Sample records for ids alert correlation

  1. Feature-based alert correlation in security systems using self organizing maps

    NASA Astrophysics Data System (ADS)

    Kumar, Munesh; Siddique, Shoaib; Noor, Humera

    2009-04-01

    The security of the networks has been an important concern for any organization. This is especially important for the defense sector as to get unauthorized access to the sensitive information of an organization has been the prime desire for cyber criminals. Many network security techniques like Firewall, VPN Concentrator etc. are deployed at the perimeter of network to deal with attack(s) that occur(s) from exterior of network. But any vulnerability that causes to penetrate the network's perimeter of defense, can exploit the entire network. To deal with such vulnerabilities a system has been evolved with the purpose of generating an alert for any malicious activity triggered against the network and its resources, termed as Intrusion Detection System (IDS). The traditional IDS have still some deficiencies like generating large number of alerts, containing both true and false one etc. By automatically classifying (correlating) various alerts, the high-level analysis of the security status of network can be identified and the job of network security administrator becomes much easier. In this paper we propose to utilize Self Organizing Maps (SOM); an Artificial Neural Network for correlating large amount of logged intrusion alerts based on generic features such as Source/Destination IP Addresses, Port No, Signature ID etc. The different ways in which alerts can be correlated by Artificial Intelligence techniques are also discussed. . We've shown that the strategy described in the paper improves the efficiency of IDS by better correlating the alerts, leading to reduced false positives and increased competence of network administrator.

  2. Improving the Quality of Alerts and Predicting Intruder's Next Goal with Hidden Colored Petri-Net

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

    Yu, Dong; Frincke, Deb A.

    2006-06-22

    Intrusion detection systems (IDS) often provide poor quality alerts, which are insufficient to support rapid identification of ongoing attacks or predict an intruder’s next likely goal. In this paper, we propose a novel approach to alert post-processing and correlation, the Hidden Colored Petri-Net (HCPN). Different from most other alert correlation methods, our approach treats the alert correlation problem as an inference problem rather than a filter problem. Our approach assumes that the intruder’s actions are unknown to the IDS and can be inferred only from the alerts generated by the IDS sensors. HCPN can describe the relationship between different stepsmore » carried out by intruders, model observations (alerts) and transitions (actions) separately, and associate each token element (system state) with a probability (or confidence). The model is an extension to Colored Petri-Net (CPN) .It is so called “hidden” because the transitions (actions) are not directly observable but can be inferred by looking through the observations (alerts). These features make HCPN especially suitable for discovering intruders’ actions from their partial observations (alerts,) and predicting intruders’ next goal. Our experiments on DARPA evaluation datasets and the attack scenarios from the Grand Challenge Problem (GCP) show that HCPN has promise as a way to reducing false positives and negatives, predicting intruder’s next possible action, uncovering intruders’ intrusion strategies after the attack scenario has happened, and providing confidence scores.« less

  3. An Automated Sample Preparation Instrument to Accelerate Positive Blood Cultures Microbial Identification by MALDI-TOF Mass Spectrometry (Vitek®MS).

    PubMed

    Broyer, Patrick; Perrot, Nadine; Rostaing, Hervé; Blaze, Jérome; Pinston, Frederic; Gervasi, Gaspard; Charles, Marie-Hélène; Dachaud, Fabien; Dachaud, Jacques; Moulin, Frederic; Cordier, Sylvain; Dauwalder, Olivier; Meugnier, Hélène; Vandenesch, Francois

    2018-01-01

    Sepsis is the leading cause of death among patients in intensive care units (ICUs) requiring an early diagnosis to introduce efficient therapeutic intervention. Rapid identification (ID) of a causative pathogen is key to guide directed antimicrobial selection and was recently shown to reduce hospitalization length in ICUs. Direct processing of positive blood cultures by MALDI-TOF MS technology is one of the several currently available tools used to generate rapid microbial ID. However, all recently published protocols are still manual and time consuming, requiring dedicated technician availability and specific strategies for batch processing. We present here a new prototype instrument for automated preparation of Vitek ® MS slides directly from positive blood culture broth based on an "all-in-one" extraction strip. This bench top instrument was evaluated on 111 and 22 organisms processed using artificially inoculated blood culture bottles in the BacT/ALERT ® 3D (SA/SN blood culture bottles) or the BacT/ALERT Virtuo TM system (FA/FN Plus bottles), respectively. Overall, this new preparation station provided reliable and accurate Vitek MS species-level identification of 87% (Gram-negative bacteria = 85%, Gram-positive bacteria = 88%, and yeast = 100%) when used with BacT/ALERT ® 3D and of 84% (Gram-negative bacteria = 86%, Gram-positive bacteria = 86%, and yeast = 75%) with Virtuo ® instruments, respectively. The prototype was then evaluated in a clinical microbiology laboratory on 102 clinical blood culture bottles and compared to routine laboratory ID procedures. Overall, the correlation of ID on monomicrobial bottles was 83% (Gram-negative bacteria = 89%, Gram-positive bacteria = 79%, and yeast = 78%), demonstrating roughly equivalent performance between manual and automatized extraction methods. This prototype instrument exhibited a high level of performance regardless of bottle type or BacT/ALERT system. Furthermore, blood culture workflow could potentially be improved by converting direct ID of positive blood cultures from a batch-based to real-time and "on-demand" process.

  4. Case-Based Multi-Sensor Intrusion Detection

    NASA Astrophysics Data System (ADS)

    Schwartz, Daniel G.; Long, Jidong

    2009-08-01

    Multi-sensor intrusion detection systems (IDSs) combine the alerts raised by individual IDSs and possibly other kinds of devices such as firewalls and antivirus software. A critical issue in building a multi-sensor IDS is alert-correlation, i.e., determining which alerts are caused by the same attack. This paper explores a novel approach to alert correlation using case-based reasoning (CBR). Each case in the CBR system's library contains a pattern of alerts raised by some known attack type, together with the identity of the attack. Then during run time, the alert streams gleaned from the sensors are compared with the patterns in the cases, and a match indicates that the attack described by that case has occurred. For this purpose the design of a fast and accurate matching algorithm is imperative. Two such algorithms were explored: (i) the well-known Hungarian algorithm, and (ii) an order-preserving matching of our own device. Tests were conducted using the DARPA Grand Challenge Problem attack simulator. These showed that the both matching algorithms are effective in detecting attacks; but the Hungarian algorithm is inefficient; whereas the order-preserving one is very efficient, in fact runs in linear time.

  5. An IDS Alerts Aggregation Algorithm Based on Rough Set Theory

    NASA Astrophysics Data System (ADS)

    Zhang, Ru; Guo, Tao; Liu, Jianyi

    2018-03-01

    Within a system in which has been deployed several IDS, a great number of alerts can be triggered by a single security event, making real alerts harder to be found. To deal with redundant alerts, we propose a scheme based on rough set theory. In combination with basic concepts in rough set theory, the importance of attributes in alerts was calculated firstly. With the result of attributes importance, we could compute the similarity of two alerts, which will be compared with a pre-defined threshold to determine whether these two alerts can be aggregated or not. Also, time interval should be taken into consideration. Allowed time interval for different types of alerts is computed individually, since different types of alerts may have different time gap between two alerts. In the end of this paper, we apply proposed scheme on DAPRA98 dataset and the results of experiment show that our scheme can efficiently reduce the redundancy of alerts so that administrators of security system could avoid wasting time on useless alerts.

  6. Using the World Wide Web for GIDEP Problem Data Processing at Marshall Space Flight Center

    NASA Technical Reports Server (NTRS)

    McPherson, John W.; Haraway, Sandra W.; Whirley, J. Don

    1999-01-01

    Since April 1997, Marshall Space Flight Center has been using electronic transfer and the web to support our processing of the Government-Industry Data Exchange Program (GIDEP) and NASA ALERT information. Specific aspects include: (1) Extraction of ASCII text information from GIDEP for loading into Word documents for e-mail to ALERT actionees; (2) Downloading of GIDEP form image formats in Adobe Acrobat (.pdf) for internal storage display on the MSFC ALERT web page; (3) Linkage of stored GRDEP problem forms with summary information for access from the MSFC ALERT Distribution Summary Chart or from an html table of released MSFC ALERTs (4) Archival of historic ALERTs for reference by GIDEP ID, MSFC ID, or MSFC release date; (5) On-line tracking of ALERT response status using a Microsoft Access database and the web (6) On-line response to ALERTs from MSFC actionees through interactive web forms. The technique, benefits, effort, coordination, and lessons learned for each aspect are covered herein.

  7. Health Alert: Adrenal Crisis Causes Death in Some People Who Were Treated with hGH

    MedlinePlus

    ... Some People Who Were Treated with hGH Health Alert: Adrenal Crisis Causes Death in Some People Who ... a medical ID card and wear a Medic-Alert bracelet to tell emergency workers that you lack ...

  8. Comparative evaluation of the drug interaction screening programs MediQ and ID PHARMA CHECK in neurological inpatients.

    PubMed

    Zorina, Olesya I; Haueis, Patrick; Semmler, Alexander; Marti, Isabelle; Gonzenbach, Roman R; Guzek, Markus; Kullak-Ublick, Gerd A; Weller, Michael; Russmann, Stefan

    2012-08-01

    The comparative evaluation of clinical decision support software (CDSS) programs regarding their sensitivity and positive predictive value for the identification of clinically relevant drug interactions. In this research, we used a cross-sectional study that identified potential drug interactions using the CDSS MediQ and the ID PHARMA CHECK in 484 neurological inpatients. Interactions were reclassified according to the Zurich Interaction System, a multidimensional classification that incorporates the Operational Classification of Drug Interactions. In 484 patients with 2812 prescriptions, MediQ and ID PHARMA CHECK generated a total of 1759 and 1082 alerts, respectively. MediQ identified 658 unique potentially interacting combinations, 8 classified as "high danger," 164 as "average danger," and 486 as "low danger." ID PHARMA CHECK detected 336 combinations assigned to one or several of 12 risk and management categories. Altogether, both CDSS issued alerts relating to 808 unique potentially interacting combinations. According to the Zurich Interaction System, 6 of these were contraindicated, 25 were provisionally contraindicated, 190 carried a conditional risk, and 587 had a minimal risk of adverse events. The positive predictive value for alerts having at least a conditional risk was 0.24 for MediQ and 0.48 for ID PHARMA CHECK. CDSS showed major differences in the identification and grading of interactions, and many interactions were only identified by one of the two CDSS. For both programs, only a small proportion of all identified interactions appeared clinically relevant, and the selected display of alerts that imply management changes is a key issue in the further development and local setup of such programs. Copyright © 2012 John Wiley & Sons, Ltd.

  9. Results of DATAS Investigation of Illegal Mode S ID's at JFK Airport

    DOT National Transportation Integrated Search

    1992-12-01

    This report documents the second deployment of the Data Link Test and Analysis : System (DATAS) as a Traffic Alert and Collision System (TCAS) monitor. The : purpose was to identify aircraft which were reporting Illegal Mode Select : (Mode S) ID's. T...

  10. Alerts Visualization and Clustering in Network-based Intrusion Detection

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

    Yang, Dr. Li; Gasior, Wade C; Dasireddy, Swetha

    2010-04-01

    Today's Intrusion detection systems when deployed on a busy network overload the network with huge number of alerts. This behavior of producing too much raw information makes it less effective. We propose a system which takes both raw data and Snort alerts to visualize and analyze possible intrusions in a network. Then we present with two models for the visualization of clustered alerts. Our first model gives the network administrator with the logical topology of the network and detailed information of each node that involves its associated alerts and connections. In the second model, flocking model, presents the network administratormore » with the visual representation of IDS data in which each alert is represented in different color and the alerts with maximum similarity move together. This gives network administrator with the idea of detecting various of intrusions through visualizing the alert patterns.« less

  11. Comparative Analysis of ACAS-Xu and DAIDALUS Detect-and-Avoid Systems

    NASA Technical Reports Server (NTRS)

    Davies, Jason T.; Wu, Minghong G.

    2018-01-01

    The Detect and Avoid (DAA) capability of a recent version (Run 3) of the Airborne Collision Avoidance System-Xu (ACAS-Xu) is measured against that of the Detect and AvoID Alerting Logic for Unmanned Systems (DAIDALUS), a reference algorithm for the Phase 1 Minimum Operational Performance Standards (MOPS) for DAA. This comparative analysis of the two systems' alerting and horizontal guidance outcomes is conducted through the lens of the Detect and Avoid mission using flight data of scripted encounters from a recent flight test. Results indicate comparable timelines and outcomes between ACAS-Xu's Remain Well Clear alert and guidance and DAIDALUS's corrective alert and guidance, although ACAS-Xu's guidance appears to be more conservative. ACAS-Xu's Collision Avoidance alert and guidance occurs later than DAIDALUS's warning alert and guidance, and overlaps with DAIDALUS's timeline of maneuver to remain Well Clear. Interesting discrepancies between ACAS-Xu's directive guidance and DAIDALUS's "Regain Well Clear" guidance occur in some scenarios.

  12. Alerts Analysis and Visualization in Network-based Intrusion Detection Systems

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

    Yang, Dr. Li

    2010-08-01

    The alerts produced by network-based intrusion detection systems, e.g. Snort, can be difficult for network administrators to efficiently review and respond to due to the enormous number of alerts generated in a short time frame. This work describes how the visualization of raw IDS alert data assists network administrators in understanding the current state of a network and quickens the process of reviewing and responding to intrusion attempts. The project presented in this work consists of three primary components. The first component provides a visual mapping of the network topology that allows the end-user to easily browse clustered alerts. Themore » second component is based on the flocking behavior of birds such that birds tend to follow other birds with similar behaviors. This component allows the end-user to see the clustering process and provides an efficient means for reviewing alert data. The third component discovers and visualizes patterns of multistage attacks by profiling the attacker s behaviors.« less

  13. Drivers of Emerging Infectious Disease Events as a Framework for Digital Detection.

    PubMed

    Olson, Sarah H; Benedum, Corey M; Mekaru, Sumiko R; Preston, Nicholas D; Mazet, Jonna A K; Joly, Damien O; Brownstein, John S

    2015-08-01

    The growing field of digital disease detection, or epidemic intelligence, attempts to improve timely detection and awareness of infectious disease (ID) events. Early detection remains an important priority; thus, the next frontier for ID surveillance is to improve the recognition and monitoring of drivers (antecedent conditions) of ID emergence for signals that precede disease events. These data could help alert public health officials to indicators of elevated ID risk, thereby triggering targeted active surveillance and interventions. We believe that ID emergence risks can be anticipated through surveillance of their drivers, just as successful warning systems of climate-based, meteorologically sensitive diseases are supported by improved temperature and precipitation data. We present approaches to driver surveillance, gaps in the current literature, and a scientific framework for the creation of a digital warning system. Fulfilling the promise of driver surveillance will require concerted action to expand the collection of appropriate digital driver data.

  14. Alertness Modulates Conflict Adaptation and Feature Integration in an Opposite Way

    PubMed Central

    Chen, Jia; Huang, Xiting; Chen, Antao

    2013-01-01

    Previous studies show that the congruency sequence effect can result from both the conflict adaptation effect (CAE) and feature integration effect which can be observed as the repetition priming effect (RPE) and feature overlap effect (FOE) depending on different experimental conditions. Evidence from neuroimaging studies suggests that a close correlation exists between the neural mechanisms of alertness-related modulations and the congruency sequence effect. However, little is known about whether and how alertness mediates the congruency sequence effect. In Experiment 1, the Attentional Networks Test (ANT) and a modified flanker task were used to evaluate whether the alertness of the attentional functions had a correlation with the CAE and RPE. In Experimental 2, the ANT and another modified flanker task were used to investigate whether alertness of the attentional functions correlate with the CAE and FOE. In Experiment 1, through the correlative analysis, we found a significant positive correlation between alertness and the CAE, and a negative correlation between the alertness and the RPE. Moreover, a significant negative correlation existed between CAE and RPE. In Experiment 2, we found a marginally significant negative correlation between the CAE and the RPE, but the correlation between alertness and FOE, CAE and FOE was not significant. These results suggest that alertness can modulate conflict adaptation and feature integration in an opposite way. Participants at the high alerting level group may tend to use the top-down cognitive processing strategy, whereas participants at the low alerting level group tend to use the bottom-up processing strategy. PMID:24250824

  15. A Survey on Anomaly Based Host Intrusion Detection System

    NASA Astrophysics Data System (ADS)

    Jose, Shijoe; Malathi, D.; Reddy, Bharath; Jayaseeli, Dorathi

    2018-04-01

    An intrusion detection system (IDS) is hardware, software or a combination of two, for monitoring network or system activities to detect malicious signs. In computer security, designing a robust intrusion detection system is one of the most fundamental and important problems. The primary function of system is detecting intrusion and gives alerts when user tries to intrusion on timely manner. In these techniques when IDS find out intrusion it will send alert massage to the system administrator. Anomaly detection is an important problem that has been researched within diverse research areas and application domains. This survey tries to provide a structured and comprehensive overview of the research on anomaly detection. From the existing anomaly detection techniques, each technique has relative strengths and weaknesses. The current state of the experiment practice in the field of anomaly-based intrusion detection is reviewed and survey recent studies in this. This survey provides a study of existing anomaly detection techniques, and how the techniques used in one area can be applied in another application domain.

  16. 75 FR 10707 - MORTGAGE ASSISTANCE RELIEF SERVICES

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ...), available at ( http://www.mbaa.org/NewsandMedia/PressCenter/71112.htm ). In December 2008, Credit Suisse.../release.php?id=1821 ). \\50\\ See State Bar of California, Ethics Alert: Legal Services to Distressed Homeowners and Foreclosure Consultants on Loan Modifications 2, Ethics Hotliner (Feb. 2, 2009), available at...

  17. A Protocol Specification-Based Intrusion Detection System for VoIP and Its Evaluation

    NASA Astrophysics Data System (ADS)

    Phit, Thyda; Abe, Kôki

    We propose an architecture of Intrusion Detection System (IDS) for VoIP using a protocol specification-based detection method to monitor the network traffics and alert administrator for further analysis of and response to suspicious activities. The protocol behaviors and their interactions are described by state machines. Traffic that behaves differently from the standard specifications are considered to be suspicious. The IDS has been implemented and simulated using OPNET Modeler, and verified to detect attacks. It was found that our system can detect typical attacks within a reasonable amount of delay time.

  18. Characterizing and Managing Intrusion Detection System (IDS) Alerts with Multi-Server/Multi-Priority Queuing Theory

    DTIC Science & Technology

    2014-12-26

    administrators dashboard , so that they can be effectively triaged, analyzed, and used to implement defensive actions to keep the network safe and...For the bank teller, some customers will require straight forward services (a quick deposit or cashing a check) while others will have questions or

  19. A model for anomaly classification in intrusion detection systems

    NASA Astrophysics Data System (ADS)

    Ferreira, V. O.; Galhardi, V. V.; Gonçalves, L. B. L.; Silva, R. C.; Cansian, A. M.

    2015-09-01

    Intrusion Detection Systems (IDS) are traditionally divided into two types according to the detection methods they employ, namely (i) misuse detection and (ii) anomaly detection. Anomaly detection has been widely used and its main advantage is the ability to detect new attacks. However, the analysis of anomalies generated can become expensive, since they often have no clear information about the malicious events they represent. In this context, this paper presents a model for automated classification of alerts generated by an anomaly based IDS. The main goal is either the classification of the detected anomalies in well-defined taxonomies of attacks or to identify whether it is a false positive misclassified by the IDS. Some common attacks to computer networks were considered and we achieved important results that can equip security analysts with best resources for their analyses.

  20. Provider acceptance of an automated electronic alert for acute kidney injury

    PubMed Central

    Oh, Janice; Bia, Joshua R.; Ubaid-Ullah, Muhamad; Testani, Jeffrey M.; Wilson, Francis Perry

    2016-01-01

    Background Clinical decision support systems, including electronic alerts, ideally provide immediate and relevant patient-specific information to improve clinical decision-making. Despite the growing capabilities of such alerts in conjunction with an expanding electronic medical record, there is a paucity of information regarding their perceived usefulness. We surveyed healthcare providers' opinions concerning the practicality and efficacy of a specific text-based automated electronic alert for acute kidney injury (AKI) in a single hospital during a randomized trial of AKI alerts. Methods Providers who had received at least one electronic AKI alert in the previous 6 months, as part of a separate randomized controlled trial (clinicaltrials.gov #01862419), were asked to complete a survey concerning their opinions about this specific AKI alert system. Individual approval of the alert system was defined by a provider's desire to continue receiving the alert after termination of the trial. Results A total of 98 individuals completed the survey, including 62 physicians, 27 pharmacists and 7 non-physician providers. Sixty-nine percent of responders approved the alert, with no significant difference among the various professions (P = 0.28). Alert approval was strongly correlated with the belief that the alerts improved patient care (P < 0.0001), and negatively correlated with the belief that alerts did not provide novel information (P = 0.0001). With each additional 30 days of trial duration, odds of approval decreased by 20% (3–35%) (P = 0.02). Conclusions The alert system was generally well received, although approval waned with time. Approval was correlated with the belief that this type of alert improved patient care. These findings suggest that perceived efficacy is critical to the success of future alert trials. PMID:27478598

  1. Feature Selection Using Information Gain for Improved Structural-Based Alert Correlation

    PubMed Central

    Siraj, Maheyzah Md; Zainal, Anazida; Elshoush, Huwaida Tagelsir; Elhaj, Fatin

    2016-01-01

    Grouping and clustering alerts for intrusion detection based on the similarity of features is referred to as structurally base alert correlation and can discover a list of attack steps. Previous researchers selected different features and data sources manually based on their knowledge and experience, which lead to the less accurate identification of attack steps and inconsistent performance of clustering accuracy. Furthermore, the existing alert correlation systems deal with a huge amount of data that contains null values, incomplete information, and irrelevant features causing the analysis of the alerts to be tedious, time-consuming and error-prone. Therefore, this paper focuses on selecting accurate and significant features of alerts that are appropriate to represent the attack steps, thus, enhancing the structural-based alert correlation model. A two-tier feature selection method is proposed to obtain the significant features. The first tier aims at ranking the subset of features based on high information gain entropy in decreasing order. The‏ second tier extends additional features with a better discriminative ability than the initially ranked features. Performance analysis results show the significance of the selected features in terms of the clustering accuracy using 2000 DARPA intrusion detection scenario-specific dataset. PMID:27893821

  2. The validity and reliability of the Functional Strength Measurement (FSM) in children with intellectual disabilities.

    PubMed

    Aertssen, W F M; Steenbergen, B; Smits-Engelsman, B C M

    2018-06-07

    There is lack of valid and reliable field-based tests for assessing functional strength in young children with mild intellectual disabilities (IDs). The aim of this study was to investigate the test-retest reliability and construct validity of the Functional Strength Measurement in children with ID (FSM-ID). Fifty-two children with mild ID (40 boys and 12 girls, mean age 8.48 years, SD = 1.48) were tested with the FSM. Test-retest reliability (n = 32) was examined by a two-way interclass correlation coefficient for agreement (ICC 2.1A). Standard error of measurement and smallest detectable change were calculated. Construct validity was determined by calculating correlations between the FSM-ID and handheld dynamometry (HHD) (convergent validity), FSM-ID, FSM-ID and subtest strength of the Bruininks-Oseretsky test of motor proficiency - second edition (BOT-2) (convergent validity) and the FSM-ID and balance subtest of the BOT-2 (discriminant validity). Test-retest reliability ICC ranged 0.89-0.98. Correlation between the items of the FSM-ID and HHD ranged 0.39-0.79 and between FSM-ID and BOT-2 (strength items) 0.41-0.80. Correlation between items of the FSM-ID and BOT-2 (balance items) ranged 0.41-0.70. The FSM-ID showed good test-retest reliability and good convergent validity with the HHD and BOT-2 subtest strength. The correlations assessing discriminant validity were higher than expected. Poor levels of postural control and core stability in children with mild IDs may be the underlying factor of those higher correlations. © 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  3. Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

    PubMed Central

    Philmon, Carla L.; Johnson, Gregory D.; Ward, William S.; Rivers, LaToya L.; Williamson, Sharon A.; Goodman, Edward L.

    2014-01-01

    Background: Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. Objective: To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Design: Interventional study with historical comparison. Methods: Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identified alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. Results: During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically significant changes in antimicrobial resistance, and no adverse patient outcomes were noted. Conclusions: The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes. PMID:25477615

  4. Anemia and Iron Deficiency in Vietnamese Children, 6 to 11 Years Old.

    PubMed

    Le Nguyen Bao, Khanh; Tran Thuy, Nga; Nguyen Huu, Chinh; Khouw, Ilse; Deurenberg, Paul

    2016-07-01

    In a population sample of 385 children, 6 to 11 years old, venous blood parameters-hemoglobin (Hb), ferritin, red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), C-reactive protein (CRP), and α1-acid glycoprotein (AGP)-were determined to get insight into the iron status. The prevalence of anemia was 11.4%; 5.6% had iron deficiency (ID), whereas 0.4% had ID anemia. Correction for inflammation based on CRP and AGP did not markedly change the overall prevalence of ID and ID anemia. Stunted children had lower Hb and ferritin values compared with nonstunted children, and thin children had lower values compared with normal-weight or overweight and obese children. Many nonanemic children had alert values for RBC, MCV, MCH, and MCHC. It is concluded that although the prevalence of anemia is of the magnitude of a mild public health problem, the iron status of many nonanemic children is borderline, as indicated by a high number of children with low values for red blood cytology. © 2016 APJPH.

  5. [Concurrent validity of the HAWIK-IV and the Intelligence and Development Scales (IDS)].

    PubMed

    Hagmann-von Arx, Priska; Grob, Alexander; Petermann, Franz; Daseking, Monika

    2012-01-01

    The present study examined the concurrent validity of the Hamburg Wechsler Intelligenztest für Kinder - IV (HAWIK-IV; Petermann & Petermann, 2010) and the Intelligence and Development Scales (IDS; Grob, Meyer & Hagmann-von Arx, 2009). HAWIK-IV and IDS were administered in counterbalanced order to N = 172 children aged 6 to 11 years. The study presents the descriptive statistics, correlations, and an exploratory factor analysis of the data. There is a high correlation between HAWIK-IV Full Scale IQ and IDS intelligence score (r = .83). HAWIK-IV indices showed moderate to high correlations with the cognitive scales of the IDS (Cognition, Language, Mathematics). Low to absent correlations were found between HAWIK-IV indices and the noncognitive scales of the IDS (Social-Emotional Competence, Psychomotor, Achievement Motivation). The factor structure can be interpreted meaningfully and allows integration of the IDS cognitive, language, and mathematical subtests into the four HAWIK-IV indices. The results show that HAWIK-IV and IDS test results can be related to each other.

  6. Estimation of alertness levels with changes in decibel scale wavelength of EEG during dual-task simulation of auditory sonar target detection.

    PubMed

    Arjunan, Sridhar P; Kumar, Dinesh K; Jung, Tzyy-Ping

    2010-01-01

    Changes in alertness levels can have dire consequences for people operating and controlling motorized equipment. Past research studies have shown the relationship of Electroencephalogram (EEG) with alertness of the person. This research reports the fractal analysis of EEG and estimation of the alertness levels of the individual based on the changes in the maximum fractal length (MFL) of EEG. The results indicate that MFL of only 2 channels of EEG can be used to identify the loss of alertness of the individual with mean (inverse) correlation coefficient = 0.82. This study has also reported that using the changes in MFL of EEG, the changes in alertness level of a person was estimated with a mean correlation coefficient = 0.69.

  7. Changes in decibel scale wavelength properties of EEG with alertness levels while performing sustained attention tasks.

    PubMed

    Arjunan, Sridhar P; Kumar, Dinesh K; Jung, Tzyy-Ping

    2009-01-01

    Loss of alertness can have dire consequences for people controlling motorized equipment or for people in professions such as defense. Electroencephalogram (EEG) is known to be related to alertness of the person, but due to high level of noise and low signal strength, the use of EEG for such applications has been considered to be unreliable. This study reports the fractal analysis of EEG and identifies the use of maximum fractal length (MFL) as a feature that is inversely correlated with the alertness of the subject. The results show that MFL (of only single channel of EEG) indicates the loss of alertness of the individual with mean (inverse) correlation coefficient = 0.82.

  8. Disrupted Structural and Functional Networks and Their Correlation with Alertness in Right Temporal Lobe Epilepsy: A Graph Theory Study.

    PubMed

    Jiang, Wenyu; Li, Jianping; Chen, Xuemei; Ye, Wei; Zheng, Jinou

    2017-01-01

    Previous studies have shown that temporal lobe epilepsy (TLE) involves abnormal structural or functional connectivity in specific brain areas. However, limited comprehensive studies have been conducted on TLE associated changes in the topological organization of structural and functional networks. Additionally, epilepsy is associated with impairment in alertness, a fundamental component of attention. In this study, structural networks were constructed using diffusion tensor imaging tractography, and functional networks were obtained from resting-state functional MRI temporal series correlations in 20 right temporal lobe epilepsy (rTLE) patients and 19 healthy controls. Global network properties were computed by graph theoretical analysis, and correlations were assessed between global network properties and alertness. The results from these analyses showed that rTLE patients exhibit abnormal small-world attributes in structural and functional networks. Structural networks shifted toward more regular attributes, but functional networks trended toward more random attributes. After controlling for the influence of the disease duration, negative correlations were found between alertness, small-worldness, and the cluster coefficient. However, alertness did not correlate with either the characteristic path length or global efficiency in rTLE patients. Our findings show that disruptions of the topological construction of brain structural and functional networks as well as small-world property bias are associated with deficits in alertness in rTLE patients. These data suggest that reorganization of brain networks develops as a mechanism to compensate for altered structural and functional brain function during disease progression.

  9. Measuring symptoms of post-traumatic stress disorder in people with intellectual disabilities: the development and psychometric properties of the Impact of Event Scale-Intellectual Disabilities (IES-IDs).

    PubMed

    Hall, James C; Jobson, Laura; Langdon, Peter E

    2014-09-01

    The aims of the study were to (1) revise the Impact of Event Scale-Revised for use with people with intellectual disabilities (IDs), creating the Impact of Event Scale-Intellectual Disabilities (IES-IDs), (2) assess the reliability of the IES-IDs, and (3) compare the IES-IDs to an existing measure trauma-related symptomatology, namely the Lancaster and Northgate Trauma Scale (LANTS), along with measures of anxiety and depression. Forty adults with IDs who had experienced at least one traumatic event were recruited and completed the IES-IDs and the LANTS on two occasions, separated by 2 weeks. Participants also completed the Glasgow Depression Scale and the Glasgow Anxiety Scale, along with the Trauma Information Form which was used to collect information about trauma history. Fifteen per cent of the sample had encountered five or more traumatic events. The IES-IDs and the LANTS had good to excellent internal consistency and test-retest reliability. Both measures correlated with self-report measures of depression and anxiety, although the strength of this correlation was greater with the LANTS. There was a significant positive correlation between trauma frequency and the IES-IDs, while trauma frequency did not correlate with the LANTS. Both the IES-IDs and the LANTS appear to have good reliability. There is a lack of well-developed questionnaires that can be used to assess symptoms of post-traumatic stress disorder (PTSD) in people with intellectual disabilities. The Impact of Event Scale-Revised was augmented creating the Impact of Event Scale-Intellectual Disabilities (IES-IDs). The IES-IDs was shown to have good psychometric properties. The IES-IDs was compared to the Lancaster and Northgate Trauma Scale (LANTS), but the LANTS did not correlate with trauma frequency. However, this study had a small sample size, and a much larger study is needed to examine the factor structure of both the IES-IDs and the LANTS. Future studies should attempt to recruit people with IDs who have a diagnosis of PTSD. © 2014 The British Psychological Society.

  10. Correlated colour temperature of morning light influences alertness and body temperature.

    PubMed

    Te Kulve, Marije; Schlangen, Luc; Schellen, Lisje; Souman, Jan L; van Marken Lichtenbelt, Wouter

    2018-03-01

    Though several studies have reported human alertness to be affected by the intensity and spectral composition of ambient light, the mechanism behind this effect is still largely unclear, especially for daytime exposure. Alerting effects of nocturnal light exposure are correlated with melatonin suppression, but melatonin levels are generally low during the day. The aim of this study was to explore the alerting effect of light in the morning for different correlated colour temperature (CCT) values, as well as its interaction with ambient temperature. Body temperature and perceived comfort were included in the study as possible mediating factors. In a randomized crossover design, 16 healthy females participated in two sessions, once under 2700K and once under 6500K light (both 55lx). Each session consisted of a baseline, a cool, a neutral and a warm thermal environment. Alertness as measured in a reaction time task was lower for the 6500K exposure, while subjective sleepiness was not affected by CCT. Also, core body temperature was higher under 6500K. Skin temperature parameters and perceived comfort were positively correlated with subjective sleepiness. Reaction time correlated with heat loss, but this association did not explain why the reaction time was improved for 2700K. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Mitigating the Insider Threat with High-Dimensional Anomaly Detection

    DTIC Science & Technology

    2004-12-01

    a more serious attack. Various systems such as NSM [56], GrIDS [57], snort [58], Emerald [59], and Spice [60] generate alerts for portscan...reboot etc. The user measurements include the user profiles such as time of login , duration of user session, cumulative CPU time, names of files...already been implemented in a real-time system for information retrieval [3]. A technique developed at SRI in the Emerald system [22] uses historical

  12. State of the Practice of Intrusion Detection Technologies

    DTIC Science & Technology

    2000-01-01

    security incident response teams ) - the role of IDS in threat management, such as defining alarm severity, monitoring, alerting, and policy-based...attacks in an effort to sneak under the radar of security specialists and intrusion detection software, a U.S. Navy network security team said today...to get the smoking gun," said Stephen Northcutt, head of the Shadow intrusion detection team at the Naval Surface Warfare Center. "To know what’s

  13. Rapid Trust Establishment for Transient Use of Unmanaged Hardware

    DTIC Science & Technology

    2006-12-01

    unclassified b . ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Keywords: Establishing...Validate OS Trusted Host OS (From Disk) Validate App 1 Untrusted code Trusted code (a) Boot with trust initiator ( b ) Boot trusted Host OS (c) Launch...be validated. Execution of process with Id 3535 has been blocked to minimize security risks. ( b ) Notification to the user from the trust alerter

  14. Wireless Emergency Alerts: Trust Model Technical Report

    DTIC Science & Technology

    2014-02-01

    Simulation=,.alse·/> <Observa1ionsl> <JNode> 4\\lode id=" M13 • Name="System Accessibilit)r Type=,_abelled~ <Partnt Nodtf> <SIJt.c>Sever~l Ouignett<l and...System_@lt3• Type~Continuous Interval"> <Pareni_Node> M13 əPareni_Nocte> <St.tn>.fnfinily • 0.0@0.0 • 10.0@10.0 • fnfinity<ISiates> <N PT> <NPT _Row

  15. Working Memory and Parent-Rated Components of Attention in Middle Childhood: A Behavioral Genetic Study

    PubMed Central

    Deater-Deckard, Kirby; Cutting, Laurie; Thompson, Lee A.; Petrill, Stephen A.

    2012-01-01

    The purpose of the current study was to investigate potential genetic and environmental correlations between working memory and three behavioral aspects of the attention network (i.e., executive, alerting, and orienting) using a twin design. Data were from 90 monozygotic (39% male) and 112 same-sex dizygotic (41% male) twins. Individual differences in working memory performance (digit span) and parent-rated measures of executive, alerting, and orienting attention included modest to moderate genetic variance, modest shared environmental variance, and modest to moderate nonshared environmental variance. As hypothesized, working memory performance was correlated with executive and alerting attention, but not orienting attention. The correlation between working memory, executive attention, and alerting attention was completely accounted for by overlapping genetic covariance, suggesting a common genetic mechanism or mechanisms underlying the links between working memory and certain parent-rated indicators of attentive behavior. PMID:21948215

  16. Inhibitor of Differentiation/DNA Binding 1 (ID1) Inhibits Etoposide-induced Apoptosis in a c-Jun/c-Fos-dependent Manner.

    PubMed

    Zhao, Yahui; Luo, Aiping; Li, Sheng; Zhang, Wei; Chen, Hongyan; Li, Yi; Ding, Fang; Huang, Furong; Liu, Zhihua

    2016-03-25

    ID1 (inhibitor of differentiation/DNA binding 1) acts an important role in metastasis, tumorigenesis, and maintenance of cell viability. It has been shown that the up-regulation of ID1 is correlated with poor prognosis and the resistance to chemotherapy of human cancers. However, the underlying molecular mechanism remains elusive. Here, we determined for the first time that up-regulating ID1 upon etoposide activation was mediated through AP-1 binding sites within theID1promoter and confirmed that ID1 enhanced cell resistance to DNA damage-induced apoptosis in esophageal squamous cell carcinoma cells. Ablation of c-Jun/c-Fos or ID1 expression enhanced etoposide-mediated apoptosis through increasing activity of caspase 3 and PARP cleavage. Moreover, c-Jun/c-Fos and ID1 were positively correlated in human cancers. More importantly, simultaneous high expression of ID1 and c-Jun or c-Fos was correlated with poor survival in cancer patients. Collectively, we demonstrate the importance of c-Jun/c-Fos-ID1 signaling pathway in chemoresistance of esophageal cancer cells and provide considerable insight into understanding the underlying molecular mechanisms in esophageal squamous cell carcinoma cell biology. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

  17. Validation of a personal fluid loss monitor.

    PubMed

    Wickwire, J; Bishop, P A; Green, J M; Richardson, M T; Lomax, R G; Casaru, C; Jones, E; Curtner-Smith, M

    2008-02-01

    Dehydration raises heat injury risk and reduces performance [ , , ]. The purpose was to validate the Hydra-Alert Jr (Acumen). The Hydra-Alert was tested in two exercise/clothing conditions. Participants wore it while wearing exercise clothing and exercising at a self-selected intensity (n = 8). Others wore the Hydra-Alert while wearing a ballistic-vest and performing an industrial-protocol (n = 8). For each condition, the Hydra-Alert was tested on two occasions (T1 and T2). The Hydra-Alert was tested against nude weight loss for both conditions. The Hydra-Alert had low test-retest reliability for both conditions (average absolute value of the error between Hydra-Alert outputs of T1 and T2 = 0.08 +/- 0.08 percentage points). With exercise-clothing, the Hydra-Alert evidenced low-moderate correlations between percent nude weight loss and Hydra-Alert output at 20 min (r = 0.59-T1, p = 0.13; r = 0.12-T2, p = 0.78), at 40 min (r = 0.93-T1, p = 0.001; r = 0.63-T2, p = 0.10), and at approximately 2 % weight loss (r = 0.21-T1 and T2, p = 0.61 and 0.62, respectively). The correlation at 40 min during T1 fell during T2 suggesting the Hydra-Alert was inconsistent. When wearing a ballistic-vest, the Hydra-Alert had poor validity (T1: r = - 0.29 [p = 0.48] for weight loss vs. monitor; T2: r = 0.11 [p = 0.80]). At the higher levels of dehydration ( approximately 2 %), the Hydra-Alert error was so high as to render its readings of little value. In some cases, the Hydra-Alert could lead to a false level of security if dehydrated. Therefore, the Hydra-Alert is of little use for those who want to measure their fluid loss while exercising in the heat.

  18. Volume 51, Issue 7-8Copyright © 2003 WILEY-VCH Verlag GmbH & Co. KGaA, WeinheimSave Title to My Profile

    E-MailPrint

    Volume 51, Issue 7-8, Pages 639-896(July 2003)

    Preface

    Preface

    NASA Astrophysics Data System (ADS)

    Andreev, O.

    2003-07-01

    We briefly review a possible scheme for getting the known QCD scaling laws within string theory. In particular, we consider amplitudes for exclusive scattering of hadrons at large momentum transfer and hadronic form factors.

  19. The Role of Id2 Protein in Neuroblatoma in Children.

    PubMed

    Wieczorek, Aleksandra; Balwierz, Walentyna

    2015-09-01

    Id (DNA binding and/or differentiation) proteins occur physiologically during ontogenesis and negatively regulate the activity of other helix-loop-helix (HLH) proteins. Id2 protein causes block of cells differentiation in the S phase of the cell cycle and regulates the activity of Rb protein. The role of Id2 protein in physiological cell cycle progression and in neuroblastoma (NBL) pathogenesis was proposed by Lasorella. The aim of the study was evaluation of Id2 expression and its prognostic significance in NBL cells coming from primary tumors and evaluation of its prognostic significance, and correlation of Id2 expression with known prognostic factors. Sixty patients with primary NBL treated from 1991 to 2005 were included in the analysis. We found 50 patients with high and 10 patients with low intensity of Id2 expression. The median percentage of NBL cells with Id2 expression was 88 %. We found no correlation between the number of NBL cells or the intensity of Id2 expression and OS and DFS. In patients with stage 4 NBL, almost all patients had high expression of Id2 and it was significantly more common than in other disease stages (p = 0,03). We found no correlation between Id2 expression and other known prognostic factor in NBL patients. We assume that Id2 is not prognostic factor. However, due to its abundant expression in most of NBL cells and its role in cell cycle, it may be potential therapeutic target. Exact knowledge of expression time may be helpful in explaining mechanisms of oncogenesis.

