.

The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem?

PubMed

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B; Ahmed, Adil

2017-01-25

Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient's problem list for patients with eligible body mass indexes (BMI) as contained in the patients' electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.

Do child healthcare professionals and parents recognize social-emotional and behavioral problems in 1-year-old infants?

PubMed

Alakortes, Jaana; Kovaniemi, Susanna; Carter, Alice S; Bloigu, Risto; Moilanen, Irma K; Ebeling, Hanna E

2017-04-01

Growing evidence supports the existence of clinically significant social-emotional/behavioral (SEB) problems among as young as 1-year-old infants. However, a substantial proportion of early SEB problems remain unidentified during contacts with child healthcare professionals. In this study, child healthcare nurse (CHCN; N = 1008) and parental (N = 518) reports about SEB worries were gathered, along with the maternal and paternal Brief Infant-Toddler Social and Emotional Assessment (BITSEA) ratings, for 12-month-old infants randomly recruited through Finnish child health centers. Only 1.4-1.8 % of CHCNs, 3.9 % of mothers, and 3.2 % of fathers reported of being worried about the assessed child's SEB development. When the CHCNs' and parental reports were combined, 7.7 % (33/428) of the infants assessed each by all three adults had one (7.0 %), two (0.7 %) or three (0 %) worry reports. Even the combination of the CHCN's and parental worry reports identified only 7.0-13.8 % of the infants with the maternal and/or paternal BITSEA Problem or Competence rating in the of-concern range. Identified associations across the three informants' worry reports, parental BITSEA ratings and sociodemographic factors are discussed in the paper. Routine and frequent use of developmentally appropriate screening measures, such as the BITSEA, might enhance identification and intervening of early SEB problems in preventive child healthcare by guiding both professionals and parents to pay more attention to substantial aspects of young children's SEB development and encouraging them to discuss possible problems and worries.

Faculty Perceptions of Problem-Based Learning in a Veterinary College

ERIC Educational Resources Information Center

Malinowski, Robert

2012-01-01

Problem-based learning (PBL) has been embraced by several veterinary colleges as one approach to manage the ever-growing body of knowledge in the profession. The goal is to foster the development of problem-solving and critical thinking skills in students, enabling them to make logical and informed decisions, rather than rely on the rote…

Consumption, Ecological Footprints and Global Inequality: A Lesson in Individual and Structural Components of Environmental Problems

ERIC Educational Resources Information Center

Obach, Brian K.

2009-01-01

As evidence of the growing ecological crisis mounts, it is imperative that sociologists speak to this social problem and incorporate a sociological perspective on environmental issues into the curriculum. Central to understanding how social issues relate to environmental problems is an examination of the ties between consumption and its ecological…

Polychronometry: The Study of Time Variables in Behavior.

ERIC Educational Resources Information Center

Mackey, William Francis

There is a growing need for instrumentation which can enable us to observe and compute phenomena that take place in time. Although problems of observation, computation, interpretation and categorization vary from field to field and from problem to problem, it is possible to design an instrument for use in any situation where time-variables have to…

Problem Definition as a Stimulus to the Creative Process: Analysis of a Classroom Exercise

ERIC Educational Resources Information Center

Vizioli, Renato; Kaminski, Paulo Carlos

2017-01-01

Dealing with problem-solving has been a growing challenge in teaching engineering and over the career of these professionals. To increase the ability to understand a problem and consequently improve the quality of the solutions, an exercise was proposed to students of an MBA program, and they have experienced some challenges on interpreting…

Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

PubMed Central

Rizzo, Gianluca; Laganà, Antonio Simone; Rapisarda, Agnese Maria Chiara; La Ferrera, Gioacchina Maria Grazia; Buscema, Massimo; Rossetti, Paola; Nigro, Angela; Muscia, Vincenzo; Valenti, Gaetano; Sapia, Fabrizio; Sarpietro, Giuseppe; Zigarelli, Micol; Vitale, Salvatore Giovanni

2016-01-01

Cobalamin is an essential molecule for humans. It acts as a cofactor in one-carbon transfers through methylation and molecular rearrangement. These functions take place in fatty acid, amino acid and nucleic acid metabolic pathways. The deficiency of vitamin B12 is clinically manifested in the blood and nervous system where the cobalamin plays a key role in cell replication and in fatty acid metabolism. Hypovitaminosis arises from inadequate absorption, from genetic defects that alter transport through the body, or from inadequate intake as a result of diet. With the growing adoption of vegetarian eating styles in Western countries, there is growing focus on whether diets that exclude animal foods are adequate. Since food availability in these countries is not a problem, and therefore plant foods are sufficiently adequate, the most delicate issue remains the contribution of cobalamin, which is poorly represented in plants. In this review, we will discuss the status of vitamin B12 among vegetarians, the diagnostic markers for the detection of cobalamin deficiency and appropriate sources for sufficient intake, through the description of the features and functions of vitamin B12 and its absorption mechanism. PMID:27916823

Diabetes's 'health shock' to schooling and earnings: increased dropout rates and lower wages and employment in young adults.

PubMed

Fletcher, Jason M; Richards, Michael R

2012-01-01

Despite a growing diabetes crisis, the nonmedical implications for young adults have gone virtually unexplored. We investigated the effects of diabetes on two key outcomes for this age group-schooling and earnings-and found that it delivers an increasingly common "health shock" to both. We identified effects in several measures of educational attainment, including a high school dropout rate that was six percentage points higher than among young adults without the disease. We also found lower employment and wages: A person with diabetes can conservatively expect to lose more than $160,000 over his or her working life, compared to a peer without the disease. For young adults with diabetes, having a parent with diabetes also leads to poorer outcomes than if one more parents do not have the disease-for example, reducing the likelihood of attending college by four to six percentage points, even after the child's health status is controlled for. These results highlight the urgency of attacking this growing health problem, as well as the need for measures such as in-school screening for whether diabetes's impact on individual learning and performance begins before the classic manifestations of clinical diabetes appear.

Quantum Entanglement Growth under Random Unitary Dynamics

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

Nahum, Adam; Ruhman, Jonathan; Vijay, Sagar

Characterizing how entanglement grows with time in a many-body system, for example, after a quantum quench, is a key problem in nonequilibrium quantum physics. We study this problem for the case of random unitary dynamics, representing either Hamiltonian evolution with time-dependent noise or evolution by a random quantum circuit. Our results reveal a universal structure behind noisy entanglement growth, and also provide simple new heuristics for the “entanglement tsunami” in Hamiltonian systems without noise. In 1D, we show that noise causes the entanglement entropy across a cut to grow according to the celebrated Kardar-Parisi-Zhang (KPZ) equation. The mean entanglement growsmore » linearly in time, while fluctuations grow like (time) 1/3 and are spatially correlated over a distance ∝(time) 2/3. We derive KPZ universal behavior in three complementary ways, by mapping random entanglement growth to (i) a stochastic model of a growing surface, (ii) a “minimal cut” picture, reminiscent of the Ryu-Takayanagi formula in holography, and (iii) a hydrodynamic problem involving the dynamical spreading of operators. We demonstrate KPZ universality in 1D numerically using simulations of random unitary circuits. Importantly, the leading-order time dependence of the entropy is deterministic even in the presence of noise, allowing us to propose a simple coarse grained minimal cut picture for the entanglement growth of generic Hamiltonians, even without noise, in arbitrary dimensionality. We clarify the meaning of the “velocity” of entanglement growth in the 1D entanglement tsunami. We show that in higher dimensions, noisy entanglement evolution maps to the well-studied problem of pinning of a membrane or domain wall by disorder.« less

Quantum Entanglement Growth under Random Unitary Dynamics

DOE PAGES

Nahum, Adam; Ruhman, Jonathan; Vijay, Sagar; ...

2017-07-24

Characterizing how entanglement grows with time in a many-body system, for example, after a quantum quench, is a key problem in nonequilibrium quantum physics. We study this problem for the case of random unitary dynamics, representing either Hamiltonian evolution with time-dependent noise or evolution by a random quantum circuit. Our results reveal a universal structure behind noisy entanglement growth, and also provide simple new heuristics for the “entanglement tsunami” in Hamiltonian systems without noise. In 1D, we show that noise causes the entanglement entropy across a cut to grow according to the celebrated Kardar-Parisi-Zhang (KPZ) equation. The mean entanglement growsmore » linearly in time, while fluctuations grow like (time) 1/3 and are spatially correlated over a distance ∝(time) 2/3. We derive KPZ universal behavior in three complementary ways, by mapping random entanglement growth to (i) a stochastic model of a growing surface, (ii) a “minimal cut” picture, reminiscent of the Ryu-Takayanagi formula in holography, and (iii) a hydrodynamic problem involving the dynamical spreading of operators. We demonstrate KPZ universality in 1D numerically using simulations of random unitary circuits. Importantly, the leading-order time dependence of the entropy is deterministic even in the presence of noise, allowing us to propose a simple coarse grained minimal cut picture for the entanglement growth of generic Hamiltonians, even without noise, in arbitrary dimensionality. We clarify the meaning of the “velocity” of entanglement growth in the 1D entanglement tsunami. We show that in higher dimensions, noisy entanglement evolution maps to the well-studied problem of pinning of a membrane or domain wall by disorder.« less

Alendronate increases skeletal mass of growing rats during unloading by inhibiting resorption of calcified cartilage

NASA Technical Reports Server (NTRS)

Bikle, D. D.; Morey-Holton, E. R.; Doty, S. B.; Currier, P. A.; Tanner, S. J.; Halloran, B. P.

1994-01-01

Loss of bone mass during periods of skeletal unloading remains an important clinical problem. To determine the extent to which resorption contributes to the relative loss of bone during skeletal unloading of the growing rat and to explore potential means of preventing such bone loss, 0.1 mg P/kg alendronate was administered to rats before unloading of the hindquarters. Skeletal unloading markedly reduced the normal increase in tibial mass and calcium content during the 9 day period of observation, primarily by decreasing bone formation, although bone resorption was also modestly stimulated. Alendronate not only prevented the relative loss of skeletal mass during unloading but led to a dramatic increase in calcified tissue in the proximal tibia compared with the vehicle-treated unloaded or normally loaded controls. Bone formation, however, assessed both by tetracycline labeling and by [3H]proline and 45Ca incorporation, was suppressed by alendronate treatment and further decreased by skeletal unloading. Total osteoclast number increased in alendronate-treated animals, but values were similar to those in controls when corrected for the increased bone area. However, the osteoclasts had poorly developed brush borders and appeared not to engage the bone surface when examined at the ultrastructural level. We conclude that alendronate prevents the relative loss of mineralized tissue in growing rats subjected to skeletal unloading, but it does so primarily by inhibiting the resorption of the primary and secondary spongiosa, leading to altered bone modeling in the metaphysis.

Increasing the practice of questioning among pediatric nurses: "The Growing Culture of Clinical Inquiry" project.

PubMed

Laibhen-Parkes, Natasha

2014-01-01

This paper describes an innovative methodology implemented in an acute care pediatric setting to build nurses' confidence and competence in questioning practice. The Growing Culture of Clinical Inquiry (GCCI) project was composed of several evidence-based strategies to attain and maintain a spirit of clinical inquiry. These strategies included PowerPoint presentations, evidence-based practice (EBP) unit champions, patient-intervention-comparison-outcome (PICO) boxes, Clinical Inquiry Posters, summaries of evidence (SOE), layman's SOE, medical librarian in-services, and journal clubs. After 1 year of implementation, the GCCI project was evaluated and found to be a promising methodology for fostering a culture of inquiry among pediatric nurses. © 2014.

Seasonality of clinical isolation of rapidly growing mycobacteria.

PubMed

Han, X Y

2008-09-01

Rapidly growing mycobacteria (RGM) are environmental organisms that have emerged as significant human pathogens. RGM infections show remarkable geographic variations. In this study, based on data from Houston, Texas, RGM were isolated from clinical cultures year-round, although peaks in the summer and autumn correlating with the seasonal variation of temperature and rainfall also were noted. These results may offer some explanation for the summer occurrence of RGM outbreaks at diverse locations.

Seasonality of clinical isolation of rapidly growing mycobacteria

PubMed Central

HAN, X. Y.

2008-01-01

SUMMARY Rapidly growing mycobacteria (RGM) are environmental organisms that have emerged as significant human pathogens. RGM infections show remarkable geographic variations. In this study, based on data from Houston, Texas, RGM were isolated from clinical cultures year-round, although peaks in the summer and autumn correlating with the seasonal variation of temperature and rainfall also were noted. These results may offer some explanation for the summer occurrence of RGM outbreaks at diverse locations. PMID:18005476

Rickets: Part I.

PubMed

Shore, Richard M; Chesney, Russell W

2013-01-01

Rickets is characterized by impaired mineralization and ossification of the growth plates of growing children caused by a variety of disorders, the most frequent of which is nutritional deficiency of vitamin D. Despite ample knowledge of its etiology and the availability of cost-effective methods of preventing it, vitamin D deficiency rickets remains a significant problem in developing and developed countries. This two-part review covers the history, etiology, pathophysiology and clinical and radiographical findings of vitamin D deficiency rickets. Other less frequent causes of rickets and some of the disorders entering into the differential diagnoses of rickets are also considered. Controversial issues surrounding vitamin D deficiency include determination of what constitutes vitamin D sufficiency and the potential relationship between low levels of vitamin D metabolites in many individuals and unexplained fractures in infants.

Introduction to tissue engineering and application for cartilage engineering.

PubMed

de Isla, N; Huseltein, C; Jessel, N; Pinzano, A; Decot, V; Magdalou, J; Bensoussan, D; Stoltz, J-F

2010-01-01

Tissue engineering is a multidisciplinary field that applies the principles of engineering, life sciences, cell and molecular biology toward the development of biological substitutes that restore, maintain, and improve tissue function. In Western Countries, tissues or cells management for clinical uses is a medical activity governed by different laws. Three general components are involved in tissue engineering: (1) reparative cells that can form a functional matrix; (2) an appropriate scaffold for transplantation and support; and (3) bioreactive molecules, such as cytokines and growth factors that will support and choreograph formation of the desired tissue. These three components may be used individually or in combination to regenerate organs or tissues. Thus the growing development of tissue engineering needs to solve four main problems: cells, engineering development, grafting and safety studies.

Epidemiology of Heart Failure

PubMed Central

Roger, Véronique L.

2013-01-01

Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged 65 and older. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain very frequent and rates of readmissions continuing to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw upon community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations. PMID:23989710

TRADING STORMWATER ABATEMENT CREDITS IN CINCINNATI'S SHEPHERD CREEK

EPA Science Inventory

The problem of stormwater runoff management grows apace with continued urbanization, yet the management tools for this growning non-profit source problem have not fully kept pace. The rapid growth of stormwater utilities around the nation is an important step toward providing an...

Taking power, politics, and policy problems seriously: the limits of knowledge translation for urban health research.

PubMed

Murphy, Kelly; Fafard, Patrick

2012-08-01

Knowledge translation (KT) is a growing movement in clinical and health services research, aimed to help make research more relevant and to move research into practice and policy. This paper examines the conventional model of policy change presented in KT and assesses its applicability for increasing the impact of urban health research on urban health policy. In general, KT conceptualizes research utilization in terms of the technical implementation of scientific findings, on the part of individual decision-makers who can be "targeted" for a KT intervention, in a context that is absent of political interests. However, complex urban health problems and interventions infrequently resemble this single decision, single decision-maker model posited by KT. In order to clarify the conditions under which urban health research is more likely or not to have an influence on public policy development, we propose to supplement the conventional model with three concepts drawn from the social science: policy stages, policy networks, and a discourse analysis approach for theorizing power in policy-making.

Attending unintended transformations of health care infrastructure

PubMed Central

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes. PMID:18043725

Depression in young people. A growing challenge for primary care.

PubMed

Cosgrave, E; McGorry, P; Allen, N; Jackson, H

2000-02-01

Recent research indicates that 27% of young people aged 18-24 have a mental health problem involving mood, anxiety, personality and/or substance abuse disorders and 15-40% report depressive symptomatology. A proportion of these young people will suicide. The morbidity associated with depressive illness in this age group is high, with those experiencing a depressive episode having reduced vocational and life prospects and being highly vulnerable to further episodes in later life. To outline the clinical features of depression in young people and to provide strategies for appropriate management. Presentation of depression in young people is likely to vary from accepted diagnostic criteria with non specific symptoms such as boredom, anxiety, failing adjustment and sleep disturbance predominating. Management includes attending to key social problems, ensuring a safe environment and counselling, which may be supportive counselling or more specific treatments of cognitive behavioural therapy or interpersonal psychotherapy. Medication is indicated for more severe depression or with failure of response to psychological strategies. Early case identification and intensive treatment of first episodes of depression is important in reducing prevalence, cost and morbidity.

[Systematic review of antimicrobial resistance in Enterobacteriaceae isolates from Colombian hospitals].

PubMed

González, Leidy; Cortés, Jorge Alberto

2014-01-01

Bacterial resistance is a public health problem worldwide that seriously compromises the possibility to treat infections. To identify levels of resistance to antibiotic markers in Enterobacteriaceae isolates from Colombian hospitals. A systematic literature survey was done including articles indexed in Medline, Embase and LILACS. A manual search was made of Colombian scientific journals and other publications on infectious disease that were not available electronically. In total, 43 observational studies and epidemiological reports were identified with information about resistance among Enterobacteriaceae isolates in Colombian hospitals, mainly from Bogotá, Cali and Medellín. The resistance rate of Escherichia coli ranges from 3 to 11%, 5 to 20% and from 0.2 to 0.8% for piperacillin-tazobactam, third generation cephalosporins and carbapenems, respectively. For Klebsiella pneumoniae resistance rates ranges from 21.8 to 48.1% to piperacillin-tazobactam, 20 to 35% to broad-spectrum cephalosporins and 3 to 8% to carbapenems, with significant variations by cities, levels of care and clinical settings. The spread of bacterial resistance in Enterobacteriaceae isolated in Colombian hospitals is a growing problem that calls for priority action to cut the chains of transmission.

Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.

PubMed

Thomas, Katja; Proschmann, Undine; Ziemssen, Tjalf

2017-10-01

Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.

Achieving the World Health Organization's vision for clinical pharmacology

PubMed Central

Henry, David; Gray, Jean; Day, Richard; Bochner, Felix; Ferro, Albert; Pirmohamed, Munir; Mörike, Klaus; Schwab, Matthias

2015-01-01

Clinical pharmacology is a medical specialty whose practitioners teach, undertake research, frame policy, give information and advice about the actions and proper uses of medicines in humans and implement that knowledge in clinical practice. It involves a combination of several activities: drug discovery and development, training safe prescribers, providing objective and evidence‐based therapeutic information to ethics, regulatory and pricing bodies, supporting patient care in an increasingly subspecialized arena where co‐morbidities, polypharmacy, altered pharmacokinetics and drug interactions are common and developing and contributing to medicines policies for Governments. Clinical pharmacologists must advocate drug quality and they must also advocate for sustainability of the Discipline. However for this they need appropriate clinical service and training support. This Commentary discusses strategies to ensure the Discipline is supported by teaching, training and policy organizations, to communicate the full benefits of clinical pharmacology services, put a monetary value on clinical pharmacology services and to grow the clinical pharmacology workforce to support a growing clinical, academic and regulatory need. PMID:26466826

Wild grapevine management

Treesearch

H. Clay Smith

1989-01-01

Wild grapevines are a problem for forest managers in many areas of the central hardwood forests. The vines grow on a wide range of soil and site conditions but usually are more concentrated on good sites (northern red oak site index 70 and above), on the faster growing more valuable timber. Presently there is more interest and concern in controlling grapevine for the...

AUTOMATED REMOVAL OF BROMINATED FLAME RETARDANT MATERIAL FROM A MIXED E-WASTE PLASTICS RECYCLING STREAM - PHASE II

EPA Science Inventory

Electronic waste (e-waste) is one of the most rapidly growing waste problems worldwide. Improper handling of e-waste results in vast amounts of toxic waste being sent to landfill and leaching into the water supply. Due to there concerns e-waste recycling is a rapidly growing...

The landowner & the snowmobiler--problem or profit?

Treesearch

George H. Moeller; George H. Moeller

1971-01-01

A conflict is growing between landowners and snowmobilers. Many landowners think snowmobiles are a nuisance: noisy; trespassing on private land. Yet some landowners are cashing in on the new and fast-growing sport of snowmobiling by operating snowmobile enterprises. However, there are a few hard and cold facts that the landowner needs to consider before he invests his...

Is Growing up Affluent Risky for Adolescents or Is the Problem Growing up in an Affluent Neighborhood?

ERIC Educational Resources Information Center

Lund, Terese J.; Dearing, Eric

2013-01-01

Community studies indicating that affluence has social-emotional consequences for youth have conflated family and neighborhood wealth. We examined adolescent boys' delinquency and adolescent girls' anxiety-depression as a function of family, neighborhood, and cumulative affluence in a sample that is primarily of European-American descent, but…

Assessment of common soybean-infecting viruses in Ohio, USA, through multisite sampling and high-throughput sequencing

USDA-ARS?s Scientific Manuscript database

To assess the scope of virus disease problems of soybean in Ohio, USA, a survey was conducted during 2011 and 2012 soybean growing seasons. A total of 259 samples were collected from 80 soybean fields distributed in 42 Ohio counties, accounting for more than 90% of major soybean-growing counties in ...

University Entrepreneurship in a Developing Country: The Case of the P. Universidad Catolica de Chile, 1985-2000

ERIC Educational Resources Information Center

Bernasconi, Andres

2005-01-01

Privatization in higher education is usually understood either as the surge of private institutions or as universities' growing reliance on private sources of funding or otherwise operating more like firms. Joining the growing literature on university entrepreneurship, this is a case study on the less examined problem of entrepreneurial…

Identifying Effective Strategies to Providing Technical Support to One-to-One Programs

ERIC Educational Resources Information Center

Thomas, Mark W.

2013-01-01

The problem of this study was that while one-to-one initiatives in the K-12 environment are growing, the technical support personnel that work in these environments are experiencing problems supporting these initiatives. The purposes of this study were to: (a) identify common problems of providing technical support in a one-to-one laptop program,…

Preschoolers Grow Their Brains: Shifting Mindsets for Greater Resiliency and Better Problem Solving

ERIC Educational Resources Information Center

Pawlina, Shelby; Stanford, Christie

2011-01-01

Challenges, mistakes, and problems are inherent every day in learning activities and social interactions. How children think about and respond to those difficult situations has an impact on how they see themselves as being able to shape their own learning and on how they handle the next problem that comes their way. Building resilience means…

Internet Plagiarism in Higher Education: Tendencies, Triggering Factors and Reasons among Teacher Candidates

ERIC Educational Resources Information Center

Eret, Esra; Ok, Ahmet

2014-01-01

While plagiarism has been a growing problem in higher education for a long time, the use of the Internet has made this increasing problem more unmanageable. In many countries, this problem has become a matter of discussion, and higher education institutions feel obliged to review their policies on academic dishonesty. As part of these efforts, the…

Profile of Self-Reported Problems with Executive Functioning in College and Professional Football Players

PubMed Central

Seichepine, Daniel R.; Stamm, Julie M.; Daneshvar, Daniel H.; Riley, David O.; Baugh, Christine M.; Gavett, Brandon E.; Tripodis, Yorghos; Martin, Brett; Chaisson, Christine; McKee, Ann C.; Cantu, Robert C.; Nowinski, Christopher J.