  20. Neuronal correlates of visual and auditory alertness in the DMT and ketamine model of psychosis.

    PubMed

    Daumann, J; Wagner, D; Heekeren, K; Neukirch, A; Thiel, C M; Gouzoulis-Mayfrank, E

    2010-10-01

    Deficits in attentional functions belong to the core cognitive symptoms in schizophrenic patients. Alertness is a nonselective attention component that refers to a state of general readiness that improves stimulus processing and response initiation. The main goal of the present study was to investigate cerebral correlates of alertness in the human 5HT(2A) agonist and N-methyl-D-aspartic acid (NMDA) antagonist model of psychosis. Fourteen healthy volunteers participated in a randomized double-blind, cross-over event-related functional magnetic resonance imaging (fMRI) study with dimethyltryptamine (DMT) and S-ketamine. A target detection task with cued and uncued trials in both the visual and the auditory modality was used. Administration of DMT led to decreased blood oxygenation level-dependent response during performance of an alertness task, particularly in extrastriate regions during visual alerting and in temporal regions during auditory alerting. In general, the effects for the visual modality were more pronounced. In contrast, administration of S-ketamine led to increased cortical activation in the left insula and precentral gyrus in the auditory modality. The results of the present study might deliver more insight into potential differences and overlapping pathomechanisms in schizophrenia. These conclusions must remain preliminary and should be explored by further fMRI studies with schizophrenic patients performing modality-specific alertness tasks.

  1. Circadian rhythms in human performance and mood under constant conditions

    NASA Technical Reports Server (NTRS)

    Monk, T. H.; Buysse, D. J.; Reynolds, C. F. 3rd; Berga, S. L.; Jarrett, D. B.; Begley, A. E.; Kupfer, D. J.

    1997-01-01

    This study explored the relationship between circadian performance rhythms and rhythms in rectal temperature, plasma cortisol, plasma melatonin, subjective alertness and well-being. Seventeen healthy young adults were studied under 36 h of 'unmasking' conditions (constant wakeful bedrest, temporal isolation, homogenized 'meals') during which rectal temperatures were measured every minute, and plasma cortisol and plasma melatonin measured every 20 min. Hourly subjective ratings of global vigour (alertness) and affect (well-being) were obtained followed by one of two performance batteries. On odd-numbered hours performance (speed and accuracy) of serial search, verbal reasoning and manual dexterity tasks was assessed. On even-numbered hours, performance (% hits, response speed) was measured at a 25-30 min visual vigilance task. Performance of all tasks (except search accuracy) showed a significant time of day variation usually with a nocturnal trough close to the trough in rectal temperature. Performance rhythms appeared not to reliably differ with working memory load. Within subjects, predominantly positive correlations emerged between good performance and higher temperatures and better subjective alertness; predominantly negative correlations between good performance and higher plasma levels of cortisol and melatonin. Temperature and cortisol rhythms correlated with slightly more performance measures (5/7) than did melatonin rhythms (4/7). Global vigour correlated about as well with performance (5/7) as did temperature, and considerably better than global affect (1/7). In conclusion: (1) between-task heterogeneity in circadian performance rhythms appeared to be absent when the sleep/wake cycle was suspended; (2) temperature (positively), cortisol and melatonin (negatively) appeared equally good as circadian correlates of performance, and (3) subjective alertness correlated with performance rhythms as well as (but not better than) body temperature, suggesting that performance rhythms were not directly mediated by rhythms in subjective alertness.

  2. Dose-response relationship for light intensity and ocular and electroencephalographic correlates of human alertness

    NASA Technical Reports Server (NTRS)

    Cajochen, C.; Zeitzer, J. M.; Czeisler, C. A.; Dijk, D. J.

    2000-01-01

    Light can elicit both circadian and acute physiological responses in humans. In a dose response protocol men and women were exposed to illuminances ranging from 3 to 9100 lux for 6.5 h during the early biological night after they had been exposed to <3 lux for several hours. Light exerted an acute alerting response as assessed by a reduction in the incidence of slow-eye movements, a reduction of EEG activity in the theta-alpha frequencies (power density in the 5-9 Hz range) as well as a reduction in self-reported sleepiness. This alerting response was positively correlated with the degree of melatonin suppression by light. In accordance with the dose response function for circadian resetting and melatonin suppression, the responses of all three indices of alertness to variations in illuminance were consistent with a logistic dose response curve. Half of the maximum alerting response to bright light of 9100 lux was obtained with room light of approximately 100 lux. This sensitivity to light indicates that variations in illuminance within the range of typical, ambient, room light (90-180 lux) can have a significant impact on subjective alertness and its electrophysiologic concomitants in humans during the early biological night.

  3. Id-1 promotes osteosarcoma cell growth and inhibits cell apoptosis via PI3K/AKT signaling pathway

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

    Hao, Liang; Liao, Qi; Tang, Qiang

    2016-02-12

    Accumulating evidence reveals that Id-1 is upregulated and functions as a potential tumor promoter in several human cancer types. However, the role of Id-1 in osteosarcoma (OS) is unknown. In present study, we found that Id-1 expression was elevated in OS tissues than adjacent normal bone tissues. More importantly, we demonstrated that overexpression of Id-1 is significantly correlated with tumor progression and poor survival in OS patients. Furthermore, increased expression of Id-1 was observed in OS cell lines and ectopic expression of Id-1 significantly enhanced in vitro cell proliferation and promoted in vivo tumor growth, whereas knockdown of Id-1 suppressed OS cellsmore » growth. Moreover, our experimental data revealed that Id-1 promotes cell proliferation by facilitating cell cycle progression and inhibits cell apoptosis. Mechanistically, the effects of Id-1 in OS cells is at least partly through activation of PI3K/Akt signaling pathway. Therefore, we identified a tumorigenic role of Id-1 in OS and suggested a potential therapeutic target for OS patients. - Highlights: • Id-1 expression is positively correlated in OS patients with poor prognosis. • Overexpression of Id-1 promotes OS cell growth in vitro and in vivo. • Id-1induces cell cycle progression and inhibits cell apoptosis. • PI3K/Akt signaling pathway contributed to the oncogenic effects of Id-1 in OS cells.« less

  4. Iron deficiency in a tertiary gastroenterology center in Romania: prevalence and significancy.

    PubMed

    Preda, Carmen Monica; Proca, Doina; Sandra, Irina; Horeanga, Boroka Claudia; Fulger, Larisa Elena; Manuc, Teodora; Bancila, Ion; Balas, Oana Elena; Manuc, Mircea; Diculescu, Mircea; Baicus, Cristian; Tieranu, Cristian; Constantinescu, Ileana

    2018-01-01

    Introduction: Iron deficiency has been known to cause significant functional impairment, lower quality of life and higher morbidity and mortality. The aim of this study was to estimate the prevalence and significance of iron deficiency in our patients and medical staff. Material and methods: We performed a prospective cross-sectional study: In July 2016, 383 persons were screened for the presence of iron deficiency (ID): 325 patients and 58 people from the medical staff. Transferrin saturation (TSAT), serum ferritin (SF) and complete blood count were performed. Absolute ID was diagnosed if SF <100 ng/ml and TSAT <20%. Relative ID was defined by SF >100 ng/ml and TSAT <20%. Results: The group of medical staff was younger and had a greater proportion of women. The prevalence of absolute ID was 22.5% in patients and 43.1% in medical staff; relative ID was present in 15% of patients and 1.7% of medical staff. Among patients, the absolute ID was significantly correlated with the female sex (p=0.002) and pre-menopausal status (p=0.01) but did not correlate with diagnosis, age, BMI, nonsteroidal anti-inflammatory drug (NSAID), aspirin or acenocoumarol consumption. The relative ID is associated with advanced age (p=0.03) and diagnosis of cancer and liver cirrhosis (p=0.01). Conclusions: Absolute ID had a high prevalence among patients (22.5%), but there was even a bigger issue among the medical staff (43.1%). Absolute ID was correlated with female sex and pre-menopausal status. Relative ID was related to advanced age, cancer and liver cirrhosis. Abbreviations: serum ferritine- SF, transferrin saturation coefficient- TSAT, iron deficiency- ID, inflammatory bowel diseases- IBD, quality of life- QoL, GI- gastrointestinal.

  5. Iron deficiency in a tertiary gastroenterology center in Romania: prevalence and significancy

    PubMed Central

    Preda, Carmen Monica; Proca, Doina; Sandra, Irina; Horeanga, Boroka Claudia; Fulger, Larisa Elena; Manuc, Teodora; Bancila, Ion; Balas, Oana Elena; Manuc, Mircea; Diculescu, Mircea; Baicus, Cristian; Tieranu, Cristian; Constantinescu, Ileana

    2018-01-01

    Introduction:Iron deficiency has been known to cause significant functional impairment, lower quality of life and higher morbidity and mortality. The aim of this study was to estimate the prevalence and significance of iron deficiency in our patients and medical staff. Material and methods:We performed a prospective cross-sectional study: In July 2016, 383 persons were screened for the presence of iron deficiency (ID): 325 patients and 58 people from the medical staff. Transferrin saturation (TSAT), serum ferritin (SF) and complete blood count were performed. Absolute ID was diagnosed if SF <100 ng/ml and TSAT <20%. Relative ID was defined by SF >100 ng/ml and TSAT <20%. Results:The group of medical staff was younger and had a greater proportion of women. The prevalence of absolute ID was 22.5% in patients and 43.1% in medical staff; relative ID was present in 15% of patients and 1.7% of medical staff. Among patients, the absolute ID was significantly correlated with the female sex (p=0.002) and pre-menopausal status (p=0.01) but did not correlate with diagnosis, age, BMI, nonsteroidal anti-inflammatory drug (NSAID), aspirin or acenocoumarol consumption. The relative ID is associated with advanced age (p=0.03) and diagnosis of cancer and liver cirrhosis (p=0.01). Conclusions:Absolute ID had a high prevalence among patients (22.5%), but there was even a bigger issue among the medical staff (43.1%). Absolute ID was correlated with female sex and pre-menopausal status. Relative ID was related to advanced age, cancer and liver cirrhosis. Abbreviations: serum ferritine- SF, transferrin saturation coefficient- TSAT, iron deficiency- ID, inflammatory bowel diseases- IBD, quality of life- QoL, GI- gastrointestinal PMID:29696062

  6. TANDI: threat assessment of network data and information

    NASA Astrophysics Data System (ADS)

    Holsopple, Jared; Yang, Shanchieh Jay; Sudit, Moises

    2006-04-01

    Current practice for combating cyber attacks typically use Intrusion Detection Sensors (IDSs) to passively detect and block multi-stage attacks. This work leverages Level-2 fusion that correlates IDS alerts belonging to the same attacker, and proposes a threat assessment algorithm to predict potential future attacker actions. The algorithm, TANDI, reduces the problem complexity by separating the models of the attacker's capability and opportunity, and fuse the two to determine the attacker's intent. Unlike traditional Bayesian-based approaches, which require assigning a large number of edge probabilities, the proposed Level-3 fusion procedure uses only 4 parameters. TANDI has been implemented and tested with randomly created attack sequences. The results demonstrate that TANDI predicts future attack actions accurately as long as the attack is not part of a coordinated attack and contains no insider threats. In the presence of abnormal attack events, TANDI will alarm the network analyst for further analysis. The attempt to evaluate a threat assessment algorithm via simulation is the first in the literature, and shall open up a new avenue in the area of high level fusion.

  7. Conditional Outlier Detection for Clinical Alerting

    PubMed Central

    Hauskrecht, Milos; Valko, Michal; Batal, Iyad; Clermont, Gilles; Visweswaran, Shyam; Cooper, Gregory F.

    2010-01-01

    We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates. PMID:21346986

  8. Conditional outlier detection for clinical alerting.

    PubMed

    Hauskrecht, Milos; Valko, Michal; Batal, Iyad; Clermont, Gilles; Visweswaran, Shyam; Cooper, Gregory F

    2010-11-13

    We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates.

  9. Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems—I-MeDeSA

    PubMed Central

    Zachariah, Marianne; Seidling, Hanna M; Neri, Pamela M; Cresswell, Kathrin M; Duke, Jon; Bloomrosen, Meryl; Volk, Lynn A; Bates, David W

    2011-01-01

    Background Medication-related decision support can reduce the frequency of preventable adverse drug events. However, the design of current medication alerts often results in alert fatigue and high over-ride rates, thus reducing any potential benefits. Methods The authors previously reviewed human-factors principles for relevance to medication-related decision support alerts. In this study, instrument items were developed for assessing the appropriate implementation of these human-factors principles in drug–drug interaction (DDI) alerts. User feedback regarding nine electronic medical records was considered during the development process. Content validity, construct validity through correlation analysis, and inter-rater reliability were assessed. Results The final version of the instrument included 26 items associated with nine human-factors principles. Content validation on three systems resulted in the addition of one principle (Corrective Actions) to the instrument and the elimination of eight items. Additionally, the wording of eight items was altered. Correlation analysis suggests a direct relationship between system age and performance of DDI alerts (p=0.0016). Inter-rater reliability indicated substantial agreement between raters (κ=0.764). Conclusion The authors developed and gathered preliminary evidence for the validity of an instrument that measures the appropriate use of human-factors principles in the design and display of DDI alerts. Designers of DDI alerts may use the instrument to improve usability and increase user acceptance of medication alerts, and organizations selecting an electronic medical record may find the instrument helpful in meeting their clinicians' usability needs. PMID:21946241

  10. The Antibody Response of Pregnant Cameroonian Women to VAR2CSA ID1-ID2a, a Small Recombinant Protein Containing the CSA-Binding Site

    PubMed Central

    Babakhanyan, Anna; Leke, Rose G. F.; Salanti, Ali; Bobbili, Naveen; Gwanmesia, Philomina; Leke, Robert J. I.; Quakyi, Isabella A.; Chen, John J.; Taylor, Diane Wallace

    2014-01-01

    In pregnant women, Plasmodium falciparum-infected erythrocytes expressing the VAR2CSA antigen bind to chondroitin sulfate A in the placenta causing placental malaria. The binding site of VAR2CSA is present in the ID1-ID2a region. This study sought to determine if pregnant Cameroonian women naturally acquire antibodies to ID1-ID2a and if antibodies to ID1-ID2a correlate with absence of placental malaria at delivery. Antibody levels to full-length VAR2CSA and ID1-ID2a were measured in plasma samples from 745 pregnant Cameroonian women, 144 Cameroonian men, and 66 US subjects. IgM levels and IgG avidity to ID1-ID2a were also determined. As expected, antibodies to ID1-ID2a were absent in US controls. Although pregnant Cameroonian women developed increasing levels of antibodies to full-length VAR2CSA during pregnancy, no increase in either IgM or IgG to ID1-ID2a was observed. Surprisingly, no differences in antibody levels to ID1-ID2a were detected between Cameroonian men and pregnant women. For example, in rural settings only 8–9% of males had antibodies to full-length VAR2CSA, but 90–96% had antibodies to ID1-ID2a. In addition, no significant difference in the avidity of IgG to ID1-ID2a was found between pregnant women and Cameroonian men, and no correlation between antibody levels at delivery and absence of placental malaria was found. Thus, the response to ID1-ID2a was not pregnancy specific, but predominantly against cross-reactivity epitopes, which may have been induced by other PfEMP1 antigens, malarial antigens, or microbes. Currently, ID1-ID2a is a leading vaccine candidate, since it binds to the CSA with the same affinity as the full-length molecule and elicits binding-inhibitory antibodies in animals. Further studies are needed to determine if the presence of naturally acquired cross-reactive antibodies in women living in malaria endemic countries will alter the response to ID1-ID2a following vaccination with ID1-ID2a. PMID:24505415

  11. VTAC: virtual terrain assisted impact assessment for cyber attacks

    NASA Astrophysics Data System (ADS)

    Argauer, Brian J.; Yang, Shanchieh J.

    2008-03-01

    Overwhelming intrusion alerts have made timely response to network security breaches a difficult task. Correlating alerts to produce a higher level view of intrusion state of a network, thus, becomes an essential element in network defense. This work proposes to analyze correlated or grouped alerts and determine their 'impact' to services and users of the network. A network is modeled as 'virtual terrain' where cyber attacks maneuver. Overlaying correlated attack tracks on virtual terrain exhibits the vulnerabilities exploited by each track and the relationships between them and different network entities. The proposed impact assessment algorithm utilizes the graph-based virtual terrain model and combines assessments of damages caused by the attacks. The combined impact scores allow to identify severely damaged network services and affected users. Several scenarios are examined to demonstrate the uses of the proposed Virtual Terrain Assisted Impact Assessment for Cyber Attacks (VTAC).

  12. The Self-Identity Protein IdsD Is Communicated between Cells in Swarming Proteus mirabilis Colonies.

    PubMed

    Saak, Christina C; Gibbs, Karine A

    2016-12-15

    Proteus mirabilis is a social bacterium that is capable of self (kin) versus nonself recognition. Swarming colonies of this bacterium expand outward on surfaces to centimeter-scale distances due to the collective motility of individual cells. Colonies of genetically distinct populations remain separate, while those of identical populations merge. Ids proteins are essential for this recognition behavior. Two of these proteins, IdsD and IdsE, encode identity information for each strain. These two proteins bind in vitro in an allele-restrictive manner. IdsD-IdsE binding is correlated with the merging of populations, whereas a lack of binding is correlated with the separation of populations. Key questions remained about the in vivo interactions of IdsD and IdsE, specifically, whether IdsD and IdsE bind within single cells or whether IdsD-IdsE interactions occur across neighboring cells and, if so, which of the two proteins is exchanged. Here we demonstrate that IdsD must originate from another cell to communicate identity and that this nonresident IdsD interacts with IdsE resident in the recipient cell. Furthermore, we show that unbound IdsD in recipient cells does not cause cell death and instead appears to contribute to a restriction in the expansion radius of the swarming colony. We conclude that P. mirabilis communicates IdsD between neighboring cells for nonlethal kin recognition, which suggests that the Ids proteins constitute a type of cell-cell communication. We demonstrate that self (kin) versus nonself recognition in P. mirabilis entails the cell-cell communication of an identity-encoding protein that is exported from one cell and received by another. We further show that this intercellular exchange affects swarm colony expansion in a nonlethal manner, which adds social communication to the list of potential swarm-related regulatory factors. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  13. The Self-Identity Protein IdsD Is Communicated between Cells in Swarming Proteus mirabilis Colonies

    PubMed Central

    Saak, Christina C.

    2016-01-01

    ABSTRACT Proteus mirabilis is a social bacterium that is capable of self (kin) versus nonself recognition. Swarming colonies of this bacterium expand outward on surfaces to centimeter-scale distances due to the collective motility of individual cells. Colonies of genetically distinct populations remain separate, while those of identical populations merge. Ids proteins are essential for this recognition behavior. Two of these proteins, IdsD and IdsE, encode identity information for each strain. These two proteins bind in vitro in an allele-restrictive manner. IdsD-IdsE binding is correlated with the merging of populations, whereas a lack of binding is correlated with the separation of populations. Key questions remained about the in vivo interactions of IdsD and IdsE, specifically, whether IdsD and IdsE bind within single cells or whether IdsD-IdsE interactions occur across neighboring cells and, if so, which of the two proteins is exchanged. Here we demonstrate that IdsD must originate from another cell to communicate identity and that this nonresident IdsD interacts with IdsE resident in the recipient cell. Furthermore, we show that unbound IdsD in recipient cells does not cause cell death and instead appears to contribute to a restriction in the expansion radius of the swarming colony. We conclude that P. mirabilis communicates IdsD between neighboring cells for nonlethal kin recognition, which suggests that the Ids proteins constitute a type of cell-cell communication. IMPORTANCE We demonstrate that self (kin) versus nonself recognition in P. mirabilis entails the cell-cell communication of an identity-encoding protein that is exported from one cell and received by another. We further show that this intercellular exchange affects swarm colony expansion in a nonlethal manner, which adds social communication to the list of potential swarm-related regulatory factors. PMID:27672195

  14. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation.

    PubMed

    Trivedi, M H; Rush, A J; Ibrahim, H M; Carmody, T J; Biggs, M M; Suppes, T; Crismon, M L; Shores-Wilson, K; Toprac, M G; Dennehy, E B; Witte, B; Kashner, T M

    2004-01-01

    The present study provides additional data on the psychometric properties of the 30-item Inventory of Depressive Symptomatology (IDS) and of the recently developed Quick Inventory of Depressive Symptomatology (QIDS), a brief 16-item symptom severity rating scale that was derived from the longer form. Both the IDS and QIDS are available in matched clinician-rated (IDS-C30; QIDS-C16) and self-report (IDS-SR30; QIDS-SR16) formats. The patient samples included 544 out-patients with major depressive disorder (MDD) and 402 out-patients with bipolar disorder (BD) drawn from 19 regionally and ethnicically diverse clinics as part of the Texas Medication Algorithm Project (TMAP). Psychometric analyses including sensitivity to change with treatment were conducted. Internal consistencies (Cronbach's alpha) ranged from 0.81 to 0.94 for all four scales (QIDS-C16, QIDS-SR16, IDS-C30 and IDS-SR30) in both MDD and BD patients. Sad mood, involvement, energy, concentration and self-outlook had the highest item-total correlations among patients with MDD and BD across all four scales. QIDS-SR16 and IDS-SR30 total scores were highly correlated among patients with MDD at exit (c = 0.83). QIDS-C16 and IDS-C30 total scores were also highly correlated among patients with MDD (c = 0.82) and patients with BD (c = 0.81). The IDS-SR30, IDS-C30, QIDS-SR16, and QIDS-C16 were equivalently sensitive to symptom change, indicating high concurrent validity for all four scales. High concurrent validity was also documented based on the SF-12 Mental Health Summary score for the population divided in quintiles based on their IDS or QIDS score. The QIDS-SR16 and QIDS-C16, as well as the longer 30-item versions, have highly acceptable psychometric properties and are treatment sensitive measures of symptom severity in depression.

  15. Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support

    PubMed Central

    Seidling, Hanna M; Phansalkar, Shobha; Seger, Diane L; Paterno, Marilyn D; Shaykevich, Shimon; Haefeli, Walter E

    2011-01-01

    Background Clinical decision support systems can prevent knowledge-based prescription errors and improve patient outcomes. The clinical effectiveness of these systems, however, is substantially limited by poor user acceptance of presented warnings. To enhance alert acceptance it may be useful to quantify the impact of potential modulators of acceptance. Methods We built a logistic regression model to predict alert acceptance of drug–drug interaction (DDI) alerts in three different settings. Ten variables from the clinical and human factors literature were evaluated as potential modulators of provider alert acceptance. ORs were calculated for the impact of knowledge quality, alert display, textual information, prioritization, setting, patient age, dose-dependent toxicity, alert frequency, alert level, and required acknowledgment on acceptance of the DDI alert. Results 50 788 DDI alerts were analyzed. Providers accepted only 1.4% of non-interruptive alerts. For interruptive alerts, user acceptance positively correlated with frequency of the alert (OR 1.30, 95% CI 1.23 to 1.38), quality of display (4.75, 3.87 to 5.84), and alert level (1.74, 1.63 to 1.86). Alert acceptance was higher in inpatients (2.63, 2.32 to 2.97) and for drugs with dose-dependent toxicity (1.13, 1.07 to 1.21). The textual information influenced the mode of reaction and providers were more likely to modify the prescription if the message contained detailed advice on how to manage the DDI. Conclusion We evaluated potential modulators of alert acceptance by assessing content and human factors issues, and quantified the impact of a number of specific factors which influence alert acceptance. This information may help improve clinical decision support systems design. PMID:21571746

  16. Event-based internet biosurveillance: relation to epidemiological observation

    PubMed Central

    2012-01-01

    Background The World Health Organization (WHO) collects and publishes surveillance data and statistics for select diseases, but traditional methods of gathering such data are time and labor intensive. Event-based biosurveillance, which utilizes a variety of Internet sources, complements traditional surveillance. In this study we assess the reliability of Internet biosurveillance and evaluate disease-specific alert criteria against epidemiological data. Methods We reviewed and compared WHO epidemiological data and Argus biosurveillance system data for pandemic (H1N1) 2009 (April 2009 – January 2010) from 8 regions and 122 countries to: identify reliable alert criteria among 15 Argus-defined categories; determine the degree of data correlation for disease progression; and assess timeliness of Internet information. Results Argus generated a total of 1,580 unique alerts; 5 alert categories generated statistically significant (p < 0.05) correlations with WHO case count data; the sum of these 5 categories was highly correlated with WHO case data (r = 0.81, p < 0.0001), with expected differences observed among the 8 regions. Argus reported first confirmed cases on the same day as WHO for 21 of the first 64 countries reporting cases, and 1 to 16 days (average 1.5 days) ahead of WHO for 42 of those countries. Conclusion Confirmed pandemic (H1N1) 2009 cases collected by Argus and WHO methods returned consistent results and confirmed the reliability and timeliness of Internet information. Disease-specific alert criteria provide situational awareness and may serve as proxy indicators to event progression and escalation in lieu of traditional surveillance data; alerts may identify early-warning indicators to another pandemic, preparing the public health community for disease events. PMID:22709988

  17. Contributors to Frequent Telehealth Alerts Including False Alerts for Patients with Heart Failure: A Mixed Methods Exploration

    PubMed Central

    Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.

    2013-01-01

    Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts. Conclusion Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576

  18. Relation between efficiency and energy cost with coordination in aquatic locomotion.

    PubMed

    Figueiredo, Pedro; Toussaint, Huub M; Vilas-Boas, João Paulo; Fernandes, Ricardo J

    2013-03-01

    The aim of this study was to establish the relationships between the intracycle velocity variation (IVV) and Froude efficiency (η(T)), energy cost (C), and index of coordination (IdC) throughout a 200-m freestyle race. Ten male international level swimmers performed a maximum 200 m front crawl swim. Performance was recorded with four below- and two above-water synchronized cameras. Oxygen consumption was measured continuously during the effort, and blood samples were collected before and after the test. IdC, body center of mass' IVV (x, y and z), and η(T) were also calculated. For assessing C swimmers performed also 50, 100 and 150 m at the same pace as in the 200-m splits to capture blood lactate samples after each 50-m lap of the 200-m effort. Swimmers attained a stable IVV (x, y, and z), as fatigue development along the 200-m effort induced a decrease in velocity, stroke length, stroke frequency, η(T), and an increase of IdC. Direct relationships between C and IdC for the second and fourth lap were found: R = 0.63 and R = 0.69 (P < 0.05), respectively. Computing partial correlation, also IdC and η(T) in the first lap were significantly correlated (R = -0.63, P < 0.05). IdC and η(T) showed to be significant for the within-subjects correlation (R = -0.45, P = 0.01), and IdC and C for the between-subjects correlation (R = 0.66, P = 0.04). Patterns of coordination modified during the 200-m event in response to the task constraints, observed by the changes in the other studied parameters, and allowing the IVV stability along the effort.

  19. The correlation between intradermal testing and serum specific IgE to house dust mite in negative skin prick test allergic rhinitis adult patients.

    PubMed

    Tantilipikorn, Pongsakorn; Danpornprasert, Piyanart; Ngaotepprutaram, Premyot; Assanasen, Paraya; Bunnag, Chaweewan; Thinkhamrop, Bandit

    2015-12-01

    Diagnosis of allergic rhinitis (AR) is based on history, physical examination, and skin prick test (SPT) while intradermal (ID) test can be performed to confirm the diagnosis in case of negative result of SPT. However, the ID test is not recommended for cat and timothy grass allergy because of its high false positive rate. As a result, the "quantitative" technique of serum specific IgE (sIgE) measurement might be helpful to diagnose AR with more confidence. To evaluate the correlation between ID tests and sIgE in the diagnosis of house dust mite (HDM)-sensitive AR patients. Patients with chronic rhinitis (CR) were recruited and SPT was performed. If SPT was negative, ID test and sIgE to HDM [Dermatophagoides pteronyssinus (Dp)] measurement were performed. Eighty-two patients with chronic rhinitis (CR), whose SPTs were negative for Dp, were included. There were 39 males (47.6%) and 43 females (52.4%) aged between 18 and 76 years old (mean age = 43.3 years). The ID test was positive in 13 patients (15.9%), and was negative in 69 patients (84.1 %). sIgE to HDM was positive ( ≥ 0.35 kUA/l) in 2 patients (2.4%). There was a fair to moderate correlation between the size of wheal of ID test and sIgE to HDM (r = 0.44, 95% confidence interval: 0.19 to 0.67, p < 0.01). ID test has a fair to moderate correlation with sIgE Dermatophagoides pteronyssinus and it can be used in CR patients with negative SPT where sIgE is not feasible.

  20. Assessing the temporal aspects of attention and its correlates in aging and chronic stroke patients.

    PubMed

    Shalev, Nir; Humphreys, Glyn; Demeyere, Nele

    2016-11-01

    Temporal dynamics of attention have been in the spotlight of research since the earliest days of cognitive psychology. Typically, researchers describe two different aspects of the temporal fluctuations of attention: one is in intervals of milliseconds (phasic alertness), and the other over minutes or even hours (tonic alertness or sustained attention). In order to evaluate individual capacities for sustained attention and phasic alertness, most studies rely on variations of the Continuous Performance Task (CPT). Indices of sustained attention and phasic alertness are typically based on reaction times to targets; phasic alertness is related to the change in reaction times following a cue, and sustained attention is related to variability of reaction times during the task. In the following study, we attempted to establish a new approach for studying sustained attention and phasic alertness, not reliant solely on reaction time measures. We developed a new variation of the CPT with conjunctive feature targets and forward and backward masking to induce a higher variability in accuracy. This allowed us to assess an individual's ability to maintain the same level of sensitivity to targets (d-prime) across a ten minute period on the task as an index for sustained attention. We also assessed reaction times as a function of previous trial type, and suggest previous trial RT benefit might be a marker for an individual's phasic alertness. We demonstrated the use of this task with healthy aging controls and stroke survivors. As a demonstration of external validity of the novel paradigm, we present a correlation between how individual performance drops over time and individual reports of distractibility in everyday life on the Cognitive Failures Questionnaire. In addition, we found significant differences between the patient and control groups in our proposed marker of phasic alertness. We discuss the implications of our study for current assessment tools, as well as general differences in phasic alertness between clinical and neurologically unimpaired groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Monitoring alert and drowsy states by modeling EEG source nonstationarity

    NASA Astrophysics Data System (ADS)

    Hsu, Sheng-Hsiou; Jung, Tzyy-Ping

    2017-10-01

    Objective. As a human brain performs various cognitive functions within ever-changing environments, states of the brain characterized by recorded brain activities such as electroencephalogram (EEG) are inevitably nonstationary. The challenges of analyzing the nonstationary EEG signals include finding neurocognitive sources that underlie different brain states and using EEG data to quantitatively assess the state changes. Approach. This study hypothesizes that brain activities under different states, e.g. levels of alertness, can be modeled as distinct compositions of statistically independent sources using independent component analysis (ICA). This study presents a framework to quantitatively assess the EEG source nonstationarity and estimate levels of alertness. The framework was tested against EEG data collected from 10 subjects performing a sustained-attention task in a driving simulator. Main results. Empirical results illustrate that EEG signals under alert versus drowsy states, indexed by reaction speeds to driving challenges, can be characterized by distinct ICA models. By quantifying the goodness-of-fit of each ICA model to the EEG data using the model deviation index (MDI), we found that MDIs were significantly correlated with the reaction speeds (r  =  -0.390 with alertness models and r  =  0.449 with drowsiness models) and the opposite correlations indicated that the two models accounted for sources in the alert and drowsy states, respectively. Based on the observed source nonstationarity, this study also proposes an online framework using a subject-specific ICA model trained with an initial (alert) state to track the level of alertness. For classification of alert against drowsy states, the proposed online framework achieved an averaged area-under-curve of 0.745 and compared favorably with a classic power-based approach. Significance. This ICA-based framework provides a new way to study changes of brain states and can be applied to monitoring cognitive or mental states of human operators in attention-critical settings or in passive brain-computer interfaces.

  2. Noninvasive assessment of extracellular and intracellular dehydration in healthy humans using the resistance-reactance-score graph method.

    PubMed

    Heavens, Kristen R; Charkoudian, Nisha; O'Brien, Catherine; Kenefick, Robert W; Cheuvront, Samuel N

    2016-03-01

    Few dehydration assessment measures provide accurate information; most are based on reference change values and very few are diagnostically accurate from a single observation or measure. Bioelectrical impedance may lack the precision to detect common forms of dehydration in healthy individuals. Limitations in bioimpedance may be addressed by a unique resistance-reactance (RXc)-score graph method, which transforms vector components into z scores for use with any impedance analyzer in any population. We tested whether the RXc-score graph method provides accurate single or serial assessments of dehydration when compared with gold-standard measures of total body water by using stable isotope dilution (deuterium oxide) combined with body-weight changes. We retrospectively analyzed data from a previous study in which 9 healthy young men participated in 3 trials: euhydration (EUH), extracellular dehydration (ED; via a diuretic), and intracellular dehydration (ID; via exercise in the heat). Participants lost 4-5% of their body weight during the dehydration trials; volume loss was similar between trials (ID compared with ED group: 3.5 ± 0.8 compared with 3.0 ± 0.6 L; P > 0.05). Despite significant losses of body water, most RXc vector scores for ED and ID groups were classified as "normal" (within the 75% population tolerance ellipse). However, directional displacement of vectors was consistent with loss of volume in both ED and ID conditions compared with the EUH condition and tended to be longer in ED than in ID conditions (P = 0.054). We conclude that, whereas individual RXc-score graph values do not provide accurate detection of dehydration from single measurements, directional changes in vector values from serial measurements are consistent with fluid loss for both ED and ID conditions. The RXc-score graph method may therefore alert clinicians to changes in hydration state, which may bolster the interpretation of other recognized change measures of hydration. © 2016 American Society for Nutrition.

  3. Iron Deficiency (ID) at Both Birth and 9 Months Predicts Right Frontal EEG Asymmetry in Infancy

    PubMed Central

    Armony-Sivan, Rinat; Zhu, Bingquan; Clark, Katy M.; Richards, Blair; Ji, Chai; Kaciroti, Niko; Shao, Jie

    2016-01-01

    This study considered effects of timing and duration of iron deficiency (ID) on frontal EEG asymmetry in infancy. In healthy term Chinese infants, EEG was recorded at 9 months in three experimental conditions: baseline, peek-a-boo, and stranger approach. Eighty infants provided data for all conditions. Prenatal ID was defined as low cord ferritin or high ZPP/H. Postnatal ID was defined as ≥ two abnormal iron measures at 9 months. Study groups were pre- and postnatal ID, prenatal ID only, postnatal ID only, and not ID. GLM repeated measure analysis showed a main effect for iron group. The pre- and postnatal ID group had negative asymmetry scores, reflecting right frontal EEG asymmetry (mean ±SE: −.18 ±.07) versus prenatal ID only (.00 ±.04), postnatal ID only (.03 ±.04), and not ID (.02 ±.04). Thus, ID at both birth and 9 months was associated with right frontal EEG asymmetry, a neural correlate of behavioral withdrawal and negative emotions. PMID:26668100

  4. Neuropsychological Predictors of Everyday Functioning in Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Su, C. Y.; Chen, C. C.; Wuang, Y. P.; Lin, Y. H.; Wu, Y. Y.

    2008-01-01

    Background: Very little is known about the neuropsychological correlates of adaptive functioning in people with intellectual disabilities (ID). This study examined whether specific cognitive deficits and demographic variables predicted everyday functioning in adults with ID. Method: People with ID (n = 101; ages 19-41 years; mean education = 11…

  5. Correlation of the Hippocampal theta rhythm to changes in hypothalamic temperature

    NASA Technical Reports Server (NTRS)

    Saleh, M. A.; Horowitz, J. M.; Hsieh, A. C. L.

    1974-01-01

    Warming and cooling the preoptic anterior hypothalamic area in awake, loosely restrained rabbits was found to evoke theta rhythm. This is consistent with previous studies indicating that theta rhythm is a nonspecific response evoked by stimulation of several sensory modalities. Several studies have correlated theta rhythm with alertness. A neural pathway involving the hypothalamus, the hippocampus, the septal area, and the reticular formation is proposed. Thus, a role of this pathway may be to alert the animal to changes in its body temperature.

  6. Is there a link between the hospital-acquired injurious fall rates in US acute care hospitals and these institutions' implementation levels of computerized systems?

    PubMed

    Tzeng, Huey-Ming; Hu, Hsou Mei; Yin, Chang-Yi

    2011-12-01

    Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study's findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes.

  7. Behavior of Cackling Canada Geese during brood rearing

    USGS Publications Warehouse

    Fowler, Ada C.; Ely, Craig R.

    1997-01-01

    We studied behavior of Cackling Canada Goose (Branta canadensis minima, cacklers) broods between 1992 and 1996 on the Yukon Delta National Wildlife Refuge in western Alaska. An increase in time spent foraging by goslings during our study was weakly correlated with an increase in the size of the local breeding population. Amount of time spent feeding by adults and goslings increased throughout the brood rearing period. Overall, goslings spent more time feeding than either adult females or males, and adult males spent the most time alert. Time alert varied among brood rearing areas and increased with brood size, but there was no variation in time spent alert among years. Increases in feeding or alert behaviors were at a cost to time spent in all other behaviors. We suggest that there is not a simple trade-off between feeding and alert behavior in cacklers, but instead that time spent feeding and alert are optimized against all other behaviors. We suggest that forage quality and availability determines the amount of time spent feeding, whereas the threat of predation or disturbance determines the amount of time spent alert.

  8. The Relationships Between Paranormal Belief, Creationism, Intelligent Design and Evolution at Secondary Schools in Vienna (Austria)

    NASA Astrophysics Data System (ADS)

    Eder, Erich; Turic, Katharina; Milasowszky, Norbert; van Adzin, Katherine; Hergovich, Andreas

    2011-05-01

    The present study is the first to investigate the relationships between a multiple set of paranormal beliefs and the acceptance of evolution, creationism, and intelligent design, respectively, in Europe. Using a questionnaire, 2,129 students at secondary schools in Vienna (Austria) answered the 26 statements of the Revised Paranormal Belief Scale (R-PBS) and three statements about naturalistic evolution, creationism and intelligent design (ID). The investigated Austrian students showed an average R-PBS score of 82.08, more than 50% of them agreed with naturalistic evolution, 28% with creationism, and more than a third agreed with ID, the latter two closely correlated with each other. Females generally showed higher belief scores in the paranormal, creationism and ID. The agreement with naturalistic evolution correlated negatively with religious belief, but not with other paranormal beliefs, whereas the two non-scientific alternatives to evolution significantly correlated with both traditional and paranormal beliefs. Religious belief showed a significant positive correlation with other paranormal beliefs. All subscales of paranormal belief decreased during the eight grades of secondary school, as did acceptance of creationism and ID. However, the acceptance of naturalistic evolution did not correlate with age or grade. Possible reasons and implications for science education and the biology curriculum at Austrian secondary schools are discussed.

  9. Idiotype vaccination in patients with myeloma reduced circulating myeloma cells (CMC).

    PubMed

    Abdalla, A O; Kokhaei, P; Hansson, L; Mellstedt, H; Osterborg, A

    2008-06-01

    Circulating myeloma cells (CMC), exhibiting the same immunoglobulin heavy-chain gene rearrangements as the plasma cells, are part of the myeloma clone. In this study, we evaluated the effect of idiotype (Id) vaccination on CMC. Eleven patients were immunized with the autologous Id in combinations with granulocyte-macrophage colony-stimulating factor and interleukin 12, and followed for CMC by quantitative real-time allele-specific PCR. Id-specific T cells were monitored by proliferation assay, enzyme-linked immunospot (interferon-gamma) assay, and quantitative real-time PCR for cytokines. Regulatory T (T(reg)) cells were analyzed by flow cytometry. CMC were detected in 9 of 11 patients at start of vaccination. In four patients, CMC declined and two had a complete molecular remission. Further two patients had stable levels of CMC during follow-up, while in three patients CMC progressively increased. Six patients had a vaccine-induced Id-specific T-cell response. A significant correlation was observed between reduced/stable levels of CMC and the Id-specific T cells (P < 0.02). The frequency of T(reg) cells was decreased in immune responders, but increased in immune nonresponders (P < 0.05). No significant change in the serum M-protein concentration was, however, observed in any patient. Id vaccination reduced CMC, which correlated with vaccine-induced Id-specific T cells. Further studies are warranted to analyze the clinical significance of CMC and clinical effects of Id vaccination.

  10. Relationships between coordination, active drag and propelling efficiency in crawl.

    PubMed

    Seifert, Ludovic; Schnitzler, Christophe; Bideault, Gautier; Alberty, Morgan; Chollet, Didier; Toussaint, Huub Martin

    2015-02-01

    This study examines the relationships between the index of coordination (IdC) and active drag (D) assuming that at constant average speed, average drag equals average propulsion. The relationship between IdC and propulsive efficiency (ep) was also investigated at maximal speed. Twenty national swimmers completed two incremental speed tests swimming front crawl with arms only in free condition and using a measurement of active drag system. Each test was composed of eight 25-m bouts from 60% to 100% of maximal intensity whereby each lap was swum at constant speed. Different regression models were tested to analyse IdC-D relationship. Correlation between IdC and ep was calculated. IdC was linked to D by linear regression (IdC=0.246·D-27.06; R(2)=0.88, P<.05); swimmers switched from catch-up to superposition coordination mode at a speed of ∼1.55ms(-1) where average D is ∼110N. No correlation between IdC and ep at maximal speed was found. The intra-individual analysis revealed that coordination plays an important role in scaling propulsive forces with higher speed levels such that these are adapted to aquatic resistance. Inter-individual analysis showed that high IdC did not relate to a high ep suggesting an individual optimization of force and power generation is at play to reach high speeds. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Autoblocker: a system for detecting and blocking of network scanning based on analysis of netflow data

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

    Bobyshev, A.; Lamore, D.; Demar, P.

    2004-12-01

    In a large campus network, such at Fermilab, with tens of thousands of nodes, scanning initiated from either outside of or within the campus network raises security concerns. This scanning may have very serious impact on network performance, and even disrupt normal operation of many services. In this paper we introduce a system for detecting and automatic blocking excessive traffic of different kinds of scanning, DoS attacks, virus infected computers. The system, called AutoBlocker, is a distributed computing system based on quasi-real time analysis of network flow data collected from the border router and core switches. AutoBlocker also has anmore » interface to accept alerts from IDS systems (e.g. BRO, SNORT) that are based on other technologies. The system has multiple configurable alert levels for the detection of anomalous behavior and configurable trigger criteria for automated blocking of scans at the core or border routers. It has been in use at Fermilab for about 2 years, and has become a very valuable tool to curtail scan activity within the Fermilab campus network.« less

  12. Police as contributors to Healthy Communities: Aiken, South Carolina.

    PubMed

    Frommer, P; Papouchado, K

    2000-01-01

    In Aiken, South Carolina, community policing has led to numerous innovative programs that have contributed to a healthy community. The MOMS and COPS (Managing Our Maternity System with Community Oriented Policing System) program has played a significant part in the county's 50% decrease in infant mortality since 1989 and contributed to Aiken's designation as an All-America City in 1997. Other programs include a mentoring program for at-risk teen girls; instant crime reporting with donated cellular phones; seminars for seniors to alert them to scams and common crimes; demolition of unsafe homes; free installation of smoke detectors; a child ID program; and parental education on child brain development.

  13. Structure-property and composition-property relationships for poly(ethylene terephthalate) surfaces modified by helium plasma-based ion implantation

    NASA Astrophysics Data System (ADS)

    Tóth, A.; Veres, M.; Kereszturi, K.; Mohai, M.; Bertóti, I.; Szépvölgyi, J.

    2011-10-01

    The surfaces of untreated and helium plasma-based ion implantation (He PBII) treated poly(ethylene terephthalate) (PET) samples were characterised by reflectance colorimetry, contact angle studies and measurements of surface electrical resistance. The results were related to the structural and compositional data obtained by the authors earlier on parallel samples by XPS and Raman spectroscopy. Inverse correlations between lightness and ID/ IG ratio and between chroma and ID/ IG ratio were obtained, suggesting that the PBII-treated PET samples darken and their colourfulness decreases with the increase of the portion of aromatic sp 2 carbon rings in the chemical structure of the modified layer. Direct correlation between water contact angle and the ID/ IG ratio and inverse correlations between surface energy and ID/ IG ratio and between dispersive component of surface energy and ID/ IG ratio were found, reflecting that surface wettability, surface energy and its dispersive component decrease with the formation of surface structure, characterised again by enhanced portion of aromatic sp 2 carbon rings. The surface electrical resistance decreased with the increase of the surface C-content determined by XPS and also with the increase of the surface concentration of conjugated double bonds, reflected by the increase of the π → π* shake-up satellite of the C 1s peak.

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

    Gustafsson, Helena; Runesson, Johan; Lundqvist, Jessica

    The objective of the EU-funded integrated project ACuteTox is to develop a strategy in which general cytotoxicity, together with organ-specific toxicity and biokinetic features, are used for the estimation of human acute systemic toxicity. Our role in the project is to characterise the effect of reference chemicals with regard to neurotoxicity. We studied cell membrane potential (CMP), noradrenalin (NA) uptake, acetylcholine esterase (AChE) activity, acetylcholine receptor (AChR) signalling and voltage-operated calcium channel (VOCC) function in human neuroblastoma SH-SY5Y cells after exposure to 23 pharmaceuticals, pesticides or industrial chemicals. Neurotoxic alert chemicals were identified by comparing the obtained data with cytotoxicitymore » data from the neutral red uptake assay in 3T3 mouse fibroblasts. Furthermore, neurotoxic concentrations were correlated with estimated human lethal blood concentrations (LC50). The CMP assay was the most sensitive assay, identifying eight chemicals as neurotoxic alerts and improving the LC50 correlation for nicotine, lindane, atropine and methadone. The NA uptake assay identified five neurotoxic alert chemicals and improved the LC50 correlation for atropine, diazepam, verapamil and methadone. The AChE, AChR and VOCC assays showed limited potential for detection of acute toxicity. The CMP assay was further evaluated by testing 36 additional reference chemicals. Five neurotoxic alert chemicals were generated and orphendrine and amitriptyline showed improved LC50 correlation. Due to the high sensitivity and the simplicity of the test protocol, the CMP assay constitutes a good candidate assay to be included in an in vitro test strategy for prediction of acute systemic toxicity.« less

  15. Collaborative knowledge acquisition for the design of context-aware alert systems.

    PubMed

    Joffe, Erel; Havakuk, Ofer; Herskovic, Jorge R; Patel, Vimla L; Bernstam, Elmer Victor

    2012-01-01

    To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts. Five internal medicine residents reviewed 18 anemia alerts, while 'talking aloud'. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set. Two staff internists assigned an alert level, etiology and treatment recommendation before and after reviewing the entire electronic medical record. The training set of 118 cases (100 plus 18) and the test set of 82 cases were explored using RIDOR and JRip algorithms. The feature set was sufficient to assess 93% of anemia cases (intraclass correlation for alert level before and after review of the records by internists 1 and 2 were 0.92 and 0.95, respectively). High-precision classifiers were constructed to identify low-level alerts (precision p=0.87, recall R=0.4), iron deficiency (p=1.0, R=0.73), and anemia associated with kidney disease (p=0.87, R=0.77). It was possible to identify low-level alerts and several conditions commonly associated with chronic anemia. This approach may reduce the number of clinically unimportant alerts. The study was limited to anemia alerts. Furthermore, clinicians were aware of the study hypotheses potentially biasing their evaluation. Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules.

  16. Alert-QSAR. Implications for Electrophilic Theory of Chemical Carcinogenesis

    PubMed Central

    Putz, Mihai V.; Ionaşcu, Cosmin; Putz, Ana-Maria; Ostafe, Vasile

    2011-01-01

    Given the modeling and predictive abilities of quantitative structure activity relationships (QSARs) for genotoxic carcinogens or mutagens that directly affect DNA, the present research investigates structural alert (SA) intermediate-predicted correlations ASA of electrophilic molecular structures with observed carcinogenic potencies in rats (observed activity, A = Log[1/TD50], i.e., ASA=f(X1SA,X2SA,…)). The present method includes calculation of the recently developed residual correlation of the structural alert models, i.e., ARASA=f(A−ASA,X1SA,X2SA,…). We propose a specific electrophilic ligand-receptor mechanism that combines electronegativity with chemical hardness-associated frontier principles, equality of ligand-reagent electronegativities and ligand maximum chemical hardness for highly diverse toxic molecules against specific receptors in rats. The observed carcinogenic activity is influenced by the induced SA-mutagenic intermediate effect, alongside Hansch indices such as hydrophobicity (LogP), polarizability (POL) and total energy (Etot), which account for molecular membrane diffusion, ionic deformation, and stericity, respectively. A possible QSAR mechanistic interpretation of mutagenicity as the first step in genotoxic carcinogenesis development is discussed using the structural alert chemoinformation and in full accordance with the Organization for Economic Co-operation and Development QSAR guidance principles. PMID:21954348

  17. Characterization of computer network events through simultaneous feature selection and clustering of intrusion alerts

    NASA Astrophysics Data System (ADS)

    Chen, Siyue; Leung, Henry; Dondo, Maxwell

    2014-05-01

    As computer network security threats increase, many organizations implement multiple Network Intrusion Detection Systems (NIDS) to maximize the likelihood of intrusion detection and provide a comprehensive understanding of intrusion activities. However, NIDS trigger a massive number of alerts on a daily basis. This can be overwhelming for computer network security analysts since it is a slow and tedious process to manually analyse each alert produced. Thus, automated and intelligent clustering of alerts is important to reveal the structural correlation of events by grouping alerts with common features. As the nature of computer network attacks, and therefore alerts, is not known in advance, unsupervised alert clustering is a promising approach to achieve this goal. We propose a joint optimization technique for feature selection and clustering to aggregate similar alerts and to reduce the number of alerts that analysts have to handle individually. More precisely, each identified feature is assigned a binary value, which reflects the feature's saliency. This value is treated as a hidden variable and incorporated into a likelihood function for clustering. Since computing the optimal solution of the likelihood function directly is analytically intractable, we use the Expectation-Maximisation (EM) algorithm to iteratively update the hidden variable and use it to maximize the expected likelihood. Our empirical results, using a labelled Defense Advanced Research Projects Agency (DARPA) 2000 reference dataset, show that the proposed method gives better results than the EM clustering without feature selection in terms of the clustering accuracy.

  18. Special Issue: Tenth International Conference on Finite Elements in Fluids, Tucson, Arizona.Copyright © 1999 John Wiley & Sons, Ltd.Save Title to My Profile

    E-MailPrint

    Volume 31, Issue 1, Pages 1-406(15 September 1999)

    Preface

    Preface

    NASA Astrophysics Data System (ADS)

    Oden, J. T.; Prudhomme, S.

    1999-09-01

    We present a new approach to deliver reliable approximations of the norm of the residuals resulting from finite element solutions to the Stokes and Oseen equations. The method is based upon a global solve in a bubble space using iterative techniques. This provides an alternative to the classical equilibrated element residual methods for which it is necessary to construct proper boundary conditions for each local problem. The method is first used to develop a global a posteriori error estimator. It is then applied in a strategy to control the numerical error in specific outputs or quantities of interest which are functions of the solutions to the Stokes and Oseen equations. Copyright

  19. Special Issue: Very large eddy simulation. Issue Edited by Dimitris Drikakis.Copyright © 2002 John Wiley & Sons, Ltd.Save Title to My Profile

    E-MailPrint

    Volume 39, Issue 9, Pages 763-864(30 July 2002)

    Research Article

    Embedded turbulence model in numerical methods for hyperbolic conservation laws

    NASA Astrophysics Data System (ADS)

    Drikakis, D.

    2002-07-01

    The paper describes the use of numerical methods for hyperbolic conservation laws as an embedded turbulence modelling approach. Different Godunov-type schemes are utilized in computations of Burgers' turbulence and a two-dimensional mixing layer. The schemes include a total variation diminishing, characteristic-based scheme which is developed in this paper using the flux limiter approach. The embedded turbulence modelling property of the above methods is demonstrated through coarsely resolved large eddy simulations with and without subgrid scale models. Copyright

  20. Cross-cultural adaptation, reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI).

    PubMed

    Ko, Jupil; Rosen, Adam B; Brown, Cathleen N

    2017-09-12

    To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants. The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers. Intra-class correlation coefficients (ICC 2,1 ) between the English and Korean versions of the IdFAI for test-retest reliability was 0.98 (standard error of measurement = 1.41). The Cronbach's alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r s  = -0.69, p < .001) and the Korean version of the Cumberland Ankle Instability Tool (r s  = -0.65, p < .001). The cutoff score of >10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91. The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations. Implications for rehabilitation The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI). The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI). The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

  1. Human Identification by Cross-Correlation and Pattern Matching of Personalized Heartbeat: Influence of ECG Leads and Reference Database Size.

    PubMed

    Jekova, Irena; Krasteva, Vessela; Schmid, Ramun

    2018-01-27

    Human identification (ID) is a biometric task, comparing single input sample to many stored templates to identify an individual in a reference database. This paper aims to present the perspectives of personalized heartbeat pattern for reliable ECG-based identification. The investigations are using a database with 460 pairs of 12-lead resting electrocardiograms (ECG) with 10-s durations recorded at time-instants T1 and T2 > T1 + 1 year. Intra-subject long-term ECG stability and inter-subject variability of personalized PQRST (500 ms) and QRS (100 ms) patterns is quantified via cross-correlation, amplitude ratio and pattern matching between T1 and T2 using 7 features × 12-leads. Single and multi-lead ID models are trained on the first 230 ECG pairs. Their validation on 10, 20, ... 230 reference subjects (RS) from the remaining 230 ECG pairs shows: (i) two best single-lead ID models using lead II for a small population RS = (10-140) with identification accuracy AccID = (89.4-67.2)% and aVF for a large population RS = (140-230) with AccID = (67.2-63.9)%; (ii) better performance of the 6-lead limb vs. the 6-lead chest ID model-(91.4-76.1)% vs. (90.9-70)% for RS = (10-230); (iii) best performance of the 12-lead ID model-(98.4-87.4)% for RS = (10-230). The tolerable reference database size, keeping AccID > 80%, is RS = 30 in the single-lead ID scenario (II); RS = 50 (6 chest leads); RS = 100 (6 limb leads), RS > 230-maximal population in this study (12-lead ECG).

  2. Gender difference of serum angiotensin-converting enzyme (ACE) activity in DD genotype of ACE insertion/deletion polymorphism in elderly Chinese.

    PubMed

    Zhang, Ya-Feng; Cheng, Qiong; Tang, Nelson L S; Chu, Tanya T W; Tomlinson, Brian; Liu, Fan; Kwok, Timothy C Y

    2014-12-01

    In this study we investigated the gender difference of serum angiotensin-converting enzyme (ACE) activity in a population of Hong Kong-dwelling elderly Chinese. A total of 1767 (843 male, 924 female) Hong Kong-dwelling elderly Chinese were recruited. ACE I/D genotypes were identified by polymerase chain reaction amplification and serum ACE activity was determined using a commercially available kinetic kit. ACE I/D genotype distribution was compared by chi-square test, the correlation between ACE I/D polymorphism and serum ACE activity was analysed by ANOVA test and gender difference of serum ACE activity of different genotypes was compared by independent sample t-test. No statistically significant difference of genotype distribution between male and female subjects was found. Serum ACE activity was significantly correlated with ACE genotype. Overall, there was no gender difference of serum ACE activity; however, when sub-grouping the subjects by ACE I/D genotype, male subjects with DD genotype had higher serum ACE activity than female subjects with DD genotype. No significant gender difference of genotype distribution was found in elderly Chinese. Serum ACE activity was significantly correlated with ACE I/D polymorphism in elderly Chinese. Male subjects with DD genotype had higher serum ACE activity than female subjects with DD genotype. © The Author(s) 2013.

  3. Psychometrics and latent structure of the IDS and QIDS with young adult students.

    PubMed

    González, David Andrés; Boals, Adriel; Jenkins, Sharon Rae; Schuler, Eric R; Taylor, Daniel

    2013-07-01

    Students and young adults have high rates of suicide and depression, thus are a population of interest. To date, there is no normative psychometric information on the IDS and QIDS in these populations. Furthermore, there is equivocal evidence on the factor structure and subscales of the IDS. Two samples of young adult students (ns=475 and 1681) were given multiple measures to test the psychometrics and dimensionality of the IDS and QIDS. The IDS, its subscales, and QIDS had acceptable internal consistencies (αs=.79-90) and favorable convergent and divergent validity correlations. A three-factor structure and two Rasch-derived subscales best fit the IDS. The samples were collected from one university, which may influence generalizability. The IDS and QIDS are desirable measures of depressive symptoms when studying young adult students. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Prevalence of intellectual disabilities in Norway: Domestic variance.

    PubMed

    Søndenaa, E; Rasmussen, K; Nøttestad, J A; Lauvrud, C

    2010-02-01

    Based on national registers, the prevalence of intellectual disability (ID) in Norway is estimated to be 0.44 per 100 inhabitants. This study aimed to examine geographic and urban-rural differences in the prevalence of ID in Norway. Methods A survey based on the national register. Financial transfers intended to provide equal services to people with ID are based on these reports. Results A higher prevalence was found in the North region of Norway. A negative correlation between the population density and the prevalence of ID was also found. Conclusion There was considerable geographic and urban-rural differences in the prevalence of ID, which may be attributable to not only the large diversity of services, but also some other factors. The results were discussed with respect to the deinstitutionalisation progress, resource-intensive services and costs. Differences also reflect some problems in diagnosing ID in people having mild ID.

  5. Chromosomal microarray analysis in developmental delay and intellectual disability with comorbid conditions.

    PubMed

    Fan, Yanjie; Wu, Yanming; Wang, Lili; Wang, Yu; Gong, Zhuwen; Qiu, Wenjuan; Wang, Jingmin; Zhang, Huiwen; Ji, Xing; Ye, Jun; Han, Lianshu; Jin, Xingming; Shen, Yongnian; Li, Fei; Xiao, Bing; Liang, Lili; Zhang, Xia; Liu, Xiaomin; Gu, Xuefan; Yu, Yongguo

    2018-05-24

    Developmental delay (DD) and intellectual disability (ID) are frequently associated with a broad spectrum of additional phenotypes. Chromosomal microarray analysis (CMA) has been recommended as a first-tier test for DD/ID in general, whereas the diagnostic yield differs significantly among DD/ID patients with different comorbid conditions. To investigate the genotype-phenotype correlation, we examined the characteristics of identified pathogenic copy number variations (pCNVs) and compared the diagnostic yields among patient subgroups with different co-occurring conditions. This study is a retrospective review of CMA results generated from a mixed cohort of 710 Chinese patients with DD/ID. A total of 247 pCNVs were identified in 201 patients (28%). A large portion of these pCNVs were copy number losses, and the size of copy number losses was generally smaller than gains. The diagnostic yields were significantly higher in subgroups with co-occurring congenital heart defects (55%), facial dysmorphism (39%), microcephaly (34%) or hypotonia (35%), whereas co-occurring conditions of skeletal malformation (26%), brain malformation (24%) or epilepsy (24%) did not alter the yield. In addition, the diagnostic yield nominally correlated with ID severity. Varied yields exist in DD/ID patients with different phenotypic presentation. The presence of comorbid conditions can be among factors to consider when planning CMA.

  6. Fungible Correlation Matrices: A Method for Generating Nonsingular, Singular, and Improper Correlation Matrices for Monte Carlo Research.

    PubMed

    Waller, Niels G

    2016-01-01

    For a fixed set of standardized regression coefficients and a fixed coefficient of determination (R-squared), an infinite number of predictor correlation matrices will satisfy the implied quadratic form. I call such matrices fungible correlation matrices. In this article, I describe an algorithm for generating positive definite (PD), positive semidefinite (PSD), or indefinite (ID) fungible correlation matrices that have a random or fixed smallest eigenvalue. The underlying equations of this algorithm are reviewed from both algebraic and geometric perspectives. Two simulation studies illustrate that fungible correlation matrices can be profitably used in Monte Carlo research. The first study uses PD fungible correlation matrices to compare penalized regression algorithms. The second study uses ID fungible correlation matrices to compare matrix-smoothing algorithms. R code for generating fungible correlation matrices is presented in the supplemental materials.

  7. Collaborative knowledge acquisition for the design of context-aware alert systems

    PubMed Central

    Joffe, Erel; Havakuk, Ofer; Herskovic, Jorge R; Patel, Vimla L

    2012-01-01

    Objective To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts. Materials and Methods Five internal medicine residents reviewed 18 anemia alerts, while ‘talking aloud’. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set. Two staff internists assigned an alert level, etiology and treatment recommendation before and after reviewing the entire electronic medical record. The training set of 118 cases (100 plus 18) and the test set of 82 cases were explored using RIDOR and JRip algorithms. Results The feature set was sufficient to assess 93% of anemia cases (intraclass correlation for alert level before and after review of the records by internists 1 and 2 were 0.92 and 0.95, respectively). High-precision classifiers were constructed to identify low-level alerts (precision p=0.87, recall R=0.4), iron deficiency (p=1.0, R=0.73), and anemia associated with kidney disease (p=0.87, R=0.77). Discussion It was possible to identify low-level alerts and several conditions commonly associated with chronic anemia. This approach may reduce the number of clinically unimportant alerts. The study was limited to anemia alerts. Furthermore, clinicians were aware of the study hypotheses potentially biasing their evaluation. Conclusion Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules. PMID:22744961

  8. Downregulation of Id1 by small interfering RNA in gastric cancer inhibits cell growth via the Akt pathway

    PubMed Central

    YANG, GUANG; ZHANG, YAN; XIONG, JIANJUN; WU, JING; YANG, CHANGFU; HUANG, HONGBING; ZHU, ZHENYU

    2012-01-01

    Inhibitor of differentiation or DNA binding (Id1) is a member of the helix-loop-helix transcription factor family that is overexpressed in various types of cancer, including gastric carcinoma. Previous studies showed that Id1 is a prognostic marker in patients with gastric cancer. However, the role of Id1 in the proliferation of human gastric cancer cells has yet to be clarified. In the present study, we downregulated the Id1 gene in SGC-7901 gastric cancer cells by RNA interference, and we also constructed a recombinant plasmid-expressing Id1 to investigate its effects on the proliferation of SGC-7901 cells. Results showed that the downregulation of Id1 inhibited proliferation of SGC-7901 cells, while the upregulation of Id1 had no effect on SGC-7901 cell proliferation. The potential mechanism was also investigated. The changes of certain proteins associated with cell proliferation, apoptosis and the cell cycle were detected by western blotting. Furthermore, we demonstrated a positive correlation between Id1 and phospho-Akt expression in SGC-7901 cells. PMID:22245935

  9. Displacement of mandibular fractures: is there a correlation with sensory loss and recovery?

    PubMed

    Scott, R A; Teo, N; Perry, M

    2014-05-01

    Fractures of the mandible are common. However, the correlation between the severity of the fracture and the recovery of any associated inferior dental (ID) nerve injury is still poorly understood. We aimed to examine the relationship between the amount of fracture displacement and how it relates to the recovery of sensation to the lower lip. One hundred and fifty patients requiring treatment of a mandibular fracture (where the fracture passed across the ID canal) were assessed. One hundred were initially assessed in a retrospective double-blinded study. A further 50 patients were then followed up prospectively. Both the maximal displacement of the fracture and the displacement specifically at the ID canal were measured. Sensory recovery, or persistence of numbness, was also recorded for each patient. Although there appeared to be a correlation between increasing displacement at the ID canal and a poorer recovery, there was not a clear relationship between the two, and there were many exceptions. Persistent numbness (>1 year) still occurred in fractures with relatively minimal displacement (≤3mm). Possible reasons for persistent numbness are discussed. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  10. See Also:physica status solidi (a)physica status solidi (c)Copyright © 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

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  1. Comparison of Measures of Ability in Adolescents with Intellectual Disability.

    PubMed

    Mungkhetklang, Chantanee; Crewther, Sheila G; Bavin, Edith L; Goharpey, Nahal; Parsons, Carl

    2016-01-01

    Finding the most appropriate intelligence test for adolescents with Intellectual Disability (ID) is challenging given their limited language, attention, perceptual, and motor skills and ability to stay on task. The study compared performance of 23 adolescents with ID on the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), one of the most widely used intelligence tests, and three non-verbal IQ tests, the Raven's Colored Progressive Matrices (RCPM), the Test of Non-verbal Intelligence-Fourth Edition and the Wechsler Non-verbal test of Ability. Results showed that the WISC-IV Full Scale IQ raw and scaled scores were highly correlated with total scores from the three non-verbal tests, although the correlations were higher for raw scores, suggesting they may lead to better understanding of within group differences and what individuals with ID can do at the time of assessment. All participants attempted more questions on the non-verbal tests than the verbal. A preliminary analysis showed that adolescents with ID without ASD (n = 15) achieved higher scores overall than those presenting with ID+ASD (n = 8). Our findings support the view that short non-verbal tests are more likely to give a similar IQ result as obtained from the WISC-IV. In terms of the time to administer and the stress for participants, they are more appropriate for assessing adolescents with ID.

  2. Prognostic stratification improvement by integrating ID1/ID3/IGJ gene expression signature and immunophenotypic profile in adult patients with B-ALL.

    PubMed

    Cruz-Rodriguez, Nataly; Combita, Alba L; Enciso, Leonardo J; Raney, Lauren F; Pinzon, Paula L; Lozano, Olga C; Campos, Alba M; Peñaloza, Niyireth; Solano, Julio; Herrera, Maria V; Zabaleta, Jovanny; Quijano, Sandra

    2017-02-28

    Survival of adults with B-Acute Lymphoblastic Leukemia requires accurate risk stratification of patients in order to provide the appropriate therapy. Contemporary techniques, using clinical and cytogenetic variables are incomplete for prognosis prediction. To improve the classification of adult patients diagnosed with B-ALL into prognosis groups, two strategies were examined and combined: the expression of the ID1/ID3/IGJ gene signature by RT-PCR and the immunophenotypic profile of 19 markers proposed in the EuroFlow protocol by Flow Cytometry in bone marrow samples. Both techniques were correlated to stratify patients into prognostic groups. An inverse relationship between survival and expression of the three-genes signature was observed and an immunophenotypic profile associated with clinical outcome was identified. Markers CD10 and CD20 were correlated with simultaneous overexpression of ID1, ID3 and IGJ. Patients with simultaneous expression of the poor prognosis gene signature and overexpression of CD10 or CD20, had worse Event Free Survival and Overall Survival than patients who had either the poor prognosis gene expression signature or only CD20 or CD10 overexpressed. By utilizing the combined evaluation of these two immunophenotypic markers along with the poor prognosis gene expression signature, the risk stratification can be significantly strengthened. Further studies including a large number of patients are needed to confirm these findings.

  3. Evaluating the Intoxicating Degree of Liquor Products with Combinations of Fusel Alcohols, Acids, and Esters.

    PubMed

    Xie, Jia; Tian, Xiao-Fei; He, Song-Gui; Wei, Yun-Lu; Peng, Bin; Wu, Zhen-Qiang

    2018-05-23

    To investigate the effects of fusel alcohols on the intoxicating degree of liquor products, formulated liquors (FLs) were prepared by blending 1-propanol, isobutanol, and isoamyl alcohol with ethanol, organic acids, and corresponding ethyl esters to simulate the formula of traditional Chinese liquors. The prepared FLs were submitted for evaluation of their intoxicating degree (ID). The results showed that the fusel alcohols had a biphasic effect on the IDs of the FLs, depending on the comprehensive coordination of the characteristic minor components. The importance of the suitable ratio of alcohols/acids/esters (RAAE) on the IDs was also revealed. Under an optimal ratio level, the fusel alcohols exhibited negligible effects on the IDs of the FLs. Moreover, the ratio of isoamyl alcohol to isobutanol (IA/IB) showed a strong positive correlation to the IDs of the FLs. This study lays a foundation for the potential application in producing low-ID liquor.

  4. A New Module in Neural Differentiation Control: Two MicroRNAs Upregulated by Retinoic Acid, miR-9 and -103, Target the Differentiation Inhibitor ID2

    PubMed Central

    Savino, Mauro; Laneve, Pietro; Caffarelli, Elisa; Nasi, Sergio

    2012-01-01

    The transcription factor ID2 is an important repressor of neural differentiation strongly implicated in nervous system cancers. MicroRNAs (miRNAs) are increasingly involved in differentiation control and cancer development. Here we show that two miRNAs upregulated on differentiation of neuroblastoma cells – miR-9 and miR-103 – restrain ID2 expression by directly targeting the coding sequence and 3′ untranslated region of the ID2 encoding messenger RNA, respectively. Notably, the two miRNAs show an inverse correlation with ID2 during neuroblastoma cell differentiation induced by retinoic acid. Overexpression of miR-9 and miR-103 in neuroblastoma cells reduces proliferation and promotes differentiation, as it was shown to occur upon ID2 inhibition. Conversely, an ID2 mutant that cannot be targeted by either miRNA prevents retinoic acid-induced differentiation more efficient than wild-type ID2. These findings reveal a new regulatory module involving two microRNAs upregulated during neural differentiation that directly target expression of the key differentiation inhibitor ID2, suggesting that its alteration may be involved in neural cancer development. PMID:22848373

  5. A new module in neural differentiation control: two microRNAs upregulated by retinoic acid, miR-9 and -103, target the differentiation inhibitor ID2.

    PubMed

    Annibali, Daniela; Gioia, Ubaldo; Savino, Mauro; Laneve, Pietro; Caffarelli, Elisa; Nasi, Sergio

    2012-01-01

    The transcription factor ID2 is an important repressor of neural differentiation strongly implicated in nervous system cancers. MicroRNAs (miRNAs) are increasingly involved in differentiation control and cancer development. Here we show that two miRNAs upregulated on differentiation of neuroblastoma cells--miR-9 and miR-103--restrain ID2 expression by directly targeting the coding sequence and 3' untranslated region of the ID2 encoding messenger RNA, respectively. Notably, the two miRNAs show an inverse correlation with ID2 during neuroblastoma cell differentiation induced by retinoic acid. Overexpression of miR-9 and miR-103 in neuroblastoma cells reduces proliferation and promotes differentiation, as it was shown to occur upon ID2 inhibition. Conversely, an ID2 mutant that cannot be targeted by either miRNA prevents retinoic acid-induced differentiation more efficient than wild-type ID2. These findings reveal a new regulatory module involving two microRNAs upregulated during neural differentiation that directly target expression of the key differentiation inhibitor ID2, suggesting that its alteration may be involved in neural cancer development.

  6. Neural Network Based Intrusion Detection System for Critical Infrastructures

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

    Todd Vollmer; Ondrej Linda; Milos Manic

    2009-07-01

    Resiliency and security in control systems such as SCADA and Nuclear plant’s in today’s world of hackers and malware are a relevant concern. Computer systems used within critical infrastructures to control physical functions are not immune to the threat of cyber attacks and may be potentially vulnerable. Tailoring an intrusion detection system to the specifics of critical infrastructures can significantly improve the security of such systems. The IDS-NNM – Intrusion Detection System using Neural Network based Modeling, is presented in this paper. The main contributions of this work are: 1) the use and analyses of real network data (data recordedmore » from an existing critical infrastructure); 2) the development of a specific window based feature extraction technique; 3) the construction of training dataset using randomly generated intrusion vectors; 4) the use of a combination of two neural network learning algorithms – the Error-Back Propagation and Levenberg-Marquardt, for normal behavior modeling. The presented algorithm was evaluated on previously unseen network data. The IDS-NNM algorithm proved to be capable of capturing all intrusion attempts presented in the network communication while not generating any false alerts.« less

  7. Decreased functional connectivity and structural deficit in alertness network with right-sided temporal lobe epilepsy.

    PubMed

    Gao, Yujun; Zheng, Jinou; Li, Yaping; Guo, Danni; Wang, Mingli; Cui, Xiangxiang; Ye, Wei

    2018-04-01

    Patients with temporal lobe epilepsy (TLE) often suffer from alertness alterations. However, specific regions connected with alertness remain controversial, and whether these regions have structural impairment is also elusive. This study aimed to investigate the characteristics and neural mechanisms underlying the functions and structures of alertness network in patients with right-sided temporal lobe epilepsy (rTLE) by performing the attentional network test (ANT), resting-state functional magnetic resonance imaging (R-SfMRI), and diffusion tensor imaging (DTI).A total of 47 patients with rTLE and 34 healthy controls underwent ANT, R-SfMRI, and DTI scan. The seed-based functional connectivity (FC) method and deterministic tractography were used to analyze the data.Patients with rTLE had longer reaction times in the no-cue and double-cue conditions. However, no differences were noted in the alertness effect between the 2 groups. The patient group had lower FC compared with the control group in the right inferior parietal lobe (IPL), amygdala, and insula. Structural deficits were found in the right parahippocampal gyrus, superior temporal pole, insula, and amygdala in the patient group compared with the control group. Also significantly negative correlations were observed between abnormal fractional anisotropy (between the right insula and the superior temporal pole) and illness duration in the patients with rTLE.The findings of this study suggested abnormal intrinsic and phasic alertness, decreased FC, and structural deficits within the alerting network in the rTLE. This study provided new insights into the mechanisms of alertness alterations in rTLE.

  8. EEG quantification of alertness: methods for early identification of individuals most susceptible to sleep deprivation

    NASA Astrophysics Data System (ADS)

    Berka, Chris; Levendowski, Daniel J.; Westbrook, Philip; Davis, Gene; Lumicao, Michelle N.; Olmstead, Richard E.; Popovic, Miodrag; Zivkovic, Vladimir T.; Ramsey, Caitlin K.

    2005-05-01

    Electroencephalographic (EEG) and neurocognitive measures were simultaneously acquired to quantify alertness from 24 participants during 44-hours of sleep deprivation. Performance on a three-choice vigilance task (3C-VT), paired-associate learning/memory task (PAL) and modified Maintenance of Wakefulness Test (MWT), and sleep technician-observed drowsiness (eye-closures, head-nods, EEG slowing) were quantified. The B-Alert system automatically classifies each second of EEG on an alertness/drowsiness continuum. B-Alert classifications were significantly correlated with technician-observations, visually scored EEG and performance measures. B-Alert classifications during 3C-VT, and technician observations and performance during the 3C-VT and PAL evidenced progressively increasing drowsiness as a result of sleep deprivation with a stabilizing effect observed at the batteries occurring between 0600 and 1100 suggesting a possible circadian effect similar to those reported in previous sleep deprivation studies. Participants were given an opportunity to take a 40-minute nap approximately 24-hours into the sleep deprivation portion of the study (i.e., 7 PM on Saturday). The nap was followed by a transient period of increased alertness. Approximately 8 hours after the nap, behavioral and physiological measures of drowsiness returned to levels prior to the nap. Cluster analysis was used to stratify individuals into three groups based on their level of impairment as a result of sleep deprivation. The combination of B-Alert and neuro-behavioral measures may identify individuals whose performance is most susceptible to sleep deprivation. These objective measures could be applied in an operational setting to provide a "biobehavioral assay" to determine vulnerability to sleep deprivation.

  9. Prevalence and correlates of bullying perpetration and victimization among school-aged youth with intellectual disabilities: A systematic review.

    PubMed

    Maïano, Christophe; Aimé, Annie; Salvas, Marie-Claude; Morin, Alexandre J S; Normand, Claude L

    2016-01-01

    Recent literature reviews show that bullying perpetration and victimization are major public health concerns for typically developing (TD) youth. Nevertheless, the magnitude of this phenomenon among youth with intellectual disabilities (ID) remains unclear. Therefore, the purpose of this review is to provide a synthesis of the empirical studies examining the prevalence and correlates of bullying perpetration and victimization among youth with ID. A systematic literature search was performed and 11 studies met the inclusion criteria. The findings from these studies showed weighted mean prevalence rates of general bullying perpetration, bullying victimization and both of 15.1%, 36.3%, and 25.2%, respectively. Weighted mean prevalence rates of bullying perpetration and victimization differed according to the characteristics of the studies (e.g., assessment context, school setting, information source, type of measures, time frame). Additionally, high weighted mean prevalence rates of physical (33.3%), verbal (50.2%), relational (37.4%), and cyber (38.3%) victimization were found among youth with ID. When youth with ID were compared to youth with other disabilities or TD peers, no clear differences were found. Finally, the present review shows that correlates of bullying perpetration and victimization in this population remain understudied. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Self-injury and aggression in adults with tuberous sclerosis complex: Frequency, associated person characteristics, and implications for assessment.

    PubMed

    Wilde, Lucy; Eden, Kate; de Vries, Petrus; Moss, Jo; Welham, Alice; Oliver, Chris

    2017-05-01

    Even though self-injury and aggression are common in tuberous sclerosis complex (TSC), understanding of these behaviours in adults with TSC and intellectual disability (ID) is limited. Little is known about their frequency in comparison to other ID-related genetic disorders or their association with other TSC-Associated Neuropsychiatric Disorders (TAND). This study determined the caregiver-reported frequency of self-injury and aggression in adults with TSC plus ID in comparison to Down syndrome (DS) and Angelman syndrome (AS), and assessed demographic and behavioural characteristics associated with the occurrence of each behaviour in TSC. Rates of self-injury and aggression in adults with TSC plus ID were 31% and 37.9% respectively. The odds of self-injury for adults with TSC were nearly twice as high as the odds for adults with DS, and the odds of aggression were over 2.5 times higher for adults with TSC than for adults with DS. When compared to adults with AS, odds of self-injury in TSC were around half those of the AS group, and odds of aggression were less than a third of those for adults with AS. These differences were not statistically significant. In adults with TSC, poorer communication and socialisation skills, gastric health problems and impulsivity were associated with self-injury; compulsive behaviour and impulsivity were associated with aggression. Caregivers and professionals should be alert to the likelihood of these behaviours in adults with TSC plus ID, and to characteristics associated with increased risk for their occurrence. We suggest assessment strategies to identify those at elevated risk. This paper adds specific examination of behavioural difficulties in adults with tuberous sclerosis complex who also have intellectual disability, a population at heightened risk of adverse behavioural outcomes which has received limited focussed examination to date. Findings support existing suggestions that there is relatively high risk for both self-injury and aggression, and provide novel insight into characteristics that may be associated with the presence of these behaviours. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Latencies in BOLD response during visual attention processes.

    PubMed

    Kellermann, Thilo; Reske, Martina; Jansen, Andreas; Satrapi, Peyman; Shah, N Jon; Schneider, Frank; Habel, Ute

    2011-04-22

    One well-investigated division of attentional processes focuses on alerting, orienting and executive control, which can be assessed applying the attentional network test (ANT). The goal of the present study was to add further knowledge about the temporal dynamics of relevant neural correlates. As a right hemispheric dominance for alerting and orienting has previously been reported for intrinsic but not for phasic alertness, we additionally addressed a potential impact of this lateralization of attention by employing a lateralized version of the ANT, capturing phasic alertness processes. Sixteen healthy subjects underwent event-related functional magnetic resonance imaging (fMRI) while performing the ANT. Analyses of BOLD magnitude replicated the engagement of a fronto-parietal network in the attentional subsystems. The amplitudes of the attentional contrasts interacted with visual field presentation in the sense that the thalamus revealed a greater involvement for spatially cued items presented in the left visual field. Comparisons of BOLD latencies in visual cortices, first, verified faster BOLD responses following contra-lateral stimulus presentation. Second and more importantly, we identified attention-modulated activation in secondary visual and anterior cingulate cortices. Results are discussed in terms of bottom-up and lateralization processes. Although intrinsic and phasic alertness are distinct cognitive processes, we propose that neural substrates of intrinsic alertness may be accessed by phasic alertness provided that the attention-dominant (i.e., the right) hemisphere is activated directly by a warning stimulus. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Neural Correlates of Alerting and Orienting Impairment in Multiple Sclerosis Patients

    PubMed Central

    Vázquez-Marrufo, Manuel; Galvao-Carmona, Alejandro; González-Rosa, Javier J.; Hidalgo-Muñoz, Antonio R.; Borges, Mónica; Ruiz-Peña, Juan Luis; Izquierdo, Guillermo

    2014-01-01

    Background A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. Results After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude). Conclusions Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients. PMID:24820333

  13. Neural correlates of alerting and orienting impairment in multiple sclerosis patients.

    PubMed

    Vázquez-Marrufo, Manuel; Galvao-Carmona, Alejandro; González-Rosa, Javier J; Hidalgo-Muñoz, Antonio R; Borges, Mónica; Ruiz-Peña, Juan Luis; Izquierdo, Guillermo

    2014-01-01

    A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude). Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients.

  14. Profiles and Correlates of Aggressive Behaviour among Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Crocker, A. G.; Mercier, C.; Allaire, J.-F.; Roy, M.-E.

    2007-01-01

    Background: Despite the heterogeneity in aggressive behaviours observed among individuals with intellectual disabilities (ID), little attention has been paid to the identification of typologies of aggression among individuals with mild or moderate ID and their associated factors. Objective: The goal of the present study was to identify profiles of…

  15. Does visual impairment lead to additional disability in adults with intellectual disabilities?

    PubMed

    Evenhuis, H M; Sjoukes, L; Koot, H M; Kooijman, A C

    2009-01-01

    This study addresses the question to what extent visual impairment leads to additional disability in adults with intellectual disabilities (ID). In a multi-centre cross-sectional study of 269 adults with mild to profound ID, social and behavioural functioning was assessed with observant-based questionnaires, prior to expert assessment of visual function. With linear regression analysis the percentage of variance, explained by levels of visual function, was calculated for the total population and per ID level. A total of 107/269 participants were visually impaired or blind (WHO criteria). On top of the decrease by ID visual impairment significantly decreased daily living skills, communication & language, recognition/communication. Visual impairment did not cause more self-absorbed and withdrawn behaviour or anxiety. Peculiar looking habits correlated with visual impairment and not with ID. In the groups with moderate and severe ID this effect seems stronger than in the group with profound ID. Although ID alone impairs daily functioning, visual impairment diminishes the daily functioning even more. Timely detection and treatment or rehabilitation of visual impairment may positively influence daily functioning, language development, initiative and persistence, social skills, communication skills and insecure movement.

  16. THE TSUNAMI SERVICE BUS, AN INTEGRATION PLATFORM FOR HETEROGENEOUS SENSOR SYSTEMS

    NASA Astrophysics Data System (ADS)

    Fleischer, J.; Häner, R.; Herrnkind, S.; Kriegel, U.; Schwarting, H.; Wächter, J.