2013-01-01

Abstract Repetitive mild traumatic brain injury (mTBI), such as that experienced by contact-sport athletes, has been associated with the development of chronic traumatic encephalopathy (CTE). Executive dysfunction is believed to be among the earliest symptoms of CTE, with these symptoms presenting in the fourth or fifth decade of life. The present study used a well-validated self-report measure to study executive functioning in football players, compared to healthy adults. Sixty-four college and professional football players were administered the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A) to evaluate nine areas of executive functioning. Scores on the BRIEF-A were compared to published age-corrected normative scores for healthy adults Relative to healthy adults, the football players indicated significantly more problems overall and on seven of the nine clinical scales, including Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, and Task Monitor. These symptoms were greater in athletes 40 and older, relative to younger players. In sum, football players reported more-frequent problems with executive functioning and these symptoms may develop or worsen in the fifth decade of life. The findings are in accord with a growing body of evidence that participation in football is associated with the development of cognitive changes and dementia as observed in CTE. PMID:23421745

Patient satisfaction among Spanish-speaking patients in a public health setting.

PubMed

Welty, Elisabeth; Yeager, Valerie A; Ouimet, Claude; Menachemi, Nir

2012-01-01

Despite the growing literature on health care quality, few patient satisfaction studies have focused upon the public health setting; where many Hispanic patients receive care. The purpose of this study was to examine the differences in satisfaction between English and Spanish-speaking patients in a local health department clinical setting. We conducted a paper-based satisfaction survey of patients that visited any of the seven Jefferson County Department of Health primary care centers from March 19 to April 19, 2008. Using Chi-squared analyses we found 25% of the Spanish-speaking patients reported regularly having problems getting an appointment compared to 16.8% among English-speakers (p < .001). Results of logistic regression analyses indicated that, despite the availability of interpreters at all JCDH primary care centers, differences in satisfaction existed between Spanish and English speaking patients controlling for center location, purpose of visit, and time spent waiting. Specifically, Spanish speaking patients were more likely to report problems getting an appointment and less likely to report having their medical problems resolved when leaving their visit as compared to those who spoke English. Findings presented herein may provide insight regarding the quality of care received, specifically regarding patient satisfaction in the public health setting. © 2011 National Association for Healthcare Quality.

Profile of self-reported problems with executive functioning in college and professional football players.

PubMed

Seichepine, Daniel R; Stamm, Julie M; Daneshvar, Daniel H; Riley, David O; Baugh, Christine M; Gavett, Brandon E; Tripodis, Yorghos; Martin, Brett; Chaisson, Christine; McKee, Ann C; Cantu, Robert C; Nowinski, Christopher J; Stern, Robert A

2013-07-15

Repetitive mild traumatic brain injury (mTBI), such as that experienced by contact-sport athletes, has been associated with the development of chronic traumatic encephalopathy (CTE). Executive dysfunction is believed to be among the earliest symptoms of CTE, with these symptoms presenting in the fourth or fifth decade of life. The present study used a well-validated self-report measure to study executive functioning in football players, compared to healthy adults. Sixty-four college and professional football players were administered the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A) to evaluate nine areas of executive functioning. Scores on the BRIEF-A were compared to published age-corrected normative scores for healthy adults Relative to healthy adults, the football players indicated significantly more problems overall and on seven of the nine clinical scales, including Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, and Task Monitor. These symptoms were greater in athletes 40 and older, relative to younger players. In sum, football players reported more-frequent problems with executive functioning and these symptoms may develop or worsen in the fifth decade of life. The findings are in accord with a growing body of evidence that participation in football is associated with the development of cognitive changes and dementia as observed in CTE.

Optimal resolution in maximum entropy image reconstruction from projections with multigrid acceleration

NASA Technical Reports Server (NTRS)

Limber, Mark A.; Manteuffel, Thomas A.; Mccormick, Stephen F.; Sholl, David S.

1993-01-01

We consider the problem of image reconstruction from a finite number of projections over the space L(sup 1)(Omega), where Omega is a compact subset of the set of Real numbers (exp 2). We prove that, given a discretization of the projection space, the function that generates the correct projection data and maximizes the Boltzmann-Shannon entropy is piecewise constant on a certain discretization of Omega, which we call the 'optimal grid'. It is on this grid that one obtains the maximum resolution given the problem setup. The size of this grid grows very quickly as the number of projections and number of cells per projection grow, indicating fast computational methods are essential to make its use feasible. We use a Fenchel duality formulation of the problem to keep the number of variables small while still using the optimal discretization, and propose a multilevel scheme to improve convergence of a simple cyclic maximization scheme applied to the dual problem.

A travel clinic in your office: grow your practice and protect international travelers.

PubMed

Kirsch, Michael

2009-01-01

Medical practices today face economic challenges from declining reimbursements and rising overhead costs. Physicians need to develop new income sources to invigorate their practices and remain viable. Travel medicine-advising and immunizing international travelers-is a rapidly growing specialty in the United States that generates substantial cash reimbursements and professional satisfaction. Travel Clinics of America, a physician-operated company, specializes in helping physicians to incorporate travel medicine into their existing practices.

The Role of Automatic Negative Reinforcement in Clinical Problems

ERIC Educational Resources Information Center

Miltenberger, Raymond G.

2005-01-01

This paper discusses the role of automatic negative reinforcement in the maintenance of clinical problems. Following a brief introduction to the functional conceptualization of clinical problems and discussion of four classes of reinforcement maintaining clinical problems, the paper suggests that automatic negative reinforcement is an understudied…

Assimilation approach to measuring organizational change from pre- to post-intervention

PubMed Central

Moore, Scott C; Osatuke, Katerine; Howe, Steven R

2014-01-01

AIM: To present a conceptual and measurement strategy that allows to objectively, sensitively evaluate intervention progress based on data of participants’ perceptions of presenting problems. METHODS: We used as an example an organization development intervention at a United States Veterans Affairs medical center. Within a year, the intervention addressed the hospital’s initially serious problems and multiple stakeholders (employees, management, union representatives) reported satisfaction with progress made. Traditional quantitative outcome measures, however, failed to capture the strong positive impact consistently reported by several types of stakeholders in qualitative interviews. To address the paradox, full interview data describing the medical center pre- and post- intervention were examined applying a validated theoretical framework from another discipline: Psychotherapy research. The Assimilation model is a clinical-developmental theory that describes empirically grounded change levels in problematic experiences, e.g., problems reported by participants. The model, measure Assimilation of Problematic Experiences Scale (APES), and rating procedure have been previously applied across various populations and problem types, mainly in clinical but also in non-clinical settings. We applied the APES to the transcribed qualitative data of intervention participants’ interviews, using the method closely replicating prior assimilation research (the process whereby trained clinicians familiar with the Assimilation model work with full, transcribed interview data to assign the APES ratings). The APES ratings summarized levels of progress which was defined as participants’ assimilation level of problematic experiences, and compared from pre- to post-intervention. RESULTS: The results were consistent with participants’ own reported perceptions of the intervention impact. Increase in APES levels from pre- to post-intervention suggested improvement, missed in the previous quantitative measures (the Maslach Burnout Inventory and the Work Environment Scale). The progress specifically consisted of participants’ moving from the APES stages where the problematic experience was avoided, to the APES stages where awareness and attention to the problems were steadily sustained, although the problems were not yet fully processed or resolved. These results explain why the conventional outcome measures failed to reflect the intervention progress; they narrowly defined progress as resolution of the presenting problems and alleviation of symptomatic distress. In the Assimilation model, this definition only applies to a sub-segment of the change continuum, specifically the latest APES stages. The model defines progress as change in psychological processes used in response to the problem, i.e., a growing ability to deal with problematic issues non-defensively, manifested differently depending on APES stages. At early stages, progress is an increased ability to face the problem rather than turning away. At later APES stages, progress involves naming, understanding and successfully addressing the problem. The assimilation approach provides a broader developmental context compared to exclusively symptom, problem-, or behavior- focused approaches that typically inform outcome measurement in interpersonally based interventions. In our data, this made the difference between reflecting (APES) vs missing (Maslach Burnout Inventory, Work Environment Scale) the pre-post change that was strongly perceived by the intervention recipients. CONCLUSION: The results illustrated a working solution to the challenge of objectively evaluating progress in subjectively experienced problems. This approach informs measuring change in psychologically based interventions. PMID:24660141

Healthcare professionals' agreement on clinical relevance of drug-related problems among elderly patients.

PubMed

Bech, Christine Flagstad; Frederiksen, Tine; Villesen, Christine Tilsted; Højsted, Jette; Nielsen, Per Rotbøll; Kjeldsen, Lene Juel; Nørgaard, Lotte Stig; Christrup, Lona Louring

2018-02-01

Background Disagreement among healthcare professionals on the clinical relevance of drug-related problems can lead to suboptimal treatment and increased healthcare costs. Elderly patients with chronic non-cancer pain and comorbidity are at increased risk of drug related problems compared to other patient groups due to complex medication regimes and transition of care. Objective To investigate the agreement among healthcare professionals on their classification of clinical relevance of drug-related problems in elderly patients with chronic non-cancer pain and comorbidity. Setting Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark. Method A pharmacist performed medication review on elderly patients with chronic non-cancer pain and comorbidity, identified their drug-related problems and classified these problems in accordance with an existing categorization system. A five-member clinical panel rated the drug-related problems' clinical relevance in accordance with a five-level rating scale, and their agreement was compared using Fleiss' κ. Main outcome measure Healthcare professionals' agreement on clinical relevance of drug related problems, using Fleiss' κ. Results Thirty patients were included in the study. A total of 162 drug related problems were identified, out of which 54% were of lower clinical relevance (level 0-2) and 46% of higher clinical relevance (level 3-4). Only slight agreement (κ = 0.12) was found between the panellists' classifications of clinical relevance using a five-level rating scale. Conclusion The clinical pharmacist identified drug related problems of lower and higher clinical relevance. Poor overall agreement on the severity of the drug related problems was found among the panelists.

Challenges of Translating Basic Research Into Therapeutics: Resveratrol as an Example

PubMed Central

Smoliga, James M.; Vang, Ole

2012-01-01

Basic science literature abounds with molecules that promise to ameliorate almost any disease, from curing cancer to slowing the aging process itself. However, most of these compounds will never even be evaluated in humans, let alone proven effective. Here, we use resveratrol as an example to highlight the enormous difficulties in understanding pharmacokinetics, determining side effects, and, ultimately, establishing mechanisms of action for a natural compound. Despite extensive interest and effort, and continuing promising results from basic science groups, very little is known even today about the effects of resveratrol in humans. Part of the problem is the unattractiveness of natural compounds to large, well-funded companies that could run clinical trials because developing their own molecules affords much greater protection for their intellectual property. In fact, selling unpatentable material motivates smaller nutraceutical companies to complicate the scientific problem even more—each creates its own proprietary blend, making it extremely difficult to compare their data with those of other companies, or of academic labs using pure compounds. But even beyond these problems lies a deeper one; resveratrol, and almost every natural compound, is likely to have many clinically relevant targets with different dose–response profiles, tissue distributions, and modifiers. Tackling this type of problem efficiently, and even beginning to address the spectrum of other molecules with claimed benefits, is likely to require the development of new paradigms and approaches. Examples include better molecular modeling to predict interactions, large-scale screens for toxic or other common effects, affinity-based methods to identify drug-interacting proteins, and better synthesis of existing data, including legislation to promote the release of trial results, and tracking of voluntary supplement usage. The evidence for benefits of resveratrol in humans remains too sparse to be conclusive; yet, the limited data that are available, combined with a growing list of animal studies, provide a strong justification for further study. PMID:21746739

When School Makes Us Sick

ERIC Educational Resources Information Center

Blodget, Alden S.

2010-01-01

There's something wrong when attending a really good workshop leaves one sad. In mid-October, 80 dedicated, bright teachers and administrators met with some workshop leaders and speakers in Vermont to explore the growing difficulties that students with "executive function" problems have in school--problems that affect such things as…

EPA RESEARCH HIGHLIGHTS -- MODELS-3/CMAQ OFFERS COMPREHENSIVE APPROACH TO AIR QUALITY MODELING

EPA Science Inventory

Regional and global coordinated efforts are needed to address air quality problems that are growing in complexity and scope. Models-3 CMAQ contains a community multi-scale air quality modeling system for simulating urban to regional scale pollution problems relating to troposphe...

The Chinese brain drain and policy options.

PubMed

Chang, P; Deng, Z

1992-01-01

The authors discuss the growing problem caused by the increasing reluctance of Chinese receiving higher education overseas to return to China following completion of their studies. They note that the Tiananmen incident of June 1989 exacerbated this problem. The policy options open to the Chinese government are reviewed.

Soft Technologies, Hard Choices. Worldwatch Paper 21.

ERIC Educational Resources Information Center

Norman, Colin

The infusion of technology into society has created social and environmental problems as well as benefits. Four concerns linked with technology are discussed in this paper: rising unemployment, growing social inequalities, dwindling oil and gas reserves, and potential long-term ecological problems. Indiscriminate transfer of modern labor-saving…

Facing the Racial Divide.

ERIC Educational Resources Information Center

Molnar, Alex

1993-01-01

Whatever its causes, racial isolation is social dynamite. Problems and destiny of America and American education cannot be separated from fate of American cities, which daily grow poorer, more violent, less socially cohesive, and more isolated. Problems cannot be addressed without taking racism into account. Schools can help students understand…

[Medicinal plants useful in the cure of circulatory problems in legs].

PubMed

Alonso, Maria José

2005-03-01

Once the fundamentals of phyto-therapy in its western use are understood, this article presents concrete a application of medicinal plants: circulatory problems in legs, a problem which affects a growing sector of the population. According to epidemiological studies, close to 80% of adults suffer problems such as tired legs, swellings, edemas, cramps, or varicose veins during their lifetimes; these appear due to an insufficiency when veins can not conveniently transport blood to the heart.

Assessment and pharmacologic treatment of sleep disturbance in autism.

PubMed

Johnson, Kyle P; Malow, Beth A

2008-10-01

Like children with other developmental disabilities, children with autism spectrum disorders suffer with sleep problems at a higher rate than do typically developing children. There is a growing recognition that addressing these sleep problems may improve daytime functioning and decrease family stress. Presented here is a discussion of the sleep problems experienced by children with autism spectrum disorders, focusing on appropriate assessment and pharmacologic treatment.

The U.S. Hardwood Situation Related to Exports

Treesearch

Philip A. Araman; John Tansey

1990-01-01

The U.S. grows more hardwood timber each year than is being used for domestic and export markets. However, we do have some problems. In this paper, the authors present a quick look at our hardwood resource situation (species, quality, availability). They also describe where the timber is growing for several species, talk about availability in the Southeast region, and...

"I Fully Expect to Die with This Debt"

ERIC Educational Resources Information Center

Patton, Stacey

2013-01-01

Student-loan debt is not just a problem for young, recent college graduates searching for their first jobs. Growing numbers of adults nearing the ends of their careers are accumulating such big debt, too, and they don't have a lifetime to pay it back. In fact, student-loan debt is growing fastest among adults ages 60 and older, with more than two…

Student Loan Debt: Trends Affecting the American Dream

ERIC Educational Resources Information Center

Greiner, Keith

2007-01-01

In recent years, there has been a growing interest in college access and with it, a growing concern about the debt incurred by students. Analysts on all sides suggest a variety of causes and solutions to this very complex problem. This paper presents a collection of informational items that can be seen as both disparate and connected. We can see…

Growing up in a Mainstream World: A Retrospective Enquiry into the Childhood Experiences of Young Adults with a Physical Disability

ERIC Educational Resources Information Center

Lumsdaine, Sally; Thurston, Mhairi

2017-01-01

Children with disabilities are at greater risk of developing mental health problems than their peers, yet the emotional well-being of this group is largely overlooked and there is scant literature about children with a mobility disability. This study examined the retrospective experiences of growing up with mobility disability. The sample…

Transcription Factors as Therapeutic Targets in Chronic Kidney Disease.

PubMed

Hishikawa, Akihito; Hayashi, Kaori; Itoh, Hiroshi

2018-05-09

The growing number of patients with chronic kidney disease (CKD) is recognized as an emerging problem worldwide. Recent studies have indicated that deregulation of transcription factors is associated with the onset or progression of kidney disease. Several clinical trials indicated that regression of CKD may be feasible via activation of the transcription factor nuclear factor erythroid-2 related factor 2 (Nrf2), which suggests that transcription factors may be potential drug targets for CKD. Agents stabilizing hypoxia-inducible factor (HIF), which may be beneficial for renal anemia and renal protection, are also now under clinical trial. Recently, we have reported that the transcription factor Kruppel-like factor 4 (KLF4) regulates the glomerular podocyte epigenome, and that the antiproteinuric effect of the renin⁻angiotensin system blockade may be partially mediated by KLF4. KLF4 is one of the Yamanaka factors that induces iPS cells and is reported to be involved in epigenetic remodeling. In this article, we summarize the transcription factors associated with CKD and particularly focus on the possibility of transcription factors being novel drug targets for CKD through epigenetic modulation.

Conceptualizing Fraudulent Studies as Viruses: New Models for Handling Retractions

ERIC Educational Resources Information Center

Montgomery, Kathleen; Oliver, Amalya L.

2017-01-01

This paper addresses the growing problem of retractions in the scientific literature of publications that contain bad data (i.e., fabricated, falsified, or containing error), also called "false science." While the problem is particularly acute in the biomedical literature because of the life-threatening implications when treatment…

Undergraduate Performance in Solving Ill-Defined Biochemistry Problems

ERIC Educational Resources Information Center

Sensibaugh, Cheryl A.; Madrid, Nathaniel J.; Choi, Hye-Jeong; Anderson, William L.; Osgood, Marcy P.

2017-01-01

With growing interest in promoting skills related to the scientific process, we studied performance in solving ill-defined problems demonstrated by graduating biochemistry majors at a public, minority-serving university. As adoption of techniques for facilitating the attainment of higher-order learning objectives broadens, so too does the need to…

Problems and Trends Regarding Vocational Teachers in China

ERIC Educational Resources Information Center

Kuang, Ying

2014-01-01

At present, China's vocational education system is undergoing a transition process from growing in size to improving in quality. Teacher and teaching force issues are a bottleneck and critical factor that will determine whether the transformation will be successful. The real-world problems of the number, deployment, capacity, and training systems…

Problem Based Learning: An Alternative to Traditional Education.

ERIC Educational Resources Information Center

Rouse, Michael W.

1990-01-01

A growing number of health care educators are concerned with the effectiveness of the traditional approach for educating health care practitioners. The problem-based learning approach has been advocated as an effective alternative method for addressing many current concerns and for producing a more effective doctor. (Author/MSE)

Risky Business: Students and Smartphones

ERIC Educational Resources Information Center

Jones, Beth H.; Chin, Amita Goyal; Aiken, Peter

2014-01-01

The increase in smartphone adoption has been no less than astounding. Unfortunately, the explosive growth has been accompanied by a rash of security problems. A contributing factor to the growing security problem is a lack of education, training, and awareness. In addition, "bring your own device" (BYOD) policies often leave security…

Growing Up Female: Navigating Body Image, Eating, and Depression.

ERIC Educational Resources Information Center

Graber, Julia A.; Brooks-Gunn, Jeanne

1996-01-01

Describes the dramatic increase in eating and depressive disorders experienced by significant numbers of girls as they pass through puberty. The Adolescent Study Program followed girls with eating and depressive problems across the entire adolescent decade. Discusses characteristics which are predictive of more intense problems while suggesting…

RACIAL IMBALANCE AND EDUCATIONAL PLANNING.

ERIC Educational Resources Information Center

CONROY, VINCENT F.

HARVARD'S ADMINISTRATIVE CAREER PROGRAM FACED THE GROWING PROBLEM OF NEGRO ENROLLMENT IN THE PUBLIC SCHOOLS. NOTING THE FREQUENCY AND INTENSITY WITH WHICH THE PROBLEM WAS ARISING AT THE NATIONAL LEVEL, A GROUP OF LAWYERS AND EDUCATORS CONVENED TO WORK OUT THE LEGAL ASPECTS OF SCHOOL INTEGRATION. FUNDS FROM THE FORD FOUNDATION INITIATED THE…

Decision Making for the Environment: Social and Behavioral Science Research Priorities

ERIC Educational Resources Information Center

Brewer, Garry D., Ed.; Stern, Paul C., Ed.

2005-01-01

With the growing number, complexity, and importance of environmental problems come demands to include a full range of intellectual disciplines and scholarly traditions to help define and eventually manage such problems more effectively. "Decision Making for the Environment: Social and Behavioral Science Research Priorities" is the result…

The Geoboard Triangle Quest

ERIC Educational Resources Information Center

Allen, Kasi C.

2013-01-01

In line with the Common Core and Standards for Mathematical Practice that portray a classroom where students are engaged in problem-solving experiences, and where various tools and arguments are employed to grow their strategic thinking, this article is the story of such a student-initiated problem. A seemingly simple question was posed by…

Historians and Film: Some Problems and Prospects

ERIC Educational Resources Information Center

O'Connor, John E.

1973-01-01

The growing interest towards using film in history classes and by historians developing a methodology for research into film is discussed in this article. Problems of using films for teachers focus on cost and poor quality. Difficulties for historical researchers concern the treatment of historical documents in film medium -- recording,…

The Impact of PBL on Transferable Skills Development in Management Education

ERIC Educational Resources Information Center

Carvalho, Ana

2016-01-01

Attention to transferable skills is growing in higher education. Problem-based learning (PBL) is increasingly used in management education for its promising potential to, amongst others, promote transferable skills, including problem-solving, critical thinking and teamwork skills. However, this relationship is seldom assessed. In this study, I use…

Aliteracy: What Teachers Can Do to Keep Johnny Reading.

ERIC Educational Resources Information Center

Decker, Barbara Cooper

Aliteracy, the ability to read but the unwillingness to do so, is a growing problem in American society. Aliteracy crosses all socioeconomic levels, thereby allowing autocratic, charismatic leaders to influence thinking and decision-making. Social changes that have contributed to the problem of aliteracy include the influence of television on…

Internet Addiction in Adolescents

ERIC Educational Resources Information Center

Rebisz, Slawomir; Sikora, Ilona

2016-01-01

The possibilities offered by the use of the Internet increasingly intensify the problem of Internet addiction, which has become more prevalent in the last decade, marked by the growing availability of mobile devices and new media and their exacerbation of the problem. Research on Internet addiction, initiated by Kimberly Young at the end of the…

Investigating Environmental Concerns and Health Issues in Clarksville, Tennessee

ERIC Educational Resources Information Center

Rainey, Shirley A.; Jones, Robert Emmet

2005-01-01

Environmental degradation is a serious problem for millions of people who are unjustly exposed to environmental conditions that threaten their everyday survival. A growing body of research shows race and class as significant predictors to exposure to environmental hazards and associated health problems. Presented are perceptions of environmental…

The Brown University Child and Adolescent Behavior Letter, 1996.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1996-01-01

These 12 monthly newsletters from 1996 explore the many problems encountered by children and adolescents as they grow up. Regular departments in the newsletter issues include "Keep Your Eye On...," which briefly presents results of research into childhood and adolescent problems; "What's New in Research," summarizing research…

The Brown University Child and Adolescent Behavior Letter, 1995.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1995-01-01

These 12 monthly newsletters from 1995 explore the myriad problems encountered by children and adolescents as they grow up. Regular departments in the newsletter issues include "Keep Your Eye On...," which briefly presents results of research into childhood and adolescent problems; "New Research," summarizing research from recent publications and…

Virtual addictions: An examination of problematic social casino game use among at-risk gamblers.

PubMed

Gainsbury, Sally M; King, Daniel L; Russell, Alex M T; Delfabbro, Paul; Hing, Nerilee

2017-01-01

The overlap of gaming and gambling activities within online digital technologies is of growing relevance to the study of technological addictions. Social casino games are immensely popular 'free to play' games that offer realistic emulation of financial gambling activities. Their structural similarities might suggest that engagement in social casino games may be particularly risky for people with existing gambling problems. Currently it is not known whether social casino games are used problematically by individuals who also experience problematic gambling, the extent of this overlap, the characteristics of those who experience problems with both activities, and the symptoms of problematic social casino game use they experience. An online survey was administered to Internet users (N=1554) to assess social casino game use and associated problems. This study examined a subsample of 176 adults who played social casino games and reported self-identified gambling problems. The results indicated that a greater frequency and diversity of social casino game playing and more frequent and larger expenditure on social casino games was significantly positively associated with symptom severity of problematic social casino game use. Gamblers who were younger, less educated, spoke a non-English language, and with higher psychological distress, were more likely to report greater problems. Playing social casino games to escape or relieve a negative mood was the most commonly reported symptom. These findings suggest that some problem gamblers may also be at risk of problematic engagement in online gambling activities that lack financial incentives. Gamblers' concurrent engagement in social casino games therefore warrants further consideration in gambling research studies and clinical practice settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cocaine problems in the coca-growing countries of South America.

PubMed

Negrete, J C

1992-01-01

The problems of cocaine present a rather particular profile in the Central Andes region from which this drug originates. On the one hand there is a relatively harmless pattern of use (coca leaf chewing) in the countries concerned which minimizes the drug's most hazardous properties. On the other hand the region suffers from some of the most severe cocaine-related problems to be observed anywhere: (a) easy access to the newer, highly toxic preparations of the drug (such as coca paste) and a rapid growth in the number of new users; (b) the abandonment of certain traditional and essential agricultural activities in favour of the more profitable coca leaf production; (c) the severe ecological damage being caused in the coca growing areas; and (d) the establishment of a powerful coca trade economy which is subverting the very fabric of society and is creating corruption, lawless violence and political anarchy.

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

PubMed

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

The growing clinical spectrum of cerebral amyloid angiopathy.

PubMed

Wermer, Marieke J H; Greenberg, Steven M

2018-02-01

Cerebral amyloid angiopathy (CAA) is diagnosed primarily as a cause of lobar intracerebral hemorrhages (ICH) in elderly patients. With improving MRI techniques, however, the role of CAA in causing other symptoms has become clear. Recognizing the full clinical spectrum of CAA is important for diagnosis and treatment. In this review we summarize recent insights in clinical CAA features, MRI biomarkers, and management. The rate of ICH recurrence in CAA is among the highest of all stroke subtypes. Cortical superficial siderosis (cSS) and cortical subarachnoid hemorrhage (cSAH) are important imaging predictors for recurrent ICH. CAA also causes cognitive problems in multiple domains. In patients with nondemented CAA, the risk of developing dementia is high especially after ICH. CAA pathology probably starts years before the first clinical manifestations. The first signs in hereditary CAA are white matter lesions, cortical microinfarcts, and impaired occipital cerebral vasoreactivity. Visible centrum semiovale perivascular spaces, lobar located lacunes, and cortical atrophy are new nonhemorrhagic MRI markers. CAA should be in the differential diagnosis of elderly patients with lobar ICH but also in those with cognitive decline and episodic transient neurological symptoms. Physicians should be aware of the cognitive effects of CAA. In patients with a previous ICH, cSS, or cSAH, anticoagulation should be considered risky. The increasing number of MRI markers may help to discriminate CAA from other small vessel diseases and dementia subtypes.

Effects of the performance management information system in improving performance: an empirical study in Shanghai Ninth People's Hospital.

PubMed

Cui, Yinghui; Wu, Zhengyi; Lu, Yao; Jin, Wenzhong; Dai, Xing; Bai, Jinxi

2016-01-01

Improving the performance of clinical departments is not only the significant content of the healthcare system reform in China, but also the essential approach to better satisfying the Chinese growing demand for medical services. Performance management is vital and meaningful to public hospitals in China. Several studies are conducted in hospital internal performance management, but almost none of them consider the effects of informational tools. Therefore, we carried out an empirical study on effects of using performance management information system in Shanghai Ninth People's Hospital. The main feature of the system is that it provides a real-time query platform for users to analyze and dynamically monitor the key performance indexes, timely detect problems and make adjustments. We collected pivotal medical data on 35 clinical departments of this hospital from January 2013 until December 2014, 1 year before and after applying the performance management information system. Comparative analysis was conducted by statistical methods. The results show that the system is beneficial to improve performance scores of clinical departments and lower the proportion of drug expenses, meanwhile, shorten the average hospitalized days and increase the bed turnover rate. That is to say, with the increasing medical services, the quality and efficiency is greatly improved. In a word, application of the performance management information system has a positive effect on improving performance of clinical departments.

Exercise and type 2 diabetes: new prescription for an old problem.

PubMed

Bird, Stephen R; Hawley, John A

2012-08-01

During the past 50 years, the prevalence of a cluster of chronic, inactivity-related diseases including obesity, insulin resistance and type 2 diabetes mellitus (T2DM), collectively referred to as 'metabolic syndrome' (MetS) has reached global epidemic proportions. Appropriate exercise training is a clinically proven, cost-effective, primary intervention that delays and in many cases prevents the health burdens associated with MetS. Indeed, there is no single intervention with greater efficacy than physical exercise to reduce the risk of virtually all chronic diseases simultaneously. However compliance to National guidelines for physical activity remains low, with "a lack of time" the most frequently cited barrier to exercise participation by adults, irrespective of age, sex and ethnic background. Part of the growing apathy to modify lifestyle habits is that current public health recommendations may be unrealistic and unattainable for the majority of the populace. Hence, there is an urgent need for innovations in exercise prescription that can be incorporated into daily living and induce clinically beneficial health outcomes. Here we focus attention on a novel form of exercise prescription, high-intensity interval training (HIT), and provide evidence that HIT is a time-efficient and well-tolerated therapeutic intervention to improve cardio-metabolic health in a number of pre-clinical and clinical populations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

Arenholt-Bindslev, D.

Increasing knowledge about the risk of toxic effects caused by anthropogenic mercury accumulation in ecosystems has resulted in a growing pressure for reduction of the discharge of mercury waste. Consequently, the mercury waste problems of dental clinics have been given increased attention, and restrictions on handling and discharge of contaminated waste have been established in several countries. Major amalgam particles from trituration surplus of those produced during the carving and burnishing of new amalgam restorations are generally collected in coarse filters and sold for refinement. Minor amalgam particles released by production of new fillings or by removal of old restorationsmore » partly sediment in tubes and drains. The remaining particles are carried with the waste water stream to the local purifying plant. In Scandinavia, the industrial discharge of mercury-contaminated waste water has been reduced to a minimum. According to recent investigations, dental clinics appear to be responsible for the major amount of mercury collected in the sludge generated in purifying plants. If threshold values for heavy metal content, including mercury, are exceeded, the sludge is not allowed to be recycled as fertilizer. Installation of an approved amalgam-separating apparatus in dental clinics is now mandatory in several countries--for example, Switzerland, Germany, Sweden, and Denmark. Approval of amalgam separators is based on national testing programs, including clinical or laboratory tests demanding 95-99% separating efficiency. 18 refs.« less

The importance of production standard operating procedure in a family business company

NASA Astrophysics Data System (ADS)

Hongdiyanto, C.

2017-12-01

Plastic industry is a growing sector, therefore UD X which engage in this business has a great potential to grow as well. The problem faced by this family business company is that no standard operating procedure is used and it lead to problem in the quality and quantity produced. This research is aim to create a production standard operating procedure for UD X. Semistructure interview is used to gather information from respondent to help writer create the SOP. There are four SOP’s created, namely: classifying SOP, sorting SOP, milling SOP and packing SOP. Having SOP will improve the effectiveness of production because employees already know how to work in each stages of production process.

A review on economic emission dispatch problems using quantum computational intelligence

NASA Astrophysics Data System (ADS)

Mahdi, Fahad Parvez; Vasant, Pandian; Kallimani, Vish; Abdullah-Al-Wadud, M.

2016-11-01

Economic emission dispatch (EED) problems are one of the most crucial problems in power systems. Growing energy demand, limitation of natural resources and global warming make this topic into the center of discussion and research. This paper reviews the use of Quantum Computational Intelligence (QCI) in solving Economic Emission Dispatch problems. QCI techniques like Quantum Genetic Algorithm (QGA) and Quantum Particle Swarm Optimization (QPSO) algorithm are discussed here. This paper will encourage the researcher to use more QCI based algorithm to get better optimal result for solving EED problems.

The Cancer Imaging Archive (TCIA) | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

TCIA is NCI’s repository for publicly shared cancer imaging data. TCIA collections include radiology and pathology images, clinical and clinical trial data, image derived annotations and quantitative features and a growing collection of related ‘omics data both from clinical and pre-clinical studies.

Manage Your Life Online: A Web-Based Randomized Controlled Trial Evaluating the Effectiveness of a Problem-Solving Intervention in a Student Sample.

PubMed

Bird, Timothy; Mansell, Warren; Wright, Jason; Gaffney, Hannah; Tai, Sara

2018-01-25

Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely rely on psychoeducation and 'homework tasks', and are specific to certain diagnoses (e.g. depression). This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic. Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures. Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression post-intervention, and again 2 weeks later, but MYLO was not found to be more effective than ELIZA. MYLO was rated as significantly more helpful than ELIZA, but there was no main effect of intervention on problem resolution. Findings are consistent with those of a previous smaller, laboratory-based trial and provide support for the acceptability and effectiveness of MYLO delivered over the internet for a non-clinical sample. The lack of a no-treatment control condition means that the effect of spontaneous recovery cannot be ruled out.

[Schistosomiasis: reproduction and expansion of the endemia to the state of Pernambuco in Brazil].

PubMed

Barbosa, C S; da Silva, C B; Barbosa, F S

1996-12-01

Schistosomiasis mansoni can be considered an important public health problem in Northeastern Brazil, in spite of the reduction in the prevalence of the hepatosplenic clinical forms which have been attributed to the large scale use of chemotherapy in this country. However, the rise in the prevalence rates and the spread of this endemic disease to new areas show that schistosomiasis is assuming its must cruel expression: less lethal but more greatly incapacitating in terms of irreversible physical and moral damage to human beings. The state of Pernambuco presents growing rates for schistosomiasis infection in humans. The epidemiological profile of this disease displays high and consistent prevalence rates (up to 80%) in rural areas, and new cases of acute infection on the coast, where schistosomiasis has recently been introduced. The reproduction and expansion of this endemic disease can be better understood on the basic of a conception of structural and historical causation. The disease construction process should be reconstructed in the light of biological as well as the social, political and cultural factors which are jointly responsible for the present endemic situation. Within that frame work, the historical and socioeconomic features that interact with the parasite and give rise to the present proportions of the schistosomiasis epidemic in Pernambuco are discussed. The mode of occupation and use of the land, unemployment, under-nutrition, migration, etc., raise the question of the growing difficulties confronting the control of the disease, both in rural areas where populations are extremely mobile as well as in the poorly organized urban population. Epidemiological investigation is fulfilling its role in its attempts to understand the complex relationships of an intrinsecally social nature of the health/disease process between health problems and the quality of life for the purpose of producing consistent disease control models.

Re-envisioning Addiction Treatment: A Six-Point Plan

PubMed Central

Kellogg, Scott H.

2012-01-01

This article is focused on improving the quality of addiction treatment. Based on observations that patients are leaving treatment too early and/or are continuing to use substances during their care, the authors propose six actions that could help reorient and revitalize this kind of clinical work: (1) conceptualize and treat addictive disorders within a psychiatric/mental health framework; (2) make the creation of a strong therapeutic alliance a core part of the healing process; (3) understand patients’ addictions and other problems using models based on multiple internal parts, voices, or modes; (4) make contingency management and the use of positive reinforcement systems a standard and central practice in all treatment settings; (5) envision long-term change and healing through the lens of identity theory; and (6) integrate the growing developments in recovery culture with formal treatment. PMID:22754086

Overview on the recent study of antimicrobial peptides: origins, functions, relative mechanisms and application.

PubMed

Li, Yanmei; Xiang, Qi; Zhang, Qihao; Huang, Yadong; Su, Zhijian

2012-10-01

Antimicrobial peptides (AMPs), which are produced by several species including insects, other animals, micro-organisms and synthesis, are a critical component of the natural defense system. With the growing problem of pathogenic organisms resistant to conventional antibiotics, especially with the emergence of NDM-1, there is increased interest in the pharmacological application of AMPs. They can protect against a broad array of infectious agents, such as bacteria, fungi, parasite, virus and cancer cells. AMPs have a very good future in the application in pharmaceuticals industry and food additive. This review focuses on the AMPs from different origins in these recent years, and discusses their various functions and relative mechanisms of action. It will provide some detailed files for clinical research of pharmaceuticals industry and food additive in application. Copyright © 2012 Elsevier Inc. All rights reserved.

Dementia resulting from traumatic brain injury

PubMed Central

Ramalho, Joana; Castillo, Mauricio

2015-01-01

Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge. PMID:29213985

TOPICAL REVIEW: Tribology of dental materials: a review

NASA Astrophysics Data System (ADS)

Zhou, Z. R.; Zheng, J.

2008-06-01

The application of tribology in dentistry is a growing and rapidly expanding field. Intensive research has been conducted to develop an understanding of dental tribology for successful design and selection of artificial dental materials. In this paper, the anatomy and function of human teeth is presented in brief, three types of current artificial dental materials are summarized, and their advantages and disadvantages, as well as typical clinical applications, are compared based on the literature. Possible tribological damage of tooth structure, which is induced by complex interfacial motion, and friction-wear test methods are reported. According to results obtained by the authors and from the literature, the main progress in the area of dental tribology on both natural teeth and artificial dental materials is reviewed. Problems and challenges are discussed and future research directions for dental tribology are recommended.

Contrast Enhanced Spectral Mammography: A Review.

PubMed

Patel, Bhavika K; Lobbes, M B I; Lewin, John

2018-02-01

Contrast-enhanced spectral mammography (CESM) provides low-energy 2D mammographic images comparable to standard digital mammography and a post-contrast recombined image to assess tumor neovascularity similar to magnetic resonance imaging (MRI). The utilization of CESM in the United States is currently low but could increase rapidly given many potential indications for clinical use. This article discusses historical background and literature review of indications and diagnostic accuracy of CESM to date. CESM is a growing technique for breast cancer detection and diagnosis that has levels of sensitivity and specificity on par with contrast-enhanced breast MRI. Because of its similar performance and ease of implementation, CESM is being adopted for multiple indications previously reserved for MRI, such as problem-solving, disease extent in newly diagnosed patients, and evaluating the treatment response of neoadjuvant chemotherapy. Copyright © 2018 Elsevier Inc. All rights reserved.

Infection caused by thymidine-requiring, trimethoprim-resistant bacteria.

PubMed Central

King, C H; Shlaes, D M; Dul, M J

1983-01-01

We first noted the appearance of thymidine-requiring, gram-negative bacilli in clinical specimens 2 years ago. Since then we have seen 10 patients colonized or infected with these organisms. These strains do not grow on Mueller-Hinton media, growth on MacConkey agar is variable, and growth in API 20E (Analytab Products) and Enterobacteriaceae-Plus Cards (AutoMicrobic system; Vitek Systems Inc.) is inadequate for reliable identifications. Thymidine-requiring organisms are routinely resistant to sulfonamides and trimethoprim. Infection or colonization is associated with previous sulfamethoxazole-trimethoprim therapy in most cases. Of 10 patients, 1 had septicemia of urinary tract origin, 5 had urinary tract colonization or infection, 2 had wound colonization, and two had colonization of respiratory secretions. Thymidine-requiring, gram-negative bacilli can be pathogens and present potential problems in diagnosis, identification, and susceptibility testing. PMID:6604070

Spirituality and Religion in Pain and Pain Management

PubMed Central

Dedeli, Ozden; Kaptan, Gulten

2013-01-01

Pain relief is a management problem for many patients, their families, and the medical professionals caring for them. Although everyone experiences pain to some degree, responses to it vary from one person to another. Recognizing and specifying someone else’s pain is clinically a well know challenge. Research on the biology and neurobiology of pain has given us a relationship between spirituality and pain. There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelations among biological, psychological, social, and spiritual factors. Patients with pain use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual factors, such as prayers, and seeking spiritual support to manage their pain. This article provides an overview of the complex phenomenon of pain, with a focus on spiritual and religious issues in pain management. PMID:26973914

The effects of deep network topology on mortality prediction.

PubMed

Hao Du; Ghassemi, Mohammad M; Mengling Feng

2016-08-01

Deep learning has achieved remarkable results in the areas of computer vision, speech recognition, natural language processing and most recently, even playing Go. The application of deep-learning to problems in healthcare, however, has gained attention only in recent years, and it's ultimate place at the bedside remains a topic of skeptical discussion. While there is a growing academic interest in the application of Machine Learning (ML) techniques to clinical problems, many in the clinical community see little incentive to upgrade from simpler methods, such as logistic regression, to deep learning. Logistic regression, after all, provides odds ratios, p-values and confidence intervals that allow for ease of interpretation, while deep nets are often seen as `black-boxes' which are difficult to understand and, as of yet, have not demonstrated performance levels far exceeding their simpler counterparts. If deep learning is to ever take a place at the bedside, it will require studies which (1) showcase the performance of deep-learning methods relative to other approaches and (2) interpret the relationships between network structure, model performance, features and outcomes. We have chosen these two requirements as the goal of this study. In our investigation, we utilized a publicly available EMR dataset of over 32,000 intensive care unit patients and trained a Deep Belief Network (DBN) to predict patient mortality at discharge. Utilizing an evolutionary algorithm, we demonstrate automated topology selection for DBNs. We demonstrate that with the correct topology selection, DBNs can achieve better prediction performance compared to several bench-marking methods.

[Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis].

PubMed

Medenica, Ivica; Luković, Milan; Radoicić, Dragan

2010-02-01

The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score--7.1). We performed total rearthroplasty by a custom-made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score--87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study.

PubMed

Gulliver, Amelia; Bennett, Kylie; Bennett, Anthony; Farrer, Louise M; Reynolds, Julia; Griffiths, Kathleen M

2015-01-01

There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences.

Preadoption adversity and long-term clinical-range behavior problems in adopted Chinese girls.

PubMed

Tan, Tony Xing; Camras, Linda A; Kim, Eun Sook

2016-04-01

In this study, we report findings on the role of preadoption adversity on long-term clinical-range problems in adopted Chinese girls. Four waves (2005, 2007, 2009 and 2011) of problem behavior data on 1,223 adopted Chinese girls (M = 4.86 years, SD = 2.82 in 2005) were collected from the adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1 (2005), data on the following indicators of preadoption adversity was collected: age at adoption, physical signs/symptoms (e.g., sores) of preadoption adversity, developmental delays at arrival, refusal/avoidance behaviors and crying/clinging behaviors toward adoptive parents during the first 3 weeks of adoption. We found that the percentage of clinical-range internalizing problems was 11.1%, 16.5%, 11.3%, and 16.1% at Wave 1, Wave 2, Wave 3, and Wave 4, respectively; the corresponding percentage of clinical-range externalizing problems was 8.4%, 10.5%, 8.4% and 9.9% respectively; and the corresponding percentage of clinical-range total CBCL problems was 9.3%, 13.0%, 9.8% and 12.6% respectively. Analyses with Mplus showed that controlling for demographic variables, indicators of preadoption adversity, except age at adoption, increased the odds for clinical-range behavior problems. Longitudinal path models revealed that controlling for demographic variables and the children's adjustment status in the previous wave, refusal/avoidance remained significant in predicting clinical-range internalizing, externalizing and total CBCL problems at Wave 2, delays at arrival and signs/symptoms were significant in predicting clinical-range internalizing problems at Wave 3. Overall, adoptees with clinical-range CBCL problems in earlier waves were 9-28 times as likely to show clinical-range CBCL problems in subsequent waves. (c) 2016 APA, all rights reserved).

[Analysis of bacterial small-colony variants isolated from clinical specimens].

PubMed

Matsumoto, Takehisa

2014-07-01

There is a slow-growing subpopulation of bacteria with distinctive phenotypic and pathogenic traits called bacterial small-colony variants (SCVs). Phenotypically, SCVs show a slow growth rate, atypical colony morphology, and unusual biochemical characteristics. SCV strains often grow on blood agar or Drigalski agar as non-pigmented or pinpoint pigmented colonies, and key biochemical tests for them are often non-reactive. This review describes analyses of hemin-dependent Escherichia coli SCV and Staphylococcus aureus thymidine-dependent SCVs based on our case reports. Because SCVs exhibit fastidious growth characteristics, clinical microbiologists may easily miss or misidentify them in the clinical laboratory. Therefore, we must elucidate the cause of SCVs, and improve laboratory methods for the identification and assessment of the susceptibility of SCVs in the clinical laboratory.

Emotional Issues and Bathroom Problems

MedlinePlus

... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

PubMed Central

Musgrove, John L.; Morris, Jason; Estrada, Carlos A.; Kraemer, Ryan R.

2016-01-01

Background Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown. Objective We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators. Methods A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013. Results The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators. Conclusions Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms. PMID:27168884

Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

PubMed

Musgrove, John L; Morris, Jason; Estrada, Carlos A; Kraemer, Ryan R

2016-05-01

Background Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown. Objective We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators. Methods A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013. Results The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators. Conclusions Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms.