    2009-12-01

    The Tsunami Service Bus (TSB) is the sensor integration platform of the German Indonesian Tsunami Early Warning System (GITEWS) [1]. The primary goal of GITEWS is to deliver reliable tsunami warnings as fast as possible. This is achieved on basis of various sensor systems like seismometers, ocean instrumentation, and GPS stations, all providing fundamental data to support prediction of tsunami wave propagation by the GITEWS warning center. However, all these sensors come with their own proprietary data formats and specific behavior. Also new sensor types might be added, old sensors will be replaced. To keep GITEWS flexible the TSB was developed in order to access and control sensors in a uniform way. To meet these requirements the TSB follows the architectural blueprint of a Service Oriented Architecture (SOA). The integration platform implements dedicated services communicating via a service infrastructure. The functionality required for early warnings is provided by loosely coupled services replacing the "hard-wired" coupling at data level. Changes in the sensor specification are confined to the data level without affecting the warning center. Great emphasis was laid on following the Sensor Web Enablement (SWE) standard [2], specified by the Open Geospatial Consortium (OGC) [3]. As a result the full functionality needed in GITEWS could be achieved by implementing the four SWE services: The Sensor Observation Service for retrieving sensor measurements, the Sensor Alert Service in order to deliver sensor alerts, the Sensor Planning Service for tasking sensors, and the Web Notification Service for conduction messages to various media channels. Beyond these services the TSB also follows SWE Observation & Measurements specifications (O&M) for data encoding and Sensor Model Language (SensorML) for meta information. Moreover, accessing sensors via the TSB is not restricted to GITEWS. Multiple instances of the TSB can be composed to realize federate warning system. Beside the already operating TSB at the BMKG warning center [4], two other organizations in Indonesia ([5], [6]) consider using the TSB, making their data centers available to GITEWS. The presentation takes a look at the concepts and implementation and reflects the usefulness of the mentioned standards. REFERENCES [1] GITEWS is a project of the German Federal Government to aid the recon¬struction of the tsunami-prone region of the Indian Ocean, http://www.gitews.org/ [2] SWE, www.opengeospatial.org/projects/groups/sensorweb [3] OGC, www.opengeospatial.org [4] Meteorological and Geophysical Agency of Indonesia (BMKG), www.bmg.go.id [5] National Coordinating Agency for Surveys and Mapping (BAKOSURTANAL), www.bakosurtanal.go.id [6] Agency for the Assessment & Application of Technology (BPPT), www.bppt.go.id

  17. Mother-Infant Face-to-Face Interaction: The Communicative Value of Infant-Directed Talking and Singing.

    PubMed

    Arias, Diana; Peña, Marcela

    Across culture, healthy infants show a high interest in infant-directed (ID) talking and singing. Despite ID talking and ID singing being very similar in physical properties, infants differentially respond to each of them. The mechanisms underpinning these different responses are still under discussion. This study explored the behavioral (n = 26) and brain (n = 14) responses from 6- to 8-month-old infants to ID talking and ID singing during a face-to-face mother-infant interaction with their own mother. Behavioral response was analyzed from offline video coding, and brain response was estimated from the analysis of electrophysiological recordings. We found that during ID talking, infants displayed a significantly higher number of visual contacts, vocalizations, and body movements than during ID singing. Moreover, only during ID talking were the number of visual contacts and vocalizations positively correlated with the number of questions and pauses in the mother's speech. Our results suggest that ID talking provides infants with specific cues that allow them not only to react to mother stimulation, but also to act toward them, displaying a rudimentary version of turn-taking behavior. Brain activity partially supported that interpretation. The relevance of our results for bonding is discussed. © 2016 S. Karger AG, Basel.

  18. Rest but busy: Aberrant resting-state functional connectivity of triple network model in insomnia.

    PubMed

    Dong, Xiaojuan; Qin, Haixia; Wu, Taoyu; Hu, Hua; Liao, Keren; Cheng, Fei; Gao, Dong; Lei, Xu

    2018-02-01

    One classical hypothesis among many models to explain the etiology and maintenance of insomnia disorder (ID) is hyperarousal. Aberrant functional connectivity among resting-state large-scale brain networks may be the underlying neurological mechanisms of this hypothesis. The aim of current study was to investigate the functional network connectivity (FNC) among large-scale brain networks in patients with insomnia disorder (ID) during resting state. In the present study, the resting-state fMRI was used to evaluate whether patients with ID showed aberrant FNC among dorsal attention network (DAN), frontoparietal control network (FPC), anterior default mode network (aDMN), and posterior default mode network (pDMN) compared with healthy good sleepers (HGSs). The Pearson's correlation analysis was employed to explore whether the abnormal FNC observed in patients with ID was associated with sleep parameters, cognitive and emotional scores, and behavioral performance assessed by questionnaires and tasks. Patients with ID had worse subjective thought control ability measured by Thought Control Ability Questionnaire (TCAQ) and more negative affect than HGSs. Intriguingly, relative to HGSs, patients with ID showed a significant increase in FNC between DAN and FPC, but a significant decrease in FNC between aDMN and pDMN. Exploratory analysis in patients with ID revealed a significantly positive correlation between the DAN-FPC FNC and reaction time (RT) of psychomotor vigilance task (PVT). The current study demonstrated that even during the resting state, the task-activated and task-deactivated large-scale brain networks in insomniacs may still maintain a hyperarousal state, looking quite similar to the pattern in a task condition with external stimuli. Those results support the hyperarousal model of insomnia.

  19. Prevalence and Correlates of Elopement in a Nationally Representative Sample of Children with Developmental Disabilities in the United States.

    PubMed

    Kiely, Bridget; Migdal, Talia R; Vettam, Sujit; Adesman, Andrew

    2016-01-01

    Despite increased awareness and concern about children with developmental disabilities wandering away from adult supervision, there is a paucity of research about elopement. This is the first study to examine and report the prevalence and correlates of elopement in a nationally representative sample of school-age children in the United States with an autism spectrum disorder (ASD) and/or cognitive impairment. Data were obtained from the CDC's "Pathways" Survey, a follow-up telephone survey of the parents of 4,032 children with a developmental condition. 3,518 children that had ASD, intellectual disability (ID), and/or developmental delay (DD) at the time of survey administration were included for analysis. Children were divided into three condition groups: ASD-only; ID/DD-only; ASD+ID/DD. Logistic regression analyses were used to compare the prevalence of elopement and rates of preventive measure use (barriers and/or electronic devices) across condition groups, and to examine the clinical and demographic correlates of elopement. T-tests were also performed to compare scores on the Children's Social Behavior Questionnaire (CSBQ) between wanderers and non-wanderers. Overall, 26.7% of children had reportedly eloped within the previous year, most commonly from public places. Children with ASD-only and ASD+ID/DD were more likely to have eloped than those with ID/DD-only. Across all groups, wanderers scored higher than non-wanderers on five out of six CSBQ subscales; they were more likely not to realize when there is danger, to have difficulty distinguishing between strangers and familiar people, to show sudden mood changes, to over-react to everything/everyone, to get angry quickly, to get lost easily, and to panic in new situations or if change occurs. Even after controlling for elopement history, parents of children in the ASD+ID/DD group were more likely than those in the other condition groups to report using physical or electronic measures to prevent wandering.

  20. Functional Characterization of the Cingulo-Opercular Network in the Maintenance of Tonic Alertness

    PubMed Central

    Sadaghiani, Sepideh; D'Esposito, Mark

    2015-01-01

    The complex processing architecture underlying attentional control requires delineation of the functional role of different control-related brain networks. A key component is the cingulo-opercular (CO) network composed of anterior insula/operculum, dorsal anterior cingulate cortex, and thalamus. Its function has been particularly difficult to characterize due to the network's pervasive activity and frequent co-activation with other control-related networks. We previously suggested this network to underlie intrinsically maintained tonic alertness. Here, we tested this hypothesis by separately manipulating the demand for selective attention and for tonic alertness in a two-factorial, continuous pitch discrimination paradigm. The 2 factors had independent behavioral effects. Functional imaging revealed that activity as well as functional connectivity in the CO network increased when the task required more tonic alertness. Conversely, heightened selective attention to pitch increased activity in the dorsal attention (DAT) network but not in the CO network. Across participants, performance accuracy showed dissociable correlation patterns with activity in the CO, DAT, and fronto-parietal (FP) control networks. These results support tonic alertness as a fundamental function of the CO network. They further the characterization of this function as the effortful process of maintaining cognitive faculties available for current processing requirements. PMID:24770711

  1. Face Preferences for Infant- and Adult-Directed Speakers in Infants of Depressed and Nondepressed Mothers: Association with Infant Cognitive Development.

    PubMed

    Kaplan, Peter S; Asherin, Ryan M; Vogeli, Jo M; Fekri, Shiva M; Scheyer, Kathryn E; Everhart, Kevin D

    2018-01-01

    Face preferences for speakers of infant-directed and adult-directed speech (IDS and ADS) were investigated in 4- to 13.5-month-old infants of depressed and non-depressed mothers. Following 1-min of exposure to an ID or AD speaker (order counterbalanced), infants had an immediate paired-comparison test with a still, silent image of the familiarized versus a novel face. In the test phase, ID face preference ratios were significantly lower in infants of depressed than non-depressed mothers. Infants' ID face preference ratios, but not AD face preference ratios, correlated with their percentile scores on the cognitive ( Cog ) scale of the Bayley Scales of Infant & Toddler Development (3 rd Edition; BSID III), assessed concurrently. Regression analyses revealed that infant ID face preferences significantly predicted infant Cog percentiles even after demographic risk factors and maternal depression had been controlled. Infants may use IDS to select social partners who are likely to support and facilitate cognitive development.

  2. Extension of platelet shelf life from 4 to 5 days by implementation of a new screening strategy in Germany.

    PubMed

    Sireis, W; Rüster, B; Daiss, C; Hourfar, M K; Capalbo, G; Pfeiffer, H-U; Janetzko, K; Goebel, M; Kempf, V A J; Seifried, E; Schmidt, M

    2011-10-01

    The Paul-Ehrlich-Institute analysed all fatalities due to bacterial infections between 1997 and 2007. Thereafter, the platelet shelf life was reduced to a maximum of 4 days after blood donation because the majority of all cases of severe transfusion-transmitted bacterial infections occurred with day 5 platelets. The current study compares the analytical sensitivity and the diagnostic specificity of four rapid bacterial detection procedures. Nine transfusion-relevant bacterial strains were spiked in pooled platelets or apheresis platelets at a low concentration (10 CFU/bag). Samples were collected after day 3, day 4 and day 5 and investigated by four rapid bacterial detection methods (modified BacT/ALERT, Bactiflow, FACS method and 16s DNA PCR methods). Seven out of nine bacterial strains were adequately detected by BacT/ALERT, Bactiflow and PCR in apheresis platelets and pooled platelets after sample collection at day 3, day 4 and day 5. For three bacterial strains, analytical sensitivity was reduced for the FACS method. Two bacterial strains did not grow under the storage conditions in either pooled or apheresis platelets. A late sample collection on day 3, day 4 or day 5 after blood donation in combination with a rapid bacterial detection method offers a new opportunity to improve blood safety and reduce errors due to sampling., BacT/ALERT, Bactiflow or 16s ID-NAT are feasible for late bacterial screening in platelets may provide data which support the extension of platelet shelf life in Germany to 5 days. © 2011 The Author(s). Vox Sanguinis © 2011 International Society of Blood Transfusion.

  3. A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience.

    PubMed

    Ghisoni, Eleonora; Katsaros, Dionyssios; Maggiorotto, Furio; Aglietta, Massimo; Vaira, Marco; De Simone, Michele; Mittica, Gloria; Giannone, Gaia; Robella, Manuela; Genta, Sofia; Lucchino, Fabiola; Marocco, Francesco; Borella, Fulvio; Valabrega, Giorgio; Ponzone, Riccardo

    2018-05-30

    Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

  4. Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system.

    PubMed

    Bode, Bruce; Gross, Kenneth; Rikalo, Nancy; Schwartz, Sherwyn; Wahl, Timothy; Page, Casey; Gross, Todd; Mastrototaro, John

    2004-04-01

    The purposes of this study were to demonstrate the accuracy and effectiveness of the Guardian Continuous Monitoring System (Medtronic MiniMed, Northridge, California) and to demonstrate that the application of real-time alarms to continuous monitoring alerts users to hypo and hyperglycemia and reduces excursions in people with diabetes. A total of 71 subjects with type 1 diabetes, mean hemoglobin A1c of 7.6 +/- 1.1%, age 44.0 +/- 11.4 years, and duration of diabetes 23.6 +/- 10.6 years were enrolled in this two-period, randomized, multicenter study. Subjects were randomized into either an Alert group or a Control group. The accuracy of the Guardian was evaluated by treating the study data as a single-sample correlational design. Effectiveness of the Guardian alerts was evaluated by comparing the Alert group with the Control group. The mean (median) absolute relative error between home blood glucose meter readings and sensor values was 21.3% (17.3%), and the Guardian, on average, read 12.8 mg/dL below the concurrent home blood glucose meter readings. The hypoglycemia alert was able to distinguished glucose values < or =70 mg/dL with 67% sensitivity, 90% specificity, and 47% false alerts. The hyperglycemia alert showed a similar ability to detect sensor values > or =250 mg/dL with 63% sensitivity, 97% specificity, and 19% false alerts. The Alert group demonstrated a median decrease in the duration of hypoglycemic excursions (-27.8 min) that was significantly greater than the median decrease in the duration of hypoglycemic excursions in the Control group (-4.5 min) (P = 0.03). A marginally significant increase in the frequency of hyperglycemic excursions (P = 0.07) between Period 1 and Period 2 was accompanied by a decrease of 9.6 min in the duration of hyperglycemic excursions in the Alert group. Glucose measurements differ between blood samples taken from the finger and interstitial fluid, especially when levels are changing rapidly; however, these results demonstrate that the Guardian is reasonably accurate while performing continuous glucose monitoring. The subjects' responses to hypoglycemia alerts resulted in a significant reduction in the duration of hypoglycemic excursions; however, overtreating hypoglycemia may have resulted in a marginally significant increase in the frequency of hyperglycemic excursions.

  5. Voxel-based statistical analysis of uncertainties associated with deformable image registration

    NASA Astrophysics Data System (ADS)

    Li, Shunshan; Glide-Hurst, Carri; Lu, Mei; Kim, Jinkoo; Wen, Ning; Adams, Jeffrey N.; Gordon, James; Chetty, Indrin J.; Zhong, Hualiang

    2013-09-01

    Deformable image registration (DIR) algorithms have inherent uncertainties in their displacement vector fields (DVFs).The purpose of this study is to develop an optimal metric to estimate DIR uncertainties. Six computational phantoms have been developed from the CT images of lung cancer patients using a finite element method (FEM). The FEM generated DVFs were used as a standard for registrations performed on each of these phantoms. A mechanics-based metric, unbalanced energy (UE), was developed to evaluate these registration DVFs. The potential correlation between UE and DIR errors was explored using multivariate analysis, and the results were validated by landmark approach and compared with two other error metrics: DVF inverse consistency (IC) and image intensity difference (ID). Landmark-based validation was performed using the POPI-model. The results show that the Pearson correlation coefficient between UE and DIR error is rUE-error = 0.50. This is higher than rIC-error = 0.29 for IC and DIR error and rID-error = 0.37 for ID and DIR error. The Pearson correlation coefficient between UE and the product of the DIR displacements and errors is rUE-error × DVF = 0.62 for the six patients and rUE-error × DVF = 0.73 for the POPI-model data. It has been demonstrated that UE has a strong correlation with DIR errors, and the UE metric outperforms the IC and ID metrics in estimating DIR uncertainties. The quantified UE metric can be a useful tool for adaptive treatment strategies, including probability-based adaptive treatment planning.

  6. Values and Psychological Acceptance as Correlates of Burnout in Support Staff Working with Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Noone, Stephen J.; Hastings, Richard P.

    2011-01-01

    There is growing evidence that acceptance and mindfulness interventions for support staff in intellectual disability (ID) services can have beneficial mental health outcomes for staff themselves and individuals with ID. However, there are few data focusing on the relevance of related psychological processes for support staff well-being. The…

  7. Relationship between individual quality of life and family quality of life for people with intellectual disability living in Italy.

    PubMed

    Bertelli, M; Bianco, A; Rossi, M; Scuticchio, D; Brown, I

    2011-12-01

    There is substantial literature investigating quality of life (QoL) of individuals with intellectual disability (ID). QoL of families of people with ID is emerging as an important field of research. Despite this, there is a lack of studies regarding their relationship. The present paper aimed to study the relationship between QoL scores of individuals with ID and members of their families. Twenty-seven parents or relatives of 27 adults with ID were recruited by four different research centres across Tuscany (Italy) to be interviewed through the Italian adaptation of the Family Quality of Life Survey - 2006 (FQoLS-2006), a tool developed for use in a multiple-country study on family QoL. The FQoLS-2006 was translated and adapted to Italian through three revisions. The last was submitted to the authors of the original version, who also maintain an electronic data file and data archive for statistical evaluations in various countries. QoL of persons with ID was assessed through the administration of the Quality of Life - Instrument Package. QoL scores were analysed to describe population characteristics and to examine the relationships among measures of individual and family QoL using correlations (Pearson and Spearman). Findings showed that family ratings of QoL were generally low. Families interviewed reported a low level of QoL in 'Support from Others' and 'Community Interaction', while 'Family Relationships' and 'Health of the Family' rated higher. For individual QoL, individuals had the lowest scores in the area of 'Spiritual being' and higher scores in the area of 'Physical being'. Correlations examining possible relationships among Importance, Satisfaction and Opportunities found some statistically significant correlation coefficients between some aspects of the three main areas of individual QoL (Being, Belonging and Becoming) and the nine family domains. Most of these correlations regarded family 'Financial Well-Being', 'Family Relationships, 'Support from Service' and 'Support from Others' areas. The results of this study suggest that QoL is perceived somewhat differently by individuals with ID and by members of their families. This difference could negatively impact QoL of people with ID, if their views are not taken into account when planning for family support. The relationships between individual and family QoL appear to be quite complex, and such complexity needs to be clarified in future research. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.

  8. Analysis of the orbit distortion by the use of the wavelet transform

    NASA Astrophysics Data System (ADS)

    Matsushita, T.; Agui, A.; Yoshigoe, A.; Takao, M.; Aoyagi, H.; Takeuchi, M.; Nakatani, T.; Tanaka, H.

    2004-05-01

    We have adopted matching pursuit algorithm of discrete wavelet transform (DWT) for the analysis of the beam position shift correlated with the motion of insertion device(ID). The beam position data measured by the rf beam position monitors have included high-frequency `noises' and fluctuation of background level. Precise evaluation of the electron beam position shift correlated with the motion of the ID is required for estimation of the steering magnet currents in order to suppress the closed orbit distortion (COD). The DWT is a powerful tool for frequency analysis and data processing. The analysis of DWT was applied to the beam position shift correlated with the phase motion of APPLE-2 type undulator (ID23) in SPring-8. The result of the analysis indicated that `noises' are mainly composed of the components of 50 ˜ 6.25Hz and < 0.1Hz. We carried out the data processing to remove the `noises' by the matching pursuit algorithm. Then we have succeeded in suppressing the COD within 2 μm by the use of the steering magnet currents calculated from the processed data.

  9. Insomnia Disorder and Brain's Default-Mode Network.

    PubMed

    Marques, Daniel Ruivo; Gomes, Ana Allen; Caetano, Gina; Castelo-Branco, Miguel

    2018-06-09

    Insomnia disorder (ID) is a prevalent sleep disorder that significantly compromises the physical and mental health of individuals. This article reviews novel approaches in the study of brain networks and impaired function in ID through the application of modern neuroimaging techniques such as functional magnetic resonance imaging (fMRI). The default-mode network (DMN) is presumed to be correlated with self-referential information processing, and it appears to be altered or unbalanced in insomnia. A growing body of evidence suggests the lack of deactivation of brain regions comprising the DMN when insomnia patients are at rest. Moreover, core areas of the DMN demonstrate greater activation in insomnia patients when compared to healthy controls in self-referential related tasks. Despite the few studies on the topic, underpinning the correlation between abnormal DMN activity and ID deserves further attention in the future. Implications for therapeutics are briefly outlined.

  10. Kinetics and biodistribution in relation to tumour detection with 111In-labelled OV-TL 3 F(ab')2 in patients with ovarian cancer.

    PubMed

    Massuger, L F; Claessens, R A; Kenemans, P; Verheijen, R H; Boerman, O C; Meeuwis, A P; Schijf, C P; Buijs, W C; Hanselaar, T G; Corstens, F H

    1991-07-01

    The biological behaviour of 111In-labelled OV-TL 3 F(ab')2 was studied in 22 patients with suspected ovarian cancer. After i.v. injection with 140 MBq 111In-OV-TL 3 F(ab')2 (1 mg) blood samples were taken up to 96 h and urine and faeces were collected throughout the whole study. At surgery, 5 to 7 days post-injection, primary and metastatic tumour tissues, as well as fragments of several normal tissues, were removed and 111In uptake was measured. Blood activity disappeared with half-life values of 6.1 +/- 1.1 and 17.9 +/- 6.5 h. Within 96 h excretion in urine and faeces was 16.1 +/- 2.0% i.d. (mean +/- S.D.) and 3.1 +/- 1.9% i.d., respectively. Mean tissue uptake, expressed as % i.d. kg-1 was 3.9 +/- 1.0 for primary tumour, 11.5 +/- 5.0 for liver and 0.4 +/- 0.1 for several normal background tissues. Higher tumour uptake correlated with a higher detection rate at immunoscintigraphy. However, no strict correlation was found between the amount of tumour uptake and the expression of the monoclonal antibody defined OA3 antigen. Quantitation of organ activity, using region of interest analysis, resulted in mean peak organ activities for the liver of 16% i.d., spleen 9% i.d. and kidney 4% i.d. Distribution data indicate that besides specific antibody-antigen interaction several other mechanisms play a role in uptake in tumour and other tissues.

  11. MALDI-TOF mass spectrometry proteomic phenotyping of clinically relevant fungi.

    PubMed

    Putignani, Lorenza; Del Chierico, Federica; Onori, Manuela; Mancinelli, Livia; Argentieri, Marta; Bernaschi, Paola; Coltella, Luana; Lucignano, Barbara; Pansani, Laura; Ranno, Stefania; Russo, Cristina; Urbani, Andrea; Federici, Giorgio; Menichella, Donato

    2011-03-01

    Proteomics is particularly suitable for characterising human pathogens with high life cycle complexity, such as fungi. Protein content and expression levels may be affected by growth states and life cycle morphs and correlate to species and strain variation. Identification and typing of fungi by conventional methods are often difficult, time-consuming and frequently, for unusual species, inconclusive. Proteomic phenotypes from MALDI-TOF MS were employed as analytical and typing expression profiling of yeast, yeast-like species and strain variants in order to achieve a microbial proteomics population study. Spectra from 303 clinical isolates were generated and processed by standard pattern matching with a MALDI-TOF Biotyper (MT). Identifications (IDs) were compared to a reference biochemical-based system (Vitek-2) and, when discordant, MT IDs were verified with genotyping IDs, obtained by sequencing the 25-28S rRNA hypervariable D2 region. Spectra were converted into virtual gel-like formats, and hierarchical clustering analysis was performed for 274 Candida profiles to investigate species and strain typing correlation. MT provided 257/303 IDs consistent with Vitek-2 ones. However, amongst 26/303 discordant MT IDs, only 5 appeared "true". No MT identification was achieved for 20/303 isolates for incompleteness of database species variants. Candida spectra clustering agreed with identified species and topology of Candida albicans and Candida parapsilosis specific dendrograms. MT IDs show a high analytical performance and profiling heterogeneity which seems to complement or even outclass existing typing tools. This variability reflects the high biological complexity of yeasts and may be properly exploited to provide epidemiological tracing and infection dispersion patterns.

  12. Effects of plasma-induced charging damage on random telegraph noise in metal-oxide-semiconductor field-effect transistors with SiO2 and high-k gate dielectrics

    NASA Astrophysics Data System (ADS)

    Kamei, Masayuki; Takao, Yoshinori; Eriguchi, Koji; Ono, Kouichi

    2014-01-01

    We clarified in this study how plasma-induced charging damage (PCD) affects the so-called “random telegraph noise (RTN)” — a principal concern in designing ultimately scaled large-scale integrated circuits (LSIs). Metal-oxide-semiconductor field-effect transistors (MOSFETs) with SiO2 and high-k gate dielectric were exposed to an inductively coupled plasma (ICP) with Ar gas. Drain current vs gate voltage (Ids-Vg) characteristics were obtained before and after the ICP plasma exposure for the same device. Then, the time evolution of Ids fluctuation defined as Ids/μIds was measured, where μIds is the mean Ids. This value corresponds to an RTN feature, and RTN was obtained under various gate voltages (Vg) by a customized measurement technique. We focused on the statistical distribution width of (Ids/μIds), δ(Ids/μIds), in order to clarify the effects of PCD on RTN. δ(Ids/μIds) was increased by PCD for both MOSFETs with the SiO2 and high-k gate dielectrics, suggesting that RTN can be used as a measure of PCD, i.e., a distribution width increase directly indicates the presence of PCD. The dependence of δ(Ids/μIds) on the overdrive voltage Vg-Vth, where Vth is the threshold voltage, was investigated by the present technique. It was confirmed that δ(Ids/μIds) increased with a decrease in the overdrive voltage for MOSFETs with the SiO2 and high-k gate dielectrics. The presence of created carrier trap sites with PCD was characterized by the time constants for carrier capture and emission. The threshold voltage shift (ΔVth) induced by PCD was also evaluated and compared with the RTN change, to correlate the RTN increase with ΔVth induced by PCD. Although the estimated time constants exhibited complex behaviors due to the nature of trap sites created by PCD, δ(Ids/μIds) showed a straightforward tendency in accordance with the amount of PCD. These findings provide an in-depth understanding of plasma-induced RTN characteristic changes in future MOSFETs.

  13. Id2 leaves the chromatin of the E2F4–p130-controlled c-myc promoter during hepatocyte priming for liver regeneration

    PubMed Central

    Rodríguez, José L.; Sandoval, Juan; Serviddio, Gaetano; Sastre, Juan; Morante, María; Perrelli, Maria-Giulia; Martínez-Chantar, María L.; Viña, José; Viña, Juan R.; Mato, José M.; Ávila, Matías A.; Franco, Luis; López-Rodas, Gerardo; Torres, Luis

    2006-01-01

    The Id (inhibitor of DNA binding or inhibitor of differentiation) helix–loop–helix proteins are involved in the regulation of cell growth, differentiation and cancer. The fact that the molecular mechanisms of liver regeneration are not completely understood prompted us to study the fate of Id2 in proliferating liver. Id2 increases in liver regeneration after partial hepatectomy, following the early induction of its gene. Co-immunoprecipitation shows that Id2 forms a complex with E2F4, p130 and mSin3A in quiescent liver and all these components are present at the c-myc promoter as shown using ChIP (chromatin immunoprecipitation). Activation of c-myc during hepatocyte priming (G0–G1 transition) correlates with the dissociation of Id2 and HDAC (histone deacetylase), albeit p130 remains bound at least until 6 h. Moreover, as the G0–G1 transition progresses, Id2 and HDAC again bind the c-myc promoter concomitantly with the repression of this gene. The time course of c-myc binding to the Id2 promoter, as determined by ChIP assays is compatible with a role of the oncoprotein as a transcriptional inducer of Id2 in liver regeneration. Immunohistochemical analysis shows that Id2 also increases in proliferating hepatocytes after bile duct ligation. In this case, the pattern of Id2 presence in the c-myc promoter parallels that found in regenerating liver. Our results may suggest a control role for Id2 in hepatocyte priming, through a p130 dissociation-independent regulation of c-myc. PMID:16776654

  14. ERβ1 inhibits the migration and invasion of breast cancer cells through upregulation of E-cadherin in a Id1-dependent manner

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

    Zhou, Yan; Ming, Jia; Xu, Yan

    2015-02-06

    Highlights: • Expression of ERβ1 was positively correlated with E-cadherin in breast cancer cell. • ERβ1 upregulates E-cadherin expression in breast cancer cell lines. • ERβ1 upregulates E-cadherin expression in a Id1-dependent manner. - Abstract: ERβ1 is a member of the nuclear receptor superfamily of ligand-regulated transcription factors. It plays an important role in regulating the progression of breast cancer. However, the mechanisms of ERβ1 in tumorigenesis, metastasis and prognosis are still not fully clear. In this study, we showed that the expression of ERβ1 was positively correlated with E-cadherin expression in breast cancer cell lines. In addition, we foundmore » that ERβ1 upregulates E-cadherin expression in breast cancer cell lines. Furthermore, we also found that ERβ1 inhibits the migration and invasion of breast cancer cells and upregulated E-cadherin expression in a Id1-dependent manner. Taken together, our study provides further understanding of the molecular mechanism of ERβ1 in tumor metastasis and suggests the feasibility of developing novel therapeutic approaches to target Id1 to inhibit breast cancer metastasis.« less

  15. Towards cross-lingual alerting for bursty epidemic events.

    PubMed

    Collier, Nigel

    2011-10-06

    Online news reports are increasingly becoming a source for event-based early warning systems that detect natural disasters. Harnessing the massive volume of information available from multilingual newswire presents as many challanges as opportunities due to the patterns of reporting complex spatio-temporal events. In this article we study the problem of utilising correlated event reports across languages. We track the evolution of 16 disease outbreaks using 5 temporal aberration detection algorithms on text-mined events classified according to disease and outbreak country. Using ProMED reports as a silver standard, comparative analysis of news data for 13 languages over a 129 day trial period showed improved sensitivity, F1 and timeliness across most models using cross-lingual events. We report a detailed case study analysis for Cholera in Angola 2010 which highlights the challenges faced in correlating news events with the silver standard. The results show that automated health surveillance using multilingual text mining has the potential to turn low value news into high value alerts if informed choices are used to govern the selection of models and data sources. An implementation of the C2 alerting algorithm using multilingual news is available at the BioCaster portal http://born.nii.ac.jp/?page=globalroundup.

  16. Alerting, orienting or executive attention networks: differential patters of pupil dilations

    PubMed Central

    Geva, Ronny; Zivan, Michal; Warsha, Aviv; Olchik, Dov

    2013-01-01

    Attention capacities, alerting responses, orienting to sensory stimulation, and executive monitoring of performance are considered independent yet interrelated systems. These operations play integral roles in regulating the behavior of diverse species along the evolutionary ladder. Each of the primary attention constructs—alerting, orienting, and executive monitoring—involves salient autonomic correlates as evidenced by changes in reactive pupil dilation (PD), heart rate, and skin conductance. Recent technological advances that use remote high-resolution recording may allow the discernment of temporo-spatial attributes of autonomic responses that characterize the alerting, orienting, and executive monitoring networks during free viewing, irrespective of voluntary performance. This may deepen the understanding of the roles of autonomic regulation in these mental operations and may deepen our understanding of behavioral changes in verbal as well as in non-verbal species. The aim of this study was to explore differences between psychosensory PD responses in alerting, orienting, and executive conflict monitoring tasks to generate estimates of concurrent locus coeruleus (LC) noradrenergic input trajectories in healthy human adults using the attention networks test (ANT). The analysis revealed a construct-specific pattern of pupil responses: alerting is characterized by an early component (Pa), its acceleration enables covert orienting, and executive control is evidenced by a prominent late component (Pe). PD characteristics seem to be task-sensitive, allowing exploration of mental operations irrespective of conscious voluntary responses. These data may facilitate development of studies designed to assess mental operations in diverse species using autonomic responses. PMID:24133422

  17. Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study.

    PubMed

    Zaal, Rianne J; Ebbers, Susan; Borms, Mirka; Koning, Bart de; Mombarg, Erna; Ooms, Piet; Vollaard, Hans; van den Bemt, Patricia M L A; Evenhuis, Heleen M

    2016-08-01

    A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples' Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional caregivers (100%) were involved. For every client included at least one drug-related problem was identified. In total 127 drug-related problems were detected, mainly potentially inappropriate or unnecessary drugs. After six months, 15.7% of the interventions were actually implemented. Medication review using STRIP seems feasible in adults with an ID and identifies drug-related problems. However, in this pilot study the implementation rate of suggested interventions was low. To improve the implementation rate, the treating physician should be involved in the review process. Besides, specific adaptations to STRIP to address drug-related problems specific for this population are required. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. A Rubric for Extracting Idea Density from Oral Language Samples

    PubMed Central

    Chand, Vineeta; Baynes, Kathleen; Bonnici, Lisa M.; Farias, Sarah Tomaszewski

    2012-01-01

    While past research has demonstrated that low idea density (ID) scores from natural language samples correlate with late life risk for cognitive decline and Alzheimer’s disease pathology, there are no published rubrics for collecting and analyzing language samples for idea density to verify or extend these findings into new settings. This paper outlines the history of ID research and findings, discusses issues with past rubrics, and then presents an operationalized method for the systematic measurement of ID in language samples, with an extensive manual available as a supplement to this article (Analysis of Idea Density, AID). Finally, reliability statistics for this rubric in the context of dementia research on aging populations and verification that AID can replicate the significant association between ID and late life cognition are presented. PMID:23042498

  19. Romantic love modulates women's identification of men's body odors.

    PubMed

    Lundström, Johan N; Jones-Gotman, Marilyn

    2009-02-01

    Romantic love is one of our most potent and powerful emotions, but very little is known with respect to the hormonal and psychological mechanisms in play. Romantic love is thought to help intimate partners stay committed to each other and two mechanisms have been proposed to mediate this commitment: increased attention towards one's partner or deflected attention away from other potential partners. Both mechanisms find support in the literature. We explored the potential influence of each of these mechanisms by assessing women's ability to identify (ID) body odors originating from their boyfriend, a same-sex friend, and an opposite-sex friend and the relationship between this ability and the degree of romantic love expressed towards their boyfriend. We hypothesized that an increase in attention towards one's partner would render a positive correlation between ID of a boyfriend's body odor and degree of romantic love; conversely, we hypothesized that attention deflected away from other potential partners would render a negative correlation between ID of an opposite-sex friend's body odor and degree of romantic love for the boyfriend. Our results supported the deflection theory as we found a negative correlation between the degree of romantic love for the subjects' boyfriends and their ability to ID the body odor of an opposite-sex friend but not of their boyfriend or same-sex friend. Our results indicate that romantic love deflects attention away from potential new partners rather than towards the present partner. These changes are likely mediated by circulating neuropeptides and a testable model is suggested.

  20. Diurnal Spectral Sensitivity of the Acute Alerting Effects of Light

    PubMed Central

    Rahman, Shadab A.; Flynn-Evans, Erin E.; Aeschbach, Daniel; Brainard, George C.; Czeisler, Charles A.; Lockley, Steven W.

    2014-01-01

    Study Objectives: Previous studies have demonstrated short-wavelength sensitivity for the acute alerting response to nocturnal light exposure. We assessed daytime spectral sensitivity in alertness, performance, and waking electroencephalogram (EEG). Design: Between-subjects (n = 8 per group). Setting: Inpatient intensive physiologic monitoring unit. Participants: Sixteen healthy young adults (mean age ± standard deviation = 23.8 ± 2.7 y). Interventions: Equal photon density exposure (2.8 × 1013 photons/cm2/s) to monochromatic 460 nm (blue) or 555 nm (green) light for 6.5 h centered in the middle of the 16-h episode of wakefulness during the biological day. Results were compared retrospectively to 16 individuals who were administered the same light exposure during the night. Measurements and Results: Daytime and nighttime 460-nm light exposure significantly improved auditory reaction time (P < 0.01 and P < 0.05, respectively) and reduced attentional lapses (P < 0.05), and improved EEG correlates of alertness compared to 555-nm exposure. Whereas subjective sleepiness ratings did not differ between the two spectral conditions during the daytime (P > 0.05), 460-nm light exposure at night significantly reduced subjective sleepiness compared to 555-nm light exposure at night (P < 0.05). Moreover, nighttime 460-nm exposure improved alertness to near-daytime levels. Conclusions: The alerting effects of short-wavelength 460-nm light are mediated by counteracting both the circadian drive for sleepiness and homeostatic sleep pressure at night, but only via reducing the effects of homeostatic sleep pressure during the day. Citation: Rahman SA; Flynn-Evans EE; Aeschbach D; Brainard GC; Czeisler CA; Lockley SW. Diurnal spectral sensitivity of the acute alerting effects of light. SLEEP 2014;37(2):271-281. PMID:24501435

  1. Attentional networks and visuospatial working memory capacity in social anxiety.

    PubMed

    Moriya, Jun

    2018-02-01

    Social anxiety is associated with attentional bias and working memory for emotional stimuli; however, the ways in which social anxiety affects cognitive functions involving non-emotional stimuli remains unclear. The present study focused on the role of attentional networks (i.e. alerting, orienting, and executive control networks) and visuospatial working memory capacity (WMC) for non-emotional stimuli in the context of social anxiety. One hundred and seventeen undergraduates completed questionnaires on social anxiety. They then performed an attentional network test and a change detection task to measure visuospatial WMC. Orienting network and visuospatial WMC were positively correlated with social anxiety. A multiple regression analysis showed significant positive associations of alerting, orienting, and visuospatial WMC with social anxiety. Alerting, orienting networks, and high visuospatial WMC for non-emotional stimuli may predict degree of social anxiety.

  2. Vaginal temperature measurement by a wireless sensor for predicting the onset of calving in Japanese Black cows.

    PubMed

    Sakatani, Miki; Sugano, Takaaki; Higo, Aiki; Naotsuka, Koji; Hojo, Takuo; Gessei, Satoru; Uehara, Hiroshi; Takenouchi, Naoki

    2018-04-15

    We evaluated the utility of the continuous measurement of vaginal temperature by a wireless sensor and wireless connection for predicting the onset of calving and for clarifying the relationships among dystocia, calf conditions, and temperature changes at a commercial beef cattle farm in Japan. A total of 625 effective delivery data was collected. The temperature sensor inserted to the vagina on 7 days before the expected due date and collected the vaginal temperature every 5 min. The sensor detected two alerts according to the temperature change, one was the vaginal temperature of 4 h moving average compared to the same time temperature of last two days decreased more than 0.4 °C (Alert 1) and the other was the rupture of the allantoic sac and the dropped sensor temperature reached to the ambient temperature (Alert 2). The detection rates of Alert 1 and Alert 2 were 88.3% and 99.4%, respectively. The average time between Alert 1 and Alert 2 (Time 1) was 22 h, and that between Alert 2 and delivery (Time 2) was 2 h. These results indicated that the continuous measurement of vaginal temperature is effective for predicting the calving time. The necessity of assistance was correlated with dystocia, calf birth weight (BW), sex, and gestation periods. Interestingly, the durations of Times 1 and 2 were also associated with dystocia. The calf BW, sex, and gestation periods affected the length of Time 2. Our findings indicate that the BW of the calf is the most important factor for dystocia risk, and that the continuous measurement of vaginal temperature could become a good indicator for predicting not only the onset of calving, but also the necessity of assistance. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Lifetime inbreeding depression, purging, and mating system evolution in a simultaneous hermaphrodite tapeworm.

    PubMed

    Benesh, Daniel P; Weinreich, Friederike; Kalbe, Martin; Milinski, Manfred

    2014-06-01

    Classical theory on mating system evolution suggests that simultaneous hermaphrodites should either outcross if they have high inbreeding depression (ID) or self-fertilize if they have low ID. However, a mixture of selfing and outcrossing persists in many species. Previous studies with the tapeworm Schistocephalus solidus have found worms to self-fertilize some of their eggs despite ID. The probability for selfing to spread depends on the relative fitness of selfers, as well as the genetic basis for ID and whether it can be effectively purged. We bred S. solidus through two consecutive generations of selfing and recorded several fitness correlates over the whole life cycle. After one round of selfing, ID was pronounced, particularly in early-life traits, and the conservatively estimated lifetime fitness of selfed progeny was only 9% that of the outcrossed controls. After a second generation of selfing, ID remained high but was significantly reduced in several traits, which is consistent with the purging of deleterious recessive alleles (the estimated load of lethal equivalents dropped by 48%). Severe ID, even if it can be rapidly purged, likely prevents transitions toward pure selfing in this parasite, although we also cannot exclude the possibility that low-level selfing has undetected benefits. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

  4. Intelligence quotient is associated with epilepsy in children with intellectual disability in India

    PubMed Central

    Lakhan, Ram

    2013-01-01

    Background: Epilepsy is a disorder that is commonly found in people with intellectual disability (ID). The prevalence of epilepsy increases with the severity of ID. The objective of this study was to determine if there is an association between intelligence quotient (IQ) and epilepsy in children with ID. Materials and Methods: A total of 262 children, aged 3-18 years, with ID were identified as part of a community-based rehabilitation project. These children were examined for epilepsy and diagnosed by a psychiatrist and physicians based on results of electroencephalogram tests. A Spearman's correlation (ρ) was used to determine if there was an association between IQ scores and the occurrence of epilepsy. X2 statistics used to examine the relationship of epilepsy with gender, socioeconomic status, population type, severity of ID, family history of mental illness, mental retardation, epilepsy, and coexisting disorder. Results: Spearman's rho –0.605 demonstrates inverse association of IQ with epilepsy. X2 demonstrates statistically significant association (P < 0.05) with gender, severity of ID, cerebral palsy, behavior problems, and family history of mental illness, mental retardation, and epilepsy. Conclusions: Lower IQ score in children with ID has association with occurrence of epilepsy. Epilepsy is also found highly associated with male gender and lower age. PMID:24347947

  5. Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system.