Radiological clinical trials: Proposal of a problem-finding questionnaire to improve study success.

PubMed

Valdora, Francesca; Bignotti, Bianca; Calabrese, Massimo; Houssami, Nehmat; Tagliafico, Alberto

2016-12-26

To develop a survey to help define the main problems in radiological clinical trials. Since 2006, we have managed seven different radiological clinical trials recruiting patients in academic and non-academic centres. We developed a preliminary questionnaire using a four-round Delphi approach to identify problems occurring in radiological clinical trials run at our centre. We investigated the recruitment experience, involvement of all multi-disciplinary team members and main obstacles to completing the projects. A final round of Delphi processes elucidated solutions to the identified problems. Among 19/20 (95%) respondents, 10 (53%) were young physicians (under 35 years old), and the respondents included non-faculty members, fellows, residents, and undergraduate students. Ninety-four percent (18/19) of respondents showed interest in conducting clinical trials. On a scale of 1 to 10, the problems with higher/worse scores (8-9) were related to technical or communication problems. The most frequent problems across all studies were technical problems related to clinical trial equipment, insufficient willingness to participate, obstacles to understanding the design of electronic-case report form and extra work. The developed questionnaire identified the main recurring problems in radiological clinical trials as perceived by end-users and helped define possible solutions that are mostly related to having dedicated clinical trial research staff.

Integrated Maintenance Information System (IMIS): A Maintenance Information Delivery Concept.

DTIC Science & Technology

1987-11-01

InterFace Figure 2. Portable Maintenance Computer Concept. provide advice for difficult fault-isolation problems . The technician will be able to accomplish...faced with an ever-growing number of paper-based technical orders (TOs). This has greatly increased costs and distribution problems . In addition, it has...compounded problems associ- ated with ensuring accurate data and the lengthy correction times involved. To improve the accuracy of technical data and

A neural network approach to job-shop scheduling.

PubMed

Zhou, D N; Cherkassky, V; Baldwin, T R; Olson, D E

1991-01-01

A novel analog computational network is presented for solving NP-complete constraint satisfaction problems, i.e. job-shop scheduling. In contrast to most neural approaches to combinatorial optimization based on quadratic energy cost function, the authors propose to use linear cost functions. As a result, the network complexity (number of neurons and the number of resistive interconnections) grows only linearly with problem size, and large-scale implementations become possible. The proposed approach is related to the linear programming network described by D.W. Tank and J.J. Hopfield (1985), which also uses a linear cost function for a simple optimization problem. It is shown how to map a difficult constraint-satisfaction problem onto a simple neural net in which the number of neural processors equals the number of subjobs (operations) and the number of interconnections grows linearly with the total number of operations. Simulations show that the authors' approach produces better solutions than existing neural approaches to job-shop scheduling, i.e. the traveling salesman problem-type Hopfield approach and integer linear programming approach of J.P.S. Foo and Y. Takefuji (1988), in terms of the quality of the solution and the network complexity.

Ergonomic risks in mask manufacturing and methods to combat them

NASA Astrophysics Data System (ADS)

Gardner, Larry; Strott, Al

1995-12-01

A growing concern throughout the world is the increasing occurrence of cumulative trauma disorders (CTDs) or repetitive motion injuries. Countries worldwide are struggling over the correct way to respond to the legal aspects of the problem, given the difficulty of root cause identification of the injury. The mask industry is no exception to this. Some companies may not be aware of the problem. Some companies may be aware, but not concerned. The reality is, however, that the problem exists and should not be ignored. Eventually, regulatory agencies such as OSHA, will take a position or stance on recognition of this as an injury status making it impossible to ignore. Companies who have not been proactive in the prevention of ergonomic injuries may find themselves in a crisis reactive mode that may cost them thousands of unplanned dollars. In this paper, we expand on the awareness of CTDs as a growing problem. We also share the actions that Intel is taking to address this problem. It is the authors' hope that the awareness and sharing presented in this paper will result in the sharing of experiences among the mask suppliers, so that we can all be successful in addressing this challenging issue.

Childhood Obesity in Colorado: A Growing Problem--The Impact of the Epidemic and Recommendations for Solutions

ERIC Educational Resources Information Center

Trujillo, Tara

2007-01-01

Colorado traditionally has ranked as one of the healthiest states in the nation, a claim that reinforces a culture of activity, community and well-being. Though Colorado is ahead of the curve in this area, Coloradans aren't immune to the growing trends that threaten the health of people across the nation. One of the most concerning elements of…

Self-growing neural network architecture using crisp and fuzzy entropy

NASA Technical Reports Server (NTRS)

Cios, Krzysztof J.

1992-01-01

The paper briefly describes the self-growing neural network algorithm, CID3, which makes decision trees equivalent to hidden layers of a neural network. The algorithm generates a feedforward architecture using crisp and fuzzy entropy measures. The results for a real-life recognition problem of distinguishing defects in a glass ribbon, and for a benchmark problen of telling two spirals apart are shown and discussed.

Stress and Violence in the Workplace and on Campus: A Growing Problem for Business, Industry and Academia

ERIC Educational Resources Information Center

Hunt, Matthew L.; Hughey, Aaron W.; Burke, Monica G.

2012-01-01

Levels of stress and violence at work have been increasing globally for the past few decades. Whether the setting is business and industry or a college campus, this disturbing trend affects a growing number of people, including those who do not work directly in these environments. In this paper the authors describe the relationship between stress…

Porous silicon for drug delivery applications and theranostics: recent advances, critical review and perspectives.

PubMed

Kumeria, Tushar; McInnes, Steven J P; Maher, Shaheer; Santos, Abel

2017-12-01

Porous silicon (pSi) engineered by electrochemical etching has been used as a drug delivery vehicle to address the intrinsic limitations of traditional therapeutics. Biodegradability, biocompatibility, and optoelectronic properties make pSi a unique candidate for developing biomaterials for theranostics and photodynamic therapies. This review presents an updated overview about the recent therapeutic systems based on pSi, with a critical analysis on the problems and opportunities that this technology faces as well as highlighting pSi's growing potential. Areas covered: Recent progress in pSi-based research includes drug delivery systems, including biocompatibility studies, drug delivery, theranostics, and clinical trials with the most relevant examples of pSi-based systems presented here. A critical analysis about the technical advantages and disadvantages of these systems is provided along with an assessment on the challenges that this technology faces, including clinical trials and investors' support. Expert opinion: pSi is an outstanding material that could improve existing drug delivery and photodynamic therapies in different areas, paving the way for developing advanced theranostic nanomedicines and incorporating payloads of therapeutics with imaging capabilities. However, more extensive in-vivo studies are needed to assess the feasibility and reliability of this technology for clinical practice. The technical and commercial challenges that this technology face are still uncertain.

A "building block" approach to application development for education and decision support in radiology: implications for integrated clinical information systems environments.

PubMed

Greenes, R A

1991-11-01

Education and decision-support resources useful to radiologists are proliferating for the personal computer/workstation user or are potentially accessible via high-speed networks. These resources are typically made available through a set of application programs that tend to be developed in isolation and operate independently. Nonetheless, there is a growing need for an integrated environment for access to these resources in the context of professional work, during clinical problem-solving and decision-making activities, and for use in conjunction with other information resources. New application development environments are required to provide these capabilities. One such architecture for applications, which we have implemented in a prototype environment called DeSyGNER, is based on separately delineating the component information resources required for an application, termed entities, and the user interface and organizational paradigms, or composition methods, by which the entities are used to provide particular kinds of capability. Examples include composition methods to support query, book browsing, hyperlinking, tutorials, simulations, or question/answer testing. Future steps must address true integration of such applications with existing clinical information systems. We believe that the most viable approach for evolving this capability is based on the use of new software engineering methodologies, open systems, client-server communication, and delineation of standard message protocols.

From normal response to clinical problem: definition and clinical features of fear of cancer recurrence.

PubMed

Lebel, Sophie; Ozakinci, Gozde; Humphris, Gerald; Mutsaers, Brittany; Thewes, Belinda; Prins, Judith; Dinkel, Andreas; Butow, Phyllis

2016-08-01

Research to date on fear of cancer recurrence (FCR) shows that moderate to high FCR affects 22-87 % of cancer survivors and is associated with higher psychological morbidity (Simard et al J Cancer Surviv 7:300-322, 2013). Despite growing research interest in FCR, the lack of consensus on its definition and characteristics when it reaches a clinical level has impeded knowledge transfer into patient services. In order to address these gaps, expert researchers, policy makers, trainees, and patient advocates attended a 2-day colloquium at the University of Ottawa in August 2015. A Delphi method was used to identify the most relevant definition of FCR, and the attendees generated possible diagnostic characteristics of clinical FCR. After three rounds of discussion and voting, the attendees reached consensus on a new definition of FCR: "Fear, worry, or concern relating to the possibility that cancer will come back or progress." Regarding clinical FCR, five possible characteristics were proposed: (1) high levels of preoccupation, worry, rumination, or intrusive thoughts; (2) maladaptive coping; (3) functional impairments; (4) excessive distress; and (5) difficulties making plans for the future. The new proposed definition of FCR reflects the broad spectrum in which patients experience FCR. A consensual definition of FCR and the identification of the essential characteristics of clinical FCR are necessary to accurately and consistently measure FCR severity and to develop effective interventions to treat FCR. We hope this broad definition can encourage further research and the development of inclusive policies for all cancer patients and survivors who are struggling with this issue.

A problem solving and decision making toolbox for approaching clinical problems and decisions.

PubMed

Margolis, C; Jotkowitz, A; Sitter, H

2004-08-01

In this paper, we begin by presenting three real patients and then review all the practical conceptual tools that have been suggested for systematically analyzing clinical problems. Each of these conceptual tools (e.g. Evidence-Based Medicine, Clinical Practice Guidelines, Decision Analysis) deals mainly with a different type or aspect of clinical problems. We suggest that all of these conceptual tools can be thought of as belonging in the clinician's toolbox for solving clinical problems and making clinical decisions. A heuristic for guiding the clinician in using the tools is proposed. The heuristic is then used to analyze management of the three patients presented at the outset. Copyright 2004 Birkhäuser Verlag, Basel

Problems Faced by Distance Learners in Using Web-Based Facilities

ERIC Educational Resources Information Center

Dharankar, Madhavi

2012-01-01

Countries like India are engaged in exploring appropriate ways of tackling the urgent problem of educating their large and growing populations in relatively little time and with limited resources. Against this background, achieving universal primary education is a major concern. If this Millennium Development Goal is to be achieved, the…

Satisfaction, Challenges, and Interaction in Online Education: A Generational Comparison

ERIC Educational Resources Information Center

Yousef, Martin C.

2012-01-01

Problem: Research suggests that multiple generations of students (predominantly Generation X and millennials) are concurrently enrolled in online classes and that the number of online students continues to grow. The problem investigated in this study was to identify the level of satisfaction as well as the preferences of students from Generation X…

75 FR 75761 - Water Quality Standards for the State of Florida's Lakes and Flowing Waters

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

... widespread, persistent, and growing problem. Nitrogen/phosphorus pollution in fresh water systems can... Florida's regulated drinking water systems and a 10 mg/L criteria for nitrate in Class I waters. FDEP..., kidney, and central nervous system problems. 44 45 \\44\\ USEPA. 2009. National Primary Drinking Water...

Implementing Schoolwide Positive Behavior Support in High School Settings: Analysis of Eight High Schools

ERIC Educational Resources Information Center

Flannery, K. Brigid; Frank, Jennifer L.; Kato, Mimi McGrath; Doren, Bonnie; Fenning, Pamela

2013-01-01

Schoolwide positive behavior support (SWPBS) is a systems-level intervention designed to prevent the occurrence of problem behavior and increase social competence. A growing body of research documents that SWPBS reduces problem behavior and improves academics (e.g., McIntosh, Chard, Boland, & Horner, 2006), yet documentation of the feasibility…

Classroom Intervention for Illness-Related Problem Behavior in Children with Developmental Disabilities

ERIC Educational Resources Information Center

Carr, Edward G.; Blakeley-Smith, Audrey

2006-01-01

There is growing evidence of an association between physical illness and problem behavior in children with developmental disabilities. Such behavior can compromise school performance. Therefore, the purpose of the present study was to evaluate, using a group design, the effectiveness of medical intervention alone (N = 11) versus behavioral plus…

Elementary School Students' Water Awareness

ERIC Educational Resources Information Center

Coban, Gul Unal; Akpinar, Ercan; Kucukcankurtaran, Evren; Yildiz, Eylem; Ergin, Omer

2011-01-01

Environmental problems grow gradually and their effects are felt in various ways such as shortage of potable water. Among the various solutions offered to solve these problems, there is one standing which has the potential of encapsulating all the solutions in, that is "water education". Therefore, the aim of this study is to present the…

The Chronically Ill Child in the School.

ERIC Educational Resources Information Center

Sexson, Sandra; Madan-Swain, Avi

1995-01-01

Examines the effects of chronic illness on the school-age population. Facilitating successful functioning of chronically ill youths is a growing problem. Focuses on problems encountered by the chronically ill student who has either been diagnosed with a chronic illness or who has survived such an illness. Discusses the role of the school…

Evaluating Remote Reference Service: A Practical Guide to Problems and Solutions

ERIC Educational Resources Information Center

Pomerantz, Jeffrey; Mon, Lorri; McClure, Charles R.

2008-01-01

This paper identifies key methodological issues affecting quality of data in the evaluation of remote reference services. Despite a growing number of studies in this area, no comprehensive effort has been made to identify potential problems and suggest solutions. The strategies proposed in this paper offer practical ways in which libraries can…

What's to Be Done?

ERIC Educational Resources Information Center

Thompson, Jane

2005-01-01

The most serious long-term problem facing the world at the moment is not terrorism but the desperate level of poverty and inequality endured by those living in the Global South--due in part to environmental problems created by the unsustainable abuse of natural resources. By the late 1990s there was a growing consensus that the prevalence of…

The Problem of Attendance: Research Findings and Solutions.

ERIC Educational Resources Information Center

Levanto, Joseph

This paper examines the growing problem of high school absenteeism and presents data gathered in a study of student attendance in a large Connecticut high school. Included are graphs displaying schoolwide patterns of absenteeism and a number of statistical tables containing attendance data related to such factors as student age, class, sex, race,…

Understanding and Preventing Violence Directed against Teachers: Recommendations for a National Research, Practice, and Policy Agenda

ERIC Educational Resources Information Center

Espelage, Dorothy; Anderman, Eric M.; Brown, Veda Evanell; Jones, Abraham; Lane, Kathleen Lynne; McMahon, Susan D.; Reddy, Linda A.; Reynolds, Cecil R.

2013-01-01

Violence directed against K-12 teachers is a serious problem that demands the immediate attention of researchers, providers of teacher pre-service and in-service training, school administrators, community leaders, and policymakers. Surprisingly, little research has been conducted on this growing problem despite the broad impact teacher…

Small Village Planning Problems in the Netherlands.

ERIC Educational Resources Information Center

Groot, Jacob P.

The problems associated with small villages are among the most difficult in Dutch physical planning, for they encompass the support of minimum social services in small towns and villages; the preservation of areas of ecological and scenic value; the acommodation of a growing population desirous of a home in the country or continued country living;…

Inequality--"Wicked Problems", Labour Market Outcomes and the Search for Silver Bullets

ERIC Educational Resources Information Center

Keep, Ewart; Mayhew, Ken

2014-01-01

In recent years concerns about inequality have been growing in prominence within UK policy debates. The many causes of inequality of earnings and income are complex in their interactions and their tendency to reinforce one another. This makes inequality an intractable or "wicked" policy problem, particularly within a contemporary context…

Trash--Our Only Growing Resource. Environmental Ecological Education Project.

ERIC Educational Resources Information Center

Giebelhausen, Maribeth R.; And Others

With the increases in population and technology, non-biodegradable materials like plastic, glass, and aluminum and waste disposal have become very real problems in out society. This unit, designed for seventh-grade students, focuses on the problems of waste disposal and examines the function of recycling, the role of the consumer in determining…

A Place To Call Home. The Crisis in Housing for the Poor.

ERIC Educational Resources Information Center

Leonard, Paul A.; And Others

For most low-income households, housing has become increasingly unaffordable. High housing cost burdens have serious implications, including the growing problems of homelessness and hunger. Data on national trends and housing conditions suggest that just as the affordable housing problems worsened dramatically for low-income households between the…

Homelessness in Urban America: A Review of the Literature.

ERIC Educational Resources Information Center

Sommer, Heidi

In the 1980s, homelessness attracted considerable attention from the media, advocates, politicians, and the public. Virtually every sector of society and the government responded. Interest in the issue has waned considerably since then, but the problem continues growing, particularly in large urban areas. While public policies address the problem,…

The Pedagogical Support for Preschool Children with Deviant Behavior

ERIC Educational Resources Information Center

Kostyunina, Nadezhda Y.; Kazaeva, Evgenia A.; Karimova, Raushan B.

2016-01-01

The relevance of the research problems of pedagogical support of preschool children with behavioral problems is explained by changes due and of taking place in modern Russia in various spheres of life: ecological and economic disadvantage, social instability, the growing influence of pseudo-culture, unfavorable climate in family, too busy parents,…

Educational Malpractice: Can the Judiciary Remedy the Growing Problem of Functional Illiteracy?

ERIC Educational Resources Information Center

Klein, Alice J.

1979-01-01

Investigates the viability of a negligence action for inadequate public school education. Explores the problems inherent in proving each element of negligence, the available defense, and the potential consequences for plaintiffs, defendants, and educational policy-making that would flow from judicial recognition of a cause of action. Journal…

Peer Relationship Problems of Children with AD/HD: Contributing Factors and Implications for Practice

ERIC Educational Resources Information Center

Ozdemir, Selda

2010-01-01

Research has consistently documented that children with attention deficit/hyperactivity disorder (AD/HD) have significant problems in peer relationships and are strongly rejected by their typically developing peers. There is a growing recognition that traditional interventions, such as social skills trainings are no longer sufficient to address…

An Interdisciplinary Program in Technical Communications: Problems Encountered.

ERIC Educational Resources Information Center

Eckman, Martha

The need for experts in technical communication is growing significantly while the number of college graduates in the field accounts for less than one percent of the need. Three major types of problems should be considered in trying to establish a technical communication program: those involving society's need for better technical communicators,…

ASIT--A Problem Solving Strategy for Education and Eco-Friendly Sustainable Design

ERIC Educational Resources Information Center

Turner, Steve

2009-01-01

There is growing recognition of the role teaching and learning experiences in technology education can contribute to Education for Sustainable Development. It appears, however, that in the Technology Education classroom little or no change has been achieved to the practice of designing and problem solving strategies oriented towards sustainable…

Possible Problems: Inverted, Flat, or Pierced Nipples

MedlinePlus

... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

[Pathological nighttime fears in children: Clinical specificities and effective therapeutics].

PubMed

Ducasse, D; Denis, H

2015-09-01

Pathological nighttime fears in children have been little studied. However, this disorder is commonly encountered in medical consultations and is discomforting and dysfunctional for both the child and the family. Most nighttime fears are part and parcel of normal development, and emanate from increasingly sophisticated cognitive development in the growing child. Thus, most children report a variety of coping strategies generally helpful in reducing their anxiety, which resolves spontaneously in the growing child. Nevertheless, in about 10% of children, nighttime fears are related to one or more anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders criteria. Then, it is estimated that severe nighttime fears and sleep problems occur in 20-30% of children. This problem is not transient and has to be treated. This study aims to review clinical features of nighttime fears and possible treatments for these patients and their families. This systematic review follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Two databases (Medline and Web of Science) were searched combining the search terms: nighttime fears AND children. English and French languages were imposed. There were no publication date or publication status limitations. Pathological nighttime fears are responsible for emotional (crying, panic, tantrums at bedtime, loss of confidence, self-disparaging negative statements, and feeling of social embarrassment) and behavioral (wandering alone in the house at night, calls for parental or sibling comfort, bed sharing with parents or siblings, light source at night, refusal to go to the toilet alone at night) disturbances. This leads to a poor quality of sleep interfering with school learning, and also affects social development and family functioning. A full assessment has to be made to eliminate organic causes, have a baseline functioning, and search for comorbid anxiety diseases. The treatments which have proved effective are some cognitive-behavioral techniques: systematic desensitization (with relaxation or emotive imagery), reinforcement (gain of points and techniques of self statement), and cognitive techniques (reinforcing self-statements, reducing the aversive aspects of being in the dark, involving reality-testing statements, and active control are preferred in children older than 6 years, whereas the "anti-monster letter" and the techniques using a doll are preferred in children under 6 years old). The modelling technique seems to be appropriate at any age. We have explained the clinical features of pathological nighttime fears and the way to assess this disease, and we have pointed out the treatments whose effectiveness has been evaluated in this indication. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Growing Up in Poverty, Growing Old in Infirmity: The Long Arm of Childhood Conditions in Great Britain.

PubMed

Tampubolon, Gindo

2015-01-01

The ageing population poses a tremendous challenge in understanding the sources of inequalities in health. Though they appear to be far removed, childhood conditions are known to be inextricably linked with adult health, and in turn on health in later life. The long arm of childhood conditions hypothesis is often tested using recollection of childhood circumstances, but such subjective recall can yield potentially inaccurate or possibly biased inferences. We tested the long arm hypothesis on three outcomes in later life, arrayed from objective to subjective health, namely: gait speed, episodic memory and mental health. We used the English Longitudinal Study of Ageing 2006 enriched with retrospective life history (N = 5,913). To deal with recall problems two solutions, covariate measurement and endogenous treatment models, were applied. Retrospective childhood material lack includes growing up without running hot or cold water, fixed bath, indoor lavatory and central heating. Adjustment is made for an extensive set of confounders including sex, age, adult health, wealth, education, occupation, social support, social connections, chronic conditions, smoking, drinking, and physical exercise. It is found that material poverty when growing up shows no association with health when growing old, assuming accurate recall. Once recall problems are controlled, we found that childhood material poverty changes inversely with later life health. A poorer childhood goes with slower gait, poorer memory and more depression in later life. This result provides a further impetus to eliminate child poverty.

Positive Youth Development, Life Satisfaction, and Problem Behaviors of Adolescents in Intact and Non-Intact Families in Hong Kong

PubMed Central

Shek, Daniel T. L.; Leung, Hildie

2013-01-01

This study investigated whether Chinese adolescents living in intact and non-intact families differed in their positive development, life satisfaction, and risk behavior. A total of 3,328 Secondary 1 students responded to measures of positive youth development (such as resilience and psychosocial competencies), life satisfaction, and risk behavior (substance abuse, delinquency, Internet addiction, consumption of pornographic materials, self-harm, and behavioral intention to engage in problem behavior). Findings revealed that adolescents growing up in intact families reported higher levels of positive developmental outcomes and life satisfaction as compared with adolescents from non-intact families. Adolescents in non-intact families also reported higher levels of risk behaviors than those growing up in intact families. PMID:24400264

Positive youth development, life satisfaction, and problem behaviors of adolescents in intact and non-intact families in Hong Kong.