    PubMed

    Dekarske, Brian M; Zimmerman, Christopher R; Chang, Robert; Grant, Paul J; Chaffee, Bruce W

    2015-12-01

    Computerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug-drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug-drug interactions when ordering medications in an electronic medical record. In this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as "indeterminate." Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses. Twenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p<0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p<0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p=0.103). Free-text use was higher in the customized configuration overall (p<0.001), and there was no difference in nonsensical response between configurations (p=0.39). There is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts. Copyright © 2015. Published by Elsevier Ireland Ltd.

  6. Regional differences of maternal health care utilization in China.

    PubMed

    Tang, Mengsha; Wang, Debin; Hu, Hong; Wang, Guoping; Li, Rongjie

    2015-03-01

    To describe regional differences in maternal health care (MHC) utilization in China. Cross-sectional comparisons of 4 MHC utilization indicators, namely, early (13 weeks within pregnancy) examinations rate (EER), prenatal examination (>4 times) rate (PER), hospital delivery rate (HDR), and postnatal visit (>1 time) rate (PVR), using index of dissimilarity (ID), linear correlation analysis, and geographical mapping. Significant differences existed across regions in all the indicators (P < .01). All the IDs for rural areas were higher than that for urban areas. The IDs for major regions ranged from 0.01 to 0.27. Linear correlation coefficients between MHC utilization indicators by regions varied from 0.007 to 0.889 (in absolute value, P < .05). Characteristic formats of geographical distribution were found with PER, EER, HDR, and PVR being in "high-plateau," "low-plateau," and "shifting" patterns, respectively. There exist substantial regional discrepancies in MHC utilization in China and future MHC-related policies should take account regional context. © 2013 APJPH.

  7. Visual perception and frontal lobe in intellectual disabilities: a study with evoked potentials and neuropsychology.

    PubMed

    Muñoz-Ruata, J; Caro-Martínez, E; Martínez Pérez, L; Borja, M

    2010-12-01

    Perception disorders are frequently observed in persons with intellectual disability (ID) and their influence on cognition has been discussed. The objective of this study is to clarify the mechanisms behind these alterations by analysing the visual event related potentials early component, the N1 wave, which is related to perception alterations in several pathologies. Additionally, the relationship between N1 and neuropsychological visual tests was studied with the aim to understand its functional significance in ID persons. A group of 69 subjects, with etiologically heterogeneous mild ID, performed an odd-ball task of active discrimination of geometric figures. N1a (frontal) and N1b (post-occipital) waves were obtained from the evoked potentials. They also performed several neuropsychological tests. Only component N1a, produced by the target stimulus, showed significant correlations with the visual integration, visual semantic association, visual analogical reasoning tests, Perceptual Reasoning Index (Wechsler Intelligence Scale for Children Fourth Edition) and intelligence quotient. The systematic correlations, produced by the target stimulus in perceptual abilities tasks, with the N1a (frontal) and not with N1b (posterior), suggest that the visual perception process involves frontal participation. These correlations support the idea that the N1a and N1b are not equivalent. The relationship between frontal functions and early stages of visual perception is revised and discussed, as well as the frontal contribution with the neuropsychological tests used. A possible relationship between the frontal activity dysfunction in ID and perceptive problems is suggested. Perceptive alteration observed in persons with ID could indeed be because of altered sensory areas, but also to a failure in the frontal participation of perceptive processes conceived as elaborations inside reverberant circuits of perception-action. © 2010 The Authors. Journal of Intellectual Disability Research © 2010 Blackwell Publishing Ltd.

  8. Stigma, public awareness about intellectual disability and attitudes to inclusion among different ethnic groups.

    PubMed

    Scior, K; Addai-Davis, J; Kenyon, M; Sheridan, J C

    2013-11-01

    Attitudes to the inclusion of people with intellectual disabilities (IDs) have been studied extensively, yet evidence on public awareness about ID and stigma is limited. The relationship between attitudes, knowledge and stigma associated with ID is poorly understood. The present study examined these factors and the relationships between them in the context of a multicultural society. UK residents of working age (n = 1002) were presented with a diagnostically unlabelled vignette of someone with a mild ID. They were asked to label the difficulties presented and to complete measures of social distance and attitudes to the inclusion of people with IDs. While attitudes to the inclusion of people with IDs were relatively positive overall, social contact was viewed with ambivalence. Inclusion attitudes and social distance were only moderately correlated. Across the whole sample 28% recognised typical symptoms of mild ID. Recognition of ID was associated with lower stigma and more positive attitudes than attribution of the difficulties presented to other causes. White Westerners showed increased knowledge, lower stigma and favoured inclusion more than participants from ethnic minorities. Among the latter group, Asians showed lower stigma and attitudes more in line with inclusion policies than participants of Black African/Caribbean backgrounds. Once a host of contextual factors were considered jointly, only contact was consistently associated with the variables measured. Stigma associated with ID is of concern across all ethnic groups, although it appears to be increased among the public from ethnic minorities. Given that contact and awareness are associated with reduced stigma, they should be considered as prime foci for efforts to tackle ID stigma. The current findings serve as baseline for attempts to increase public awareness and tackle stigma. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

  9. Novel ID-based anti-collision approach for RFID

    NASA Astrophysics Data System (ADS)

    Zhang, De-Gan; Li, Wen-Bin

    2016-09-01

    Novel correlation ID-based (CID) anti-collision approach for RFID under the banner of the Internet of Things (IOT) has been presented in this paper. The key insights are as follows: according to the deterministic algorithms which are based on the binary search tree, we propose a method to increase the association between tags so that tags can initiatively send their own ID under certain trigger conditions, at the same time, we present a multi-tree search method for querying. When the number of tags is small, by replacing the actual ID with the temporary ID, it can greatly reduce the number of times that the reader reads and writes to tag's ID. Active tags send data to the reader by the way of modulation binary pulses. When applying this method to the uncertain ALOHA algorithms, the reader can determine the locations of the empty slots according to the position of the binary pulse, so it can avoid the decrease in efficiency which is caused by reading empty slots when reading slots. Theory and experiment show that this method can greatly improve the recognition efficiency of the system when applied to either the search tree or the ALOHA anti-collision algorithms.

  10. External modulation of the sustained attention network in traumatic brain injury.

    PubMed

    Richard, Nadine M; O'Connor, Charlene; Dey, Ayan; Robertson, Ian H; Levine, Brian

    2018-05-07

    Traumatic brain injury (TBI) is associated with impairments in processing speed as well as higher-level cognitive functions that depend on distributed neural networks, such as regulating and sustaining attention. Although exogenous alerting cues have been shown to support patients in sustaining attentive, goal-directed behavior, the neural correlates of this rehabilitative effect are unclear. The purpose of this study was to explore the effects of moderate to severe TBI on activity and functional connectivity in the well-documented right-lateralized frontal-subcortical-parietal sustained attention network, and to assess the effects of alerting cues. Using multivariate analysis of fMRI data, TBI patients and matched neurologically healthy (NH) comparison participants were scanned as they performed the Sustained Attention to Response Task (SART) in 60-s blocks, with or without exogenous cueing through brief auditory alerting tones. Results documented inefficient voluntary control of attention in the TBI patients, with reduced functional connectivity in the sustained attention network relative to NH participants. When alerting cues were present during the SART, however, functional connectivity increased and became comparable to activity patterns seen in the NH group. These findings provide novel evidence of a neural mechanism for the facilitatory effects of alerting cues on goal-directed behavior in patients with damaged attentional brain systems, and support their use in cognitive rehabilitation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  11. Combined deficiency of iron and (n-3) fatty acids in male rats disrupts brain monoamine metabolism and produces greater memory deficits than iron deficiency or (n-3) fatty acid deficiency alone.

    PubMed

    Baumgartner, Jeannine; Smuts, Cornelius M; Malan, Linda; Arnold, Myrtha; Yee, Benjamin K; Bianco, Laura E; Boekschoten, Mark V; Müller, Michael; Langhans, Wolfgang; Hurrell, Richard F; Zimmermann, Michael B

    2012-08-01

    Deficiencies of iron (Fe) (ID) and (n-3) fatty acids (FA) [(n-3)FAD] may impair brain development and function through shared mechanisms. However, little is known about the potential interactions between these 2 common deficiencies. We studied the effects of ID and (n-3)FAD, alone and in combination, on brain monoamine pathways (by measuring monoamines and related gene expression) and spatial working and reference memory (by Morris water maze testing). Using a 2 × 2 design, male rats were fed an ID, (n-3)FAD, ID+(n-3)FAD, or control diet for 5 wk postweaning (postnatal d 21-56) after (n-3)FAD had been induced over 2 generations. The (n-3)FAD and ID diets decreased brain (n-3) FA by 70-76% and Fe by 20-32%, respectively. ID and (n-3)FAD significantly increased dopamine (DA) concentrations in the olfactory bulb (OB) and striatum, with an additive 1- to 2-fold increase in ID+(n-3)FAD rats compared with controls (P < 0.05). ID decreased serotonin (5-HT) levels in OB, with a significant decrease in ID+(n-3)FAD rats. Furthermore, norepinephrine concentrations were increased 2-fold in the frontal cortex (FC) of (n-3)FAD rats (P < 0.05). Dopa decarboxylase was downregulated in the hippocampus of ID and ID+(n-3)FAD rats (fold-change = -1.33; P < 0.05). ID and (n-3)FAD significantly impaired working memory performance and the impairment positively correlated with DA concentrations in FC (r = 0.39; P = 0.026). Reference memory was impaired in the ID+(n-3)FAD rats (P < 0.05) and was negatively associated with 5-HT in FC (r = -0.42; P = 0.018). These results suggest that the combined deficiencies of Fe and (n-3) FA disrupt brain monoamine metabolism and produce greater deficits in reference memory than ID or (n-3)FAD alone.

  12. The Familial Co-Aggregation of Attention-Deficit/Hyperactivity Disorder and Intellectual Disability: A Register-Based Family Study.

    PubMed

    Faraone, Stephen V; Ghirardi, Laura; Kuja-Halkola, Ralf; Lichtenstein, Paul; Larsson, Henrik

    2017-02-01

    Although many studies document an association between attention-deficit/hyperactivity disorder (ADHD) and intellectual disability (ID), little is known about the etiology of this comorbidity and how it should be addressed in clinical settings. We sought to clarify this issue. All individuals born in Sweden between 1987 and 2006 (n = 2,049,587) were identified using the Medical Birth Register (MBR). From this we selected 7 cohorts of relatives: 1,899,654 parent-offspring pairs, 4,180 monozygotic twin pairs, 12,655 dizygotic twin pairs, 914,848 full sibling pairs, 136,962 maternal half-sibling pairs, 134,502 paternal half-sibling pairs, and 2,790,164 full cousin pairs. We used within-individual and within-family analyses to assess the association between ADHD and ID. Individuals with ID were at increased risk for ADHD compared to those without ID, and relatives of participants with ID were at increased risk of ADHD compared with relatives of those without ID. The magnitude of this association was positively associated with the fraction of the genome shared by the relative pair and was lower for severe compared with mild and moderate ID. Model-fitting analyses demonstrated that 91% of the correlation between the liabilities of ADHD and ID was attributable to genetic factors. These data provide evidence that nearly all of the comorbidity between ADHD and ID can be attributed to genetic factors, which has implications for diagnostic practice. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  13. Vestibular afferent responses to linear accelerations in the alert squirrel monkey

    NASA Technical Reports Server (NTRS)

    Somps, Christopher J.; Schor, Robert H.; Tomko, David L.

    1994-01-01

    The spontaneous activity of 40 otolith afferents and 44 canal afferents was recorded in 4 alert, intact squirrel monkeys. Polarization vectors and response properties of otolith afferents were determined during static re-orientations relative to gravity and during Earth-horizontal, sinusoidal, linear oscillations. Canal afferents were tested for sensitivity to linear accelerations. For regular otolith afferents, a significant correlation between upright discharge rate and sensitivity to dynamic acceleration in the horizontal plane was observed. This correlation was not present in irregular units. The sensitivity of otolith afferents to both static tilts and dynamic linear acceleration was much greater in irregularly discharging units than in regularly discharging units. The spontaneous activity and static and dynamic response properties of regularly discharging otolith afferents were similar to those reported in barbiturate-anesthetized squirrel monkeys. Irregular afferents also had similar dynamic response properties when compared to anesthetized monkeys. However, this sample of irregular afferents in alert animals had higher resting discharge rates and greater sensitivity to static tilts. The majority of otolith polarization vectors were oriented near the horizontal in the plane of the utricular maculae; however, directions of maximum sensitivity were different during dynamic and static testing. Canal afferents were not sensitive to static tilts or linear oscillations of the head.

  14. Volume 10, Issue 11-12© 2001 WILEY-VCH Verlag Berlin GmbH, Fed. Rep. of GermanySave Title to My Profile

    E-MailPrint

    Volume 10, Issue 11-12, Pages 887-984(November 2001)

    Original Paper

    Imaging of atomic orbitals with the Atomic Force Microscope - experiments and simulations

    NASA Astrophysics Data System (ADS)

    Giessibl, F. J.; Bielefeldt, H.; Hembacher, S.; Mannhart, J.

    2001-11-01

    Atomic force microscopy (AFM) is a mechanical profiling technique that allows to image surfaces with atomic resolution. Recent progress in reducing the noise of this technique has led to a resolution level where previously undetectable symmetries of the images of single atoms are observed. These symmetries are related to the nature of the interatomic forces. The Si(111)-(7 × 7) surface is studied by AFM with various tips and AFM images are simulated with chemical and electrostatic model forces. The calculation of images from the tip-sample forces is explained in detail and the implications of the imaging parameters are discussed. Because the structure of the Si(111)-(7 × 7) surface is known very well, the shape of the adatom images is used to determine the tip structure. The observability of atomic orbitals by AFM and scanning tunneling microscopy is discussed.

  15. Validation and adaptation of the Norwegian version of Hayes Ability Screening Index for intellectual difficulties in a psychiatric sample.

    PubMed

    Søndenaa, Erik; Nygård, Øyvind; Nøttestad, Jim Aage; Linaker, Olav Martin

    2011-02-01

    Intellectual disabilities (ID) among psychiatric patients have traditionally been neglected. A lack of convenient instruments and competency in ID may have worsened the conditions and treatment availability for these patients. Validation and adaptation of a screening instrument for ID (Hayes Ability Screening Index; HASI) in a psychiatric hospital setting. This is a cross-sectional study of 50 psychiatric patients in two Norwegian psychiatric hospitals comparing results of the HASI with the Wechsler Abbreviated Scale of Intelligence (WASI). The HASI correlated well with the standard IQ test used (r= 0.67, P< 0.001). At a stated cut-off score of 85, the HASI had a sensitivity of 100% and specificity of 34%. The HASI is a valid and time-saving screening instrument for ID among psychiatric patients. The prescribed cut-off score, however, resulted in a large number of false positives.

  16. Adaptation and validation of the Tower of London test of planning and problem solving in people with intellectual disabilities.

    PubMed

    Masson, J D; Dagnan, D; Evans, J

    2010-05-01

    There is a need for validated, standardised tools for the assessment of executive functions in adults with intellectual disabilities (ID). This study examines the validity of a test of planning and problem solving (Tower of London) with adults with ID. Participants completed an adapted version of the Tower of London (ToL) while day-centre staff completed adaptive function (Adaptive Behaviour Scale - Residential and Community: Second Edition, modified version) and dysexecutive function (DEX-Independent Rater) questionnaires for each participant. Correlation analyses of test and questionnaire variables were undertaken. The adapted ToL has a robust structure and shows significant associations with independent living skills, challenging behaviour and behaviours related to dysexecutive function. The adapted ToL is a valid test for use with people with ID. However, there is also a need to develop other ecologically valid tools based on everyday planning tasks undertaken by people with ID.

  17. Attention Performance Measured by Attention Network Test Is Correlated with Global and Regional Efficiency of Structural Brain Networks

    PubMed Central

    Xiao, Min; Ge, Haitao; Khundrakpam, Budhachandra S.; Xu, Junhai; Bezgin, Gleb; Leng, Yuan; Zhao, Lu; Tang, Yuchun; Ge, Xinting; Jeon, Seun; Xu, Wenjian; Evans, Alan C.; Liu, Shuwei

    2016-01-01

    Functional neuroimaging studies have indicated the involvement of separate brain areas in three distinct attention systems: alerting, orienting, and executive control (EC). However, the structural correlates underlying attention remains unexplored. Here, we utilized graph theory to examine the neuroanatomical substrates of the three attention systems measured by attention network test (ANT) in 65 healthy subjects. White matter connectivity, assessed with diffusion tensor imaging deterministic tractography was modeled as a structural network comprising 90 nodes defined by the automated anatomical labeling (AAL) template. Linear regression analyses were conducted to explore the relationship between topological parameters and the three attentional effects. We found a significant positive correlation between EC function and global efficiency of the whole brain network. At the regional level, node-specific correlations were discovered between regional efficiency and all three ANT components, including dorsolateral superior frontal gyrus, thalamus and parahippocampal gyrus for EC, thalamus and inferior parietal gyrus for alerting, and paracentral lobule and inferior occipital gyrus for orienting. Our findings highlight the fundamental architecture of interregional structural connectivity involved in attention and could provide new insights into the anatomical basis underlying human behavior. PMID:27777556

  18. Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency.

    PubMed

    Toki, Yasumichi; Ikuta, Katsuya; Kawahara, Yoshie; Niizeki, Noriyasu; Kon, Masayuki; Enomoto, Motoki; Tada, Yuko; Hatayama, Mayumi; Yamamoto, Masayo; Ito, Satoshi; Shindo, Motohiro; Kikuchi, Yoko; Inoue, Mitsutaka; Sato, Kazuya; Fujiya, Mikihiro; Okumura, Toshikatsu

    2017-07-01

    Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. If RET-He is, indeed, capable of evaluating iron deficiency (ID), it would be useful for immediate diagnosis of IDA. In the present study, we examined the usefulness of RET-He for diagnosis of ID. Blood samples were obtained from 211 patients. Anemia was defined as hemoglobin (Hb) level of <12 g/dL. Iron deficiency was defined as serum ferritin level of <12 ng/mL. Patients were classified into four groups: IDA, ID, control, and non-ID with anemia. Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.902, indicating that RET-He facilitates the diagnosis of ID with high accuracy. RET-He changed in parallel with changes in Hb during iron administration for 21 IDA patients. Our results indicate that RET-He may be a clinically useful marker for determining ID in the general population.

  19. Attentional Lapses of Adults with Attention Deficit Hyperactivity Disorder in Tasks of Sustained Attention.

    PubMed

    Gmehlin, Dennis; Fuermaier, Anselm B M; Walther, Stephan; Tucha, Lara; Koerts, Janneke; Lange, Klaus W; Tucha, Oliver; Weisbrod, Matthias; Aschenbrenner, Steffen

    2016-06-01

    Adults with attention deficit hyperactivity disorder (ADHD) show attentional dysfunction such as distractibility and mind-wandering, especially in lengthy tasks. However, fundamentals of dysfunction are ambiguous and relationships of neuropsychological test parameters with self-report measures of ADHD symptoms are marginal. We hypothesize that basic deficits in sustaining attention explain more complex attentional dysfunction in persons with ADHD and relate to ADHD symptoms. Attentional function was analyzed by computing ex-Gaussian parameters for 3 time Blocks in a 20 min test of sustained alertness. Changes in performance across these blocks were analyzed by comparing adult persons with ADHD (n = 24) with healthy matched controls (n = 24) and correlated with neuropsychological measures of selective and divided attention as well as self-report measures of ADHD symptoms. We found a significantly steeper increase in the number of slow responses (ex-Gaussian parameter τ) in persons with ADHD with time on task in basic sustained alertness. They also performed significantly worse in tasks of sustained selective and divided attention. However, after controlling for an increase in τ during the alertness task, significant differences between groups disappeared for divided and partly selective attention. Increases in τ in the sustained alertness task correlated significantly with self-report measures of ADHD symptoms. Our results provide evidence that very basic deficits in sustaining attention in adults with ADHD are related to infrequent slow responses (=attentional lapses), with changes over time being relevant for more complex attentional function and experienced ADHD symptoms in everyday life. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. GEOGLE: context mining tool for the correlation between gene expression and the phenotypic distinction.

    PubMed

    Yu, Yao; Tu, Kang; Zheng, Siyuan; Li, Yun; Ding, Guohui; Ping, Jie; Hao, Pei; Li, Yixue

    2009-08-25

    In the post-genomic era, the development of high-throughput gene expression detection technology provides huge amounts of experimental data, which challenges the traditional pipelines for data processing and analyzing in scientific researches. In our work, we integrated gene expression information from Gene Expression Omnibus (GEO), biomedical ontology from Medical Subject Headings (MeSH) and signaling pathway knowledge from sigPathway entries to develop a context mining tool for gene expression analysis - GEOGLE. GEOGLE offers a rapid and convenient way for searching relevant experimental datasets, pathways and biological terms according to multiple types of queries: including biomedical vocabularies, GDS IDs, gene IDs, pathway names and signature list. Moreover, GEOGLE summarizes the signature genes from a subset of GDSes and estimates the correlation between gene expression and the phenotypic distinction with an integrated p value. This approach performing global searching of expression data may expand the traditional way of collecting heterogeneous gene expression experiment data. GEOGLE is a novel tool that provides researchers a quantitative way to understand the correlation between gene expression and phenotypic distinction through meta-analysis of gene expression datasets from different experiments, as well as the biological meaning behind. The web site and user guide of GEOGLE are available at: http://omics.biosino.org:14000/kweb/workflow.jsp?id=00020.

  1. Association of a Best-Practice Alert and Prenatal Administration With Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccination Rates.

    PubMed

    Morgan, Jamie L; Baggari, Sangameshwar R; Chung, Wendy; Ritch, Julia; McIntire, Donald D; Sheffield, Jeanne S

    2015-08-01

    To evaluate how implementation of a best-practice alert, a reminder of clinical guidelines within the electronic medical record, in combination with the recommended change in immunization timing from postpartum to antepartum, affected tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) rates, and to examine the association of vaccination with local pertussis attack rates. A Tdap best-practice alert was introduced into the electronic prenatal charting system in June 2013. The best-practice alert was designed to appear starting at 32 weeks of gestation and to reappear at every subsequent encounter until vaccine acceptance was recorded or delivery occurred. The overall acceptance rate was then compared with postpartum vaccination rates at our institution from the previous year. Records of pertussis cases in children younger than 2 years of age diagnosed since 2012 in Dallas County were also reviewed to correlate local trends with vaccination efforts. Of the 10,201 women offered Tdap during prenatal care, 9,879 (96.8%) ultimately accepted. This is compared with a 48% (5,064 of 10,600) Tdap postpartum immunization rate in the year prior, before introduction of the best-practice alert. The incidence of pertussis among neonates born to mothers who received prenatal care at Parkland Hospital showed a nonsignificant decline from 13 cases per 10,000 deliveries (19 of 14,834, 95% confidence interval [CI] 7-19) between January 2012 and May 2013 to seven per 10,000 deliveries during the study period (eight of 11,788, 95% CI 2-11, P=.174). The use of a best-practice alert, in concert with the recommended change in timing of maternal vaccination from postpartum to antepartum, was associated with an increase in the Tdap immunization rate to 97%. II.

  2. Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery and the Risk of Platinum Resistance in Epithelial Ovarian Cancer.

    PubMed

    da Costa, Alexandre A B A; Valadares, Camila V; Baiocchi, Glauco; Mantoan, Henrique; Saito, Augusto; Sanches, Solange; Guimarães, Andréia P; Achatz, Maria Isabel W

    2015-12-01

    Interval debulking surgery (IDS) is an option for treating patients with advanced ovarian carcinoma. Two randomized trials have shown similar survival rates for primary debulking surgery (PDS) and IDS. One of the concerns with IDS is the potentially higher risk of inducing platinum resistance when treating patients with greater disease volume. A retrospective review of data on 237 patients with stage IIIC and IV ovarian carcinoma who were treated at a single institution from 2000 to 2013. We analyzed the association of IDS with time to first platinum resistant relapse (TTPR); platinum-resistant disease at first relapse, defined as a platinum-free interval (PFI) after first-line chemotherapy of <6 months; and overall response rate (ORR) to chemotherapy at first platinum-sensitive relapse. The TTPR was 60 months, and the median TTPR was longer for the PDS (80.8 months) versus IDS group (39.3 months; p = 0.012) and for patients with residual disease (RD) ≤10 mm (80.8 months) compared with those with RD >10 mm (26.1 months; p < 0.001). In the multivariate analysis, IDS [hazard ratio (HR) 1.92; p = 0.009] and RD >10 mm (HR 1.65; p < 0.001) retained an increased risk of developing platinum-resistant disease. IDS was not associated with a greater risk of PFI <6 months at first relapse, and the ORR to platinum-based chemotherapy at first platinum-sensitive relapse was 87.2 % for patients who were treated with PDS compared with 68.0 % for those who underwent IDS (p = 0.051). IDS correlates with a higher risk of the development of platinum resistance.

  3. Home literacy environment of pre-school children with intellectual disabilities.

    PubMed

    van der Schuit, M; Peeters, M; Segers, E; van Balkom, H; Verhoeven, L

    2009-12-01

    For pre-school children, the home literacy environment (HLE) plays an important role in the development of language and literacy skills. As there is little known about the HLE of children with intellectual disabilities (ID), the aim of the present study was to investigate the HLE of children with ID in comparison with children without disabilities. Parent questionnaires concerning aspects of the HLE were used to investigate differences between 48 children with ID, 107 children without disabilities of the same chronological age and 36 children without disabilities of the same mental age (MA). Furthermore, for the children with ID, correlations were computed between aspects of the HLE and children's non-verbal intelligence, speech intelligibility, language and early literacy skills. From the results of the multivariate analyses of variance it could be concluded that the HLE of children with ID differed from that of children in the chronological age group on almost all aspects. When compared with children in the MA group, differences in the HLE remained. However, differences mainly concerned child-initiated activities and not parent-initiated activities. Correlation analyses showed that children's activities with literacy materials were positively related with MA, productive syntax and vocabulary age, and book orientation skills. Also, children's involvement during storybook reading was related with their MA, receptive language age, productive syntax and vocabulary age, book orientation and rapid naming of pictures. The amount of literacy materials parents provided was related to a higher productive syntax age and level of book orientation of the children. Parent play activities were also positively related to children's speech intelligibility. The cognitive disabilities of the children were the main cause of the differences found in the HLE between children with ID and children without disabilities. Parents also adapt their level to the developmental level of their child, which may not always be the most stimulating for the children.

  4. Tumor dormancy and cell signaling. V. Regrowth of the BCL1 tumor after dormancy is established.

    PubMed

    Vitetta, E S; Tucker, T F; Racila, E; Huang, Y W; Marches, R; Lane, N; Scheuermann, R H; Street, N E; Watanabe, T; Uhr, J W

    1997-06-15

    The majority of BALB/c mice immunized with the BCL1 lymphoma-derived idiotype (Id+) IgM and subsequently challenged with BCL1 tumor cells develop a state of tumor dormancy. The vast majority of dormant lymphoma cells are in cell cycle arrest, but there are also residual replicating cells. In the present studies, we attempted to define features of both the dormant lymphoma cells and the host that lead to escape from dormancy. Escape from dormancy occurs at a steady rate over a 2-year period, suggesting that it is a stochastic process. We found that, in the majority of mice, escape was due to the emergence of genetic variants that were no longer susceptible to the anti-Id-mediated induction of dormancy. Ten percent of these variants were Id-; the remainder were Id+ but could grow in the presence of anti-Id antibodies, suggesting that there were mutations in molecules involved in one or more mIg-mediated negative-signaling pathways. In two of five such escapees, alterations in either Syk, HS1, and/or Lyn were observed. In a small percentage of mice, a low titer of circulating anti-Id antibody before tumor challenge correlated with a subsequent, more rapid loss of dormancy.

  5. Preeclampsia is associated with ACE I/D polymorphism, obesity and oxidative damage in Mexican women.

    PubMed

    González-Garrido, José A; García-Sánchez, José R; Tovar-Rodríguez, José M; Olivares-Corichi, Ivonne M

    2017-10-01

    This study sought to determine whether the angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism, obesity and oxidative damage are risk factors for the development of preeclampsia in Mexican women. A total of 66 women with preeclampsia (PE) and 37 women with normal pregnancies (NP) were included in the study. DNA was extracted from whole blood, and the ACE I/D polymorphism was evaluated by polymerase chain reaction. ACE activity and oxidative damage were assessed in plasma. The intergroup comparisons were analyzed by an analysis of variance (ANOVA) with post hoc tests. Hardy-Weinberg equilibrium (HWE) was tested by x 2 analysis, odds ratios (OR) were calculated as a measure of the degree of relative risk of preeclampsia, and for correlations, we used Spearman's correlation coefficient. The frequency of the DD genotype was higher in PE (34.84%) than NP (10.82%). The OR of the DD genotype and D allele were associated with a 4.4-fold (CI=95% 2.24-14) and 3-fold (CI=95% 1.69-5.62) increased risk of developing PE, respectively. Major ACE activity in the DD genotype and obesity were features of the PE group; oxidative damage to proteins and a reduction in the activity of the antioxidant system showed a correlation with BMI (p<0.01). Our results suggest that ACE I/D polymorphism, high ACE activity, body mass index and oxidative damage may play key roles in the pathogenesis of PE in the Mexican population. Furthermore, these findings could be used as predictive factors of PE. Copyright © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  6. Downregulated bone morphogenetic protein signaling in nitrofen-induced congenital diaphragmatic hernia.

    PubMed

    Makanga, Martine; Dewachter, Céline; Maruyama, Hidekazu; Vuckovic, Aline; Rondelet, Benoit; Naeije, Robert; Dewachter, Laurence

    2013-08-01

    Bone morphogenetic proteins (BMP) have been shown to play crucial roles in not only lung and heart development, but also in the pathogenesis of pulmonary vascular remodeling in pulmonary hypertension (PH). We therefore hypothesized that BMP signaling could be altered in nitrofen-induced congenital diaphragmatic hernia (CDH) and associated PH. Pregnant rats were exposed to either 100 mg nitrofen or vehicle on embryonic day (E) 9.5. On E17 and E21, fetuses were delivered by cesarean section, killed and checked for left-sided CDH. The tissue was then harvested for pathobiological evaluation. In nitrofen-induced CDH, pulmonary expressions of BMP4, BMP receptor (BMPR) type 2 and Id1 decreased on E17 and E21. On E17, pulmonary gremlin-1 expression increased, while BMP7 decreased. In the lungs, Id1 expression was correlated to BMP4 and BMPR2 and inversely correlated to gremlin-1 expression. Myocardial expressions of BMPR2, BMPR1A, BMP7 and SERCA-2A decreased, while gremlin-1 and noggin expressions increased on E17. On E21, myocardial expressions of Id1 and SERCA-2A decreased, while gremlin-1 expression increased. Moreover, BMPR2 and BMPR1A expressions were correlated to SERCA-2A expression and inversely correlated to pro-apoptotic Bax/Bcl2 ratio within the myocardium. Downregulation of BMP signaling seems to contribute to pulmonary and myocardial anomalies observed in nitrofen-induced CDH.

  7. Reduction in the cumulative effect of stress-induced inbreeding depression due to intragenerational purging in Drosophila melanogaster.

    PubMed

    Enders, L S; Nunney, L

    2016-03-01

    Environmental stress generally exacerbates the harmful effects of inbreeding and it has been proposed that this could be exploited in purging deleterious alleles from threatened inbred populations. However, understanding what factors contribute to variability in the strength of inbreeding depression (ID) observed across adverse environmental conditions remains a challenge. Here, we examined how the nature and timing of stress affects ID and the potential for purging using inbred and outbred Drosophila melanogaster larvae exposed to biotic (larval competition, bacteria infection) and abiotic (ethanol, heat) stressors compared with unstressed controls. ID was measured during (larval survival) and after (male mating success) stress exposure. The level of stress imposed by each stressor was approximately equal, averaging a 42% reduction in outbred larval survival relative to controls. All stressors induced on average the same ID, causing a threefold increase in lethal equivalents for larval survival relative to controls. However, stress-induced ID in larval success was followed by a 30% reduction in ID in mating success of surviving males. We propose that this fitness recovery is due to 'intragenerational purging' whereby fitness correlations facilitate stress-induced purging that increases the average fitness of survivors in later life history stages. For biotic stressors, post-stress reductions in ID are consistent with intragenerational purging, whereas for abiotic stressors, there appeared to be an interaction between purging and stress-induced physiological damage. For all stressors, there was no net effect of stress on lifetime ID compared with unstressed controls, undermining the prediction that stress enhances the effectiveness of population-level purging across generations.

  8. Reduction in the cumulative effect of stress-induced inbreeding depression due to intragenerational purging in Drosophila melanogaster

    PubMed Central

    Enders, L S; Nunney, L

    2016-01-01

    Environmental stress generally exacerbates the harmful effects of inbreeding and it has been proposed that this could be exploited in purging deleterious alleles from threatened inbred populations. However, understanding what factors contribute to variability in the strength of inbreeding depression (ID) observed across adverse environmental conditions remains a challenge. Here, we examined how the nature and timing of stress affects ID and the potential for purging using inbred and outbred Drosophila melanogaster larvae exposed to biotic (larval competition, bacteria infection) and abiotic (ethanol, heat) stressors compared with unstressed controls. ID was measured during (larval survival) and after (male mating success) stress exposure. The level of stress imposed by each stressor was approximately equal, averaging a 42% reduction in outbred larval survival relative to controls. All stressors induced on average the same ID, causing a threefold increase in lethal equivalents for larval survival relative to controls. However, stress-induced ID in larval success was followed by a 30% reduction in ID in mating success of surviving males. We propose that this fitness recovery is due to ‘intragenerational purging' whereby fitness correlations facilitate stress-induced purging that increases the average fitness of survivors in later life history stages. For biotic stressors, post-stress reductions in ID are consistent with intragenerational purging, whereas for abiotic stressors, there appeared to be an interaction between purging and stress-induced physiological damage. For all stressors, there was no net effect of stress on lifetime ID compared with unstressed controls, undermining the prediction that stress enhances the effectiveness of population-level purging across generations. PMID:26604190

  9. Algorithm of reducing the false positives in IDS based on correlation Analysis

    NASA Astrophysics Data System (ADS)

    Liu, Jianyi; Li, Sida; Zhang, Ru

    2018-03-01

    This paper proposes an algorithm of reducing the false positives in IDS based on correlation Analysis. Firstly, the algorithm analyzes the distinguishing characteristics of false positives and real alarms, and preliminary screen the false positives; then use the method of attribute similarity clustering to the alarms and further reduces the amount of alarms; finally, according to the characteristics of multi-step attack, associated it by the causal relationship. The paper also proposed a reverse causation algorithm based on the attack association method proposed by the predecessors, turning alarm information into a complete attack path. Experiments show that the algorithm simplifies the number of alarms, improve the efficiency of alarm processing, and contribute to attack purposes identification and alarm accuracy improvement.

  10. See Also:Mechanics of Cohesive-frictional MaterialsCopyright © 2004 John Wiley & Sons, Ltd.Get Sample Copy

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  1. Insertion/Deletion Polymorphisms and Serum Angiotensin-converting Enzyme Levels in Iranian Patients with Sarcoidosis

    PubMed Central

    JAVADI, Alireza; SHAMAEI, Masoud; ZAREI, Masoud; REZAEIAN, Lida; KIANI, Arda; ABEDINI, Atefeh

    2016-01-01

    Background: Sarcoidosis is a multisystem inflammatory disease of unknown origin with characterization of small granulomas. Angiotensin-converting enzyme (ACE) is a pathophysiologic marker of sarcoidosis. We present the ACE insertion/deletion (I/D) polymorphism in correlation with serum ACE level in Iranian patients with sarcoidosis. Methods: From Jan 2014 to Jan 2015, 102 Iranian patients who histopathologically diagnosed for sarcoidosis and 192 healthy age and sex-matched controls were recruited. PCR was used for detection of I/D polymorphism in ACE gene. Results: Frequency of II/ID/DD genotype in sarcoidosis disease was 17%, 35.5%, and 47.1%, respectively. The frequency of D allele was 0.65. A significant association between I/D genotypes and mean of sACE level was seen (DD=85.2±22.9, P<0.001). More frequent genotype in sarcoidosis patients was DD (47%), ID genotype (45.9%) was found more in controls. Logistic regression analysis adjusting age and sex showed that ID to II (OR=0.35, 95%CI=0.17–0.73, P=0.005) and DD to II (OR=2.11, 95%CI=0.98–4.54, P=0.05) could be considered as a predictor factor for the disease activity. No significant model for men in sarcoidosis group was seen, while women with II/ID were associated with a reduced risk for the disease. Conclusion: Although more regional studies with appropriate statistical scale must be done to provide a better diagnosis and prognostic tool for this disease, this study demonstrates that ID and DD genotype could be predictive factors for sarcoidosis. PMID:28032065

  2. Putative anticancer potential of novel 4-thiazolidinone derivatives: cytotoxicity toward rat C6 glioma in vitro and correlation of general toxicity with the balance of free radical oxidation in rats.

    PubMed

    Коbylinska, Lesya I; Boiko, Nataliya M; Panchuk, Rostyslav R; Grytsyna, Iryna I; Klyuchivska, Olga Yu; Biletska, Liliya P; Lesyk, Roman B; Zіmenkovsky, Borys S; Stoika, Rostyslav S

    2016-04-23

    To evaluate the cytotoxic action of 4-thiazolidinone derivatives (ID 3288, ID 3882, and ID 3833) toward rat glioma C6 cells and to compare the effects of these compounds and doxorubicin on the balance of free radical oxidation (FRO) and antioxidant activity (AOA) in the serum of rats. Glioma cells were treated with ID 3882, ID 3288, ID 3833, and doxorubicin, and their cytotoxicity was studied using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and Trypan blue exclusion test, light and fluorescent microscopy, and flow cytometric study of cell cycling and apoptosis, including measuring of Annexin V-positive cells. The contents of superoxide radical, hydrogen peroxide, hydroxyl radical, malonic dialdehyde, and hydrogen sulfide were measured in the serum of rats. Enzymatic activity of superoxide dismutase (SOD), catalase (Cat), and glutathione peroxydase (GPO) was determined. Among novel 4-thiazolidinone derivatives, ID 3288 was most toxic toward rat glioma C6 cells, even compared with doxorubicin. All applied derivatives were less active than doxorubicin in inducing reactive oxygen species-related indicators in the serum of rats. A similar effect was observed when enzymatic indicators of AOA processes were measured. While doxorubicin inhibited the activity of SOD, GPO, and Cat, the effects of 4-thiazolidinone derivatives were less prominent. Novel 4-thiazolidinone derivatives differ in their antineoplastic action toward rat glioma C6 cells, and ID 3288 possesses the highest activity compared to doxorubicin. Measurement of indicators of FRO and AOA in the serum of rats treated with these compounds showed their lower general toxicity compared with doxorubicin's toxicity.

  3. Assessing theory of mind nonverbally in those with intellectual disability and ASD: the penny hiding game.

    PubMed

    San José Cáceres, Antonia; Keren, Noa; Booth, Rhonda; Happé, Francesca

    2014-10-01

    Individuals with autism spectrum disorder (ASD) and low intellectual/language abilities are often omitted from experimental studies because of the challenges of testing these individuals. It is vital to develop appropriate and accessible tasks so that this significant part of the spectrum is not neglected. The theory of mind (ToM) has been extensively assessed in ASD, predominantly in relatively high-functioning individuals with reasonable language skills. This study aims to assess the ToM abilities of a sample of 132 participants with intellectual disability (ID) with and without ASD, matched in verbal mental age (VMA) and chronological age, using a naturalistic and nonverbal deception task: the Penny Hiding Game (PHG). The relationship between performance on the PHG and everyday adaptation was also studied. The PHG proved accessible to most participants, suggesting its suitability for use with individuals with low cognitive skills, attentional problems, and limited language. The ASD + ID group showed significantly more PHG errors, and fewer tricks, than the ID group. PHG performance correlated with Vineland adaptation scores for both groups. VMA was a major predictor of passing the task in both groups, and participants with ASD + ID required, on average, 2 years higher VMA than those with ID only, to achieve the same level of PHG success. VMA moderated the association between PHG performance and real-life social skills for the ASD + ID more than the ID group, suggesting that severely impaired individuals with ASD may rely on verbal ability to overcome their social difficulties, whereas individuals with ID alone may use more intuitive social understanding both in the PHG and everyday situations. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.

  4. Absolute Reliability and Concurrent Validity of Hand Held Dynamometry and Isokinetic Dynamometry in the Hip, Knee and Ankle Joint: Systematic Review and Meta-analysis

    PubMed Central

    Chamorro, Claudio; Armijo-Olivo, Susan; De la Fuente, Carlos; Fuentes, Javiera; Javier Chirosa, Luis

    2017-01-01

    Abstract The purpose of the study is to establish absolute reliability and concurrent validity between hand-held dynamometers (HHDs) and isokinetic dynamometers (IDs) in lower extremity peak torque assessment. Medline, Embase, CINAHL databases were searched for studies related to psychometric properties in muscle dynamometry. Studies considering standard error of measurement SEM (%) or limit of agreement LOA (%) expressed as percentage of the mean, were considered to establish absolute reliability while studies using intra-class correlation coefficient (ICC) were considered to establish concurrent validity between dynamometers. In total, 17 studies were included in the meta-analysis. The COSMIN checklist classified them between fair and poor. Using HHDs, knee extension LOA (%) was 33.59%, 95% confidence interval (CI) 23.91 to 43.26 and ankle plantar flexion LOA (%) was 48.87%, CI 35.19 to 62.56. Using IDs, hip adduction and extension; knee flexion and extension; and ankle dorsiflexion showed LOA (%) under 15%. Lower hip, knee, and ankle LOA (%) were obtained using an ID compared to HHD. ICC between devices ranged between 0.62, CI (0.37 to 0.87) for ankle dorsiflexion to 0.94, IC (0.91to 0.98) for hip adduction. Very high correlation were found for hip adductors and hip flexors and moderate correlations for knee flexors/extensors and ankle plantar/dorsiflexors. PMID:29071305

  5. Parenting stress in mothers of children with an intellectual disability: the effects of parental cognitions in relation to child characteristics and family support.