PubMed

Shek, Daniel T L; Leung, Hildie

2013-01-01

This study investigated whether Chinese adolescents living in intact and non-intact families differed in their positive development, life satisfaction, and risk behavior. A total of 3,328 Secondary 1 students responded to measures of positive youth development (such as resilience and psychosocial competencies), life satisfaction, and risk behavior (substance abuse, delinquency, Internet addiction, consumption of pornographic materials, self-harm, and behavioral intention to engage in problem behavior). Findings revealed that adolescents growing up in intact families reported higher levels of positive developmental outcomes and life satisfaction as compared with adolescents from non-intact families. Adolescents in non-intact families also reported higher levels of risk behaviors than those growing up in intact families.

Relationship Between Emotional Processing, Drinking Severity and Relapse in Adults Treated for Alcohol Dependence in Poland

PubMed Central

Kopera, Maciej; Jakubczyk, Andrzej; Suszek, Hubert; Glass, Jennifer M.; Klimkiewicz, Anna; Wnorowska, Anna; Brower, Kirk J.; Wojnar, Marcin

2015-01-01

Aims: Growing data reveals deficits in perception, understanding and regulation of emotions in alcohol dependence (AD). The study objective was to explore the relationships between emotional processing, drinking history and relapse in a clinical sample of alcohol-dependent patients. Methods: A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland was recruited and assessed at baseline and follow-up after 12 months. Baseline information about demographics, psychopathological symptoms, personality and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence (EI) Test and Toronto Alexithymia Scale (TAS) were utilized for emotional processing assessment. Follow-up information contained data on drinking alcohol during the last month. Results: At baseline assessment, the duration of alcohol drinking was associated with lower ability to utilize emotions. Patients reporting more difficulties with describing feelings drank more during their last episode of heavy drinking, and had a longer duration of intensive alcohol use. A longer duration of the last episode of heavy drinking was associated with more problems identifying and regulating emotions. Poor utilization of emotions and high severity of depressive symptoms contributed to higher rates of drinking at follow-up. Conclusions: These results underline the importance of systematic identification of discrete emotional problems and dynamics related to AD. This knowledge has implications for treatment. Psychotherapeutic interventions to improve emotional skills could be utilized in treatment of alcohol-dependent patients. PMID:25543129

The yellow x paper birch hybrid--a potential substitute for yellow birch on problem sites

Treesearch

Knud E. Clausen

1977-01-01

Yellow x paper birch hybrids and yellow birches with common female parents were compared after 5 growing seasons in an open field. Survival of the hybrids was 91 percent compared with 64 percent for the yellow birch trees. The hybrids were from 25 to 32 percent taller than the yellow birches and had 19-40 percent greater diameter. Because this hybrid not only grows...

Clinical trials in crisis: four simple methodologic fixes

PubMed Central

Vickers, Andrew J.

2014-01-01

There is growing consensus that the US clinical trials system is broken, with trial costs and complexity increasing exponentially, and many trials failing to accrue. Yet concerns about the expense and failure rate of randomized trials are only the tip of the iceberg; perhaps what should worry us most is the number of trials that are not even considered because of projected costs and poor accrual. Several initiatives, including the Clinical Trials Transformation Initiative and the “Sensible Guidelines Group” seek to push back against current trends in clinical trials, arguing that all aspects of trials - including design, approval, conduct, monitoring, analysis and dissemination - should be based on evidence rather than contemporary norms. Proposed here are four methodologic fixes for current clinical trials. The first two aim to simplify trials, reducing costs and increasing patient acceptability by dramatically reducing eligibility criteria - often to the single criterion that the consenting physician is uncertain which of the two randomized arms is optimal - and by clinical integration, investment in data infrastructure to bring routinely collected data up to research grade to be used as endpoints in trials. The second two methodologic fixes aim to shed barriers to accrual, either by cluster randomization of clinicians (in the case of modifications to existing treatment) or by early consent, where patients are offered the chance of being randomly selected to be offered a novel intervention if disease progresses at a subsequent point. Such solutions may be partial, or result in a new set of problems of their own. Yet the current crisis in clinical trials mandates innovative approaches: randomized trials have resulted in enormous benefits for patients and we need to ensure that they continue to do so. PMID:25278228

Clinical trials in crisis: Four simple methodologic fixes.

PubMed

Vickers, Andrew J

2014-12-01

There is growing consensus that the US clinical trials system is broken, with trial costs and complexity increasing exponentially, and many trials failing to accrue. Yet, concerns about the expense and failure rate of randomized trials are only the tip of the iceberg; perhaps what should worry us most is the number of trials that are not even considered because of projected costs and poor accrual. Several initiatives, including the Clinical Trials Transformation Initiative and the "Sensible Guidelines Group" seek to push back against current trends in clinical trials, arguing that all aspects of trials-including design, approval, conduct, monitoring, analysis, and dissemination-should be based on evidence rather than contemporary norms. Proposed here are four methodologic fixes for current clinical trials. The first two aim to simplify trials, reducing costs, and increasing patient acceptability by dramatically reducing eligibility criteria-often to the single criterion that the consenting physician is uncertain which of the two randomized arms is optimal-and by clinical integration, investment in data infrastructure to bring routinely collected data up to research grade to be used as endpoints in trials. The second two methodologic fixes aim to shed barriers to accrual, either by cluster randomization of clinicians (in the case of modifications to existing treatment) or by early consent, where patients are offered the chance of being randomly selected to be offered a novel intervention if disease progresses at a subsequent point. Such solutions may be partial, or result in a new set of problems of their own. Yet, the current crisis in clinical trials mandates innovative approaches: randomized trials have resulted in enormous benefits for patients, and we need to ensure that they continue to do so. © The Author(s) 2014.

Clinical Problem Analysis (CPA): A Systematic Approach To Teaching Complex Medical Problem Solving.

ERIC Educational Resources Information Center

Custers, Eugene J. F. M.; Robbe, Peter F. De Vries; Stuyt, Paul M. J.

2000-01-01

Discusses clinical problem analysis (CPA) in medical education, an approach to solving complex clinical problems. Outlines the five step CPA model and examines the value of CPA's content-independent (methodical) approach. Argues that teaching students to use CPA will enable them to avoid common diagnostic reasoning errors and pitfalls. Compares…

Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known.

PubMed

Makaroun, Lena K; Taylor, Laura; Rosen, Tony

2018-02-01

At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

How Can Vaccines Contribute to Solving the Antimicrobial Resistance Problem?

PubMed Central

Siber, George R.

2016-01-01

ABSTRACT There is a growing appreciation for the role of vaccines in confronting the problem of antimicrobial resistance (AMR). Vaccines can reduce the prevalence of resistance by reducing the need for antimicrobial use and can reduce its impact by reducing the total number of cases. By reducing the number of pathogens that may be responsible for a particular clinical syndrome, vaccines can permit the use of narrower-spectrum antibiotics for empirical therapy. These effects may be amplified by herd immunity, extending protection to unvaccinated persons in the population. Because much selection for resistance is due to selection on bystander members of the normal flora, vaccination can reduce pressure for resistance even in pathogens not included in the vaccine. Some vaccines have had disproportionate effects on drug-resistant lineages within the target species, a benefit that could be more deliberately exploited in vaccine design. We describe the effects of current vaccines in controlling AMR, survey some vaccines in development with the potential to do so further, and discuss strategies to amplify these benefits. We conclude with a discussion of research and policy priorities to more fully enlist vaccines in the battle against AMR. PMID:27273824

Sleep in caregivers: what we know and what we need to learn.

PubMed

McCurry, Susan M; Song, Yeonsu; Martin, Jennifer L

2015-11-01

The number of informal caregivers providing assistance to adults is increasing commensurate with our aging society. Sleep disturbances are prevalent in caregivers and associated with negative physical, medical, and functional outcomes. Here, we describe the predisposing, precipitating, and perpetuating factors contributing to the development of sleep problems in caregivers, and discuss three understudied caregiving populations that have clinical importance and unique circumstances influencing sleep quality and health. There is clear evidence supporting the interaction between sleep loss, caregiving stress, and vulnerability to chronic disease. Telehealth and telemedicine sleep interventions for caregivers combined with assistive technologies targeting care-receivers have potential to be more individualized, affordable, and widely accessible than traditional in-person insomnia treatment approaches. Limited data exist describing the etiology and treatment of sleep problems in caregivers of veterans, medical patients newly discharged from the hospital, and developmentally disabled adults. There is a growing literature describing the general determinants of sleep disturbances in caregivers, the health consequences of these disturbances, and intervention strategies for treating them. Identifying effective sleep treatments suited to more specialized caregiving situations and increasing intervention access will help caregivers continue to provide quality care while protecting their own health and well-being.

Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors

PubMed Central

Bradford, Andrea; Kunik, Mark E.; Schulz, Paul; Williams, Susan P.; Singh, Hardeep

2009-01-01

Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion based on patient symptomsor caregivers’ concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient-, caregiver-, provider-, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and appeared to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but appears to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis. PMID:19568149

Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers

PubMed Central

Siegel, Rebecca S; Dickstein, Daniel P

2012-01-01

Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy), and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact. PMID:24600282

A comparative study: classification vs. user-based collaborative filtering for clinical prediction.

PubMed

Hao, Fang; Blair, Rachael Hageman

2016-12-08

Recommender systems have shown tremendous value for the prediction of personalized item recommendations for individuals in a variety of settings (e.g., marketing, e-commerce, etc.). User-based collaborative filtering is a popular recommender system, which leverages an individuals' prior satisfaction with items, as well as the satisfaction of individuals that are "similar". Recently, there have been applications of collaborative filtering based recommender systems for clinical risk prediction. In these applications, individuals represent patients, and items represent clinical data, which includes an outcome. Application of recommender systems to a problem of this type requires the recasting a supervised learning problem as unsupervised. The rationale is that patients with similar clinical features carry a similar disease risk. As the "Big Data" era progresses, it is likely that approaches of this type will be reached for as biomedical data continues to grow in both size and complexity (e.g., electronic health records). In the present study, we set out to understand and assess the performance of recommender systems in a controlled yet realistic setting. User-based collaborative filtering recommender systems are compared to logistic regression and random forests with different types of imputation and varying amounts of missingness on four different publicly available medical data sets: National Health and Nutrition Examination Survey (NHANES, 2011-2012 on Obesity), Study to Understand Prognoses Preferences Outcomes and Risks of Treatment (SUPPORT), chronic kidney disease, and dermatology data. We also examined performance using simulated data with observations that are Missing At Random (MAR) or Missing Completely At Random (MCAR) under various degrees of missingness and levels of class imbalance in the response variable. Our results demonstrate that user-based collaborative filtering is consistently inferior to logistic regression and random forests with different imputations on real and simulated data. The results warrant caution for the collaborative filtering for the purpose of clinical risk prediction when traditional classification is feasible and practical. CF may not be desirable in datasets where classification is an acceptable alternative. We describe some natural applications related to "Big Data" where CF would be preferred and conclude with some insights as to why caution may be warranted in this context.

Regional cooperation in transportation planning.

DOT National Transportation Integrated Search

2012-02-01

As Floridas urbanized areas grow and merge, : neighboring jurisdictions experience interrelated : problems and opportunities, and regional : cooperation becomes an imperative. In the : transportation sector, Floridas metropolitan : planning org...

Efficacy of tilmicosin phosphate (Pulmotil premix) in feed for the treatment of a clinical outbreak of Actinobacillus pleuropneumoniae infection in growing-finishing pigs.

PubMed

Hoflack, G; Maes, D; Mateusen, B; Verdonck, M; de Kruif, A

2001-11-01

A double-blind randomized clinical trial was carried out to investigate the efficacy of tilmicosin (Pulmotil premix) for the treatment of a clinical outbreak of Actinobacillus pleuropneumoniae infection in growing-finishing pigs. The effects of tilmicosin administration in the feed at 400 mg/kg and an injection therapy of clinically diseased pigs with long-acting oxytetracycline (Terramycine LA) at 20 mg/kg bodyweight were compared. Both groups, totalling 147 pigs, were compared during a medication period of 15 days and a post-medication period of 11 days by means of different clinical and performance parameters. During the medication period, the tilmicosin group showed a significant advantage with respect to the number of new disease cases (P < 0.01), and a non-significant advantage regarding the number of removed pigs (P = 0.16), the number of sick pigs that recovered (P = 0.27) and the time to recovery (P = 0.42). During the post-medication period, the pigs of the tilmicosin group showed numerical non-significant benefits (P > 0.05) with respect to the clinical parameters. During the overall study period (26 days), the average daily gain and the feed conversion ratio were both significantly (P < 0.01) better in pigs from the tilmicosin group compared with pigs from the oxytetracycline group. This study demonstrated that in-feed medication of tilmicosin at a dosage of 400 mg/kg is efficacious for the treatment of a clinical respiratory disease outbreak of A. pleuropneumoniae infection in growing-finishing pigs. Compared with oxytetracycline injection of clinically diseased pigs, the tilmicosin treatment is particularly beneficial in the prevention of new disease cases while increasing or maintaining the performance of the pigs.

Perceptions of International Teacher Turnover in East Asia Regional Council of Schools

ERIC Educational Resources Information Center

Tkachyk, Leon Michael

2017-01-01

High teacher turnover has become a serious problem globally, in many international schools, and is a growing concern in segments of the East Asia Regional Council of Schools (EARCOS). This persistent problem has a detrimental effect on student learning and upsets the culture of school communities. Herzberg's motivation-hygiene theory served as the…

A Transition Course from Advanced Placement to College Calculus

ERIC Educational Resources Information Center

Lucas, Timothy A.; Spivey, Joseph

2011-01-01

In the Spring of 2007, a group of highly motivated mathematics graduate students conducted a review of Duke's Calculus curriculum. They focused on two main problems. The first problem is the result of a very positive trend: a growing number of students are earning AP credit for Calculus I in high school. However, this results in Calculus II…

Automated Information Security Will Not Improve until Effectively Supported by IRM.

ERIC Educational Resources Information Center

Chick, Morey J.

1989-01-01

The first of two articles on the nature of the growing problem of automated information systems security, especially in the federal government, this article presents a brief history of the problem and describes the need for integrating security activities into overall policies and programs to help reduce system vulnerabilities and risks. (23…

The Casualties of the Twenty-First-Century Community College

ERIC Educational Resources Information Center

Wilson, David McKay

2010-01-01

This article discusses academic freedom that is currently under threat at many public two-year schools, which serve almost one-half of the nation's first-year college students. The growing reliance on part-time faculty exacerbates the problem, with many adjuncts feeling muzzled for fear of losing their jobs. The problem of academic freedom at…

Forest recreation research at the Pacific Southwest Forest and Range Experiment Station

Treesearch

Robert H. Twiss; Harry W. Camp

1963-01-01

As a land use, an activity, and an industry, forest recreation is rapidly growing in importance. But it is relatively new in terms of objective data and theory. Critical problems are being met by an interdisciplinary research team drawing on seven fields of knowledge. Research problems, approaches, studies, and plans are summarized.

Bibliotherapy for Children: Using Books and Other Media to Help Children Cope.

ERIC Educational Resources Information Center

Weinstein, Stuart H.

Children are able to cope with a majority of problems of learning and growing; some problems, however, may require guidance and support. A technique available to all people, trained or untrained in counseling or guidance is bibliotherapy--a process of dynamic interaction between the personality of the reader and literature which may be used for…

Prenatal Exposure to Maternal Smoking and Childhood Behavioural Problems: A Quasi-Experimental Approach

ERIC Educational Resources Information Center

McCrory, Cathal; Layte, Richard

2012-01-01

This retrospective cross-sectional paper examines the relationship between maternal smoking during pregnancy and children's behavioural problems at 9 years of age independent of a wide range of possible confounders. The final sample comprised 7,505 nine-year-old school children participating in the first wave of the Growing Up in Ireland study.…

Hiding in Plain Sight: Identifying Computational Thinking in the Ontario Elementary School Curriculum

ERIC Educational Resources Information Center

Hennessey, Eden J. V.; Mueller, Julie; Beckett, Danielle; Fisher, Peter A.

2017-01-01

Given a growing digital economy with complex problems, demands are being made for education to address computational thinking (CT)--an approach to problem solving that draws on the tenets of computer science. We conducted a comprehensive content analysis of the Ontario elementary school curriculum documents for 44 CT-related terms to examine the…

Examining the Cross-Cultural Effect between Moral Suasion and Academic Dishonesty

ERIC Educational Resources Information Center

Gold, Andrew M.

2014-01-01

Academic and workplace dishonesty have become a growing and costly problem within society. While academic misconduct is nothing new, over the past 40 years the problem appears to be getting worse. The literature indicated a steady increase in academic cheating rates over the past four decades from 50% to as much as 75%. Compounding this problem…

Impulse Control and Aggressive Response Generation as Predictors of Aggressive Behaviour in Children with Mild Intellectual Disabilities and Borderline Intelligence

ERIC Educational Resources Information Center

van Nieuwenhuijzen, M.; Orobio de Castro, B.; van Aken, M. A. G.; Matthys, W.

2009-01-01

Background: A growing interest exists in mechanisms involved in behaviour problems in children with mild intellectual disabilities and borderline intelligence (MID/BI). Social problem solving difficulties have been found to be an explanatory mechanism for aggressive behaviour in these children. However, recently a discrepancy was found between…

"Growing" Education in Difficult Environments Promoting Problem Solving: A Case from Palestine

ERIC Educational Resources Information Center

Jabr, Dua

2009-01-01

This paper presents a collaborative educational experiment "The Death of the Dead Sea: A Problem Based Learning" that was applied in two governmental high schools in Ramallah, Palestine in the school year 2006-2007. The students' role was to raise awareness to the phenomenon of the saltiest lake that shrinks towards extinction. In spite…

Violence in Schools: Perspectives (and Hope) from Galtung and Buber

ERIC Educational Resources Information Center

Cremin, Hilary; Guilherme, Alexandre

2016-01-01

Research into violence in schools has been growing steadily at an international level, and has shown high degrees of violence at various different levels. Given the seriousness of the problem, finding ways of responding to this issue in schools becomes an imperative for educationists. In this article, we engage with this problem by defending the…

Problem-Based Learning Pedagogies: Psychological Processes and Enhancement of Intelligences

ERIC Educational Resources Information Center

Tan, Oon-Seng

2007-01-01

Education in this 21st century is concerned with developing intelligences. Problem solving in real-world contexts involves multiple ways of knowing and learning. Intelligence in the real world involves not only learning how to do things effectively but also more importantly the ability to deal with novelty and growing our capacity to adapt, select…

Maritime Tactile Education for Urban Secondary Education Students

ERIC Educational Resources Information Center

Sulzer, Arthur Henry, IV

2012-01-01

Urban high-school students' low average level of academic achievement is a national problem. A lack of academic progress is a factor that contributes to students failing to graduate. In response to these urban high school student problems, a growing number of urban charter high schools have opened as an alternative to the traditional public high…

Factors Affecting Police Officers' Acceptance of GIS Technologies: A Study of the Turkish National Police

ERIC Educational Resources Information Center

Cakar, Bekir

2011-01-01

The situations and problems that police officers face are more complex in today's society, due in part to the increase of technology and growing complexity of globalization. Accordingly, to solve these problems and deal with the complexities, law enforcement organizations develop and apply new techniques and methods such as geographic information…

Convergent Evolution in the Interest of Integrative Problem Solving: Connecting the Policy Sciences and Interdisciplinary Studies

ERIC Educational Resources Information Center

Wallace, Richard L.; Clark, Susan G.

2014-01-01

The contemporary fields of interdisciplinary studies and the policy sciences have evolved over similar intellectual paths and timelines, beginning in the early 20th century. Both have their roots in professional efforts--within and outside the academy--to address numerous, growing, and complex problems that face humanity. The policy sciences'…

Evaluating the Relevance of Educational Videos Using BKT and Big Data

ERIC Educational Resources Information Center

MacHardy, Zachary; Pardos, Zachary A.

2015-01-01

Along with the advent of MOOCs and other online learning platforms such as Khan Academy, the role of online education has continued to grow in relation to that of traditional on-campus instruction. Rather than tackle the problem of evaluating large educational units such as entire online courses, this paper approaches a smaller problem: exploring…

Motivating Learners in Massive Open Online Courses: A Design-Based Research Approach

ERIC Educational Resources Information Center

Li, Kun

2015-01-01

There has been a growing interest among educators and researchers in studying Massive Open Online Courses (MOOCs) and their impact on education. Issues and problems have been reported in the research and in practice, including problems related to MOOC learners' motivation and engagement during the course. However, very few studies have adopted a…

Optimising Inter-Disciplinary Problem-Based Learning in Postgraduate Environmental and Science Education: Recommendations from a Case Study

ERIC Educational Resources Information Center

Redshaw, Clare H; Frampton, Ian

2014-01-01

As the value of multi-disciplinary working in the business and research worlds is becoming more recognised, the number of inter-disciplinary postgraduate environmental and health sciences courses is also increasing. Equally, the popularity of problem-based learning (PBL) is expected to grow and influence instructional approaches in many…

Association of Stress, General Health, and Alcohol Use with Poor Sleep Quality among U.S. College Students

ERIC Educational Resources Information Center

Valerio, Teresa D.; Kim, Myoung Jin; Sexton-Radek, Kathy

2016-01-01

Background: Poor sleep among college students is a major, growing problem associated with lower academic performance, higher rates of health and emotional problems, and development of chronic sleep disorders. Purpose: Though previous studies have focused on individual colleges, our study purpose was to reveal the association of behaviors and…

Profile of an Aggressor: Childhood Bullies Evolve into Violent Youths

ERIC Educational Resources Information Center

Lake, Vicki

2004-01-01

Violence in schools and communities is no longer an urban school problem; it is every school's problem ( Garbarino, 1999 ). What factors cause children to interact with increasingly violent and anti-social behaviors? What strategies can teachers and schools use in order to help these childhood bullies who grow up to be violent youths? This paper…

Exploring the Cognitive Demand and Features of Problem Solving Tasks in Primary Mathematics Classrooms

ERIC Educational Resources Information Center

McCormick, Melody

2016-01-01

Student learning is greatest in classrooms where students engage in problem solving tasks that are cognitively demanding. However, there are growing concerns that many Australian students are given limited opportunities to engage in these types of tasks. 108 upper primary school teachers were surveyed to examine task features and cognitive demand…

The Next 25 Years: Crises and Challenges.

ERIC Educational Resources Information Center

Amara, Roy

Within the next 25 years each major world problem will continue to grow and challenge the finest minds for equitable solutions. Yet the core world issue, from which most other problems stem, is the maintenance of an equitable and dynamic equilibrium between world populations and world resources. We are faced with a set of challenges stemming from…

The prevalence of obesity documentation in Primary Care Electronic Medical Records

PubMed Central

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B.

2017-01-01

Summary Background Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient’s problem list for patients with eligible body mass indexes (BMI) as contained in the patients’ electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. Method This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Results Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Conclusion Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese. PMID:28119990

Evaluating the link between human resource management decisions and patient satisfaction with quality of care.

PubMed

Oppel, Eva-Maria; Winter, Vera; Schreyögg, Jonas

Patient satisfaction with quality of care is becoming increasingly important in the competitive hospital market. Simultaneously, the growing shortage of clinical staff poses a considerable challenge to ensuring a high quality of care. In this context, a question emerges regarding whether and how human resource management (HRM) might serve as a means to reduce staff shortage problems and to increase patient satisfaction. Although considerable efforts have been devoted to understanding the concepts of patient satisfaction and HRM, little is known about the interrelationships between these concepts or about the link between staff shortage problems and patients' satisfaction with quality of care. The aim of this study was to investigate the relationship between strategic human resource management (SHRM), staff shortage problems, and patients' satisfaction with care. Furthermore, we analyze how the HRM decision to fill short-term vacancies through temporary staffing affects patient satisfaction. We differentiate between physicians and nurses. We develop and empirically test a theoretical model. The data (n = 165) are derived from a survey on SHRM that was sent to 732 German hospitals and from a survey on patient satisfaction that comprises 436,848 patient satisfaction ratings. We use a structural equation modeling approach to test the model. The results indicate that SHRM significantly reduces staff shortage problems for both occupational groups. Having fewer physician shortage problems is significantly associated with higher levels of patient satisfaction, whereas this effect is not significant for nurses. Furthermore, the use of temporary staffing considerably reduces patients' satisfaction with care. Hospital managers are advised to consider the effects of HRM decisions on patients' satisfaction with care. In particular, investments in SHRM targeted at physicians have significantly positive effects on patient satisfaction, whereas the temporary staffing of physicians and nurses should be avoided.

Regional cooperation in transportation planning : [summary].

DOT National Transportation Integrated Search

2012-01-01

As Floridas urbanized areas grow and merge, : neighboring jurisdictions experience interrelated : problems and opportunities, and regional : cooperation becomes an imperative. In the : transportation sector, Floridas metropolitan : planning org...

West Nile Virus

MedlinePlus

... Body Works Puberty & Growing Up Staying Healthy Staying Safe Recipes & Cooking Health Problems Illnesses & Injuries Relax & Unwind People, Places & Things That Help Feelings Expert Answers Q&A Movies & More for Teens ...

Encephalitis (For Parents)

MedlinePlus

... Body Works Puberty & Growing Up Staying Healthy Staying Safe Recipes & Cooking Health Problems Illnesses & Injuries Relax & Unwind People, Places & Things That Help Feelings Expert Answers Q&A Movies & More for Teens ...

ABE Has Growing Pains

ERIC Educational Resources Information Center

Frank, Boris

1970-01-01

There are problems in adult basic education--little specially produced professional material available to it; little time spent on preplanning stages; severe budgetary limitations; and an elementary school syndrome. (EB)

India's growing participation in global clinical trials.

PubMed

Gupta, Yogendra K; Padhy, Biswa M

2011-06-01

Lower operational costs, recent regulatory reforms and several logistic advantages make India an attractive destination for conducting clinical trials. Efforts for maintaining stringent ethical standards and the launch of Pharmacovigilance Program of India are expected to maximize the potential of the country for clinical research. Copyright © 2011. Published by Elsevier Ltd.

The mechanical problems on additive manufacturing of viscoelastic solids with integral conditions on a surface increasing in the growth process

NASA Astrophysics Data System (ADS)

Parshin, D. A.; Manzhirov, A. V.

2018-04-01

Quasistatic mechanical problems on additive manufacturing aging viscoelastic solids are investigated. The processes of piecewise-continuous accretion of such solids are considered. The consideration is carried out in the framework of linear mechanics of growing solids. A theorem about commutativity of the integration over an arbitrary surface increasing in the solid growing process and the time-derived integral operator of viscoelasticity with a limit depending on the solid point is proved. This theorem provides an efficient way to construct on the basis of Saint-Venant principle solutions of nonclassical boundary-value problems for describing the mechanical behaviour of additively formed solids with integral satisfaction of boundary conditions on the surfaces expanding due to the additional material influx to the formed solid. The constructed solutions will retrace the evolution of the stress-strain state of the solids under consideration during and after the processes of their additive formation. An example of applying the proved theorem is given.

The Causality of Evolution on Different Fitness Landscapes

NASA Astrophysics Data System (ADS)

Vyawahare, Saurabh; Austin, Robert; Zhang, Qiucen; Kim, Hyunsung; Bestoso, John

2013-03-01

Evolution of antibiotic resistance is a growing problem. One major reason why most antibiotics fail is because of mutations on drug targets (e.g. essential enzymes). Sequencing of clinically resistant isolates have shown that multiple mutational-hotspots exist in coding regions, which could potentially prohibit the binding of drugs. However, it is not clear whether the appearance of each mutation is random or influenced by other factors. In this paper, we compare evolution of resistance to ciprofloxacin from two distinct but well characterized genetic backgrounds. By combining our recently developed evolution reactor and deep whole-genome sequencing, we show different alleles of σs factor lead to fixation of different mutations in gyrA gene that confer ciprofloxacin resistance to bacteria Escherichia coli. Such causality of evolution in different genes provides an opportunity to control the evolution of antibiotic resistance. Sponsored by the NCI/NIH Physical Sciences Oncology Centers

Linking acute kidney injury to chronic kidney disease: the missing links.

PubMed

Kaballo, Mohammed A; Elsayed, Mohamed E; Stack, Austin G

2017-08-01

Acute kidney injury (AKI) is considered to be a major public health problem around the globe, and it is associated with major adverse clinical outcomes and significant health care costs. There is growing evidence suggesting that AKI is associated with the subsequent development of chronic kidney disease (CKD). While recovery of kidney function occurs in the majority of patients surviving an AKI episode, a large number of patients do not recover completely. Similarly, CKD is a well-known risk factor for the development of AKI. Recent studies suggest that both AKI and CKD are not separate disease entities but are in fact components of a far more closely interconnected disease continuum. However, the true nature of this relationship is complex and poorly understood. This review explores potential relationships between AKI and CKD, and seeks to uncover a number of "missing links" in this tentative emerging relationship.

Bitterness prediction in-silico: A step towards better drugs.

PubMed

Bahia, Malkeet Singh; Nissim, Ido; Niv, Masha Y

2018-02-05

Bitter taste is innately aversive and thought to protect against consuming poisons. Bitter taste receptors (Tas2Rs) are G-protein coupled receptors, expressed both orally and extra-orally and proposed as novel targets for several indications, including asthma. Many clinical drugs elicit bitter taste, suggesting the possibility of drugs re-purposing. On the other hand, the bitter taste of medicine presents a major compliance problem for pediatric drugs. Thus, efficient tools for predicting, measuring and masking bitterness of active pharmaceutical ingredients (APIs) are required by the pharmaceutical industry. Here we highlight the BitterDB database of bitter compounds and survey the main computational approaches to prediction of bitter taste based on compound's chemical structure. Current in silico bitterness prediction methods provide encouraging results, can be constantly improved using growing experimental data, and present a reliable and efficient addition to the APIs development toolbox. Copyright © 2017 Elsevier B.V. All rights reserved.

Lost Dollars Threaten Research in Public Academic Health Centers.

PubMed

Bourne, Henry R; Vermillion, Eric B

2017-03-01

The decrease of federal and state support threatens long-term sustainability of research in publicly supported academic health centers. In weathering these financial threats, research at the University of California, San Francisco (UCSF), has undergone 3 substantial changes: institutional salary support goes preferentially to senior faculty, whereas the young increasingly depend on grants; private and government support for research grows apace in clinical departments but declines in basic science departments; and research is judged more on its quantity (numbers of investigators and federal and private dollars) than on its goals, achievements, or scientific quality. We propose specific measures to alleviate these problems. Other large public academic health centers probably confront similar issues, but-except for UCSF-such centers have not been subjected to detailed public analysis.-Bourne, H. R., Vermillion, E. B. Lost dollars threaten research in public academic health centers. © FASEB.

Heat stroke risk for open-water swimmers during long-distance events.

PubMed

Macaluso, Filippo; Barone, Rosario; Isaacs, Ashwin W; Farina, Felicia; Morici, Giuseppe; Di Felice, Valentina

2013-12-01

Open-water swimming is a rapidly growing sport discipline worldwide, and clinical problems associated with long-distance swimming are now better recognized and managed more effectively. The most prevalent medical risk associated with an open-water swimming event is hypothermia; therefore, the Federation Internationale De Natation (FINA) has instituted 2 rules to reduce this occurrence related to the minimum water temperature and the time taken to complete the race. Another medical risk that is relevant to open-water swimmers is heat stroke, a condition that can easily go unnoticed. The purpose of this review is to shed light on this physiological phenomenon by examining the physiological response of swimmers during long-distance events, to define a maximum water temperature limit for competitions. We conclude that competing in water temperatures exceeding 33°C should be avoided. Copyright © 2013 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Quantitative proteomics to study carbapenem resistance in Acinetobacter baumannii

PubMed Central

Tiwari, Vishvanath; Tiwari, Monalisa

2014-01-01

Acinetobacter baumannii is an opportunistic pathogen causing pneumonia, respiratory infections and urinary tract infections. The prevalence of this lethal pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source. Moreover it resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. Resistance against carbapenem has emerged in Acinetobacter baumannii which can create significant health problems and is responsible for high morbidity and mortality. With the development of quantitative proteomics, a considerable progress has been made in the study of carbapenem resistance of Acinetobacter baumannii. Recent updates showed that quantitative proteomics has now emerged as an important tool to understand the carbapenem resistance mechanism in Acinetobacter baumannii. Present review also highlights the complementary nature of different quantitative proteomic methods used to study carbapenem resistance and suggests to combine multiple proteomic methods for understanding the response to antibiotics by Acinetobacter baumannii. PMID:25309531

Health information technology knowledge and skills needed by HIT employers.

PubMed

Fenton, S H; Gongora-Ferraez, M J; Joost, E

2012-01-01

To evaluate the health information technology (HIT) workforce knowledge and skills needed by HIT employers. Statewide face-to-face and online focus groups of identified HIT employer groups in Austin, Brownsville, College Station, Dallas, El Paso, Houston, Lubbock, San Antonio, and webinars for rural health and nursing informatics. HIT employers reported needing an HIT workforce with diverse knowledge and skills ranging from basic to advanced, while covering information technology, privacy and security, clinical practice, needs assessment, contract negotiation, and many other areas. Consistent themes were that employees needed to be able to learn on the job and must possess the ability to think critically and problem solve. Many employers wanted persons with technical skills, yet also the knowledge and understanding of healthcare operations. The HIT employer focus groups provided valuable insight into employee skills needed in this fast-growing field. Additionally, this information will be utilized to develop a statewide HIT workforce needs assessment survey.

Systolic hypertension: an increasing clinical challenge in Asia

PubMed Central

Park, Jeong Bae; Kario, Kazuomi; Wang, Ji-Guang

2015-01-01

Systolic hypertension, the predominant form of hypertension in patients aged over 50–60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications. PMID:25503845

Maxillary overlay removable partial dentures for the restoration of worn teeth.

PubMed

Fonseca, Júlio; Nicolau, Pedro; Daher, Tony

2011-04-01

Prolonged tooth maintenance by a more aged population considerably increases the probability of dentists having to treat patients with high levels of tooth wear. Pathological tooth wear, caused primarily by parafunction, seems to be a growing problem that affects a large number of adult patients. The clinical report presents a case of a partially edentulous patient with an elevated degree of wear in the upper jaw caused by attrition and erosion, rehabilitated with a maxillary overlay removable partial denture (ORPD) consisting of a chrome-cobalt (Cr-Co) framework with anterior acrylic resin veneers, posterior cast overlays, and acrylic resin denture bases. Removable partial prosthesis is a treatment alternative when teeth are found to be severely worn or when the patient needs a simple and economical option. Because economics is a conditional factor of the treatment, the clinician should present different treatment alternatives to the patient, in which the overlay prosthesis can be considered.

[Radial Approach for Percutaneous Coronary Interventions in Patients With Ischemic Heart Disease: Advantages and Disadvantages, Complications Rate in Comparison With Femoral Approach].

PubMed

Fettser, D V; Batyraliev, T A; Pershukov, I V; Vanyukov, A E; Sidorenko, B A

2017-05-01

During recent 10-15 years, percutaneous coronary interventions (PCI) have reached a new level of efficacy and safety. Rate of serious coronary complications has decreased. That to a greater degree exposes the problem of peripheral complications at the site of arterial approach. At the same time portion of patients older than 75 years in the total pool of PCI constantly increases. Number of patients with pronounced obesity also grows each year. Radial approach for PCI allows to substantially decrease rate of peripheral complications at the account of lowered rate of bleedings, and to shorten duration of hospitalization. In this literature review we present results of a number of relevant clinical studies including those which contained groups of elderly patients and of patients with obesity. We also have summarized main advantages and disadvantages of radial approach as compared with femoral approach for coronary angiography and PCI.

Application of Nanoparticle Technologies in the Combat against Anti-Microbial Resistance.

PubMed

Kumar, Mayur; Curtis, Anthony; Hoskins, Clare

2018-01-14

Anti-microbial resistance is a growing problem that has impacted the world and brought about the beginning of the end for the old generation of antibiotics. Increasingly, more antibiotics are being prescribed unnecessarily and this reckless practice has resulted in increased resistance towards these drugs, rendering them useless against infection. Nanotechnology presents a potential answer to anti-microbial resistance, which could stimulate innovation and create a new generation of antibiotic treatments for future medicines. Preserving existing antibiotic activity through novel formulation into or onto nanotechnologies can increase clinical longevity of action against infection. Additionally, the unique physiochemical properties of nanoparticles can provide new anti-bacterial modes of action which can also be explored. Simply concentrating on antibiotic prescribing habits will not resolve the issue but rather mitigate it. Thus, new scientific approaches through the development of novel antibiotics and formulations is required in order to employ a new generation of therapies to combat anti-microbial resistance.

Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: a clinical comparison study between four clinics.

PubMed

de Graaf, Nastasja M; Cohen-Kettenis, Peggy T; Carmichael, Polly; de Vries, Annelou L C; Dhondt, Karlien; Laridaen, Jolien; Pauli, Dagmar; Ball, Juliane; Steensma, Thomas D

2018-07-01

Adolescents seeking professional help with their gender identity development often present with psychological difficulties. Existing literature on psychological functioning of gender diverse young people is limited and mostly bound to national chart reviews. This study examined the prevalence of psychological functioning and peer relationship problems in adolescents across four European specialist gender services (The Netherlands, Belgium, the UK, and Switzerland), using the Child Behavioural Checklist (CBCL) and the Youth Self-Report (YSR). Differences in psychological functioning and peer relationships were found in gender diverse adolescents across Europe. Overall, emotional and behavioural problems and peer relationship problems were most prevalent in adolescents from the UK, followed by Switzerland and Belgium. The least behavioural and emotional problems and peer relationship problems were reported by adolescents from The Netherlands. Across the four clinics, a similar pattern of gender differences was found. Birth-assigned girls showed more behavioural problems and externalising problems in the clinical range, as reported by their parents. According to self-report, internalising problems in the clinical range were more prevalent in adolescent birth-assigned boys. More research is needed to gain a better understanding of the difference in clinical presentations in gender diverse adolescents and to investigate what contextual factors that may contribute to this.

Decaying and growing eigenmodes in open quantum systems: Biorthogonality and the Petermann factor

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

Lee, Soo-Young

2009-10-15

We study the biorthogonality between decaying and growing eigenmodes in one-dimensional potential barrier problems. It is shown that Petermann factors K{sub n} of the eigenmodes, a measure of nonorthogonality, are involved in decaying mechanism of an initially confined particle. We also show that the decay tail of the growing modes at an exceptional point (EP), where K{sub n} become infinite, is not exponential, but {approx}t{sup 2}e{sup -{gamma}{sub EP}t}, {gamma}{sub EP} the decay rate of the decaying mode at EP. In addition, the geometrical phase near an EP is illustrated by the evolution of wave function.

A Review of "Life Cycle: How We Grow and Change"

ERIC Educational Resources Information Center

Digioia, Melissa Keyes

2010-01-01

Sexuality education curricula designed for youths with special needs are sparse. "Life Cycle: How We Grow and Change" (Vavricheck & Tolle, 2008) is a new curriculum by clinical social workers Sherrie Mansfield Vavricheck and R. Kay Tolle. Each chapter addresses a particular developmental stage between birth and death. Lessons within each chapter…

Young Indigenous Students en Route to Generalising Growing Patterns

ERIC Educational Resources Information Center

Miller, Jodie

2016-01-01

This paper presents a hypothesised learning trajectory for a Year 3 Indigenous student en route to generalising growing patterns. The trajectory emerged from data collected across a teaching experiment (students n = 18; including a pre-test and three 45-minute mathematics lessons) and clinical interviews (n = 3). A case study of one student is…

Oversight overload: harried hospitals say the growing number of billing audits they face could actually increase costs.

PubMed

Daly, Rich

2011-11-21

Providers say the administration's growing emphasis on billing audits is pushing them to the limit and threatens to increase their costs. Many billing problems stem from simple errors, not fraud, they say. "When you get into the nuts and bolts of some of these programs you realize it's not as easy as taking the overpayment line out of the budget," says Michael Regier, of VHA.

A parsimonious tree-grow method for haplotype inference.

PubMed

Li, Zhenping; Zhou, Wenfeng; Zhang, Xiang-Sun; Chen, Luonan

2005-09-01

Haplotype information has become increasingly important in analyzing fine-scale molecular genetics data, such as disease genes mapping and drug design. Parsimony haplotyping is one of haplotyping problems belonging to NP-hard class. In this paper, we aim to develop a novel algorithm for the haplotype inference problem with the parsimony criterion, based on a parsimonious tree-grow method (PTG). PTG is a heuristic algorithm that can find the minimum number of distinct haplotypes based on the criterion of keeping all genotypes resolved during tree-grow process. In addition, a block-partitioning method is also proposed to improve the computational efficiency. We show that the proposed approach is not only effective with a high accuracy, but also very efficient with the computational complexity in the order of O(m2n) time for n single nucleotide polymorphism sites in m individual genotypes. The software is available upon request from the authors, or from http://zhangroup.aporc.org/bioinfo/ptg/ chen@elec.osaka-sandai.ac.jp Supporting materials is available from http://zhangroup.aporc.org/bioinfo/ptg/bti572supplementary.pdf

Comparison of clinical diagnosis and microbiological test results in vaginal infections.

PubMed

Karaca, M; Bayram, A; Kocoglu, M E; Gocmen, A; Eksi, F

2005-01-01

Lower genital tract infections continue to be a problem due to the fact that the clinical diagnosis is usually inadequate, and subsequent care is suboptimal. This study aimed at evaluating the accuracy of clinical diagnosis by comparing it with microbiologic test results, and to determine the causative agents of vaginal infections. Sixty-seven nonpregnant women (18-45 years of age) with the clinical diagnosis of lower genital tract infection were enrolled in the study. Patients were not included if they had a history of vaginal infection during the previous three-month period or intrauterine device. The clinical diagnosis was based on the combinations of symptoms, direct observation of wet mount, homogeneous discharge, vaginal pH > 4.5, and detection of the amine odor after exposure of vaginal secretions to 10% KOH. Vaginal samples were taken with two cotton swabs, one was used for pH determination, and the second was utilized for microbiological tests. Gram staining and cultures with Sabouraud agar and chocolate agar were performed for microbiological diagnosis, and the results were compared. The clinical diagnoses included 26 (38.8%) candidiasis, 18 (26.8%) bacterial vaginosis, three (4.5%) trichomoniasis, and 20 (29.9%) mixed vaginal infections. Of the 26 patients with clinical diagnoses of candidiasis, 12 (46.1%) revealed Candiada albicans, nine (34.6) patients revealed microorganisms other than candida species, and five (19.2%) patients had no growth. Five (27.8%) bacterial vaginosis patients revealed Gardnarella vaginalis and 12 patients (66.6%) did not grow any microorganism. The overall rate of accurate clinical diagnoses confirmed by microbiological test results was 43.2%. Seventeen (43.6) of the 39 microbiological test results correlated with clinical diagnosis, and no growth was observed in 28 (41.8%) cultures. We conclude that the clinical diagnosis of vaginal infection is inadequate and should be confirmed with microbiological testing if the resources are avaliable.

Clinical behavior of Japanese community pharmacists for preventing prescription drug overdose.

PubMed

Shimane, Takuya; Matsumoto, Toshihiko; Wada, Kiyoshi

2015-04-01

Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. This study examined the community pharmacist's clinical behavior regarding patients who overdose on prescribed drugs, and explored the possibility of overdose prevention by community pharmacists. We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about clinical behavior such as medication counseling and referral to the prescriber if prescription drug overdose was identified. Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. Half of respondents evaluated their practice such as medication counseling and referral to the prescriber as 'good'. On multivariate analysis, a 'poor' self-evaluation of referral to the prescriber was significantly associated with the following perceptions: 'insufficient confidence in communication with prescribers' (odds ratio [OR], 2.7; 95% confidence interval [95%CI]: 1.4-5.3), and 'to avoid trouble with prescribers' (OR, 1.7; 95%CI: 1.0-2.7). Japanese community pharmacists could prevent prescription drug abuse in their practice, but the pharmacists who have insufficient confidence in communication with prescribers and who are afraid of trouble with a prescriber, reported poor self-evaluation for referral to the prescribers. All prescribers should understand the importance of referral by community pharmacists, to assist community pharmacists in playing a critical role in prevention of prescription drug abuse. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

[Organizational ethics: a study in ophthalmologic clinics].

PubMed

Sanches, Maria Aparecida; Scarpi, Marinho Jorge

2005-01-01

Research on the field of organizational ethics to investigate to which extent ophthalmologic clinics, inserted in the competitive atmosphere, in the condition of organizations in search of survival, subordinate ethics to competitiveness in the managerial praxis, that is, in the administrative sphere. Kohlberg is taken as theoretical reference, approaching the theme of ethical subordination to competitiveness. The instrument to evaluate moral behaviors of organizations, elaborated by Licht, is applied. The quantitative method is used, adopting analytic instruments, such as Q of Yule and non parametric tests, when dealing with the data of 41 ophthalmologic clinics. The results of the research seem to indicate that administrators of ophthalmologic clinics of greater performance subordinate ethical principles to competitiveness, seeking to assure the survival of the company and, when confronted with the instrument to evaluate their moral behavior, proposed by Kohlberg, have a significantly smaller presence in the postconventional stage than administrators of ophthalmologic clinics with a smaller performance. One may affirm, according to non parametric tests, at the level of significance of 0.05, that the levels of moral development of the two groups differ significantly. The obtained results are according to the literature, especially concerning the "paradox of the ethical subordination and competitiveness". They also suggest that the warrant of the survival of the company tends to reduce the perception of the groups in power regarding the problems that happen in the community, and that a reduction of the ethical values subordinated to competition occurs, and such reduction provokes growing feelings of economical disputes in the social sphere.