    PubMed

    Hassall, R; Rose, J; McDonald, J

    2005-06-01

    Recent theories of stress and coping in parents of children with intellectual disabilities (ID) emphasize the importance of cognitive appraisals in influencing parents' levels of stress and their adaptations to difficulties presented by the children. This study investigated the relationships between parental cognitions, child characteristics, family support and parenting stress. The aspects of cognitions studied were: parenting self-esteem (including efficacy and satisfaction) and parental locus of control. The group studied consisted of 46 mothers of children with ID. The Vineland Adaptive Behavior Scales and Maladaptive Behavior Domain were administered by interview. Mothers also completed four questionnaires: the Family Support Scale, the Parenting Sense of Competence Scale, a shortened form of the Parental Locus of Control Scale and the Parenting Stress Index (Short Form). Data were analysed using Pearson's correlation coefficients, partial correlations and a regression analysis. The results indicated that most of the variance in parenting stress was explained by parental locus of control, parenting satisfaction and child behaviour difficulties. Whilst there was also a strong correlation between family support and parenting stress, this was mediated by parental locus of control. The results demonstrate the potential importance of parental cognitions in influencing parental stress levels. It is argued that these results have implications for clinical interventions for promoting parents' coping strategies in managing children with ID and behavioural difficulties.

  6. A Calibration Method for Nanowire Biosensors to Suppress Device-to-device Variation

    PubMed Central

    Ishikawa, Fumiaki N.; Curreli, Marco; Chang, Hsiao-Kang; Chen, Po-Chiang; Zhang, Rui; Cote, Richard J.; Thompson, Mark E.; Zhou, Chongwu

    2009-01-01

    Nanowire/nanotube biosensors have stimulated significant interest; however the inevitable device-to-device variation in the biosensor performance remains a great challenge. We have developed an analytical method to calibrate nanowire biosensor responses that can suppress the device-to-device variation in sensing response significantly. The method is based on our discovery of a strong correlation between the biosensor gate dependence (dIds/dVg) and the absolute response (absolute change in current, ΔI). In2O3 nanowire based biosensors for streptavidin detection were used as the model system. Studying the liquid gate effect and ionic concentration dependence of strepavidin sensing indicates that electrostatic interaction is the dominant mechanism for sensing response. Based on this sensing mechanism and transistor physics, a linear correlation between the absolute sensor response (ΔI) and the gate dependence (dIds/dVg) is predicted and confirmed experimentally. Using this correlation, a calibration method was developed where the absolute response is divided by dIds/dVg for each device, and the calibrated responses from different devices behaved almost identically. Compared to the common normalization method (normalization of the conductance/resistance/current by the initial value), this calibration method was proved advantageous using a conventional transistor model. The method presented here substantially suppresses device-to-device variation, allowing the use of nanosensors in large arrays. PMID:19921812

  7. Validation of sleep-2-Peak: A smartphone application that can detect fatigue-related changes in reaction times during sleep deprivation.

    PubMed

    Brunet, Jean-François; Dagenais, Dominique; Therrien, Marc; Gartenberg, Daniel; Forest, Geneviève

    2017-08-01

    Despite its high sensitivity and validity in the context of sleep loss, the Psychomotor Vigilance Test (PVT) could be improved. The aim of the present study was to validate a new smartphone PVT-type application called sleep-2-Peak (s2P) by determining its ability to assess fatigue-related changes in alertness in a context of extended wakefulness. Short 3-min versions of s2P and of the classic PVT were administered at every even hour during a 35-h total sleep deprivation protocol. In addition, subjective measures of sleepiness were collected. The outcomes on these tests were then compared using Pearson product-moment correlations, t tests, and repeated measures within-groups analyses of variance. The results showed that both tests significantly correlated on all outcome variables, that both significantly distinguished between the alert and sleepy states in the same individual, and that both varied similarly through the sleep deprivation protocol as sleep loss accumulated. All outcome variables on both tests also correlated significantly with the subjective measures of sleepiness. These results suggest that a 3-min version of s2P is a valid tool for differentiating alert from sleepy states and is as sensitive as the PVT for tracking fatigue-related changes during extended wakefulness and sleep loss. Unlike the PVT, s2P does not provide feedback to subjects on each trial. We discuss how this feature of s2P raises the possibility that the performance results measured by s2P could be less impacted by motivational confounds, giving this tool added value in particular clinical and/or research settings.

  8. The implications of having attention-deficit/hyperactivity disorder in male adolescents with intellectual disability.

    PubMed

    Carmeli, Eli; Klein, Neomy; Sohn, Mordechai

    2007-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. The purpose of this study was to demonstrate a correlation between social skills and ADHD among adolescents with intellectual disabilities (ID). The study concerns the specific cognitive and adaptive skills of adolescents dually diagnosed with mild intellectual disabilities and comorbid pathology as ADHD. Three age-and IQ-match groups (males, n = 12 in each group) were investigated. Group I--composed of adolescent diagnosed with mild ID, group II--adolescents diagnosed with ADHD, and group III--adolescents diagnosed with ID and ADHD. The instruments used in the study were Wechsler Intelligence Scale for Children (WISC, according to the chronological age of the subjects) and the short version of the Developmental Behavior Checklist (DBC). Results confirm that comorbidity is a factor differentiating. ADHD strongly increased the impairment of social skills, while behavioral disorders were less damaging in ID performance. The WISC and DBC instruments should be used with confidence in clinical and service settings, to allow a better assessment of co-occurrence morbidity in adolescents with ID. The interactions between intellectual disability and psychopathology behavior highlight the need to plan a more accurate diagnosis and appropriate rehabilitative intervention program, essential for improving the quality of life of the ID population.

  9. Staff attributions towards men with intellectual disability who have a history of sexual offending and challenging behaviour.

    PubMed

    MacKinlay, L; Langdon, P E

    2009-09-01

    Staff working within secure services for people with intellectual disabilities (ID) are likely to work with sexual offenders, but very little attention has been paid to how they think about this sexual offending behaviour. Forty-eight staff working within secure services for people with ID were recruited and completed the Attribution Style Questionnaire in relation to the sexual offending behaviour and challenging behaviour of men with mild ID. Attributions towards challenging behaviour and sexual offending were compared and relationships between level of ID and seriousness of the sexual offence were explored. The results indicated that staff attributed sexual offending as more external to the staff group than they did for challenging behaviour. Sexual offending behaviour was also seen as more stable, and less controllable by people with ID than was challenging behaviour. Sexual offending was also attributed as more uncontrollable by the staff group than challenging behaviour. There was a significant negative correlation between general intellectual functioning and several attributional dimensions regarding sexual offending, but not challenging behaviour. Sexual offending that was coded as more serious was attributed as universal and uncontrollable by the staff group. The differences between staff attributions regarding challenging behaviour and sexual offending potentially relate to the decision-making processes involved in deciding whether or not to involve criminal justice agencies when someone with ID commits a sexual offence. Further research within this area is warranted.

  10. Weak central coherence in weight-restored adolescent anorexia nervosa: Characteristics and remediation.

    PubMed

    Weinbach, Noam; Perry, Amit; Sher, Helene; Lock, James D; Henik, Avishai

    2017-08-01

    Weak central coherence (WCC) refers to a bias towards processing details (local processing) at the expense of paying attention to the bigger picture (global processing). Multiple studies reported WCC in adults with anorexia nervosa (AN). Evidence for WCC in adolescents with AN has been inconsistent. The current study characterizes WCC in weight-restored adolescents with AN (WR-AN) using a direct measure of WCC, and examines whether WCC can be remediated by increasing alertness level-a manipulation that was found useful in enhancing global processing in healthy individuals and clinical populations. 40 adolescents (18 WR-AN and 22 healthy adolescents) performed a global/local processing task (Navon task). Auditory alerting cues that elevate alertness level were integrated into the task. Both groups processed global information faster than local information. However, compared with controls, adolescents with WR-AN were better at ignoring an irrelevant bigger picture while attending to details (smaller global interference) and had greater difficulty ignoring irrelevant details while attending to the bigger picture (larger local interference). These differences were attenuated when adolescents with WR-AN were under a state of high alertness. Additionally, the local interference effect was positively correlated with three independent self-report questionnaires assessing eating disorders symptomatology. This study suggests that abnormal interference by irrelevant global and local information is a central characteristic of WCC in adolescents with WR-AN that cannot be accounted for by enduring illness or malnourishment. Additionally, this study demonstrates that WCC can be temporarily remediated by encouraging a state of high alertness. © 2017 Wiley Periodicals, Inc.

  11. Sleep and alertness in North Sea helicopter operations.

    PubMed

    Simons, Ries; Wilschut, Ellen S; Valk, Pierre J L

    2011-07-01

    Dutch North Sea helicopter operations are characterized by multiple sector flights to offshore platforms under difficult environmental conditions. In the context of a Ministry of Transport program to improve safety levels of helicopter operations, we assessed effects of pre-duty sleep, pre-duty travel time, and workload factors on the alertness and vigilance of pilots. Data of 24 pilots comprising 224 duty days were analyzed. Pilots performed 10-min test sessions after wake up, pre-duty, halfway-duty, end-duty, and at bedtime during normal duty rosters. Test sessions included completion of a vigilance task, vigor and sleepiness ratings, and questions on sleep and operational characteristics. Pilots wore an actometer to objectify sleep data. Vigor scores were high and sleepiness levels were low during the entire flight duty periods (FDPs), while vigilance was impaired only 6.8% in the course of the FDPs. Pre-duty sleep before morning duties was 1.5 h shorter than sleep before duties starting after midday. Longer pre-duty travel time was correlated with shorter pre-duty sleep and lower vigilance levels during duty. During the FDPs, pilots maintained alertness and vigilance levels that may be considered safe in terms of alertness-related flight safety. This favorable outcome may be attributed to reasonable length of FDPs, favorable circadian start and end times of duties, sufficient opportunities for restorative pre-duty sleep, and relatively good weather conditions. Appropriate FDP scheduling is an important measure to optimize alertness of helicopter pilots who have to cope with adverse environmental conditions and limited landing and air traffic control facilities.

  12. A novel 13C-urea breath test device for the diagnosis of Helicobacter pylori infection: continuous online measurements allow for faster test results with high accuracy.

    PubMed

    Israeli, Eran; Ilan, Yaron; Meir, Shimon Bar; Buenavida, Claudia; Goldin, Eran

    2003-08-01

    The aim of this study is to determine the accuracy of a novel laptop sized 13C-Urea breath test analyzer that continuously measures expired breath and to use its advantages to decrease testing time. One hundred and eighty-six subjects (mean age of 47.8 years) were tested simultaneously by the BreathID system (Oridion, Israel), and by the traditional IRMS. BreathID continuously measured the expired breath for a ratio of 13CO(2):12CO(2.) This value was expressed as delta over baseline (DOB) and displayed graphically on a screen in real time. One hundred and one subjects were positive and 85 were negative for H. pylori by isotope ratio mass spectrometry (IRMS). The correlation for the BreathID system at 30 minutes was 100% for positive cases and 98% for negative cases. Analysis of the continuous curves generated by the BreathID for all patients permitted definition of different DOB thresholds for a positive or negative result at shorter time intervals. Thus, after 6 minutes a conclusive test result could be obtained for 64% of subjects, and after 10 minutes for 92% of subjects. The 13C-Urea breath test utilizing the technology of molecular correlation spectrometry is an accurate method for determining infection by H. pylori. The advantage of continuous measurements can shorten testing time without compromising accuracy.

  13. Anger is a distinctive feature of epilepsy patients with depression.

    PubMed

    Mori, Yasuhiro; Kanemoto, Kousuke; Onuma, Teiichi; Tanaka, Masaki; Oshima, Tomohiro; Kato, Hiroko; Tachimori, Hisateru; Wada, Kazumaru; Kikuchi, Takashi; Tomita, Tetsu; Chen, Lei; Fang, Liu; Yoshida, Shuichi; Kato, Masaaki; Kaneko, Sunao

    2014-02-01

    Controversy exists regarding the similarity between depression as seen in patients with epilepsy and in those with idiopathic major depression. The objective of this study was to examine whether anger is a distinctive feature of depression in epilepsy. Participants included 487 adult patients with epilepsy (study group) and 85 patients with idiopathic major depression according to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria, and without other neurological complications (control group). All participants completed the Inventory of Depressive Symptomatology Self-Report (IDS-SR) and the Buss-Perry Aggression Questionnaire (BAQ). The IDS-SR is a self-report questionnaire that measures depression severity and assesses all symptoms of depression as defined by the DSM-IV. The BAQ is a self-rating scale designed for assessing aggression. After examining potential confounding factors (i.e., demographic and clinical variables) using a multivariate linear regression model, BAQ scores were compared between the study (n = 85) and control groups (n = 54) for patients with moderate or severe depression using established cut-off points (IDS-SR score > 25). BAQ scores were significantly higher in the study group (P = 0.009). Among the BAQ subscales, only anger showed a statistically significant difference (P = 0.013). Although a significant correlation was revealed between the IDS-SR and BAQ scores in the study group, no such correlation was found in the control group. Thus, anger might be a constituent component of depression among epilepsy patients, but not among idiopathic major depression patients.

  14. Subtelomeric rearrangements in Indian children with idiopathic intellectual disability/developmental delay: Frequency estimation & clinical correlation using fluorescence in situ hybridization (FISH)

    PubMed Central

    Mohan, Shruthi; Koshy, Teena; Vekatachalam, Perumal; Nampoothiri, Sheela; Yesodharan, Dhanya; Gowrishankar, Kalpana; Kumar, Jeevan; Ravichandran, Latha; Joseph, Santhosh; Chandrasekaran, Anupama; Paul, Solomon F. D.

    2016-01-01

    Background & objectives: Subtelomeres are prone to deleterious rearrangements owing to their proximity to unique sequences on the one end and telomeric repetitive sequences, which increase their tendency to recombine, on the other end. These subtelomeric rearrangements resulting in segmental aneusomy are reported to contribute to the aetiology of idiopathic intellectual disability/developmental delay (ID/DD). We undertook this study to estimate the frequency of subtelomeric rearrangements in children with ID/DD. Methods: One hundred and twenty seven children with idiopathic ID/DD were tested for subtelomeric rearrangements using karyotyping and FISH. Blood samples were cultured, harvested, fixed and GTG-banded using the standard protocols. Results: Rearrangements involving the subtelomeres were observed in 7.8 per cent of the tested samples. Detection of rearrangements visible at the resolution of the karyotype constituted 2.3 per cent, while those rearrangements detected only with FISH constituted 5.5 per cent. Five deletions and five unbalanced translocations were detected. Analysis of parental samples wherever possible was informative regarding the inheritance of the rearrangement. Interpretation & conclusions: The frequency of subtelomeric rearrangements observed in this study was within the reported range of 0-35 per cent. All abnormal genotypes were clinically correlated. Further analysis with array technologies presents a future prospect. Our results suggest the need to test individuals with ID/DD for subtelomeric rearrangements using sensitive methods such as FISH. PMID:27934799

  15. Distinguishing subtypes of extrinsic motivation among people with mild to borderline intellectual disability.

    PubMed

    Frielink, N; Schuengel, C; Embregts, P

    2017-07-01

    According to self-determination theory, motivation is ordered in types, including amotivation, extrinsic motivation and intrinsic motivation. Self-determination theory defines four subtypes of extrinsic motivation: external motivation, introjected motivation, identified motivation and integrated motivation. Although it has been argued theoretically that the different types of motivation are universally applicable, Reid et al. () proposed a dichotomy of broad subtypes of extrinsic motivation for people with intellectual disability (ID) due to their cognitive limitations. The current study challenges this proposal by testing whether the four subtypes of extrinsic motivation can be differentiated among people with ID as well. The subtypes of extrinsic motivation were measured using two adapted versions of the Self-Regulation Questionnaire, one regarding exercise and one regarding support. In total, 186 adults with mild to borderline ID participated in the study. Results supported the distinction between the four subtypes of extrinsic motivation regarding both exercise and support. In addition, the correlation coefficients supported a quasi-simplex pattern of correlations among the subtypes, indicating that adjacent subtypes were more closely related than non-adjacent subtypes. Moreover, the study showed sufficient Cronbach's alphas and test-retest reliabilities for early stage research. Overall, the results of the current study provide initial evidence for the universality of the four subtypes of extrinsic motivation across populations with and without ID. © 2017 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disibilities and John Wiley & Sons Ltd.

  16. Motor competency and social communication skills in preschool children with autism spectrum disorder.

    PubMed

    Craig, Francesco; Lorenzo, Alessandro; Lucarelli, Elisabetta; Russo, Luigi; Fanizza, Isabella; Trabacca, Antonio

    2018-06-01

    This study aimed to investigate the association between motor competency and social communication in children with Autism Spectrum Disorder (ASD) compared with children with Intellectual Disabilities (ID) and typically developing (TD) children. Motor competency, ASD symptoms, and nonverbal Intelligent Quotient (IQ) were investigated through the following tests: Movement Assessment Battery for Children, second edition (MABC-2), Social Communication Questionnaire (SCQ), Autism Classification System of Functioning: Social Communication (ACSF:SC) and Leiter International Performances Scale Revised (Leiter-R). The ASD + ID and ID groups had lower MABC-2-manual dexterity mean scores, MABC-2-aiming and catching mean scores, MABC-2-static and dynamic balance mean scores and MABC-2-TTS compared with the TD group (P < 0.05). In addition, the ASD + ID group had lower MABC-2-aiming and catching mean scores compared with the ID group. In the ASD + ID group, we found a significant negative correlation (P < 0.001) between MABC-2-aiming and catching scores with SCQ scores, nonverbal IQ and ACSF:SC levels. Our findings provide new insight into the common neuropsychological mechanisms underlying social communication and motor deficits in ASD. Multiple deficits in motor functioning may be present in ASD and ID, however deficits involving the ability to integrate motor and social cues are somewhat specific to ASD. Autism Res 2018, 11: 893-902. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. This study highlighted the specificity of motor impairment in ASD comparing performances on a frequently used measure of motor impairment between clinical groups (ASD + ID and ID) and a non-clinical group. While previous research has suggested that multiple deficits in motor functioning may be present in ASD, our findings suggest that deficits in tasks involving the ability to integrate visual and motor cues (aiming and catching task) are somewhat specific to ASD. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

  17. Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts

    PubMed Central

    McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras

    2016-01-01

    Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time—the time elapsed from when an interruptive alert is generated to when it is dismissed—could be calculated by using historical alert data from log files. Drug–drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1–4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < .001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < .001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. PMID:26499101

  18. Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record.

    PubMed

    Wright, Adam; Aaron, Skye; Seger, Diane L; Samal, Lipika; Schiff, Gordon D; Bates, David W

    2018-05-15

    Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue. To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates. Two before-and-after studies. 3277 clinicians who received a DDI alert in the outpatient setting. Introduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria. Alert burden and proportion of alerts accepted. Overall interruptive DDI alert burden increased by a factor of 6 from the legacy EHR to the commercial EHR. The acceptance rate for the most severe alerts fell from 100 to 8.4%, and from 29.3 to 7.5% for medium severity alerts (P < 0.001). After disabling the least severe alerts, total DDI alert burden fell by 50.5%, and acceptance of Tier 1 alerts rose from 9.1 to 12.7% (P < 0.01). Changing from a highly tailored DDI alerting system to a more general one as part of an EHR conversion decreased acceptance of DDI alerts and increased alert burden on users. The decrease in acceptance rates cannot be fully explained by differences in the clinical knowledge base, nor can it be fully explained by alert fatigue associated with increased alert burden. Instead, workflow factors probably predominate, including timing of alerts in the prescribing process, lack of differentiation of more and less severe alerts, and features of how users interact with alerts.

  19. INITIATE: An Intelligent Adaptive Alert Environment.

    PubMed

    Jafarpour, Borna; Abidi, Samina Raza; Ahmad, Ahmad Marwan; Abidi, Syed Sibte Raza

    2015-01-01

    Exposure to a large volume of alerts generated by medical Alert Generating Systems (AGS) such as drug-drug interaction softwares or clinical decision support systems over-whelms users and causes alert fatigue in them. Some of alert fatigue effects are ignoring crucial alerts and longer response times. A common approach to avoid alert fatigue is to devise mechanisms in AGS to stop them from generating alerts that are deemed irrelevant. In this paper, we present a novel framework called INITIATE: an INtellIgent adapTIve AlerT Environment to avoid alert fatigue by managing alerts generated by one or more AGS. We have identified and categories the lifecycle of different alerts and have developed alert management logic as per the alerts' lifecycle. Our framework incorporates an ontology that represents the alert management strategy and an alert management engine that executes this strategy. Our alert management framework offers the following features: (1) Adaptability based on users' feedback; (2) Personalization and aggregation of messages; and (3) Connection to Electronic Medical Records by implementing a HL7 Clinical Document Architecture parser.

  20. Attachment quality of children with ID and its link to maternal sensitivity and structuring.

    PubMed

    Feniger-Schaal, Rinat; Joels, Tirtsa

    2018-05-01

    Attachment theory produced a fertile field of research and clinical application. Although the topic of attachment of children with intellectual disability (ID) has received increasing research attention over the past 15 years, the empirical evidence is still limited. We applied theoretical and empirical knowledge of parenting typically developing children to examine the mother-child relationship in the ID population. The aim was to examine maternal sensitivity and structuring and its association with children's attachment classification and their disability. Forty preschool children (mean age 47.25, range 26-75 months) with non-specific ID and their mothers participated in the study. The mean developmental age was 25.92 months (SD = 10.89), The DQ mean score was 55.45 (SD = 17.28). We assessed children's quality of attachment using the SSP and maternal interactive behavior using the Emotional Availability Scales. Forty percent of children showed secure attachment, and 32.5% showed disorganized attachment. Attachment classifications correlated significantly with maternal sensitivity and maternal structuring but not with the child's cognitive disability. The results point to the importance of maternal interactive behavior for children with ID. Clinical implication may consider interventions aiming to enhance maternal sensitivity and structuring to improve children's quality of attachment. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. The Study of Biobehavioral Rhythms in a Psychology Laboratory Course.

    ERIC Educational Resources Information Center

    Rowland, David L.; Wesselhoft, Theresa

    1998-01-01

    Reports on a laboratory experiment where students measured their heart rate, blood pressure, mood, alertness, and cognitive performance. Measures showed significant circadian heart rhythm variations. They were strongly correlated and peaked at different times. Discusses the implications of this and students' reactions to the experiment. (MJP)

  2. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  3. Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability.

    PubMed

    Moss, Sarah J; Czyz, Stanislaw H

    2018-02-01

    The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart ® ) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs). Fifty-eight participants wore ActiHeart ® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart ® . Results were compared by means of correlation analyses. The level of agreement was presented with Bland-Altman plots. Objective PA (ActiHeart ® ) was higher (225.57 ± 91.96 min/week) than IPAQ-S PA reported by care-givers (177.06 ± 309.17 min/week). Weak significant correlations were observed between the ActiHeart ® and IPAQ-S instruments for sedentary behavior (r = 0.31; p = 0.04); no significant correlations for light (r= -0.04; p = 0.8), moderate (r= -0.07; p = 0.63), or vigorous PA (r= -0.2; p = 0.18) were found. Limited agreement between objectively determine PA (ActiHeart ® ) and IPAQ-S was found. IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort. Implications for Rehabilitation Persons with intellectual disability (ID) report insufficient physical activity for health benefits. Physical activity is often determined by means of subjective proxy reporting. Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID. Exercise interventions should be based on objective physical activity measurements.

  4. Motivational Correlates of Physical Activity in Persons with an Intellectual Disability: A Systematic Literature Review

    ERIC Educational Resources Information Center

    Hutzler, Y.; Korsensky, O.

    2010-01-01

    Background: The purpose of this study is to systematically retrieve, examine and discuss scientific studies focusing on motivational correlates that both contribute to, and can be assumed to be effects of, participation in sport, recreation, or health-related physical activities in persons with intellectual disability (ID). Methods: A systematic…

  5. Correlating interleukin-12 stimulated interferon-γ production and the absence of ectodermal dysplasia and anhidrosis (EDA) in patients with mutations in NF-κB essential modulator (NEMO).

    PubMed

    Haverkamp, Margje H; Marciano, Beatriz E; Frucht, David M; Jain, Ashish; van de Vosse, Esther; Holland, Steven M

    2014-05-01

    Patients with hypomorphic mutations in Nuclear Factor-κB Essential Modulator (NEMO) are immunodeficient (ID) and most display ectodermal dysplasia and anhidrosis (EDA). We compared cytokine production by NEMO-ID patients with and without EDA. PBMCs of NEMO-ID patients, four with EDA carrying E315A, C417R, D311N and Q403X, and three without EDA carrying E315A, E311_L333del and R254G, were cultured with PHA, PHA plus IL-12p70, LPS, LPS plus IFN-γ, TNF and IL-1β. The production of various cytokines was measured in the supernatants. Fifty-nine healthy individuals served as controls. PBMCs of NEMO-ID patients without EDA produce subnormal amounts of IFN-γ after stimulation with PHA, but normal amounts of IFN-γ after PHA plus IL-12p70. In contrast, IFN-γ production by patients with EDA was low in both cases. Patients with EDA also generate lower PHA-stimulated IL-10 and IL-1β than controls, whereas the production of these cytokines by patients without EDA was normal. Responses of PBMCs in NEMO-ID patients with EDA to PHA with and without IL-12p70 appear less robust than in NEMO-ID patients without EDA. This possibly indicates a better preserved NEMO function in our patients without EDA.

  6. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires.

    PubMed

    Fischer, Anja; Fischer, Marcus; Nicholls, Robert A; Lau, Stephanie; Poettgen, Jana; Patas, Kostas; Heesen, Christoph; Gold, Stefan M

    2015-09-01

    Multiple sclerosis and major depressive disorder frequently co-occur but depression often remains undiagnosed in this population. Self-rated depression questionnaires are a good option where clinician-based standardized diagnostics are not feasible. However, there is a paucity of data on diagnostic accuracy of self-report measures for depression in multiple sclerosis (MS). Moreover, head-to-head comparisons of common questionnaires are largely lacking. This could be particularly relevant for high-risk patients with depressive symptoms. Here, we compare the diagnostic accuracy of the Beck Depression Inventory (BDI) and 30-item version of the Inventory of Depressive Symptomatology Self-Rated (IDS-SR30) for major depressive disorder (MSS) against diagnosis by a structured clinical interview. Patients reporting depressive symptoms completed the BDI, the IDS-SR30 and underwent diagnostic assessment (Mini International Neuropsychiatric Interview, M.I.N.I.). Receiver-Operating Characteristic analyses were performed, providing error estimates and false-positive/negative rates of suggested thresholds. Data from n = 31 MS patients were available. BDI and IDS-SR30 total score were significantly correlated (r = 0.82). The IDS-SR30total score, cognitive subscore, and BDI showed excellent to good accuracy (area under the curve (AUC) 0.86, 0.91, and 0.85, respectively). Both the IDS-SR30 and the BDI are useful to quantify depressive symptoms showing good sensitivity and specificity. The IDS-SR30 cognitive subscale may be useful as a screening tool and to quantify affective/cognitive depressive symptomatology.

  7. A missense mutation in the CRBN gene that segregates with intellectual disability and self-mutilating behaviour in a consanguineous Saudi family

    PubMed Central

    Sheereen, Atia; Alaamery, Manal; Bawazeer, Shahad; Al Yafee, Yusra; Massadeh, Salam; Eyaid, Wafaa

    2017-01-01

    Background Autosomal-recessive non-syndromic intellectual disability (ARNS-ID) is an aetiologically heterogeneous disorder. Although little is known about the function of human cereblon (CRBN), its relationship to mild cognitive deficits suggests that it is involved in the basic processes of human memory and learning. Objectives We aim to identify the genetic cause of intellectual disability and self-mutilation in a consanguineous Saudi family with five affected members. Methods Clinical whole-exome sequencing was performed on the proband patient, and Sanger sequencing was done to validate and confirm segregation in other family members. Results A missense variant (c. 1171T>C) in the CRBN gene was identified in five individuals with severe intellectual disability (ID) in a consanguineous Saudi family. The homozygous variant was co-segregating in the family with the phenotype of severe ID, seizures and self-mutilating behaviour. The missense mutation (p.C391R) reported here results in the replacement of a conserved cysteine residue by an arginine in the CULT (cereblon domain of unknown activity, binding cellular ligands and thalidomide) domain of CRBN, which contains a zinc-binding site. Conclusions These findings thus contribute to a growing list of ID disorders caused by CRBN mutations, broaden the spectrum of phenotypes attributable to ARNS-ID and provide new insight into genotype–phenotype correlations between CRBN mutations and the aetiology of ARNS-ID. PMID:28143899

  8. Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD.

    PubMed

    Formiga, Magno F; Roach, Kathryn E; Vital, Isabel; Urdaneta, Gisel; Balestrini, Kira; Calderon-Candelario, Rafael A; Campos, Michael A; Cahalin, Lawrence P

    2018-01-01

    The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Test-retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test-retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. The TIRE measures of MIP, SMIP and ID have excellent test-retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.

  9. Effects of an 8-Week Structured Physical Activity Program on Psychosocial Behaviors of Children With Intellectual Disabilities.

    PubMed

    Choi, Peggy H; Cheung, Siu Yin

    2016-01-01

    The study aimed to investigate the impact of an 8-wk structured physical activity program on selected psychosocial behaviors of children with intellectual disabilities (ID) and to estimate whether generalization occurred. Thirty children (22 boys, 8 girls) with mild ID took part in the study. The ANCOVA results showed a significant difference between the training group and the control group in emotional self-control mean scores, F(1, 25) = 7.61, p = .011, with the posttest mean score of the training group being better than that of the control group. The correlation analysis showed a medium, positive correlation between the gain scores of emotional self-control in the training context and classroom context of the training group (r = .41, n = 16, p = .12). Hence, generalization appeared to have occurred.

  10. Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts.

    PubMed

    McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras; Hoffman, James M

    2016-04-01

    Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time-the time elapsed from when an interruptive alert is generated to when it is dismissed-could be calculated by using historical alert data from log files. Drug-drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1-4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < 001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < 001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Machine Learning Techniques for Prediction of Early Childhood Obesity.

    PubMed

    Dugan, T M; Mukhopadhyay, S; Carroll, A; Downs, S

    2015-01-01

    This paper aims to predict childhood obesity after age two, using only data collected prior to the second birthday by a clinical decision support system called CHICA. Analyses of six different machine learning methods: RandomTree, RandomForest, J48, ID3, Naïve Bayes, and Bayes trained on CHICA data show that an accurate, sensitive model can be created. Of the methods analyzed, the ID3 model trained on the CHICA dataset proved the best overall performance with accuracy of 85% and sensitivity of 89%. Additionally, the ID3 model had a positive predictive value of 84% and a negative predictive value of 88%. The structure of the tree also gives insight into the strongest predictors of future obesity in children. Many of the strongest predictors seen in the ID3 modeling of the CHICA dataset have been independently validated in the literature as correlated with obesity, thereby supporting the validity of the model. This study demonstrated that data from a production clinical decision support system can be used to build an accurate machine learning model to predict obesity in children after age two.

  12. Prediction of protein subcellular localization by weighted gene ontology terms.

    PubMed

    Chi, Sang-Mun

    2010-08-27

    We develop a new weighting approach of gene ontology (GO) terms for predicting protein subcellular localization. The weights of individual GO terms, corresponding to their contribution to the prediction algorithm, are determined by the term-weighting methods used in text categorization. We evaluate several term-weighting methods, which are based on inverse document frequency, information gain, gain ratio, odds ratio, and chi-square and its variants. Additionally, we propose a new term-weighting method based on the logarithmic transformation of chi-square. The proposed term-weighting method performs better than other term-weighting methods, and also outperforms state-of-the-art subcellular prediction methods. Our proposed method achieves 98.1%, 99.3%, 98.1%, 98.1%, and 95.9% overall accuracies for the animal BaCelLo independent dataset (IDS), fungal BaCelLo IDS, animal Höglund IDS, fungal Höglund IDS, and PLOC dataset, respectively. Furthermore, the close correlation between high-weighted GO terms and subcellular localizations suggests that our proposed method appropriately weights GO terms according to their relevance to the localizations. Copyright 2010 Elsevier Inc. All rights reserved.

  13. Optical and X-ray early follow-up of ANTARES neutrino alerts

    NASA Astrophysics Data System (ADS)

    Adrián-Martínez, S.; Ageron, M.; Albert, A.; Samarai, I. Al; André, M.; Anton, G.; Ardid, M.; Aubert, J.-J.; Baret, B.; Barrios-Martí, J.; Basa, S.; Bertin, V.; Biagi, S.; Bogazzi, C.; Bormuth, R.; Bou-Cabo, M.; Bouwhuis, M. C.; Bruijn, R.; Brunner, J.; Busto, J.; Capone, A.; Caramete, L.; Carr, J.; Chiarusi, T.; Circella, M.; Coniglione, R.; Costantini, H.; Coyle, P.; Creusot, A.; Dekeyser, I.; Deschamps, A.; De Bonis, G.; Distefano, C.; Donzaud, C.; Dornic, D.; Drouhin, D.; Dumas, A.; Eberl, T.; Elsässer, D.; Enzenhöfer, A.; Fehn, K.; Felis, I.; Fermani, P.; Folger, F.; Fusco, L. A.; Galatà, S.; Gay, P.; Geißelsöder, S.; Geyer, K.; Giordano, V.; Gleixner, A.; Gracia-Ruiz, R.; Graf, K.; van Haren, H.; Heijboer, A. J.; Hello, Y.; Hernández-Rey, J. J.; Herrero, A.; Hößl, J.; Hofestädt, J.; Hugon, C.; James, C. W.; de Jong, M.; Kadler, M.; Kalekin, O.; Katz, U.; Kießling, D.; Kooijman, P.; Kouchner, A.; Kreykenbohm, I.; Kulikovskiy, V.; Lahmann, R.; Lambard, G.; Lattuada, D.; Lefèvre, D.; Leonora, E.; Loucatos, S.; Mangano, S.; Marcelin, M.; Margiotta, A.; Martínez-Mora, J. A.; Martini, S.; Mathieu, A.; Michael, T.; Migliozzi, P.; Moussa, A.; Mueller, C.; Neff, M.; Nezri, E.; Păvălaš, G. E.; Pellegrino, C.; Perrina, C.; Piattelli, P.; Popa, V.; Pradier, T.; Racca, C.; Riccobene, G.; Richter, R.; Roensch, K.; Rostovtsev, A.; Saldaña, M.; Samtleben, D. F. E.; Sanguineti, M.; Sapienza, P.; Schmid, J.; Schnabel, J.; Schulte, S.; Schüssler, F.; Seitz, T.; Sieger, C.; Spurio, M.; Steijger, J. J. M.; Stolarczyk, Th.; Sánchez-Losa, A.; Taiuti, M.; Tamburini, C.; Trovato, A.; Tselengidou, M.; Tönnis, C.; Turpin, D.; Vallage, B.; Vallée, C.; Van Elewyck, V.; Vecchi, M.; Visser, E.; Vivolo, D.; Wagner, S.; Wilms, J.; Zornoza, J. D.; Zúñiga, J.; Klotz, A.; Boer, M.; Le Van Suu, A.; Akerlof, C.; Zheng, W.; Evans, P.; Gehrels, N.; Kennea, J.; Osborne, J. P.; Coward, D. M.

    2016-02-01

    High-energy neutrinos could be produced in the interaction of charged cosmic rays with matter or radiation surrounding astrophysical sources. Even with the recent detection of extraterrestrial high-energy neutrinos by the IceCube experiment, no astrophysical neutrino source has yet been discovered. Transient sources, such as gamma-ray bursts, core-collapse supernovae, or active galactic nuclei are promising candidates. Multi-messenger programs offer a unique opportunity to detect these transient sources. By combining the information provided by the ANTARES neutrino telescope with information coming from other observatories, the probability of detecting a source is enhanced, allowing the possibility of identifying a neutrino progenitor from a single detected event. A method based on optical and X-ray follow-ups of high-energy neutrino alerts has been developed within the ANTARES collaboration. This method does not require any assumptions on the relation between neutrino and photon spectra other than time-correlation. This program, denoted as TAToO, triggers a network of robotic optical telescopes (TAROT and ROTSE) and the Swift-XRT with a delay of only a few seconds after a neutrino detection, and is therefore well-suited to search for fast transient sources. To identify an optical or X-ray counterpart to a neutrino signal, the images provided by the follow-up observations are analysed with dedicated pipelines. A total of 42 alerts with optical and 7 alerts with X-ray images taken with a maximum delay of 24 hours after the neutrino trigger have been analysed. No optical or X-ray counterparts associated to the neutrino triggers have been found, and upper limits on transient source magnitudes have been derived. The probability to reject the gamma-ray burst origin hypothesis has been computed for each alert.

  14. Optical and X-ray early follow-up of ANTARES neutrino alerts

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

    Adrián-Martínez, S.; Ardid, M.; Ageron, M.

    High-energy neutrinos could be produced in the interaction of charged cosmic rays with matter or radiation surrounding astrophysical sources. Even with the recent detection of extraterrestrial high-energy neutrinos by the IceCube experiment, no astrophysical neutrino source has yet been discovered. Transient sources, such as gamma-ray bursts, core-collapse supernovae, or active galactic nuclei are promising candidates. Multi-messenger programs offer a unique opportunity to detect these transient sources. By combining the information provided by the ANTARES neutrino telescope with information coming from other observatories, the probability of detecting a source is enhanced, allowing the possibility of identifying a neutrino progenitor from amore » single detected event. A method based on optical and X-ray follow-ups of high-energy neutrino alerts has been developed within the ANTARES collaboration. This method does not require any assumptions on the relation between neutrino and photon spectra other than time-correlation. This program, denoted as TAToO, triggers a network of robotic optical telescopes (TAROT and ROTSE) and the Swift-XRT with a delay of only a few seconds after a neutrino detection, and is therefore well-suited to search for fast transient sources. To identify an optical or X-ray counterpart to a neutrino signal, the images provided by the follow-up observations are analysed with dedicated pipelines. A total of 42 alerts with optical and 7 alerts with X-ray images taken with a maximum delay of 24 hours after the neutrino trigger have been analysed. No optical or X-ray counterparts associated to the neutrino triggers have been found, and upper limits on transient source magnitudes have been derived. The probability to reject the gamma-ray burst origin hypothesis has been computed for each alert.« less

  15. The effects of spectral tuning of evening ambient light on melatonin suppression, alertness and sleep.

    PubMed

    Rahman, Shadab A; St Hilaire, Melissa A; Lockley, Steven W

    2017-08-01

    We compared the effects of bedroom-intensity light from a standard fluorescent and a blue- (i.e., short-wavelength) depleted LED source on melatonin suppression, alertness, and sleep. Sixteen healthy participants (8 females) completed a 4-day inpatient study. Participants were exposed to blue-depleted circadian-sensitive (C-LED) light and a standard fluorescent light (FL, 4100K) of equal illuminance (50lx) for 8h prior to a fixed bedtime on two separate days in a within-subject, randomized, cross-over design. Each light exposure day was preceded by a dim light (<3lx) control at the same time 24h earlier. Compared to the FL condition, control-adjusted melatonin suppression was significantly reduced. Although subjective sleepiness was not different between the two light conditions, auditory reaction times were significantly slower under C-LED conditions compared to FL 30min prior to bedtime. EEG-based correlates of alertness corroborated the reduced alertness under C-LED conditions as shown by significantly increased EEG spectral power in the delta-theta (0.5-8.0Hz) bands under C-LED as compared to FL exposure. There was no significant difference in total sleep time (TST), sleep efficiency (SE%), and slow-wave activity (SWA) between the two conditions. Unlike melatonin suppression and alertness, a significant order effect was observed on all three sleep variables, however. Individuals who received C-LED first and then FL had increased TST, SE% and SWA averaged across both nights compared to individuals who received FL first and then C-LED. These data show that the spectral characteristics of light can be fine-tuned to attenuate non-visual responses to light in humans. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Design and implementation of low complexity wake-up receiver for underwater acoustic sensor networks

    NASA Astrophysics Data System (ADS)

    Yue, Ming

    This thesis designs a low-complexity dual Pseudorandom Noise (PN) scheme for identity (ID) detection and coarse frame synchronization. The two PN sequences for a node are identical and are separated by a specified length of gap which serves as the ID of different sensor nodes. The dual PN sequences are short in length but are capable of combating severe underwater acoustic (UWA) multipath fading channels that exhibit time varying impulse responses up to 100 taps. The receiver ID detection is implemented on a microcontroller MSP430F5529 by calculating the correlation between the two segments of the PN sequence with the specified separation gap. When the gap length is matched, the correlator outputs a peak which triggers the wake-up enable. The time index of the correlator peak is used as the coarse synchronization of the data frame. The correlator is implemented by an iterative algorithm that uses only one multiplication and two additions for each sample input regardless of the length of the PN sequence, thus achieving low computational complexity. The real-time processing requirement is also met via direct memory access (DMA) and two circular buffers to accelerate data transfer between the peripherals and the memory. The proposed dual PN detection scheme has been successfully tested by simulated fading channels and real-world measured channels. The results show that, in long multipath channels with more than 60 taps, the proposed scheme achieves high detection rate and low false alarm rate using maximal-length sequences as short as 31 bits to 127 bits, therefore it is suitable as a low-power wake-up receiver. The future research will integrate the wake-up receiver with Digital Signal Processors (DSP) for payload detection.