In vitro activity of flomoxef against rapidly growing mycobacteria.

PubMed

Tsai, Moan-Shane; Tang, Ya-Fen; Eng, Hock-Liew

2008-06-01

The aim of this study was to determine the in vitro sensitivity of rapidly growing mycobacteria (RGM) to flomoxef in respiratory secretions collected from 61 consecutive inpatients and outpatients at Chang Gung Memorial Hospital-Kaohsiung medical center between July and December, 2005. Minimal inhibitory concentrations (MIC) of flomoxef were determined by the broth dilution method for the 61 clinical isolates of RGMs. The MICs of flomoxef at which 90% of clinical isolates were inhibited was >128 microg/mL in 26 isolates of Mycobacterium abscessus and 4 microg/mL in 31 isolates of M. fortuitum. Three out of 4 clinical M. peregrinum isolates were inhibited by flomoxef at concentrations of 4 microg/mL or less. Although the numbers of the clinical isolates of RGMs were small, these preliminary in vitro results demonstrate the potential activity of flomoxef in the management of infections due to M. fortuitum, and probably M. peregrinum in humans.

The "Growing" Reality of the Neurological Complications of Global "Stem Cell Tourism".

PubMed

Julian, Katie; Yuhasz, Nick; Hollingsworth, Ethan; Imitola, Jaime

2018-04-01

"Stem cell tourism" is defined as the unethical practice of offering unproven cellular preparations to patients suffering from various medical conditions. This phenomenon is rising in the field of neurology as patients are requesting information and opportunities for treatment with stem cells for incurable conditions such as multiple sclerosis and amyotrophic lateral sclerosis, despite their clinical research and experimental designation. Here, we review the recent trends in "stem cell tourism" in both the United States and abroad, and discuss the recent reports of neurological complications from these activities. Finally, we frame critical questions for the field of neurology regarding training in the ethical, legal, and societal issues of the global "stem cell tourism," as well as suggest strategies to alleviate this problem. Although there are ongoing legitimate clinical trials with stem cells for neurological diseases, procedures offered by "stem cell clinics" cannot be defined as clinical research. They lack the experimental and state-of-the-art framework defined by peers and the FDA that focus on human research that safeguard the protection of human subjects against economical exploitation, unwanted side effects, and futility of unproven procedures. "Stem cell tourism" ultimately exploits therapeutic hope of patients and families with incurable neurological diseases and can put in danger the legitimacy of stem cell research as a whole. We posit that an improvement in education, regulation, legislation, and involvement of authorities in global health in neurology and neurosurgery is required. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Upper airway obstruction in Norwich Terriers: 16 cases.

PubMed

Johnson, L R; Mayhew, P D; Steffey, M A; Hunt, G B; Carr, A H; McKiernan, B C

2013-01-01

Norwich Terriers have grown increasingly popular as show animals and pets, and awareness of respiratory problems within the breed is growing. To describe components of obstructive upper airway syndrome in a nonbrachycephalic terrier breed. Sixteen Norwich Terriers; 12 with and 4 without clinical signs of respiratory disease. Prospective case series. Physical and laryngoscopic examinations were performed by 1 investigator in all dogs. Medical and surgical interventions were summarized and results of follow-up examination or owner reports were recorded. The study population was comprised of 9 females (6 intact) and 7 males (5 intact). Median age was 3.0 years (range, 0.5-11 years). Of 12 dogs presented for a respiratory complaint, physical examination was normal in 4 dogs. Laryngoscopic examination was abnormal in 11/12 dogs with redundant supra-arytenoid folds, laryngeal collapse, everted laryngeal saccules, and a narrowed laryngeal opening in most. Of 4 dogs lacking clinical signs, all had normal physical examination; however, 3/4 dogs had similar appearance of the larynx to dogs with clinical signs. Response to surgical intervention was minimal to moderate in all dogs. Norwich Terriers suffer from an upper airway obstructive syndrome that differs from that encountered in brachycephalic breeds. Affected dogs are difficult to identify without laryngoscopic examination because of the lack of clinical signs and abnormalities in physical examination findings, despite severe airway obstruction. Care is warranted when anesthetizing Norwich Terriers because of the small size of the laryngeal opening. Copyright © 2013 by the American College of Veterinary Internal Medicine.

"It is not just about the alcohol": service users' views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence.

PubMed

Alves, Paula Cristina Gomes; Sales, Célia Maria Dias; Ashworth, Mark

2016-07-19

The involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised. A focus group was conducted and data were analysed using a framework synthesis approach. Service users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0-20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments. Patients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.

The impact of health information technology on collaborative chronic care management.

PubMed

Marchibroda, Janet M

2008-03-01

Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

A proteomic approach to cold acclimation of Staphylococcus aureus CECT 976 grown at room and human body temperatures.

PubMed

Sánchez, B; Cabo, M L; Margolles, A; Herrera, J J R

2010-11-15

Staphylococcus aureus is an important pathogenic microorganism that has been associated with serious infection problems in different fields, from food to clinic. In the present study, we have taken into account that the main reservoirs of this microorganism are the human body and some parts of food processing plants, which have normal temperatures of around 37 and 25°C, respectively. It can be expected that S. aureus must acclimate its metabolism to colder temperatures before growing in food matrices. Since temperature abuse for foods occurs at approximately 12°C, it is expected that S. aureus must acclimate its metabolism to colder temperatures before growing in food. For this reason, we have performed a proteomic comparison between exponential- and stationary-phase cultures of S. aureus CECT 976 acclimated to 12°C after growing at 25°C or 37°C. The analysis led to the identification of two different protein patterns associated with cold acclimation, denominated pattern A and pattern B. The first was characteristic of cultures at stationary phase of growth, grown at 25°C and acclimated to 12°C. The second appeared in the rest of experimental cases. Pattern A was distinguished by the presence of glycolytic proteins, whereas pattern B was differentiated by the presence of general stress and regulatory proteins. Pattern A was related through physiological experiments with a cross-resistance to acid pH, whereas pattern B conferred resistance to nisin. This prompted us to conclude that both molecular strategies could be valid, in vivo, for the process of acclimation of S. aureus to cold temperatures. Copyright © 2010 Elsevier B.V. All rights reserved.

Three-dimensional printing: changing clinical care or just a passing fad?

PubMed

Ryan, Justin; Gregg, Chelsea; Frakes, David; Pophal, Stephen

2017-01-01

Advances in medical imaging and three-dimensional (3D) reconstruction software have enabled a proliferation of 3D modeling and 3D printing for clinical applications. In particular, 3D printing has garnered an extraordinary media presence over the past few years. There is growing optimism that 3D printing can address patient specificity and complexity for improved interventional and surgical planning. Will this relatively untested technology bring about a paradigm shift in the clinical environment, or is it just a transient fad? Case studies and series centered around 3D printing are omnipresent in clinical and engineering journals. These primarily qualitative studies support the potential efficacy of the emerging technology. Few studies analyze the value of 3D printing, weighing its potential benefits against increasing costs (e.g., institutional overhead, labor, and materials). Clinical integration of 3D printing is growing rapidly, and its adoption into clinical practice presents unique workflow challenges. There are numerous clinical trials on the horizon that will finally help to elucidate the measured impact of 3D printing on clinical outcomes through quantitative analyses of clinical and economic metrics. The contrived integration of 3D printing into clinical practice seems all but certain as the value of this technology becomes more and more evident.

State-dependent and reflex drives to the upper airway: basic physiology with clinical implications

PubMed Central

Hughes, Stuart W.; Malhotra, Atul

2013-01-01

The root cause of the most common and serious of the sleep disorders is impairment of breathing, and a number of factors predispose a particular individual to hypoventilation during sleep. In turn, obstructive hypopneas and apneas are the most common of the sleep-related respiratory problems and are caused by dysfunction of the upper airway as a conduit for airflow. The overarching principle that underpins the full spectrum of clinical sleep-related breathing disorders is that the sleeping brain modifies respiratory muscle activity and control mechanisms and diminishes the ability to respond to respiratory distress. Depression of upper airway muscle activity and reflex responses, and suppression of arousal (i.e., “waking-up”) responses to respiratory disturbance, can also occur with commonly used sedating agents (e.g., hypnotics and anesthetics). Growing evidence indicates that the sometimes critical problems of sleep and sedation-induced depression of breathing and arousal responses may be working through common brain pathways acting on common cellular mechanisms. To identify these state-dependent pathways and reflex mechanisms, as they affect the upper airway, is the focus of this paper. Major emphasis is on the synthesis of established and recent findings. In particular, we specifically focus on 1) the recently defined mechanism of genioglossus muscle inhibition in rapid-eye-movement sleep; 2) convergence of diverse neurotransmitters and signaling pathways onto one root mechanism that may explain pharyngeal motor suppression in sleep and drug-induced brain sedation; 3) the lateral reticular formation as a key hub of respiratory and reflex drives to the upper airway. PMID:23970535

Towards efficient use of research resources: a nationwide database of ongoing primary care research projects in the Netherlands.

PubMed

Kortekaas, Marlous F; van de Pol, Alma C; van der Horst, Henriëtte E; Burgers, Jako S; Slort, Willemjan; de Wit, Niek J

2014-04-01

PURPOSE. Although in the last decades primary care research has evolved with great success, there is a growing need to prioritize the topics given the limited resources available. Therefore, we constructed a nationwide database of ongoing primary care research projects in the Netherlands, and we assessed if the distribution of research topics matched with primary care practice. We conducted a survey among the main primary care research centres in the Netherlands and gathered details of all ongoing primary care research projects. We classified the projects according to research topic, relation to professional guidelines and knowledge deficits, collaborative partners and funding source. Subsequently, we compared the frequency distribution of clinical topics of research projects to the prevalence of problems in primary care practice. We identified 296 ongoing primary care research projects from 11 research centres. Most projects were designed as randomized controlled trial (35%) or observational cohort (34%), and government funded mostly (60%). Thematically, most research projects addressed chronic diseases, mainly cardiovascular risk management (8%), depressive disorders (8%) and diabetes mellitus (7%). One-fifth of the projects was related to defined knowledge deficits in primary care guidelines. From a clinical primary care perspective, research projects on dermatological problems were significantly underrepresented (P = 0.01). This survey of ongoing projects demonstrates that primary care research has a firm basis in the Netherlands, with a strong focus on chronic disease. The fit with primary care practice can improve, and future research should address knowledge deficits in professional guidelines more.

COMT genotype, gambling activity, and cognition.

PubMed

Grant, Jon E; Leppink, Eric W; Redden, Sarah A; Odlaug, Brian L; Chamberlain, Samuel R

2015-09-01

Neuropsychological studies of adults with problem gambling indicate impairments across multiple cognitive domains. Catechol-O-methyltransferase (COMT) plays a unique role in the regulation of dopamine in the prefrontal cortex, and has been implicated in the cognitive dysfunction evident in problem gambling. This study examined adults with varying levels of gambling behavior to determine whether COMT genotype was associated with differences in gambling symptoms and cognitive functioning. 260 non-treatment-seeking adults aged 18-29 years with varying degrees of gambling behavior provided saliva samples for genotyping COMT val158met (rs4680). All subjects underwent clinical evaluations and neurocognitive assessment of decision-making, working memory, and impulsivity. The Val/Val COMT genotype was associated with the largest percentage of subjects with gambling disorder (31.8%), a rate significantly different from the Val/Met (13.2%) group (p = 0.001). The Val/Val COMT group was also associated with significantly more gambling disorder diagnostic criteria being met, greater frequency of gambling behavior, and significantly worse cognitive performance on the Cambridge Gamble Task (risk adjustment and delay aversion) and the Spatial Working Memory task (total errors). This study adds to the growing literature on the role of COMT in impulsive behaviors by showing that the Val/Val genotype was associated with specific clinical and cognitive elements among young adults who gamble, in the absence of differences on demographic measures and other cognitive domains. Future work should consider using genotyping to explore whether certain polymorphisms predict subsequent development of impulsive behaviors including gambling disorder, and treatment outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

PubMed Central

Morris, Mary B; Chapula, Bushimbwa Tambatamba; Chi, Benjamin H; Mwango, Albert; Chi, Harmony F; Mwanza, Joyce; Manda, Handson; Bolton, Carolyn; Pankratz, Debra S; Stringer, Jeffrey SA; Reid, Stewart E

2009-01-01

The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region. PMID:19134202

Toward Improving Quality of End-of-Life Care: Encoding Clinical Guidelines and Standing Orders Using the Omaha System.

PubMed

Slipka, Allison F; Monsen, Karen A

2018-02-01

End-of-life care (EOLC) relieves the suffering of millions of people around the globe each year. A growing body of hospice care research has led to the creation of several evidence-based clinical guidelines for EOLC. As evidence for the effectiveness of timely EOLC swells, so does the increased need for efficient information exchange between disciplines and across the care continuum. The purpose of this study was to investigate the feasibility of using the Omaha System as a framework for encoding interoperable evidence-based EOL interventions with specified temporality for use across disciplines and settings. Four evidence-based clinical guidelines and one current set of hospice standing orders were encoded using the Omaha System Problem Classification Scheme and Intervention Scheme, as well as Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). The resulting encoded guideline was entered on a Microsoft Excel spreadsheet and made available for public use on the Omaha System Guidelines website. The resulting EOLC guideline consisted of 153 interventions that may enable patients and their surrogates, clinicians, and ancillary providers to communicate interventions in a universally comprehensible way. Evidence-based interventions from diverse disciplines involved in EOLC are described within this guideline using the Omaha System. Because the Omaha System and clinical guidelines are maintained in the public domain, encoding interventions is achievable by anyone with access to the Internet and basic Excel skills. Using the guideline as a documentation template customized for unique patient needs, clinicians can quantify and track patient care across the care continuum to ensure timely evidence-based interventions. Clinical guidelines coded in the Omaha System can support the use of multidisciplinary evidence-based interventions to improve quality of EOLC across settings and professions. © 2017 Sigma Theta Tau International.

Problem-Based Learning in Professional Entry-Level Therapy Education: A Review of Controlled Evaluation Studies

ERIC Educational Resources Information Center

O'Donoghue, Grainne; McMahon, Sinead; Doody, Catherine; Smith, Kathyrn; Cusack, Tara

2011-01-01

Although there has been growing interest in problem-based learning (PBL) by professional entry-level therapy educators, its effectiveness is as yet unclear. Existing overviews of the field do not provide high-quality evidence in terms of the effectiveness or otherwise of PBL in professional therapy education. The purposes of this article is to…

Firing the Executive: When an Analytic Approach to Problem Solving Helps and Hurts

ERIC Educational Resources Information Center

Aiello, Daniel A.; Jarosz, Andrew F.; Cushen, Patrick J.; Wiley, Jennifer

2012-01-01

There is a general assumption that a more controlled or more focused attentional state is beneficial for most cognitive tasks. However, there has been a growing realization that creative problem solving tasks, such as the Remote Associates Task (RAT), may benefit from a less controlled solution approach. To test this hypothesis, in a 2x2 design,…

Project-Based Learning about Nutrition with Technology in an African-American Middle School

ERIC Educational Resources Information Center

Banks, Sibyl

2010-01-01

In the last few years, there has been a growing problem with the prevalence of being overweight. This is becoming an accepted lifestyle in the African American community, and has begun to impact not just adults, but also adolescents and young children. There are problems associated with being overweight or obese that could have lifetime…

Exploring the effects of population growth on future land use change in the Las Vegas Wash watershed: an integrated approach of geospatial modeling and analytics

EPA Science Inventory

The Las Vegas Valley metropolitan area is one of the fastest growing areas in the southwestern United States. The rapid urbanization has led to many environmental problems. For instance, as population growth and urbanization continue, there will be a problem with water shortage. ...

A prescription for hospital safety: treating workplace violence.

PubMed

Westerfield, O

1995-08-01

Workplace violence is on the rise. The spillover effect includes psychological threats and a plethora of lingering mental health problems. The violent workplace mirrors an increasingly violent society. The increase in violence at work is directly proportional to the increase in violent crimes in our general population. This document examines the growing problem of workplace violence nd ways that can curtail potential incidences.

Using Problem-Based Learning: New Constellations for the 21st Century

ERIC Educational Resources Information Center

Savin-Baden, Maggi

2014-01-01

The author argues that there is still too much teaching to the test, and the consequence is growing "constellations" of problem-based learning (PBL), some of which are useful, and some of which are not. Today, what passes for PBL practice often seems more like guidelines than any kind of reasoned pedagogy. While at one level the range of…

A Community Prevention Intervention to Reduce Youth from Inhaling and Ingesting Harmful Legal Products

ERIC Educational Resources Information Center

Johnson, Knowlton; Courser, Matthew; Holder, Harold; Miller, Brenda; Ogilvie, Kristen; Moore, Roland; Collins, David; Saltz, Bob; Ogilvie, Diane; Saylor, Brian

2007-01-01

Youth use of harmful legal products, including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a growing health problem for American society. As such, a single targeted approach to preventing such a drug problem in a community is unlikely to be sufficient to reduce use and abuse at the…

Preventing Alcohol Problems among Young People: Californians Support Key Public Policies. Growing Up Well. Focus on Prevention.

ERIC Educational Resources Information Center

Mosher, James F.

This report, fourth in a series of eight, highlights the views of Californians about policies local communities and the state can establish to reduce the potential for alcohol problems among young people. In the California Center for Health Improvement (CCHI) "Children and Youth Survey," 51% of the adults surveyed said that they were…

Online Health-Related Fitness Courses: A Wolf in Sheep's Clothing or a Solution to Some Common Problems?

ERIC Educational Resources Information Center

Ransdell, Lynda B.; Rice, Kerry; Snelson, Chareen; DeCola, Josh

2008-01-01

Distance education is growing rapidly at the collegiate and secondary levels. Online courses, which deliver information via a computer, are a form of distance education that has been both praised and condemned. Those skeptical of online courses maintain that learners have to deal with technology problems, low motivation, isolation, and lack of…

BEST in CLASS: A Classroom-Based Model for Ameliorating Problem Behavior in Early Childhood Settings

ERIC Educational Resources Information Center

Vo, Abigail; Sutherland, Kevin S.; Conroy, Maureen A.

2012-01-01

As more young children enter school settings to attend early childhood programs, early childhood teachers and school psychologists have been charged with supporting a growing number of young children with chronic problem behaviors that put them at risk for the development of emotional/behavioral disorders (EBDs). There is a need for effective,…

Challenging Childhoods: Young People's Accounts of "Getting By" in Families with Substance Use Problems

ERIC Educational Resources Information Center

Backett-Milburn, Kathryn; Wilson, Sarah; Bancroft, Angus; Cunningham-Burley, Sarah

2008-01-01

Concern is increasing about children growing up in families where there are substance use problems but relatively little is known about the perspectives of the children themselves. This article reports on a qualitative study with young people who grew up in such families, exploring their accounts of their daily lives at home, school and leisure.…

A Meta-Analytic and Qualitative Review of Online versus Face-to-Face Problem-Based Learning

ERIC Educational Resources Information Center

Jurewitsch, Brian

2012-01-01

Problem-based learning (PBL) is an instructional strategy that is poised for widespread application in the current, growing, on-line digital learning environment. While enjoying a track record as a defensible strategy in face-to-face learning settings, the research evidence is not clear regarding PBL in on-line environments. A review of the…

School-Based Intervention for Social Skills in Children from Divorced Families

ERIC Educational Resources Information Center

Angacian, Sevan; Bray, Melissa A.; Kehle, Thomas J.; Byer-Alcorace, Gabriel; Theodore, Lea A.; Cross, Karen; DeBiase, Emily

2015-01-01

Divorce is an increasingly prevalent occurrence in society that has the potential to result in many adverse short- and long-term consequences for children and their parents. Social skills, such as those with peers, are one of the problems that may emerge for children of divorce. Despite this growing problem, there is a paucity of research…

Harm Reduction for the Prevention of Youth Gambling Problems: Lessons Learned From Adolescent High-Risk Behavior Prevention Programs

ERIC Educational Resources Information Center

Dickson, Laurie M.; Derevensky, Jeffrey L.; Gupta, Rina

2004-01-01

Despite the growing popularity of the harm reduction approach in the field of adolescent alcohol and substance abuse, a harm reduction approach to prevention and treatment of youth problem gambling remains largely unexplored. This article poses the question of whether the harm reduction paradigm is a promising approach to the prevention of…

Ubiquitous computing in shared-care environments.

PubMed

Koch, S

2006-07-01

In light of future challenges, such as growing numbers of elderly, increase in chronic diseases, insufficient health care budgets and problems with staff recruitment for the health-care sector, information and communication technology (ICT) becomes a possible means to meet these challenges. Organizational changes such as the decentralization of the health-care system lead to a shift from in-hospital to both advanced and basic home health care. Advanced medical technologies provide solutions for distant home care in form of specialist consultations and home monitoring. Furthermore, the shift towards home health care will increase mobile work and the establishment of shared care teams which require ICT-based solutions that support ubiquitous information access and cooperative work. Clinical documentation and decision support systems are the main ICT-based solutions of interest in the context of ubiquitous computing for shared care environments. This paper therefore describes the prerequisites for clinical documentation and decision support at the point of care, the impact of mobility on the documentation process, and how the introduction of ICT-based solutions will influence organizations and people. Furthermore, the role of dentistry in shared-care environments is discussed and illustrated in the form of a future scenario.

Reaffirming normal: the high risk of pathologizing healthy adults when interpreting the MMPI-2-RF.

PubMed

Odland, Anthony P; Lammy, Andrew B; Perle, Jonathan G; Martin, Phillip K; Grote, Christopher L

2015-01-01

Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65 T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales--Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF's multiscale composition does not contribute to high rates of elevated scores.

Putative histidine kinase inhibitors with antibacterial effect against multi-drug resistant clinical isolates identified by in vitro and in silico screens

NASA Astrophysics Data System (ADS)

Velikova, Nadya; Fulle, Simone; Manso, Ana Sousa; Mechkarska, Milena; Finn, Paul; Conlon, J. Michael; Oggioni, Marco Rinaldo; Wells, Jerry M.; Marina, Alberto

2016-05-01

Novel antibacterials are urgently needed to address the growing problem of bacterial resistance to conventional antibiotics. Two-component systems (TCS) are widely used by bacteria to regulate gene expression in response to various environmental stimuli and physiological stress and have been previously proposed as promising antibacterial targets. TCS consist of a sensor histidine kinase (HK) and an effector response regulator. The HK component contains a highly conserved ATP-binding site that is considered to be a promising target for broad-spectrum antibacterial drugs. Here, we describe the identification of putative HK autophosphorylation inhibitors following two independent experimental approaches: in vitro fragment-based screen via differential scanning fluorimetry and in silico structure-based screening, each followed up by the exploration of analogue compounds as identified by ligand-based similarity searches. Nine of the tested compounds showed antibacterial effect against multi-drug resistant clinical isolates of bacterial pathogens and include three novel scaffolds, which have not been explored so far in other antibacterial compounds. Overall, putative HK autophosphorylation inhibitors were found that together provide a promising starting point for further optimization as antibacterials.

Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality.

PubMed

Wright, Emily K; Novak, Kerri L; Lu, Cathy; Panaccione, Remo; Ghosh, Subrata; Wilson, Stephanie R

2015-01-01

Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of luminal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.

Degenerative dementias and their medical care in the movies.

PubMed

Segers, Kurt

2007-01-01

Compared with other neurologic problems, few films have been dedicated to degenerative dementia. To our knowledge, this is the first systematic review about the way in which dementia patients and their medical care are described in films. Twenty-four of the 53 relevant films that were found in online movie databases could be viewed. The author describes the demographics of the characters suffering from dementia, the clinical picture including neuropsychiatric manifestations, diagnostic procedures, medical follow-up, pharmacologic and nonpharmacologic treatment and the attitude of the caregivers. Most characters are played by actors in their seventh or eighth decade. There is an overrepresentation of highly educated people. Although the clinical picture is often accurate, some films suggest that even in the late stages of the disease patients have sudden moments of full insight in their disease. Among the neuropsychiatric signs, activity disturbances and aggressiveness are most often described. Few patients seek medical help, only 2 patients take acetylcholinesterase inhibitors and follow-up is absent for 5 of the 11 relevant patients. Only in 10 of 23 films, the term "Alzheimer" is used. Although there is a growing cinematographic interest in Alzheimer patients, even recent films tend to reinforce therapeutic and even diagnostic nihilism.

"One level more:" A narrative review on internet gaming disorder.

PubMed

Naskar, Subrata; Victor, Robin; Nath, Kamal; Sengupta, Chiradeep

2016-01-01

Due to explosive growth in technology and internet usage in the last few years, internet gaming disorder (IGD) has manifested as rapidly growing public health problem mainly affecting the teen and preteen population worldwide. It has a negative impact upon physical, psychological, social, and occupational functioning of the affected individual, often leading to severe consequences. It was only recently that it has been recognized as a separate diagnosable disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Not much data is available regarding the exact prevalence and the various sociodemographic, clinical, and other risk factors to identify the individuals vulnerable to develop this disorder, especially in the developing countries such as India. According to a recent report, India ranks 22 nd in the list of highest revenue-generating countries from gaming-related businesses, thus highlighting the magnitude of risk faced by Indian population. The aim of this review is to provide an insight about the disorder to identify the risk factors and clinical features, to understand the effect of IGD upon the psychological and physical health with a special focus on neural changes, and to provide information on the various upcoming preventive and treatment strategies.

Advanced drug delivery systems for antithrombotic agents

PubMed Central

Greineder, Colin F.; Howard, Melissa D.; Carnemolla, Ronald; Cines, Douglas B.

2013-01-01

Despite continued achievements in antithrombotic pharmacotherapy, difficulties remain in managing patients at high risk for both thrombosis and hemorrhage. Utility of antithrombotic agents (ATAs) in these settings is restricted by inadequate pharmacokinetics and narrow therapeutic indices. Use of advanced drug delivery systems (ADDSs) may help to circumvent these problems. Various nanocarriers, affinity ligands, and polymer coatings provide ADDSs that have the potential to help optimize ATA pharmacokinetics, target drug delivery to sites of thrombosis, and sense pathologic changes in the vascular microenvironment, such as altered hemodynamic forces, expression of inflammatory markers, and structural differences between mature hemostatic and growing pathological clots. Delivery of ATAs using biomimetic synthetic carriers, host blood cells, and recombinant fusion proteins that are activated preferentially at sites of thrombus development has shown promising outcomes in preclinical models. Further development and translation of ADDSs that spare hemostatic fibrin clots hold promise for extending the utility of ATAs in the management of acute thrombotic disorders through rapid, transient, and targeted thromboprophylaxis. If the potential benefit of this technology is to be realized, a systematic and concerted effort is required to develop clinical trials and translate the use of ADDSs to the clinical arena. PMID:23798715

Child sexual abuse: an Italian perspective.

PubMed

Cattaneo, Cristina; Ruspa, Marina; Motta, Tiziano; Gentilomo, Andrea; Scagnelli, Chiara

2007-06-01

The problem of child sexual abuse is a growing reality in Italy. The experience of over 200 children seen by the SVS (Soccorso Violenza Sessuale) Centre in Milan (the first Italian large-scale study) may give more information on the European situation. This study is a retrospective study based on information contained in the files of children beneath the age of 14 seen at the SVS Centre between May 1996 and May 2003, who arrived with a suspicion of child sexual abuse. Over 80% of all cases fell within the normal-aspecific category according to Adams' 2001 classification. This first Italian survey, though not based on substantiated cases but only on cases of suspected sexual abuse, supplies a perspective on a large northern European city such as Milan. Data seem similar to those published in other non-European studies, particularly as regards clinical signs observed. Thus, the results of this study, with all their limitations, start to give a perspective on the frequency and type of child population reaching this Italian center, what the scenarios are, what signs the children present and how infrequent it is to find clinical anogenital signs concerning for sexual abuse.

“One level more:” A narrative review on internet gaming disorder

PubMed Central

Naskar, Subrata; Victor, Robin; Nath, Kamal; Sengupta, Chiradeep

2016-01-01

Due to explosive growth in technology and internet usage in the last few years, internet gaming disorder (IGD) has manifested as rapidly growing public health problem mainly affecting the teen and preteen population worldwide. It has a negative impact upon physical, psychological, social, and occupational functioning of the affected individual, often leading to severe consequences. It was only recently that it has been recognized as a separate diagnosable disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Not much data is available regarding the exact prevalence and the various sociodemographic, clinical, and other risk factors to identify the individuals vulnerable to develop this disorder, especially in the developing countries such as India. According to a recent report, India ranks 22nd in the list of highest revenue-generating countries from gaming-related businesses, thus highlighting the magnitude of risk faced by Indian population. The aim of this review is to provide an insight about the disorder to identify the risk factors and clinical features, to understand the effect of IGD upon the psychological and physical health with a special focus on neural changes, and to provide information on the various upcoming preventive and treatment strategies. PMID:28659692

A recombinant live attenuated tetravalent vaccine for the prevention of dengue.

PubMed

Guy, Bruno; Noriega, Fernando; Ochiai, R Leon; L'azou, Maïna; Delore, Valentine; Skipetrova, Anna; Verdier, François; Coudeville, Laurent; Savarino, Stephen; Jackson, Nicholas

2017-07-01

Dengue is an important and still growing public health problem associated with substantial morbidity, as well as significant social and economic impact. The present review describes the main features and development of the first dengue vaccine (CYD-TDV, Dengvaxia®), which has been licensed by several dengue-endemic countries in Asia and Latin America for use in populations above 9 years of age. Areas covered: The review focuses on the large clinical development of CYD-TDV, which includes in particular two pivotal phase III efficacy trials conducted in Asia and Latin America and supported vaccine licensure. Based on these clinical data, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended considering introduction of the vaccine in geographic settings (national or subnational) with high burden of disease. Long-term safety follow-up studies of the efficacy trials are currently ongoing, and post-licensure studies will evaluate the vaccine effectiveness and safety in 'real-life' following vaccine introduction. Expert commentary: During vaccine development, a number of complexities were tackled, innovation pursued, and risk managed. These aspects, as well as the potential impact of CYD-TDV on public health are also discussed.

Interactions of aquaculture and waste disposal in the coastal zone

NASA Astrophysics Data System (ADS)

Zhai, Xuemei; Hawkins, S. J.

2002-04-01

Throughout the world, the coastal zones of many countries are used increasingly for aquaculture in addition to other activities such as waste disposal. These activities can cause environmental problems and health problems where they overlap. The interaction between aquaculture and waste disposal, and their relationship with eutrophication are the subjects of this paper. Sewage discharge without adequate dispersion can lead to nutrient elevation and hence eutrophication which has clearly negative effects on aquaculture with the potential for toxic blooms. Blooms may be either toxic or anoxia-causing through the decay process or simply clog the gills of filter-feeding animals in some cases. With the development of aquaculture, especially intensive aquaculture, many environmental problems appeared, and have resulted in eutrophication in some areas. Eutrophication may destroy the health of whole ecosystem which is important for sustainable aquaculture. Sewage discharge may also cause serious public health problems. Filter-feeding shellfish growing in sewage-polluted waters accumulate micro-organims, including human pathogenic bacteria and viruses, and heavy metal ion, presenting a significant health risk. Some farmed animals may also accumulate heavy metals from sewage. Bivalves growing in areas affected by toxic algae blooms may accumulate toxins (such as PSP, DSP) which can be harmful to human beings.

Deformed Palmprint Matching Based on Stable Regions.

PubMed

Wu, Xiangqian; Zhao, Qiushi

2015-12-01

Palmprint recognition (PR) is an effective technology for personal recognition. A main problem, which deteriorates the performance of PR, is the deformations of palmprint images. This problem becomes more severe on contactless occasions, in which images are acquired without any guiding mechanisms, and hence critically limits the applications of PR. To solve the deformation problems, in this paper, a model for non-linearly deformed palmprint matching is derived by approximating non-linear deformed palmprint images with piecewise-linear deformed stable regions. Based on this model, a novel approach for deformed palmprint matching, named key point-based block growing (KPBG), is proposed. In KPBG, an iterative M-estimator sample consensus algorithm based on scale invariant feature transform features is devised to compute piecewise-linear transformations to approximate the non-linear deformations of palmprints, and then, the stable regions complying with the linear transformations are decided using a block growing algorithm. Palmprint feature extraction and matching are performed over these stable regions to compute matching scores for decision. Experiments on several public palmprint databases show that the proposed models and the KPBG approach can effectively solve the deformation problem in palmprint verification and outperform the state-of-the-art methods.

Direct Numerical Simulation of Fingering Instabilities in Coating Flows

NASA Astrophysics Data System (ADS)

Eres, Murat H.; Schwartz, Leonard W.

1998-11-01

We consider stability and finger formation in free surface flows. Gravity driven downhill drainage and temperature gradient driven climbing flows are two examples of such problems. The former situation occurs when a mound of viscous liquid on a vertical wall is allowed to flow. Constant surface shear stress due to temperature gradients (Marangoni stress) can initiate the latter problem. The evolution equations are derived using the lubrication approximation. We also include the effects of finite-contact angles in the evolution equations using a disjoining pressure model. Evolution equations for both problems are solved using an efficient alternating-direction-implicit method. For both problems a one-dimensional base state is established, that is steady in a moving reference frame. This base state is unstable to transverse perturbations. The transverse wavenumbers for the most rapidly growing modes are found through direct numerical solution of the nonlinear evolution equations, and are compared with published experimental results. For a range of finite equilibrium contact angles, the fingers can grow without limit leading to semi-finite steady fingers in a moving coordinate system. A computer generated movie of the nonlinear simulation results, for several sets of input parameters, will be shown.

"Pressure Blocking" Effect in the Growing Vapor Bubble in a Highly Superheated Liquid

NASA Astrophysics Data System (ADS)

Zudin, Yu. B.; Zenin, V. V.

2016-09-01

The problem on the growth of a vapor bubble in a liquid whose superheating enthalpy exceeds the phase transition heat has been considered. A physical model of the "pressure blocking" in the bubble is presented. The problem for the conditions of the experiment on the effervescence of a butane drop has been solved numerically. An algorithm for constructing an analytical solution of the problem on the bubble growth in a highly superheated liquid is proposed.

On the Integration of Logic Programming and Functional Programming.

DTIC Science & Technology

1985-06-01

be performed with simple handtools and devices. However, if the problem is more complex, say involving the cylinders, camshaft , or drive train, then...f(x,x) with f(y, g(y)), and would bind x to g(x) (Ref. 7]. The problem, of course, is that the attempt to prune the search tree allows circularity...combinatorial-explosion, since the search trees generated can grow very unpredictably (Re£. 19: p. 2293. Somewhat akin to the halting problem, it means that a

Role of the clinical research nurse in tissue viability.

PubMed

Hemingway, Beverley; Storey, Carron

Opportunities for nurses to be involved in clinical research have increased with the growing emphasis on research in the NHS. This article examines the experiences of two registered nurses adapting to the role of clinical research nurse in a pressure ulcer programme of research. The challenges, rewards and strategies involved are discussed.

Gene Therapy and Children (For Parents)

MedlinePlus

... Body Works Puberty & Growing Up Staying Healthy Staying Safe Recipes & Cooking Health Problems Illnesses & Injuries Relax & Unwind People, Places & Things That Help Feelings Expert Answers Q&A Movies & More for Teens ...

Rett Syndrome

MedlinePlus

Rett syndrome is a rare genetic disease that causes developmental and nervous system problems, mostly in girls. It's related to autism spectrum disorder. Babies with Rett syndrome seem to grow and develop normally at first. ...

Effective use of real-life events as tools for teaching-learning clinical pharmacology in a problem-based learning curriculum.

PubMed

James, Henry; Al Khaja, Khalid A; Sequeira, Reginald P

2015-01-01

This paper describes how in a problem-based learning (PBL) medical curriculum, having identified the learning outcomes, problems can be developed from real-life events for teaching-learning clinical pharmacology topics for which PBL cases might be inadequate. Such problems can be very interesting and educational. Using the story of the development and withdrawal of rofecoxib (Vioxx(®)), we developed a problem for undergraduate medical students to address important issues related to clinical pharmacology and therapeutics such as new drug development, preclinical testing, clinical trials, adverse drug reactions, professionalism, and critical appraisal of literature. These topics would otherwise be difficult to address in patient-based problems. The evaluation of the problem based on pooled feedback from 57 tutorial groups, each comprising 8-10 students, collected over 5 years, supported the effectiveness of the problem. A systematic approach described in this paper can be used for the development and validation of educational material for introducing focal topics of pharmacology/clinical pharmacology integrated with other disciplines in innovative medical (and other health profession) curricula.

Growing multiplex networks with arbitrary number of layers

NASA Astrophysics Data System (ADS)

Momeni, Naghmeh; Fotouhi, Babak

2015-12-01

This paper focuses on the problem of growing multiplex networks. Currently, the results on the joint degree distribution of growing multiplex networks present in the literature pertain to the case of two layers and are confined to the special case of homogeneous growth and are limited to the state state (that is, the limit of infinite size). In the present paper, we first obtain closed-form solutions for the joint degree distribution of heterogeneously growing multiplex networks with arbitrary number of layers in the steady state. Heterogeneous growth means that each incoming node establishes different numbers of links in different layers. We consider both uniform and preferential growth. We then extend the analysis of the uniform growth mechanism to arbitrary times. We obtain a closed-form solution for the time-dependent joint degree distribution of a growing multiplex network with arbitrary initial conditions. Throughout, theoretical findings are corroborated with Monte Carlo simulations. The results shed light on the effects of the initial network on the transient dynamics of growing multiplex networks and takes a step towards characterizing the temporal variations of the connectivity of growing multiplex networks, as well as predicting their future structural properties.

Practical Problems with Medication Use that Older People Experience: A Qualitative Study

PubMed Central

Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

2014-01-01

Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

Joint Probability Models of Radiology Images and Clinical Annotations

ERIC Educational Resources Information Center

Arnold, Corey Wells

2009-01-01

Radiology data, in the form of images and reports, is growing at a high rate due to the introduction of new imaging modalities, new uses of existing modalities, and the growing importance of objective image information in the diagnosis and treatment of patients. This increase has resulted in an enormous set of image data that is richly annotated…

Pattern Formation in Complex Fluids

NASA Astrophysics Data System (ADS)

Shelley, Michael

2000-03-01

Classical fluid instabilities -- such as the Saffman-Taylor instability in a Hele-Shaw cell -- are dramatically modified by using complex fluids. For example, polymeric liquids driven in a Hele-Shaw cell yield "dendritic" patterns with an apparent directional anisotropy. The dynamics of complex liquids can also lead to new instabilities and patterns, such as space-filling patterns formed by successive bucklings of growing "elastica" seen in the phase transition of a liquid crystalline material. Understanding such problems requires an interplay between physical modeling, mathematical analysis, and sophisticated nonlinear simulation. For the first problem, I will discuss a non-Newtonian version of Darcy's law for Hele-Shaw flow. This yields a free-boundary problem for the pattern formation, and requires the solution of a nonlinear elliptic equation in a time-dependent domain. This is pushing the development of adaptive grid methods that represent the geometry accurately and efficiently. Our simulations yield insight into how shear-thinning, as is evinced by polymeric liquids, can produce patterns reminiscent of experiment, with "dendritic fingers", side-branching, and reduced tip-splitting. In the second problem, a long filament in a smectic-A phase grows within an isotropic fluid. The splay deformation of the material gives this filament an elastic response. The macroscopic model describes the dynamics of a growing, elastic filament immersed in a Stokesian fluid. The model marries filament elasticity and tensile forces with a numerically tractable nonlocal slender-body theory. Analysis shows that growth of the filament, despite fluid drag, produces a buckling instability. When coupled to a nonlocal hydrodynamic self-interaction, our fully nonlinear simulations show that such instabilities iterate along the filament, and give "space-filling" patterns.

Multimodality Tumor Delineation and Predictive Modelling via Fuzzy-Fusion Deformable Models and Biological Potential Functions

NASA Astrophysics Data System (ADS)

Wasserman, Richard Marc

The radiation therapy treatment planning (RTTP) process may be subdivided into three planning stages: gross tumor delineation, clinical target delineation, and modality dependent target definition. The research presented will focus on the first two planning tasks. A gross tumor target delineation methodology is proposed which focuses on the integration of MRI, CT, and PET imaging data towards the generation of a mathematically optimal tumor boundary. The solution to this problem is formulated within a framework integrating concepts from the fields of deformable modelling, region growing, fuzzy logic, and data fusion. The resulting fuzzy fusion algorithm can integrate both edge and region information from multiple medical modalities to delineate optimal regions of pathological tissue content. The subclinical boundaries of an infiltrating neoplasm cannot be determined explicitly via traditional imaging methods and are often defined to extend a fixed distance from the gross tumor boundary. In order to improve the clinical target definition process an estimation technique is proposed via which tumor growth may be modelled and subclinical growth predicted. An in vivo, macroscopic primary brain tumor growth model is presented, which may be fit to each patient undergoing treatment, allowing for the prediction of future growth and consequently the ability to estimate subclinical local invasion. Additionally, the patient specific in vivo tumor model will be of significant utility in multiple diagnostic clinical applications.

Preclinical and clinical development of YFV 17D-based chimeric vaccines against dengue, West Nile and Japanese encephalitis viruses.

PubMed

Guy, Bruno; Guirakhoo, Farshad; Barban, Veronique; Higgs, Stephen; Monath, Thomas P; Lang, Jean

2010-01-08

Dengue viruses (DENV), West Nile virus (WNV) and Japanese encephalitis virus (JEV) are major global health and growing medical problems. While a live-attenuated vaccine exists since decades against the prototype flavivirus, yellow fever virus (YFV), there is an urgent need for vaccines against dengue or West Nile diseases, and for improved vaccines against Japanese encephalitis. Live-attenuated chimeric viruses were constructed by replacing the genes coding for Premembrane (prM) and Envelope (E) proteins from YFV 17D vaccine strain with those of heterologous flaviviruses (ChimeriVax technology). This technology has been used to produce vaccine candidates for humans, for construction of a horse vaccine for West Nile fever, and as diagnostic reagents for dengue, Japanese encephalitis, West Nile and St. Louis encephalitis infections. This review focuses on human vaccines and their characterization from the early stages of research through to clinical development. Phenotypic and genetic properties and stability were examined, preclinical evaluation through in vitro or animal models, and clinical testing were carried out. Theoretical environmental concerns linked to the live and genetically modified nature of these vaccines have been carefully addressed. Results of the extensive characterizations are in accordance with the immunogenicity and excellent safety profile of the ChimeriVax-based vaccine candidates, and support their development towards large-scale efficacy trials and registration.

Antibiotic Resistance

MedlinePlus

... lives. But there is a growing problem of antibiotic resistance. It happens when bacteria change and become able ... resistant to several common antibiotics. To help prevent antibiotic resistance Don't use antibiotics for viruses like colds ...

CaPTC Biennial Meetings

Cancer.gov

CaPTC hosts the 'Biennial Science of Global Prostate Cancer Disparities in Black Men' conference to address the growing global public health problem of prostate cancer among Black men in industrialized and developing countries.

Diabetes and Foot Problems

MedlinePlus

... medicated pads use liquid corn and callus removers Cutting and over-the counter corn removal products can ... nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing ...

Diabetes Movie (For Parents)

MedlinePlus Videos and Cool Tools

... for Parents Parents site Sitio para padres General Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & ... Growing Up Staying Healthy Staying Safe Recipes & Cooking Health Problems Illnesses & Injuries Relax & Unwind People, Places & Things ...

The existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review

PubMed Central

Salmani, Zahra; Zargham-Boroujeni, Ali; Salehi, Mehrdad; K.Killeen, Therese; Merghati-Khoei, Effat

2015-01-01

Background: In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. Objective: In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. Materials and Methods: For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, “pearl-growing” techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, “orgasm AND intervention”. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. Results: The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Conclusion: Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women’ sexual problems such as FOD in the Iranian settings. PMID:26494987

Envisioning the future of polymer therapeutics for brain disorders.

PubMed

Rodriguez-Otormin, Fernanda; Duro-Castano, Aroa; Conejos-Sánchez, Inmaculada; Vicent, María J

2018-06-14

The growing incidence of brain-related pathologies and the problems that undermine the development of efficient and effective treatments have prompted both researchers and the pharmaceutical industry to search for novel therapeutic alternatives. Polymer therapeutics (PT) display properties well suited to the treatment of neuro-related disorders, which help to overcome the many hidden obstacles on the journey to the central nervous system (CNS). The inherent features of PT, derived from drug(s) conjugation, in parallel with the progress in synthesis and analytical methods, the increasing knowledge in molecular basis of diseases, and collected clinical data through the last four decades, have driven the translation from "bench to bedside" for various biomedical applications. However, since the approval of Gliadel® wafers, little progress has been made in the CNS field, even though brain targeting represents an ever-growing challenge. A thorough assessment of the steps required for successful brain delivery via different administration routes and the consideration of the disease-specific hallmarks are essential to progress in the field. Within this review, we hope to summarize the latest developments, successes, and failures and discuss considerations on designs and strategies for PT in the treatment of CNS disorders. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Neurological Disease Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease. © 2018 Wiley Periodicals, Inc.