  17. PURA syndrome: clinical delineation and genotype-phenotype study in 32 individuals with review of published literature

    PubMed Central

    Reijnders, Margot R F; Janowski, Robert; Alvi, Mohsan; Self, Jay E; van Essen, Ton J; Vreeburg, Maaike; Rouhl, Rob P W; Stevens, Servi J C; Stegmann, Alexander P A; Schieving, Jolanda; Pfundt, Rolph; van Dijk, Katinke; Smeets, Eric; Stumpel, Connie T R M; Bok, Levinus A; Cobben, Jan Maarten; Engelen, Marc; Mansour, Sahar; Whiteford, Margo; Chandler, Kate E; Douzgou, Sofia; Cooper, Nicola S; Tan, Ene-Choo; Foo, Roger; Lai, Angeline H M; Rankin, Julia; Green, Andrew; Lönnqvist, Tuula; Isohanni, Pirjo; Williams, Shelley; Ruhoy, Ilene; Carvalho, Karen S; Dowling, James J; Lev, Dorit L; Sterbova, Katalin; Lassuthova, Petra; Neupauerová, Jana; Waugh, Jeff L; Keros, Sotirios; Clayton-Smith, Jill; Smithson, Sarah F; Brunner, Han G; van Hoeckel, Ceciel; Anderson, Mel; Clowes, Virginia E; Siu, Victoria Mok; DDD study, The; Selber, Paulo; Leventer, Richard J; Nellaker, Christoffer; Niessing, Dierk; Hunt, David; Baralle, Diana

    2018-01-01

    Background De novo mutations in PURA have recently been described to cause PURA syndrome, a neurodevelopmental disorder characterised by severe intellectual disability (ID), epilepsy, feeding difficulties and neonatal hypotonia. Objectives To delineate the clinical spectrum of PURA syndrome and study genotype-phenotype correlations. Methods Diagnostic or research-based exome or Sanger sequencing was performed in individuals with ID. We systematically collected clinical and mutation data on newly ascertained PURA syndrome individuals, evaluated data of previously reported individuals and performed a computational analysis of photographs. We classified mutations based on predicted effect using 3D in silico models of crystal structures of Drosophila-derived Pur-alpha homologues. Finally, we explored genotype-phenotype correlations by analysis of both recurrent mutations as well as mutation classes. Results We report mutations in PURA (purine-rich element binding protein A) in 32 individuals, the largest cohort described so far. Evaluation of clinical data, including 22 previously published cases, revealed that all have moderate to severe ID and neonatal-onset symptoms, including hypotonia (96%), respiratory problems (57%), feeding difficulties (77%), exaggerated startle response (44%), hypersomnolence (66%) and hypothermia (35%). Epilepsy (54%) and gastrointestinal (69%), ophthalmological (51%) and endocrine problems (42%) were observed frequently. Computational analysis of facial photographs showed subtle facial dysmorphism. No strong genotype-phenotype correlation was identified by subgrouping mutations into functional classes. Conclusion We delineate the clinical spectrum of PURA syndrome with the identification of 32 additional individuals. The identification of one individual through targeted Sanger sequencing points towards the clinical recognisability of the syndrome. Genotype-phenotype analysis showed no significant correlation between mutation classes and disease severity. PMID:29097605

  18. Characteristics of napping in community-dwelling insomnia patients.

    PubMed

    Jang, Kwang Ho; Lee, Jung Hie; Kim, Seong Jae; Kwon, Hyo Jeong

    2018-05-01

    We aimed to determine napping characteristics of community-dwelling patients with insomnia disorder (ID) compared to characteristics of normal controls (NC), and to examine the effect of napping on nocturnal sleep. Adult volunteers who were more than 18 years old were recruited from three rural public health centers in Korea. Data from actigraphy recording and a sleep diary filled out for seven days were obtained. Finally, 115 ID patients and 80 NC subjects were included in this study. Parameters and timing of nocturnal sleep and nap were compared between the ID and NC groups. Two-way analysis of covariance (ANCOVA) was performed to determine the effect of ID diagnosis and napping on sleep parameters. Sleep efficiency (SE) in the ID group was significantly lower (p = 0.010), and wake time after sleep onset (WASO) was significantly greater (p = 0.023), compared to the NC group. There was no significant difference in nocturnal sleep or nap timing between the two groups. Nap frequency in the ID group was significantly higher than that in the NC group (p = 0.025). Although ID diagnosis and napping had no independent effect on fragmentation index, their interaction had a significant effect on fragmentation index (p = 0.021). Nap frequency was positively correlated with PSQI score (r = 0.166, p = 0.033). Insomnia patients showed no significant difference in nap timing or nap duration compared to NC subjects. However, insomnia patients showed higher nap frequency. Frequent napping was associated with poorer subjective sleep quality. Therefore, although napping might not have a negative impact on nocturnal sleep maintenance in NC subjects, it did have an effect on nocturnal sleep in insomnia patients. Copyright © 2018 Elsevier B.V. All rights reserved.

  19. Development and validation of the Learning Disabilities Needs Assessment Tool (LDNAT), a HoNOS-based needs assessment tool for use with people with intellectual disability.

    PubMed

    Painter, J; Trevithick, L; Hastings, R P; Ingham, B; Roy, A

    2016-12-01

    In meeting the needs of individuals with intellectual disabilities (ID) who access health services, a brief, holistic assessment of need is useful. This study outlines the development and testing of the Learning Disabilities Needs Assessment Tool (LDNAT), a tool intended for this purpose. An existing mental health (MH) tool was extended by a multidisciplinary group of ID practitioners. Additional scales were drafted to capture needs across six ID treatment domains that the group identified. LDNAT ratings were analysed for the following: item redundancy, relevance, construct validity and internal consistency (n = 1692); test-retest reliability (n = 27); and concurrent validity (n = 160). All LDNAT scales were deemed clinically relevant with little redundancy apparent. Principal component analysis indicated three components (developmental needs, challenging behaviour, MH and well-being). Internal consistency was good (Cronbach alpha 0.80). Individual item test-retest reliability was substantial-near perfect for 20 scales and slight-fair for three scales. Overall reliability was near perfect (intra-class correlation = 0.91). There were significant associations with five of six condition-specific measures, i.e. the Waisman Activities of Daily Living Scale (general ability/disability), Threshold Assessment Grid (risk), Behaviour Problems Inventory for Individuals with Intellectual Disabilities-Short Form (challenging behaviour) Social Communication Questionnaire (autism) and a bespoke physical health questionnaire. Additionally, the statistically significant correlations between these tools and the LDNAT components made sense clinically. There were no statistically significant correlations with the Psychiatric Assessment Schedules for Adults with Developmental Disabilities (a measure of MH symptoms in people with ID). The LDNAT had clinically utility when rating the needs of people with ID prior to condition-specific assessment(s). Analyses of internal and external validity were promising. Further evaluation of its sensitivity to changes in needs is now required. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  20. Randomised controlled trial of the efficacy of a blue-enriched light intervention to improve alertness and performance in night shift workers.

    PubMed

    Sletten, Tracey L; Ftouni, Suzanne; Nicholas, Christian L; Magee, Michelle; Grunstein, Ronald R; Ferguson, Sally; Kennaway, David J; O'Brien, Darren; Lockley, Steven W; Rajaratnam, Shantha M W

    2017-11-01

    Night workers often experience high levels of sleepiness due to misalignment of the sleep-wake cycle from the circadian pacemaker, in addition to acute and chronic sleep loss. Exposure to light, in particular short wavelength light, can improve alertness and neurobehavioural performance. This randomised controlled trial examined the efficacy of blue-enriched polychromatic light to improve alertness and neurobehavioural performance in night workers. Participants were 71 night shift workers (42 males; 32.8±10.5 years) who worked at least 6 hours between 22:00 and 08:00 hours. Sleep-wake logs and wrist actigraphy were collected for 1-3 weeks, followed by 48-hour urine collection to measure the circadian 6-sulphatoxymelatonin (aMT6s) rhythm. On the night following at least two consecutive night shifts, workers attended a simulated night shift in the laboratory which included subjective and objective assessments of sleepiness and performance. Workers were randomly assigned for exposure to one of two treatment conditions from 23:00 hours to 07:00 hours: blue-enriched white light (17 000 K, 89 lux; n=36) or standard white light (4000 K, 84 lux; n=35). Subjective and objective sleepiness increased during the night shift in both light conditions (p<0.05, η p 2 =0.06-0.31), but no significant effects of light condition were observed. The 17 000 K light, however, did improve subjective sleepiness relative to the 4000 K condition when light exposure coincided with the time of the aMT6s peak (p<0.05, d=0.41-0.60). This study suggests that, while blue-enriched light has potential to improve subjective sleepiness in night shift workers, further research is needed in the selection of light properties to maximise the benefits. The Australian New Zealand Clinical Trials Registry ACTRN12610000097044 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320845&isReview=true). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. See Also:physica status solidi (a)physica status solidi (c)Copyright © 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

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  1. Physicians’ response to computerised alerts for psychotropic drugs in older persons: a multilevel analysis of the associated alert, patient and physician characteristics

    PubMed Central

    Tamblyn, Robyn; Reidel, Kristen; Patel, Vaishali

    2012-01-01

    Objective Computerised drug alerts are expected to reduce patients’ risk of adverse drug events. However, physicians over-ride most drug alerts, because they believe that the benefit exceeds the risk. The purpose of this study was to determine the drug alert, patient and physician characteristics associated with the: (1) occurrence of psychotropic drug alerts for elderly patients and the (2) response to these alerts by their primary care physicians. Setting Primary care, Quebec, Canada. Design Prospective cohort study. Participants Sixty-one physicians using an electronic prescribing and drug alert decision-support system in their practice, and 3413 elderly patients using psychotropic drugs. Primary and secondary measures Psychotropic drug class, alert severity, patient risk for fall injuries and physician experience, practice volume and computer use were evaluated in relationship to the likelihood of having: (1) a psychotropic drug alert, (2) the prescription revised in response to an alert. Cluster-adjusted alternating logistic regression was used to assess multilevel predictors of alert occurrence and response. Results In total 13 080 psychotropic drug alerts were generated in 8931 visits. Alerts were more likely to be generated for male patients at higher risk of fall-related injury and for physicians who established the highest alert threshold. In 9.9% of alerts seen, the prescription was revised. The highest revision rate was for antipsychotic alerts (22.6%). Physicians were more likely to revise prescriptions for severe alerts (OR 2.03; 95%CI 1.39 to 2.98), if patients had cognitive impairment (OR 1.95; 95%CI 1.13 to 3.36), and if they made more visits to their physician (OR 1.05 per 5 visits; 95%CI 1 to 1.09). Conclusions Physicians view and respond to a small proportion of alerts, mainly for higher-risk patients. To reduce the risk of psychotropic drug-related fall injuries, a new generation of evidence-based drug alerts should be developed. PMID:23024254

  2. Differential effects of phasic and tonic alerting on the efficiency of executive attention.

    PubMed

    Asanowicz, Dariusz; Marzecová, Anna

    2017-05-01

    The study examined how alerting and executive attention interact in a task involving conflict resolution. We proposed a tentative scenario in which an initial exogenous phasic alerting phase is followed by an endogenous tonic alerting phase, and hypothesized that these two processes may have distinct effects on conflict resolution. Phasic alerting was expected to increase the conflict, whereas tonic alerting was expected to decrease the conflict. Three experiments were conducted using different variants of the flanker task with visual alerting cues and varied cue-target intervals (SOA), to differentiate between effects of phasic alerting (short SOA) and tonic alerting (long SOA). The results showed that phasic alerting consistently decreased the efficiency of conflict resolution indexed by response time and accuracy, whereas tonic alerting increased the accuracy of conflict resolution, but at a cost in the speed of processing the conflict. The third experiment additionally showed that the effects of phasic alerting may be modulated by the psychophysical strength of alerting cues. Discussed are possible mechanisms that could account for the observed interactions between alerting and conflict resolution, as well as some discrepancies between the current and previous studies. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Linking infant-directed speech and face preferences to language outcomes in infants at risk for autism spectrum disorder.

    PubMed

    Droucker, Danielle; Curtin, Suzanne; Vouloumanos, Athena

    2013-04-01

    In this study, the authors aimed to examine whether biases for infant-directed (ID) speech and faces differ between infant siblings of children with autism spectrum disorder (ASD) (SIBS-A) and infant siblings of typically developing children (SIBS-TD), and whether speech and face biases predict language outcomes and risk group membership. Thirty-six infants were tested at ages 6, 8, 12, and 18 months. Infants heard 2 ID and 2 adult-directed (AD) speech passages paired with either a checkerboard or a face. The authors assessed expressive language at 12 and 18 months and general functioning at 12 months using the Mullen Scales of Early Learning (Mullen, 1995). Both infant groups preferred ID to AD speech and preferred faces to checkerboards. SIBS-TD demonstrated higher expressive language at 18 months than did SIBS-A, a finding that correlated with preferences for ID speech at 12 months. Although both groups looked longer to face stimuli than to the checkerboard, the magnitude of the preference was smaller in SIBS-A and predicted expressive vocabulary at 18 months in this group. Infants' preference for faces contributed to risk-group membership in a logistic regression analysis. Infants at heightened risk of ASD differ from typically developing infants in their preferences for ID speech and faces, which may underlie deficits in later language development and social communication.

  4. Optimized molecular resolution of cross-contamination alerts in clinical mycobacteriology laboratories.

    PubMed

    Martín, Ana; Herranz, Marta; Lirola, Miguel Martínez; Fernández, Rosa Fernández; Bouza, Emilio; García de Viedma, Darío

    2008-02-14

    The phenomenon of misdiagnosing tuberculosis (TB) by laboratory cross-contamination when culturing Mycobacterium tuberculosis (MTB) has been widely reported and it has an obvious clinical, therapeutic and social impact. The final confirmation of a cross-contamination event requires the molecular identification of the same MTB strain cultured from both the potential source of the contamination and from the false-positive candidate. The molecular tool usually applied in this context is IS6110-RFLP which takes a long time to provide an answer, usually longer than is acceptable for microbiologists and clinicians to make decisions. Our purpose in this study is to evaluate a novel PCR-based method, MIRU-VNTR as an alternative to assure a rapid and optimized analysis of cross-contamination alerts. MIRU-VNTR was prospectively compared with IS6110-RFLP for clarifying 19 alerts of false positivity from other laboratories. MIRU-VNTR highly correlated with IS6110-RFLP, reduced the response time by 27 days and clarified six alerts unresolved by RFLP. Additionally, MIRU-VNTR revealed complex situations such as contamination events involving polyclonal isolates and a false-positive case due to the simultaneous cross-contamination from two independent sources. Unlike standard RFLP-based genotyping, MIRU-VNTR i) could help reduce the impact of a false positive diagnosis of TB, ii) increased the number of events that could be solved and iii) revealed the complexity of some cross-contamination events that could not be dissected by IS6110-RFLP.

  5. Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study

    PubMed Central

    Dahmen, Brigitte; Schulte-Rüther, Martin; Legenbauer, Tanja; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2016-01-01

    Objective Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN. Method Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention. Results The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively. Discussion Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN. PMID:27607439

  6. Optimizing the real-time ground level enhancement alert system based on neutron monitor measurements: Introducing GLE Alert Plus

    NASA Astrophysics Data System (ADS)

    Souvatzoglou, G.; Papaioannou, A.; Mavromichalaki, H.; Dimitroulakos, J.; Sarlanis, C.

    2014-11-01

    Whenever a significant intensity increase is being recorded by at least three neutron monitor stations in real-time mode, a ground level enhancement (GLE) event is marked and an automated alert is issued. Although, the physical concept of the algorithm is solid and has efficiently worked in a number of cases, the availability of real-time data is still an open issue and makes timely GLE alerts quite challenging. In this work we present the optimization of the GLE alert that has been set into operation since 2006 at the Athens Neutron Monitor Station. This upgrade has led to GLE Alert Plus, which is currently based upon the Neutron Monitor Database (NMDB). We have determined the critical values per station allowing us to issue reliable GLE alerts close to the initiation of the event while at the same time we keep the false alert rate at low levels. Furthermore, we have managed to treat the problem of data availability, introducing the Go-Back-N algorithm. A total of 13 GLE events have been marked from January 2000 to December 2012. GLE Alert Plus issued an alert for 12 events. These alert times are compared to the alert times of GOES Space Weather Prediction Center and Solar Energetic Particle forecaster of the University of Málaga (UMASEP). In all cases GLE Alert Plus precedes the GOES alert by ≈8-52 min. The comparison with UMASEP demonstrated a remarkably good agreement. Real-time GLE alerts by GLE Alert Plus may be retrieved by http://cosray.phys.uoa.gr/gle_alert_plus.html, http://www.nmdb.eu, and http://swe.ssa.esa.int/web/guest/space-radiation. An automated GLE alert email notification system is also available to interested users.

  7. Evaluation of health alerts from an early illness warning system in independent living.

    PubMed

    Rantz, Marilyn J; Scott, Susan D; Miller, Steven J; Skubic, Marjorie; Phillips, Lorraine; Alexander, Greg; Koopman, Richelle J; Musterman, Katy; Back, Jessica

    2013-06-01

    Passive sensor networks were deployed in independent living apartments to monitor older adults in their home environments to detect signs of impending illness and alert clinicians so they can intervene and prevent or delay significant changes in health or functional status. A retrospective qualitative deductive content analysis was undertaken to refine health alerts to improve clinical relevance to clinicians as they use alerts in their normal workflow of routine care delivery to older adults. Clinicians completed written free-text boxes to describe actions taken (or not) as a result of each alert; they also rated the clinical significance (relevance) of each health alert on a scale of 1 to 5. Two samples of the clinician's written responses to the health alerts were analyzed after alert algorithms had been adjusted based on results of a pilot study using health alerts to enhance clinical decision-making. In the first sample, a total of 663 comments were generated by seven clinicians in response to 385 unique alerts; there are more comments than alerts because more than one clinician rated the same alert. The second sample had a total of 142 comments produced by three clinicians in response to 88 distinct alerts. The overall clinical relevance of the alerts, as judged by the content of the qualitative comments by clinicians for each alert, improved from 33.3% of the alerts in the first sample classified as clinically relevant to 43.2% in the second. The goal is to produce clinically relevant alerts that clinicians find useful in daily practice. The evaluation methods used are described to assist others as they consider building and iteratively refining health alerts to enhance clinical decision making.

  8. A Developmental Decline in the Learning-Promoting Effects of Infant-Directed Speech for Infants of Mothers with Chronically Elevated Symptoms of Depression

    PubMed Central

    Kaplan, Peter S.; Danko, Christina M.; Kalinka, Christina J.; Cejka, Anna M.

    2014-01-01

    Infants of mothers who varied in symptoms of depression were tested at 4 and 12 months of age for their ability to associate a segment of an unfamiliar non-depressed mother’s infant-directed speech (IDS) with a face. At 4 months, all infants learned the voice-face association. At 12 months, despite the fact that none of the mothers were still clinically depressed, infants of mothers with chronically elevated self-reported depressive symptoms, and infants of mothers with elevated self-reported depressive symptoms at 4 months but not 12 months, on average did not learn the association. For infants of mothers diagnosed with depression in remission, learning at 12 months was negatively correlated with the postpartum duration of the mother’s depressive episode. At neither age did extent of pitch modulation in the IDS segments correlate with infant learning. However, learning scores at 12 months correlated significantly with concurrent maternal reports of infant receptive language development. The roles of the duration and timing of maternal depressive symptoms are discussed. PMID:22721737

  9. Alertness and cognitive control: Toward a spatial grouping hypothesis.

    PubMed

    Schneider, Darryl W

    2018-05-01

    A puzzling interaction involving alertness and cognitive control is indicated by the finding of faster performance but larger congruency effects on alert trials (on which alerting cues are presented before the task stimuli) than on no-alert trials in selective attention tasks. In the present study, the author conducted four experiments to test hypotheses about the interaction. Manipulation of stimulus spacing revealed a difference in congruency effects between alert and no-alert trials for narrowly spaced stimuli but not for widely spaced stimuli, inconsistent with the hypothesis that increased alertness is associated with more diffuse attention. Manipulation of color grouping revealed similar differences in congruency effects between alert and no-alert trials for same-color and different-color groupings of targets and distractors, inconsistent with the general hypothesis that increased alertness is associated with more perceptual grouping. To explain the results, the author proposes that increased alertness is associated specifically with more spatial grouping of stimuli, possibly by modulating the threshold for parsing stimulus displays into distinct objects.

  10. Impulsive Driving: Definition and Measurement Using the I-Driving Scale (IDS).

    PubMed

    Pérez-Moreno, Elisa; Hernández-Lloreda, María José; Gallego-Largo, Trinidad Ruiz; Castellanos, Miguel Ángel

    2015-11-27

    Impulsivity has been widely studied in the context of traffic. The trait is believed to be the root of some accidents, along with other variables like aggression and anger. The present research objective is to develop a new scale - the I-Driving Scale (IDS) - to evaluate and measure the construct of impulsivity in specific driving situations. To that end, two studies were conducted, with 162 and 107 participants, respectively. In both studies, participants were recruited via their social networks, and answered anonymously. In addition to the IDS, they completed the Use the Vehicle to Express Anger subscale of the Driving Anger Expression Inventory (DAX), the Driving Anger Scale (DAS), and the Barratt Impulsivity Scale (BIS11), and also provided demographic information. The final scale had 11 items falling into two factors: impatience, and aggressiveness/abruptness. The results show a high consistency (αT = .81, αI = .70, and αA = .85 in the first study; αT = .83, αI = .80, and αA = .88 in the second study). Statistical results of Exploratory Factor Analysis in the first sample indicated goodness of fit to a two-factor model (RMSR = .057, GFI = .98). The second study confirmed that factorial structure (χ2/df = 80.50/43 = 1.87, RMSEA = .088, CFI = .94, TLI = .92). Correlations with other measures indicated the Impatience subscale is associated with different expressions of anger behind the wheel, and directly correlated with the loss of driver's license points. Furthermore, the Aggressiveness or Abruptness subscale was associated with more mechanical aspects, and correlated inversely with age.

  11. Feasibility of measuring dissolved carbon dioxide based on head space partial pressures

    USGS Publications Warehouse

    Watten, B.J.; Boyd, C.E.; Schwartz, M.F.; Summerfelt, S.T.; Brazil, B.L.

    2004-01-01

    We describe an instrument prototype that measures dissolved carbon dioxide (DC) without need for standard wetted probe membranes or titration. DC is calculated using Henry's Law, water temperature, and the steady-state partial pressure of carbon dioxide that develops within the instrument's vertical gas-liquid contacting chamber. Gas-phase partial pressures were determined with either an infrared detector (ID) or by measuring voltage developed by a pH electrode immersed in an isolated sodium carbonate solution (SC) sparged with recirculated head space gas. Calculated DC concentrations were compared with those obtained by titration over a range of DC (2, 4, 8, 12, 16, 20, 24, and 28mg/l), total alkalinity (35, 120, and 250mg/l as CaCO3), total dissolved gas pressure (-178 to 120 mmHg), and dissolved oxygen concentrations (7, 14, and 18 mg/l). Statistically significant (P < 0.001) correlations were established between head space (ID) and titrimetrically determined DC concentrations (R2 = 0.987-0.999, N = 96). Millivolt and titrimetric values from the SC solution tests were also correlated (P < 0.001, R 2 = 0.997, N = 16). The absolute and relative error associated with the use of the ID and SC solution averaged 0.9mg/l DC and 7.0% and 0.6 mg/l DC and 9.6%, respectively. The precision of DC estimates established in a second test series was good; coefficients of variation (100(SD/mean)) for the head space (ID) and titration analyses were 0.99% and 1.7%. Precision of the SC solution method was 1.3%. In a third test series, a single ID was coupled with four replicate head space units so as to permit sequential monitoring (15 min intervals) of a common water source. Here, appropriate gas samples were secured using a series of solenoid valves (1.6 mm bore) activated by a time-based controller. This system configuration reduced the capital cost per sample site from US$ 2695 to 876. Absolute error averaged 2.9, 3.1, 3.7, and 2.7 mg/ l for replicates 1-4 (N = 36) during a 21-day test period (DC range, 36-40 mg/l). The ID meter was then modified so as to provide for DO as well as DC measurements across components of an intensive fish production system. ?? 2003 Elsevier B.V. All rights reserved.

  12. Managing the Alert Process at NewYork-Presbyterian Hospital

    PubMed Central

    Kuperman, Gilad J; Diamente, Rosanna; Khatu, Vrinda; Chan-Kraushar, Terri; Stetson, Pete; Boyer, Aurelia; Cooper, Mary

    2005-01-01

    Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources. PMID:16779073

  13. Optimizing drug-dose alerts using commercial software throughout an integrated health care system.

    PubMed

    Saiyed, Salim M; Greco, Peter J; Fernandes, Glenn; Kaelber, David C

    2017-11-01

    All default electronic health record and drug reference database vendor drug-dose alerting recommendations (single dose, daily dose, dose frequency, and dose duration) were silently turned on in inpatient, outpatient, and emergency department areas for pediatric-only and nonpediatric-only populations. Drug-dose alerts were evaluated during a 3-month period. Drug-dose alerts fired on 12% of orders (104 098/834 911). System-level and drug-specific strategies to decrease drug-dose alerts were analyzed. System-level strategies included: (1) turning off all minimum drug-dosing alerts, (2) turning off all incomplete information drug-dosing alerts, (3) increasing the maximum single-dose drug-dose alert threshold to 125%, (4) increasing the daily dose maximum drug-dose alert threshold to 125%, and (5) increasing the dose frequency drug-dose alert threshold to more than 2 doses per day above initial threshold. Drug-specific strategies included changing drug-specific maximum single and maximum daily drug-dose alerting parameters for the top 22 drug categories by alert frequency. System-level approaches decreased alerting to 5% (46 988/834 911) and drug-specific approaches decreased alerts to 3% (25 455/834 911). Drug-dose alerts varied between care settings and patient populations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Cancer stem cell-related gene expression as a potential biomarker of response for first-in-class imipridone ONC201 in solid tumors.

    PubMed

    Prabhu, Varun V; Lulla, Amriti R; Madhukar, Neel S; Ralff, Marie D; Zhao, Dan; Kline, Christina Leah B; Van den Heuvel, A Pieter J; Lev, Avital; Garnett, Mathew J; McDermott, Ultan; Benes, Cyril H; Batchelor, Tracy T; Chi, Andrew S; Elemento, Olivier; Allen, Joshua E; El-Deiry, Wafik S

    2017-01-01

    Cancer stem cells (CSCs) correlate with recurrence, metastasis and poor survival in clinical studies. Encouraging results from clinical trials of CSC inhibitors have further validated CSCs as therapeutic targets. ONC201 is a first-in-class small molecule imipridone in Phase I/II clinical trials for advanced cancer. We have previously shown that ONC201 targets self-renewing, chemotherapy-resistant colorectal CSCs via Akt/ERK inhibition and DR5/TRAIL induction. In this study, we demonstrate that the anti-CSC effects of ONC201 involve early changes in stem cell-related gene expression prior to tumor cell death induction. A targeted network analysis of gene expression profiles in colorectal cancer cells revealed that ONC201 downregulates stem cell pathways such as Wnt signaling and modulates genes (ID1, ID2, ID3 and ALDH7A1) known to regulate self-renewal in colorectal, prostate cancer and glioblastoma. ONC201-mediated changes in CSC-related gene expression were validated at the RNA and protein level for each tumor type. Accordingly, we observed inhibition of self-renewal and CSC markers in prostate cancer cell lines and patient-derived glioblastoma cells upon ONC201 treatment. Interestingly, ONC201-mediated CSC depletion does not occur in colorectal cancer cells with acquired resistance to ONC201. Finally, we observed that basal expression of CSC-related genes (ID1, CD44, HES7 and TCF3) significantly correlate with ONC201 efficacy in >1000 cancer cell lines and combining the expression of multiple genes leads to a stronger overall prediction. These proof-of-concept studies provide a rationale for testing CSC expression at the RNA and protein level as a predictive and pharmacodynamic biomarker of ONC201 response in ongoing clinical studies.

  15. Cancer stem cell-related gene expression as a potential biomarker of response for first-in-class imipridone ONC201 in solid tumors

    PubMed Central

    Zhao, Dan; Kline, Christina Leah B.; Van den Heuvel, A. Pieter J.; Lev, Avital; Garnett, Mathew J.; McDermott, Ultan; Benes, Cyril H.; Batchelor, Tracy T.; Chi, Andrew S.; Elemento, Olivier; Allen, Joshua E.

    2017-01-01

    Cancer stem cells (CSCs) correlate with recurrence, metastasis and poor survival in clinical studies. Encouraging results from clinical trials of CSC inhibitors have further validated CSCs as therapeutic targets. ONC201 is a first-in-class small molecule imipridone in Phase I/II clinical trials for advanced cancer. We have previously shown that ONC201 targets self-renewing, chemotherapy-resistant colorectal CSCs via Akt/ERK inhibition and DR5/TRAIL induction. In this study, we demonstrate that the anti-CSC effects of ONC201 involve early changes in stem cell-related gene expression prior to tumor cell death induction. A targeted network analysis of gene expression profiles in colorectal cancer cells revealed that ONC201 downregulates stem cell pathways such as Wnt signaling and modulates genes (ID1, ID2, ID3 and ALDH7A1) known to regulate self-renewal in colorectal, prostate cancer and glioblastoma. ONC201-mediated changes in CSC-related gene expression were validated at the RNA and protein level for each tumor type. Accordingly, we observed inhibition of self-renewal and CSC markers in prostate cancer cell lines and patient-derived glioblastoma cells upon ONC201 treatment. Interestingly, ONC201-mediated CSC depletion does not occur in colorectal cancer cells with acquired resistance to ONC201. Finally, we observed that basal expression of CSC-related genes (ID1, CD44, HES7 and TCF3) significantly correlate with ONC201 efficacy in >1000 cancer cell lines and combining the expression of multiple genes leads to a stronger overall prediction. These proof-of-concept studies provide a rationale for testing CSC expression at the RNA and protein level as a predictive and pharmacodynamic biomarker of ONC201 response in ongoing clinical studies. PMID:28767654

  16. Association of Increased Serum ACE Activity with Logical Memory Ability in Type 2 Diabetic Patients with Mild Cognitive Impairment

    PubMed Central

    Tian, Sai; Han, Jing; Huang, Rong; Xia, Wenqing; Sun, Jie; Cai, Rongrong; Dong, Xue; Shen, Yanjue; Wang, Shaohua

    2016-01-01

    Background: Angiotensin-converting enzyme (ACE) is involved in the chronic complications of type 2 diabetes mellitus (T2DM) and Alzheimer's disease. This study aimed to assess the pathogenetic roles of ACE and the genetic predisposition of its insertion/deletion (I/D) polymorphism in mild cognitive impairment (MCI) among T2DM patients. Methods: A total of 210 T2DM patients were enrolled. Among these patients, 116 satisfied the MCI diagnostic criteria and 94 exhibited healthy cognition. The cognitive functions of the patients were extensively assessed. The serum level and activity of ACE were measured via enzyme-linked immunosorbent assay and ultraviolet spectrophotography. The single-nucleotide polymorphisms of I/D gene of ACE were analyzed. Results: The serum level and activity of ACE in diabetic MCI patients (p = 0.022 and p = 0.008, respectively) were both significantly higher than those in the healthy controls. A significant negative correlation was found between their ACE activity and logical memory test score (LMT) (p = 0.002). Multiple stepwise regression iterated the negative correlation between ACE activity and LMT score (p = 0.035). Although no significant difference was found in the genotype or allele distribution of ACE I/D polymorphism between the groups, the serum levels and activity of ACE were higher in the DD group than in the ID and II groups (p < 0.05). Conclusions: Serum ACE activity could better predict logical memory in T2DM patients than ACE level. Further investigations on a large population size are necessary to test whether the D-allele of the ACE gene polymorphism is susceptible to memory deterioration. PMID:28066203

  17. Association of Increased Serum ACE Activity with Logical Memory Ability in Type 2 Diabetic Patients with Mild Cognitive Impairment.

    PubMed

    Tian, Sai; Han, Jing; Huang, Rong; Xia, Wenqing; Sun, Jie; Cai, Rongrong; Dong, Xue; Shen, Yanjue; Wang, Shaohua

    2016-01-01

    Background: Angiotensin-converting enzyme (ACE) is involved in the chronic complications of type 2 diabetes mellitus (T2DM) and Alzheimer's disease. This study aimed to assess the pathogenetic roles of ACE and the genetic predisposition of its insertion/deletion (I/D) polymorphism in mild cognitive impairment (MCI) among T2DM patients. Methods: A total of 210 T2DM patients were enrolled. Among these patients, 116 satisfied the MCI diagnostic criteria and 94 exhibited healthy cognition. The cognitive functions of the patients were extensively assessed. The serum level and activity of ACE were measured via enzyme-linked immunosorbent assay and ultraviolet spectrophotography. The single-nucleotide polymorphisms of I/D gene of ACE were analyzed. Results: The serum level and activity of ACE in diabetic MCI patients ( p = 0.022 and p = 0.008, respectively) were both significantly higher than those in the healthy controls. A significant negative correlation was found between their ACE activity and logical memory test score (LMT) ( p = 0.002). Multiple stepwise regression iterated the negative correlation between ACE activity and LMT score ( p = 0.035). Although no significant difference was found in the genotype or allele distribution of ACE I/D polymorphism between the groups, the serum levels and activity of ACE were higher in the DD group than in the ID and II groups ( p < 0.05). Conclusions: Serum ACE activity could better predict logical memory in T2DM patients than ACE level. Further investigations on a large population size are necessary to test whether the D-allele of the ACE gene polymorphism is susceptible to memory deterioration.

  18. The Three-item ALERT-B Questionnaire Provides a Validated Screening Tool to Detect Chronic Gastrointestinal Symptoms after Pelvic Radiotherapy in Cancer Survivors.

    PubMed

    Taylor, S; Byrne, A; Adams, R; Turner, J; Hanna, L; Staffurth, J; Farnell, D; Sivell, S; Nelson, A; Green, J

    2016-10-01

    Although pelvic radiotherapy is an effective treatment for various malignancies, around half of patients develop significant gastrointestinal problems. These symptoms often remain undetected, despite the existence of effective treatments. This study developed and refined a simple screening tool to detect common gastrointestinal symptoms in outpatient clinics. These symptoms have a significant effect on quality of life. This tool will increase detection rates and so enable access to specialist gastroenterologists, which will in turn lead to improved symptom control and quality of life after treatment. A literature review and expert consensus meeting identified four items for the ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) screening tool. ALERT-B was face tested for its usability and acceptability using cognitive interviews with 12 patients experiencing late gastrointestinal symptoms after pelvic radiotherapy. Thematic analysis and probe category were used to analyse interview transcripts. Interview data were presented to a group of experts to agree on the final content and format of the tool. ALERT-B was assessed for reliability and tested for validity against the Gastrointestinal Symptom Rating Scale in a clinical study (EAGLE). Overall, the tool was found to be acceptable in terms of wording, response format and completion time. Participant-reported experiences, including lifestyle modifications and the psychological effect of the symptoms, led to further modifications of the tool. The refined tool includes three questions covering rectal bleeding, incontinence, nocturnal bowel movements and impact on quality of life, including mood, relationships and socialising. ALERT-B was successfully validated against the Gastrointestinal Symptom Rating Scale in the EAGLE study with the tool shown broadly to be internally consistent (Cronbach's α = 0.61 and all item-subscale correlation [Spearman] coefficients are > 0.6). The ALERT-B screening tool can be used in clinical practice to improve post-treatment supportive care by triggering the clinical assessment of patients suitable for referral to a gastroenterologist. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. Single-particle structure determination by correlations of snapshot X-ray diffraction patterns (CXIDB ID 20)

    DOE Data Explorer

    Starodub, D.

    2013-03-25

    This deposition includes the diffraction images generated by the paired polystyrene spheres in random orientations. These images were used to determine and phase the single particle diffraction volume from their autocorrelation functions.

  20. A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety.

    PubMed

    Page, N; Baysari, M T; Westbrook, J I

    2017-09-01

    To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions about the amount and type of decision support that should be integrated into CPOE systems to increase safety while reducing the risk of alert fatigue. Virtually no studies have sought to investigate the impact on changes to prescriber behavior and outcomes overall when alerts from multiple categories are incorporated within the same system. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Monitoring sepsis using electrical cell profiling.

    PubMed

    Prieto, Javier L; Su, Hao-Wei; Hou, Han Wei; Vera, Miguel Pinilla; Levy, Bruce D; Baron, Rebecca M; Han, Jongyoon; Voldman, Joel

    2016-11-01

    Sepsis is a potentially lethal condition that may be ameliorated through early monitoring of circulating activated leukocytes for faster stratification of severity of illness and improved administration of targeted treatment. Characterization of the intrinsic electrical properties of leukocytes is label-free and can provide a quick way to quantify the number of activated cells as sepsis progresses. Iso-dielectric separation (IDS) uses dielectrophoresis (DEP) to characterize the electrical signatures of cells. Here, we use IDS to show that activated and non-activated leukocytes have different electrical properties. We then present a double-sided version of the IDS platform to increase throughput to characterize thousands of cells. This new platform is less prone to cell fouling and allows faster characterization. Using peripheral blood samples from a cecal ligation and puncture (CLP) model of polymicrobial sepsis in mice, we estimate the number of activated leukocytes by looking into differences in the electrical properties of cells. We show for the first time using animal models that electrical cell profiling correlates with flow cytometry (FC) results and that IDS is therefore a good candidate for providing rapid monitoring of sepsis by quantifying the number of circulating activated leukocytes.

  2. Vitek 2 ANC card versus BBL Crystal Anaerobe and RapID ANA II for identification of clinical anaerobic bacteria.

    PubMed

    Blairon, Laurent; Maza, Mengi L; Wybo, Ingrid; Piérard, Denis; Dediste, Anne; Vandenberg, Olivier

    2010-08-01

    The Vitek 2 Anaerobe and Corynebacterium Identification Card (ANC) was recently evaluated in a multicentre study. In the present work, this system was compared with the BBL Crystal Anaerobe and RapID ANA II panels. These kits were tested using 196 strains of anaerobes that had been previously identified by gas-liquid chromatography. Identification to the species or to the genus level was 75.0%, 81.1% and 70.9% for Crystal, RapID and Vitek, respectively. Vitek ANC failed to provide any identification in 20.4% of the strains, but it had fewer misidentifications than RapID. The confidence factors provided on the results report of each kit were not always correlated with a lower risk of major errors, with the exception of Vitek 2 in which a confidence factor higher than 0.86 excluded the risk of misidentification in more than 87% of isolates. The lower rate of identification by the Vitek and Crystal panels is mostly due the lower ability of these systems to identify the Clostridia. Overall, the three panels are comparable but need improvement to a better accuracy. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  3. Monitoring multiple myeloma by idiotype-specific peptide binders of tumor-derived exosomes.

    PubMed

    Iaccino, Enrico; Mimmi, Selena; Dattilo, Vincenzo; Marino, Fabiola; Candeloro, Patrizio; Di Loria, Antonio; Marimpietri, Danilo; Pisano, Antonio; Albano, Francesco; Vecchio, Eleonora; Ceglia, Simona; Golino, Gaetanina; Lupia, Antonio; Fiume, Giuseppe; Quinto, Ileana; Scala, Giuseppe

    2017-10-13

    Tumor-derived exosomes (TDEs) play a pivotal role in tumor establishment and progression, and are emerging biomarkers for tumor diagnosis in personalized medicine. To date, there is a lack of efficient technology platforms for exosome isolation and characterization. Multiple myeloma (MM) is an incurable B-cell malignancy due to the rapid development of drug-resistance. MM-released exosomes express the immunoglobulin B-cell receptor (Ig-BCR) of the tumor B-cells, which can be targeted by Idiotype-binding peptides (Id-peptides). In this study, we analyzed the production of MM-released exosomes in the murine 5T33MM multiple myeloma model as biomarkers of tumor growth. To this end, we selected Id-peptides by screening a phage display library using as bait the Ig-BCR expressed by 5T33MM cells. By FACS, the FITC-conjugated Id-peptides detected the MM-released exosomes in the serum of 5T33MM-engrafted mice, levels of which are correlated with tumor progression at an earlier time point compared to serum paraprotein. These results indicate that Id-peptide-based recognition of MM-released exosomes may represent a very sensitive diagnostic approach for clinical evaluation of disease progression.

  4. Prescription order risk factors for pediatric dosing alerts.

    PubMed

    Stultz, J S; Porter, K; Nahata, M C

    2015-02-01

    To determine dosing alert rates based on prescription order characteristics and identify prescription order risk factors for the occurrence of dosing alerts. A retrospective analysis of inpatient medication orders and dosing alerts occurring during October 2011 and January, April, and July 2012 at a pediatric institution. Prescription orders and alerts were categorized by: medication class, patient age, route of administration, and month of the year. There were 228,259 orders during the studied period, with 11,072 alerted orders (4.9%). The most frequently alerted medication class was the non-analgesic central nervous system agent class (14% of alerts). Age, route, medication class, and month all independently affected dosing alert rates. The alert rate was highest for immunosuppressive agents (54%), neonates (6.7%), and orders for rectal administration (9.5%). The alert rate was higher in adult patients receiving their care at a pediatric institution (5.7%) compared to children (4.7%), but after multivariate analysis, pediatric orders had higher odds for an alert (OR 1.1, 95% CI 1.05-1.16). Mercaptopurine had the highest alert rate when categorized by active ingredient (73.9%). Albuterol 2.5mg/mL continuous aerosol and heparin 1000 units in 0.9% sodium chloride injection solution were the unique medications with the highest alert rates (100.0% and 97.7%, respectively). Certain types of prescription orders have a higher risk for causing dosing alerts than others. Patient age, medication class, route of administration, and the month of year can affect dosing alert rates. Design and customization efforts should focus on these medications and prescription order characteristics that increase the risk for dosing alerts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Evaluation of Antimicrobial Stewardship-Related Alerts Using a Clinical Decision Support System.

    PubMed

    Ghamrawi, Riane J; Kantorovich, Alexander; Bauer, Seth R; Pallotta, Andrea M; Sekeres, Jennifer K; Gordon, Steven M; Neuner, Elizabeth A

    2017-11-01

    Background: Information technology, including clinical decision support systems (CDSS), have an increasingly important and growing role in identifying opportunities for antimicrobial stewardship-related interventions. Objective: The aim of this study was to describe and compare types and outcomes of CDSS-built antimicrobial stewardship alerts. Methods: Fifteen alerts were evaluated in the initial antimicrobial stewardship program (ASP) review. Preimplementation, alerts were reviewed retrospectively. Postimplementation, alerts were reviewed in real-time. Data collection included total number of actionable alerts, recommendation acceptance rates, and time spent on each alert. Time to de-escalation to narrower spectrum agents was collected. Results: In total, 749 alerts were evaluated. Overall, 306 (41%) alerts were actionable (173 preimplementation, 133 postimplementation). Rates of actionable alerts were similar for custom-built and prebuilt alert types (39% [53 of 135] vs 41% [253 of 614], P = .68]. In the postimplementation group, an intervention was attempted in 97% of actionable alerts and 70% of interventions were accepted. The median time spent per alert was 7 minutes (interquartile range [IQR], 5-13 minutes; 15 [12-17] minutes for actionable alerts vs 6 [5-7] minutes for nonactionable alerts, P < .001). In cases where the antimicrobial was eventually de-escalated, the median time to de-escalation was 28.8 hours (95% confidence interval [CI], 10.0-69.1 hours) preimplementation vs 4.7 hours (95% CI, 2.4-22.1 hours) postimplementation, P < .001. Conclusions: CDSS have played an important role in ASPs to help identify opportunities to optimize antimicrobial use through prebuilt and custom-built alerts. As ASP roles continue to expand, focusing time on customizing institution specific alerts will be of vital importance to help redistribute time needed to manage other ASP tasks and opportunities.

  6. Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.

    PubMed

    Simpao, Allan F; Ahumada, Luis M; Desai, Bimal R; Bonafide, Christopher P; Gálvez, Jorge A; Rehman, Mohamed A; Jawad, Abbas F; Palma, Krisha L; Shelov, Eric D

    2015-03-01

    To develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project. We used visual analytics software to develop the dashboard. We collaborated with the hospital-wide Clinical Decision Support committee to perform three interventions successively deactivating clinically irrelevant drug-drug interaction (DDI) alert rules. We analyzed the impact of the interventions on care providers' and pharmacists' alert and override rates using an interrupted time series framework with piecewise regression. We evaluated 2 391 880 medication alerts between January 31, 2011 and January 26, 2014. For pharmacists, the median alert rate prior to the first DDI deactivation was 58.74 alerts/100 orders (IQR 54.98-60.48) and 25.11 alerts/100 orders (IQR 23.45-26.57) following the three interventions (p<0.001). For providers, baseline median alert rate prior to the first round of DDI deactivation was 19.73 alerts/100 orders (IQR 18.66-20.24) and 15.11 alerts/100 orders (IQR 14.44-15.49) following the three interventions (p<0.001). In a subgroup analysis, we observed a decrease in pharmacists' override rates for DDI alerts that were not modified in the system from a median of 93.06 overrides/100 alerts (IQR 91.96-94.33) to 85.68 overrides/100 alerts (IQR 84.29-87.15, p<0.001). The medication serious safety event rate decreased during the study period, and there were no serious safety events reported in association with the deactivated alert rules. An alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists' frequency of selecting the 'cancel' option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. The influence of essential oils on human attention. I: alertness.

    PubMed

    Ilmberger, J; Heuberger, E; Mahrhofer, C; Dessovic, H; Kowarik, D; Buchbauer, G

    2001-03-01

    Scientific research on the effects of essential oils on human behavior lags behind the promises made by popular aromatherapy. Nearly all aspects of human behavior are closely linked to processes of attention, the basic level being that of alertness, which ranges from sleep to wakefulness. In our study we measured the influence of essential oils and components of essential oils [peppermint, jasmine, ylang-ylang, 1,8-cineole (in two different dosages) and menthol] on this core attentional function, which can be experimentally defined as speed of information processing. Substances were administered by inhalation; levels of alertness were assessed by measuring motor and reaction times in a reaction time paradigm. The performances of the six experimental groups receiving substances (n = 20 in four groups, n = 30 in two groups) were compared with those of corresponding control groups receiving water. Between-group analysis, i.e. comparisons between experimental groups and their respective control groups, mainly did not reach statistical significance. However, within-group analysis showed complex correlations between subjective evaluations of substances and objective performance, indicating that effects of essentials oils or their components on basic forms of attentional behavior are mainly psychological.

  8. Influence of acute sleep loss on the neural correlates of alerting, orientating and executive attention components.

    PubMed

    Muto, Vincenzo; Shaffii-le Bourdiec, Anahita; Matarazzo, Luca; Foret, Ariane; Mascetti, Laura; Jaspar, Mathieu; Vandewalle, Gilles; Phillips, Christophe; Degueldre, Christian; Balteau, Evelyne; Luxen, André; Collette, Fabienne; Maquet, Pierre

    2012-12-01

    The Attention Network Test (ANT) is deemed to assess the alerting, orientating and executive components of human attention. Capitalizing on the opportunity to investigate three facets of attention in a single task, we used functional magnetic resonance imaging (fMRI) to assess the effect of sleep deprivation (SD) on brain responses associated with the three attentional components elicited by the ANT. Twelve healthy volunteers were scanned in two conditions 1 week apart, after a normal night of sleep (rested wakefulness, RW) or after one night of total sleep deprivation. Sleep deprivation was associated with a global increase in reaction times, which did not affect specifically any of the three attention effects. Brain responses associated with the alerting effect did not differ between RW and SD. Higher-order attention components (orientating and conflict effects) were associated with significantly larger thalamic responses during SD than during RW. These results suggest that SD influences different components of human attention non-selectively, through mechanisms that might either affect centrencephalic structures maintaining vigilance or ubiquitously perturb neuronal function. Compensatory responses can counter these effects transiently by recruiting thalamic responses, thereby supporting thalamocortical function. © 2012 European Sleep Research Society.

  9. Provider management strategies of abnormal test result alerts: a cognitive task analysis.

    PubMed

    Hysong, Sylvia J; Sawhney, Mona K; Wilson, Lindsay; Sittig, Dean F; Espadas, Donna; Davis, Traber; Singh, Hardeep

    2010-01-01

    Electronic medical records (EMRs) facilitate abnormal test result communication through "alert" notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results.

  10. The Relationship between Non-Cognitive Coaching Interventions and College Student Persistence at a Rural Community College

    ERIC Educational Resources Information Center

    Valora, Jenniffer

    2017-01-01

    The purpose of this quantitative correlation study was to contribute empirical research findings concerning the relationship of non-cognitive coaching interventions on at-risk student persistence at a rural public community college located in northwest New Mexico. The sample population included 210 undergraduate at-risk students who an alert was…

  11. Motivational Correlates of Academic Success in an Educational Psychology Course

    ERIC Educational Resources Information Center

    Herman, William E.

    2011-01-01

    The variables of class attendance and the institution-wide Early Alert Grading System were employed to predict academic success at the end of the semester. Classroom attendance was found to be statistically and significantly related to final average and accounted for 14-16% of the variance in academic performance. Class attendance was found to…

  12. The NAS Alert System: A look at the first eight years

    USGS Publications Warehouse

    Fuller, Pamela L.; Neilson, Matt; Huge, Dane H.

    2013-01-01

    The U.S. Geological Survey's Nonindigenous Aquatic Species (NAS) database program (http://nas.er.usgs.gov) tracks the distribution of introduced aquatic organisms across the United States. Awareness of, and timely response to, novel species introductions by those involved in nonindigenous aquatic species management and research requires a framework for rapid dissemination of occurrence data as it is incorporated into the NAS database. In May 2004, the NAS program developed an alert system to notify registered users of new introductions as part of a national early detection/rapid response system. This article summarizes information on system users and dispatched alerts from the system's inception through the end of 2011. The NAS alert system has registered over 1,700 users, with approximately 800 current subscribers. A total of 1,189 alerts had been transmitted through 2011. More alerts were sent for Florida (134 alerts) than for any other state. Fishes comprise the largest taxonomic group of alerts (440), with mollusks, plants, and crustaceans each containing over 100 alerts. Most alerts were for organisms that were intentionally released (414 alerts), with shipping, escape from captivity, and hitchhiking also representing major vectors. To explore the archive of sent alerts and to register, the search and signup page for the alert system can be found online at http://nas.er.usgs.gov/AlertSystem/default.aspx.

  13. Wertheim's hypothesis on 'highway hypnosis': empirical evidence from a study on motorway and conventional road driving.

    PubMed

    Cerezuela, Gemma Pastor; Tejero, Pilar; Chóliz, Mariano; Chisvert, Mauricio; Monteagudo, M José

    2004-11-01

    This paper aims to study the phenomenon known as 'highway hypnosis' or 'driving without attention mode', which has been defined as a state showing sleepiness signs and attention slip resulting from driving a motor vehicle for a long period in a highly predictable environment with low event occurrence, this being the case with motorways and very familiar roads [Highway hypnosis: a theoretical analysis. In: Gale, A.G., Brown, I.D., Haslegrave, C.M., Moorhead, I., Taylor, S. (Eds.), Vision in Vehicles-III. Elsevier, North-Holland, pp. 467-472]. According to Wertheim's hypothesis on 'highway hypnosis', long-term driving on motorways and conventional roads, e.g. main roads, secondary roads--implies differences in the predictability of the movement pattern of the visual stimulation, in the eye musculature activity and in the type of feedback used in visual information processing (mostly extra-retinal on motorways and retinal and extra-retinal on conventional roads). All this ultimately leads to alertness differences between both road types. Our research is intended to provide empirical evidence from the hypothesis, based on the data recorded during the actual driving experience of a group of subjects on a motorway and a conventional road. We studied whether or not significant alertness differences were found-measured by EEG data relative to time periods of on-target eye-tracking performance--between motorway and conventional road driving. Our results partially support the hypothesis, as drowsiness proved to be higher on motorways than on conventional roads during the final driving period but not during the starting stage, when the opposite trend was noticed. This result could be explained by the fact that during the first driving periods the effects of the stimulus movement predictability had not yet become apparent, since they tend to show after a long drive.

  14. Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation

    PubMed Central

    Russ, Alissa L; Zillich, Alan J; Melton, Brittany L; Russell, Scott A; Chen, Siying; Spina, Jeffrey R; Weiner, Michael; Johnson, Elizabette G; Daggy, Joanne K; McManus, M Sue; Hawsey, Jason M; Puleo, Anthony G; Doebbeling, Bradley N; Saleem, Jason J

    2014-01-01

    Objective To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. Materials and methods We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug–allergy, drug–drug interaction, and drug–disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Results Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1–5) compared to original alerts: 4 (1–7); p=0.024). Discussion Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. Conclusions This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes. PMID:24668841

  15. Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation.

    PubMed

    Russ, Alissa L; Zillich, Alan J; Melton, Brittany L; Russell, Scott A; Chen, Siying; Spina, Jeffrey R; Weiner, Michael; Johnson, Elizabette G; Daggy, Joanne K; McManus, M Sue; Hawsey, Jason M; Puleo, Anthony G; Doebbeling, Bradley N; Saleem, Jason J

    2014-10-01

    To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p=0.024). Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

    PubMed Central

    Shah, Priya; Wyatt, Jeremy C; Makubate, Boikanyo; Cross, Frank W

    2011-01-01

    Objective Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems. Design A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task. Measurements The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems. Results Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04). Conclusions Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes. PMID:21836158

  17. Fluorescence guided surgery and tracer-dose, fact or fiction?

    PubMed

    KleinJan, Gijs H; Bunschoten, Anton; van den Berg, Nynke S; Olmos, Renato A Valdès; Klop, W Martin C; Horenblas, Simon; van der Poel, Henk G; Wester, Hans-Jürgen; van Leeuwen, Fijs W B

    2016-09-01

    Fluorescence guidance is an upcoming methodology to improve surgical accuracy. Challenging herein is the identification of the minimum dose at which the tracer can be detected with a clinical-grade fluorescence camera. Using a hybrid tracer such as indocyanine green (ICG)-(99m)Tc-nanocolloid, it has become possible to determine the accumulation of tracer and correlate this to intraoperative fluorescence-based identification rates. In the current study, we determined the lower detection limit of tracer at which intraoperative fluorescence guidance was still feasible. Size exclusion chromatography (SEC) provided a laboratory set-up to analyze the chemical content and to simulate the migratory behavior of ICG-nanocolloid in tissue. Tracer accumulation and intraoperative fluorescence detection findings were derived from a retrospective analysis of 20 head-and-neck melanoma patients, 40 penile and 20 prostate cancer patients scheduled for sentinel node (SN) biopsy using ICG-(99m)Tc-nanocolloid. In these patients, following tracer injection, single photon emission computed tomography fused with computed tomography (SPECT/CT) was used to identify the SN(s). The percentage injected dose (% ID), the amount of ICG (in nmol), and the concentration of ICG in the SNs (in μM) was assessed for SNs detected on SPECT/CT and correlated with the intraoperative fluorescence imaging findings. SEC determined that in the hybrid tracer formulation, 41 % (standard deviation: 12 %) of ICG was present in nanocolloid-bound form. In the SNs detected using fluorescence guidance a median of 0.88 % ID was present, compared to a median of 0.25 % ID in the non-fluorescent SNs (p-value < 0.001). The % ID values could be correlated to the amount ICG in a SN (range: 0.003-10.8 nmol) and the concentration of ICG in a SN (range: 0.006-64.6 μM). The ability to provide intraoperative fluorescence guidance is dependent on the amount and concentration of the fluorescent dye accumulated in the lesion(s) of interest. Our findings indicate that intraoperative fluorescence detection with ICG is possible above a μM concentration.

  18. On the relationship between motor performance and executive functioning in children with intellectual disabilities.

    PubMed

    Hartman, E; Houwen, S; Scherder, E; Visscher, C

    2010-05-01

    It has been suggested that children with intellectual disabilities (ID) have motor problems and higher-order cognitive deficits. The aim of this study was to examine the motor skills and executive functions in school-age children with borderline and mild ID. The second aim was to investigate the relationship between the two performance domains. Sixty-one children aged between 7 and 12 years diagnosed with borderline ID (33 boys and 28 girls; 71 < IQ < 79) and 36 age peers with mild ID (24 boys and 12 girls; 54 < IQ < 70) were assessed. Their abilities were compared with those of 97 age- and gender-matched typically developing children. Qualitative motor skills, i.e. locomotor ability and object control, were evaluated with the Test of Gross Motor Development (TGMD-2). Executive functioning (EF), in terms of planning ability, strategic decision-making and problem solving, was gauged with the Tower of London (TOL) task. Compared with the reference group, the full ID cohort scored significantly lower on all assessments. For the locomotor skills, the children with mild ID scored significantly lower than the children with borderline ID, but for the object control skills and the TOL score, no significant differences between the two groups were found. Motor performance and EF correlated positively. At the most complex level, the TOL showed decision time to be a mediator between motor performance and EF: the children with the lower motor scores had significantly shorter decision times and lower EF scores. Analogously, the children with the lower object control scores had longer execution times and lower EF scores. The current results support the notion that besides being impaired in qualitative motor skills intellectually challenged children are also impaired in higher-order executive functions. The deficits in the two domains are interrelated, so early interventions boosting their motor and cognitive development are recommended.

  19. Chromosomal microarray analysis of Bulgarian patients with epilepsy and intellectual disability.

    PubMed

    Peycheva, Valentina; Kamenarova, Kunka; Ivanova, Neviana; Stamatov, Dimitar; Avdjieva-Tzavella, Daniela; Alexandrova, Iliana; Zhelyazkova, Sashka; Pacheva, Iliana; Dimova, Petya; Ivanov, Ivan; Litvinenko, Ivan; Bozhinova, Veneta; Tournev, Ivailo; Simeonov, Emil; Mitev, Vanyo; Jordanova, Albena; Kaneva, Radka

    2018-08-15

    High resolution chromosomal microarray analysis (CMA) has facilitated the identification of small chromosomal rearrangements throughout the genome, associated with various neurodevelopmental phenotypes, including ID/DD. Recently, it became evident that intellectual disability (ID)/developmental delay (DD) can occur with associated co-morbidities like epileptic seizures, autism and additional congenital anomalies. These observations require whole genome approach in order to detect the genetic causes of these complex disorders. In this study, we examined 92 patients of Bulgarian origin at age between 1 and 22 years with ID, generalized epilepsy, autistic signs and congenital anomalies. CMA was carried out using SurePrint G3 Human CGH Microarray Kit, 4 × 180 K and SurePrint G3 Unrestricted CGH ISCA v2, 4 × 180 K oligo platforms. Referral indications for selection of the patients were the presence of generalized refractory seizures disorders and co-morbid ID. Clearly pathogenic copy number variations (CNVs) were detected in eight patients (8.7%) from our cohort. Additionally, possibly pathogenic rearrangements of unclear clinical significance were detected in six individuals (6.5%), which make for an overall diagnostic yield of 15.2% among our cohort of patients. We report here the patients with clearly pathogenic CNVs, discuss the potential causality of the possibly pathogenic CNVs and make genotype - phenotype correlations. One novel possibly pathogenic heterozygous deletion in 15q22.31 region was detected in a case with ID/DD. Additionally, whole APBA2 gene duplication in 15q13.1 was found in three generations of a family with epilepsy, ID and psychiatric abnormalities. The results from this study allow us to define the genetic diagnosis in a subset of Bulgarian patients and improve the genetic counseling of the affected families. To our knowledge, this is the first aCGH evaluation of a Bulgarian cohort of children with epilepsy and ID so far. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Low prevalence of iron-deficiency anaemia among Inuit preschool children: Nunavut Inuit Child Health Survey, 2007-2008.

    PubMed

    Pacey, Angela; Weiler, Hope; Egeland, Grace M

    2011-08-01

    To report the prevalence rates and correlates for anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among Inuit preschool-aged children. A cross-sectional study assessed iron intake, demographic information, medical history, anthropometrics, Hb, ferritin, C-reactive protein and antibodies to Helicobacter pylori. Sixteen selected Inuit communities in Nunavut Territory, Canada. Inuit (n 388) aged 3-5 years randomly recruited from communities. Anaemia (3-4 years: Hb < 110 g/l; 5 years: Hb < 115 g/l) was prevalent in 16·8 % of children. The prevalence of ID (ferritin < 12 μg/l) was 18·0 % and that of IDA was 5·4 %. When ID was defined as ferritin <10 μg/l, 10·8 % of children were iron deficient and 3·3 % had IDA. In multiple logistic regression, boys were more likely to be iron deficient (OR = 2·28, 95 % CI 1·17, 8·25), but no other risk factor emerged for ID. Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID (OR = 0·11, 95 % CI 0·08, 0·58). Anaemia from other causes was more common among children residing in crowded homes (OR = 2·30, 95 % CI 1·37, 12·31) and those treated for past-year ear infection (OR = 1·35, 95 % CI 1·05, 7·21). The low prevalence of ID and IDA is encouraging, but efforts are still needed to reduce rates as they continue to be higher than general population rates. Household crowding and infections may contribute to anaemia and warrant further research.

  1. Reliability and validity of the 6-min walk test in adults and seniors with intellectual disabilities.

    PubMed

    Guerra-Balic, Myriam; Oviedo, Guillermo R; Javierre, Casimiro; Fortuño, Jesús; Barnet-López, Silvia; Niño, Oscar; Alamo, Juan; Fernhall, Bo

    2015-12-01

    Adults with intellectual disabilities (ID) have significantly lower rates of physical activity and fitness than adults without ID. The 6-min walk test (6 MWT) is an inexpensive and simple way to test mobility and submaximal work capacity. To evaluate the test-retest reliability and validity of the 6 MWT in adults and seniors with ID and explore factors contributing to the 6 MWT distance (6 MWD). 46 participants with mild, moderate and severe ID levels (age=41 ± 11 years) performed the 6 MWT three times (T1; T2; T3) to determine test-retest reliability. To test validity, peak oxygen uptake (VO2 peak) was measured using a treadmill protocol. To analyze factors contributing to the 6 MWD, sex, height, fat mass % and fat free mass %, ID level, isometric leg strength and relative VO2 peak were also measured. The walking distances for T1, T2 and T3 were 460.3 ± 76.9; 489.4 ± 81.2 and 491.4 ± 77.9 m, respectively. The 6 MWDs between T1-T2 and T1-T3 were significantly different (p<0.001), but T2 and T3 were not different. The intraclass correlation coefficient between T2 and T3 was 0.96 indicating high reliability. Relative VO2 peak and isometric leg strength significantly contributed to the 6 MWD (R(2)=0.55). The 6 MWT is an easy, inexpensive, reliable and valid test in adults and seniors with ID. Familiarization is necessary to obtain reliable values. Relative VO2 peak and leg strength have significant impact on the distance walked. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Evaluation of cerebrospinal fluid lactate and plasma lactate concentrations in anesthetized dogs with and without intracranial disease

    PubMed Central

    Caines, Deanne; Sinclair, Melissa; Wood, Darren; Valverde, Alexander; Dyson, Doris; Gaitero, Luis; Nykamp, Stephanie

    2013-01-01

    The objectives of this study were to establish a reference interval for canine cerebrospinal fluid lactate (CSFL) and to compare CSFL and plasma lactate (PL) concentrations in anesthetized dogs with and without intracranial disease. Using a prospective study, canine blood and cerebrospinal fluid were collected for lactate analysis in 11 dogs with intracranial disease after undergoing magnetic resonance imaging (MRI) (Group ID-MRI), in 10 healthy dogs post-MRI (Group H-MRI), and in 39 healthy dogs after induction of anesthesia (Group H-Sx). Dogs were anesthetized for the procedures using different anesthetic protocols. Neurological scores (NS) and sedation scores (SS) were assessed pre-anesthesia in ID-MRI dogs. The CSFL reference interval [90% confidence interval (CI) for lower and upper limits] was 1.1 (1.0 to 1.2) to 2.0 (2.0 to 2.1) mmol/L. Mean ± SD CSFL concentrations were: ID-MRI, 2.1 ± 0.8; H-MRI, 1.6 ± 0.4; and H-Sx, 1.6 ± 0.2 mmol/L. There was a tendency for higher CSFL in dogs in the ID-MRI group than in those in the H-MRI or H-Sx groups (P = 0.12). There was agreement between CSFL and PL in ID-MRI dogs (P = 0.007), but not in dogs in H-MRI (P = 0.5) or H-Sx (P = 0.2). Of the ID-MRI dogs, those with worse NS had higher CSFL (r2 = 0.44). The correlation between CSFL and PL in dogs with intracranial disease and between worse NS and higher CSFL warrants further investigation into the use of CSFL and PL for diagnostic and prognostic purposes. PMID:24124273

  3. Outcomes of Chemoradiotherapy With 5-Fluorouracil and Mitomycin C for Anal Cancer in Immunocompetent Versus Immunodeficient Patients

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

    Seo, Yuji; Kinsella, Michael T.; Reynolds, Harry L.

    2009-09-01

    Purpose: Information is limited as to how we should treat invasive anal squamous cell carcinoma (SCC) in patients with chronic immunosuppression, since the majority of clinical studies to date have excluded such patients. The objective of this study is to compare treatment outcomes in immunocompetent (IC) versus immunodeficient (ID) patients with invasive anal SCC treated similarly with combined modality therapy. Methods and Materials: Between January 1999 and March 2007, a total of 36 consecutive IC and ID patients received concurrent chemoradiotherapy using three-dimensional conformal radiotherapy with infusional 5-fluorouracil and mitomycin C. The IC and ID groups consisted of 19 andmore » 17 patients, respectively, with 14 human immunodeficiency virus-positive (HIV+) and 3 post-solid organ transplant ID patients. There were no significant differences in tumor size, T stage, N stage, chemotherapy doses, or radiation doses between the two groups. Results: With a median follow-up of 3.1 years, no differences were found in overall survival, disease-specific survival, and colostomy-free survival. Three-year overall survival was 83.6% (95% CI = 68.2-100) and 91.7% (95% CI = 77.3-100) in the IC and ID groups, respectively. In addition, there were no differences in acute and late toxicity profiles between the two groups. In the human immunodeficiency virus-positive patients, Cox modeling showed no difference in overall survival by pretreatment CD4 counts (hazard ratio = 0.994, 95% CI = 0.98-1.01). No correlation was found between CD4 counts and the degree of acute toxicities. Conclusion: Our data suggest that standard combined modality therapy with three-dimensional conformal radiotherapy and 5-fluorouracil plus mitomycin C is as safe and effective for ID patients as for IC patients.« less

  4. Provider management strategies of abnormal test result alerts: a cognitive task analysis

    PubMed Central

    Sawhney, Mona K; Wilson, Lindsay; Sittig, Dean F; Espadas, Donna; Davis, Traber; Singh, Hardeep

    2010-01-01

    Objective Electronic medical records (EMRs) facilitate abnormal test result communication through “alert” notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. Design 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. Results Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. Conclusion Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results. PMID:20064805

  5. Concurrence of the strengths and difficulties questionnaire and developmental behaviour checklist among children with an intellectual disability.

    PubMed

    Rice, L J; Emerson, E; Gray, K M; Howlin, P; Tonge, B J; Warner, G L; Einfeld, S L

    2018-02-01

    The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Parents of 83 young people with ID aged 4-17 years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  6. [Candida and Aspergillus infections in the light of a new list of alarm factors on the example of the Lodz Medical University Hospital No. 1].

    PubMed

    Tyczkowska-Sieroń, Ewa; Bartoszko-Tyczkowska, Anna

    2012-01-01

    In 2011, the Polish Ministry of Health introduced Candida sp. resistant to fluconazole and Aspergillus sp. to the list of Alarm Factors as alert pathogens. The purpose of this paper is to confirm the validity of continuous monitoring of fungal infections caused by the pathogens mentioned above. The role offluconazole therapy in the Candida sp. infections is also discussed. The analysis of the fungal infections is performed based on the results obtained in the University Clinic Hospital (UCH) No. 1 in Lodz in 2009-2011. The swabs were plated on Sabouraud's agar. Body fluids and blood were incubated in an automated system Bactec 9050. Yeast ID Phoenix BD panels were used to determine the species of fungi. In turn, antimicrobial susceptibility testing was carried out by E-tests (bioMerieux). In the analysis of fungal infections occurring among patients in the UCH No. 1 in Lodz in 2009-2011, C. albicans, C. non-albicans and Aspergillus sp. infections are taken into account. This analysis is performed based on relations of the number of infections (per 100 patients) versus six-month periods. As one can see in Fig. 1, a clear, linear and statistically significant increase in the number of C. albicans and C. non-albicans infections is observed throughout the entire time period under discussion. On the other hand, the number of Aspergillus sp. infections remains at an almost constant low level. The more detailed analysis of fungal infections in the different hospital units, which are particularly exposed to this type of infections (Figs. 2-6), shows that there is a clear correlation between the number of C. non-albicans infections and the frequency of therapy with fluconazole. The results presented in this paper show in the example of the UCH No. 1 in Lodz that the number of infections caused by C. albicans and C. non-albicans resistant to fluconazole is clearly increasing in a hospital environment in recent years, which is a great clinical problem. Although the number of Aspergillus sp. infections is relatively much lower in comparison to that of Candidia sp., these infections also constitute a problem of clinical importance. In light of the presented analysis, it should be assessed positively the fact that Candida sp. resistant to fluconazole and Aspergillus sp. are considered to be alert pathogens that require the continuous monitoring.

  7. Competition between frontoparietal control and default networks supports social working memory and empathy

    PubMed Central

    Xin, Fei

    2015-01-01

    An extensive body of literature has indicated that there is increased activity in the frontoparietal control network (FPC) and decreased activity in the default mode network (DMN) during working memory (WM) tasks. The FPC and DMN operate in a competitive relationship during tasks requiring externally directed attention. However, the association between this FPC-DMN competition and performance in social WM tasks has rarely been reported in previous studies. To investigate this question, we measured FPC-DMN connectivity during resting state and two emotional face recognition WM tasks using the 2-back paradigm. Thirty-four individuals were instructed to perform the tasks based on either the expression [emotion (EMO)] or the identity (ID) of the same set of face stimuli. Consistent with previous studies, an increased anti-correlation between the FPC and DMN was observed during both tasks relative to the resting state. Specifically, this anti-correlation during the EMO task was stronger than during the ID task, as the former has a higher social load. Intriguingly, individual differences in self-reported empathy were significantly correlated with the FPC-DMN anti-correlation in the EMO task. These results indicate that the top-down signals from the FPC suppress the DMN to support social WM and empathy. PMID:25556209

  8. Validation of personal digital photography to assess dietary quality among people with intellectual disabilities.

    PubMed

    Elinder, L S; Brunosson, A; Bergström, H; Hagströmer, M; Patterson, E

    2012-02-01

    Dietary assessment is a challenge in general, and specifically in individuals with intellectual disabilities (ID). This study aimed to evaluate personal digital photography as a method of assessing different aspects of dietary quality in this target group. Eighteen adults with ID were recruited from community residences and activity centres in Stockholm County. Participants were instructed to photograph all foods and beverages consumed during 1 day, while observed. Photographs were coded by two raters. Observations and photographs of meal frequency, intake occasions of four specific food and beverage items, meal quality and dietary diversity were compared. Evaluation of inter-rater reliability and validity of the method was performed by intra-class correlation analysis. With reminders from staff, 85% of all observed eating or drinking occasions were photographed. The inter-rater reliability was excellent for all assessed variables (ICC ≥ 0.88), except for meal quality where ICC was 0.66. The correlations between items assessed in photos and observations were strong to almost perfect with ICC values ranging from 0.71 to 0.92 and all were statistically significant. Personal digital photography appears to be a feasible, reliable and valid method for assessing dietary quality in people with mild to moderate ID, who have daily staff support. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.

  9. Increased Evoked Potentials and Behavioral Indices in Response to Pain Among Individuals with Intellectual Disability.

    PubMed

    Benromano, Tali; Pick, Chaim G; Granovsky, Yelena; Defrin, Ruth

    2017-09-01

    Previous studies on the sensitivity and reactivity to pain of individuals with intellectual disability (ID) are inconsistent. The inconsistency may result from the reliance on self-reports and facial expressions of pain that are subject to internal and external biases. The aim was therefore to evaluate the reactivity to pain of individuals with ID by recording pain-evoked potentials (EPs), here for the first time, and testing their association with behavioral pain indices. Forty-one healthy adults, 16 with mild-moderate ID and 25 controls. Subjects received series of phasic heat stimuli and rated their pain on self-report scales. Changes in facial expressions and in pain EPs were recorded and analyzed offline. Pain self-reports, facial expressions, and the N2P2 amplitudes of the EPs exhibited stimulus-response relationship with stimulation intensity in both groups. The facial expressions and N2P2 amplitudes of individuals with ID were increased and N2P2 latency prolonged compared with controls. N2P2 amplitudes correlated with self-reports only in controls. Individuals with ID are hypersensitive/reactive to pain, a finding bearing clinical implications. Although pain EPs may reflect a somewhat different aspect of pain than the behavioral indices do, there is evidence to support their use to record pain in noncommunicative individuals, pending further validation. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Investigation of injection dose and camera integration time on quantifying pharmacokinetics of a Cy5.5-GX1 probe with dynamic fluorescence imaging in vivo

    NASA Astrophysics Data System (ADS)

    Dai, Yunpeng; Chen, Xueli; Yin, Jipeng; Kang, Xiaoyu; Wang, Guodong; Zhang, Xianghan; Nie, Yongzhan; Wu, Kaichun; Liang, Jimin

    2016-08-01

    The aim of this article is to investigate the influence of a tracer injection dose (ID) and camera integration time (IT) on quantifying pharmacokinetics of Cy5.5-GX1 in gastric cancer BGC-823 cell xenografted mice. Based on three factors, including whether or not to inject free GX1, the ID of Cy5.5-GX1, and the camera IT, 32 mice were randomly divided into eight groups and received 60-min dynamic fluorescence imaging. Gurfinkel exponential model (GEXPM) and Lammertsma simplified reference tissue model (SRTM) combined with a singular value decomposition analysis were used to quantitatively analyze the acquired dynamic fluorescent images. The binding potential (Bp) and the sum of the pharmacokinetic rate constants (SKRC) of Cy5.5-GX1 were determined by the SRTM and EXPM, respectively. In the tumor region, the SKRC value exhibited an obvious trend with change in the tracer ID, but the Bp value was not sensitive to it. Both the Bp and SKRC values were independent of the camera IT. In addition, the ratio of the tumor-to-muscle region was correlated with the camera IT but was independent of the tracer ID. Dynamic fluorescence imaging in conjunction with a kinetic analysis may provide more quantitative information than static fluorescence imaging, especially for a priori information on the optimal ID of targeted probes for individual therapy.

  11. Preparation of 68Ga-PSMA-11 with a Synthesis Module for Micro PET-CT Imaging of PSMA Expression during Prostate Cancer Progression

    PubMed Central

    Shao, Guoqiang; Wu, Jianping; Cui, Can; Zang, Shimin; Qiu, Fan

    2018-01-01

    Objective To synthesize 68Ga-Glu-urea-Lys(Ahx)-HBED-CC (68Ga-PSMA-11) with a synthesis module and investigate PET-CT imaging to monitor PSMA expression during prostate cancer (PCa) progression and tumor growth in mice bearing subcutaneous PCa xenografts. Method The radiochemical purity and stability of  68Ga-PSMA-11 were determined via radio-HPLC. The PCa cell lines of different PSMA expression levels (PC3, VCAP±, CWR22RV1+, and LNCaP++) were selected to mimic the PCa progression. 68Ga-PSMA-11 biodistribution was studied by dissection method and in vivo imaging with micro PET-CT. The expression levels of PSMA in tumor cells and tissues were analyzed by immunofluorescence, flow cytometry, and western blot. The correlation between PSMA expression and radio-uptake was also evaluated. 2-PMPA preadministration served as a block group. Results The radiochemical purity of  68Ga-PSMA-11 was 99.6 ± 0.1% and stable in vitro for 2 h. The equilibrium binding constant (Kd) of  68Ga-PSMA-11 to LNCaP, CWR22Rv1, PC-3, and VCAP cells was 4.3 ± 0.8 nM, 16.4 ± 1.3 nM, 225.3 ± 20.8 nM, and 125.6 ± 13.1 nM, respectively. Results of tumor uptake (% ID and % ID/g or % ID/cm3) of  68Ga-PSMA-11 in biodistribution and micro PET imaging were LNCaP > CWR22RV1 > PC-3 and VCAP due to different PSMA expression levels. It was confirmed by flow cytometry, western blot, and immunofluorescence. Tumor uptake (% ID/cm3) of  68Ga-PSMA-11 increased with the tumor anatomical volume in quadratic polynomial fashion and reached the peak (when tumor volume was 0.5 cm3) earlier than tumor uptake (% ID). Tumor uptake (% ID/cm3) of  68Ga-PSMA-11 based on functional volume correlated well with the PSMA expression in a linear manner (y = 9.35x + 2.59, R2 = 0.8924, and p < 0.0001); however, low dose 2-PMPA causes rapid renal clearance of increased tumor/kidney uptake of  68Ga-PSMA-11. Conclusions The 68Ga-PSMA-11 PET-CT imaging could invasively evaluate PSMA expression during PCa progression and tumor growth with % ID/cm3 (based on functional volume) as an important index. Low dose 2-PMPA preadministration might be a choice to decrease kidney uptake of  68Ga-PSMA-11. PMID:29853810

  12. An Evaluation of Microbial Profile in Halitosis with Tongue Coating Using PCR (Polymerase Chain Reaction)- A Clinical and Microbiological Study

    PubMed Central

    Kamaraj R., Dinesh; Bhushan, Kala S.; K.L., Vandana

    2014-01-01

    Background: Medline search using key words halitosis, tongue coating, polymerase chain reaction, microbial profile did not reveal any study. Hence, the purpose of the present investigation was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms using Polymerase Chain Reaction technique in chronic periodontitis patients. Materials and Methods: The study included 30 chronic periodontitis patients. Halitosis was detected using organoleptic assessment & tanita breath alert. Microbial analysis of Pg, Tf & Fn was done using PCR. Plaque index (PI), gingival index (GI), gingival bleeding index (GBI) were recorded. Result: The maximum score of 3 for tongue coating was found in 60% of selected subjects. The tanita breath alert measured VSC level of score 2 in 60% of selected subjects while organoleptic score of 4 was found in 50% of subjects. The maximum mean value of 31.1±36.5 was found to be of F. nucleatum (Fn) followed by P. gingivalis (Pg) (13±13.3) & T. forsythia (Tf) (7.16±8.68) in tongue samples of selected patients. A weak positive correlation was found between VSC levels (tanita score & organoleptic score) and clinical parameters. Conclusion: The halitosis assessment by measuring VSC levels using organoleptic method and tanita breath alert are clinically feasible. Maximum tongue coating was found in 60% of patients. Fn was found comparatively more than the Pg & Tf. A weak positive correlation was found between VSC levels and clinical parameters such as PI, GI & GBI. Thus,the dentist/ periodontist should emphasise on tongue cleaning measures that would reduce the odoriferous microbial load. PMID:24596791

  13. The effect of phasic auditory alerting on visual perception.

    PubMed

    Petersen, Anders; Petersen, Annemarie Hilkjær; Bundesen, Claus; Vangkilde, Signe; Habekost, Thomas

    2017-08-01

    Phasic alertness refers to a short-lived change in the preparatory state of the cognitive system following an alerting signal. In the present study, we examined the effect of phasic auditory alerting on distinct perceptual processes, unconfounded by motor components. We combined an alerting/no-alerting design with a pure accuracy-based single-letter recognition task. Computational modeling based on Bundesen's Theory of Visual Attention was used to examine the effect of phasic alertness on visual processing speed and threshold of conscious perception. Results show that phasic auditory alertness affects visual perception by increasing the visual processing speed and lowering the threshold of conscious perception (Experiment 1). By manipulating the intensity of the alerting cue, we further observed a positive relationship between alerting intensity and processing speed, which was not seen for the threshold of conscious perception (Experiment 2). This was replicated in a third experiment, in which pupil size was measured as a physiological marker of alertness. Results revealed that the increase in processing speed was accompanied by an increase in pupil size, substantiating the link between alertness and processing speed (Experiment 3). The implications of these results are discussed in relation to a newly developed mathematical model of the relationship between levels of alertness and the speed with which humans process visual information. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Preventing dispensing errors by alerting for drug confusions in the pharmacy information system-A survey of users.

    PubMed

    Campmans, Zizi; van Rhijn, Arianne; Dull, René M; Santen-Reestman, Jacqueline; Taxis, Katja; Borgsteede, Sander D

    2018-01-01

    Drug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system. To evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion. In May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire. Of the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. 'Alert fatigue' was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences. Pharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue.

  15. See Also:physica status solidi (a)physica status solidi (c)Copyright © 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

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  1. Reduction in alert fatigue in an assisted electronic prescribing system, through the Lean Six Sigma methodology.

    PubMed

    Cuéllar Monreal, Mª Jesús; Reig Aguado, Jorge; Font Noguera, Isabel; Poveda Andrés, José Luis

    2017-01-01

    To reduce the alert fatigue in our Assisted Electronic Prescribing System (AEPS), through the Lean Six Sigma (LSS) methodology. An observational (transversal) and retrospective study, in a general hospital with 850 beds and AEPS. The LSS methodology was followed in order to evaluate the alert fatigue situation in the AEPS system, to implement improvements, and to assess outcomes. The alerts generated during two trimesters studied (before and after the intervention) were analyzed. In order to measure the qualitative indicators, the most frequent alert types were analyzed, as well as the molecules responsible for over 50% of each type of alert. The action by the prescriber was analyzed in a sample of 496 prescriptions that generated such alerts. For each type of alert and molecule, there was a prioritization of the improvements to be implemented according to the alert generated and its quality. A second survey evaluated the pharmacist action for the alerts most highly valued by physicians. The problem, the objective, the work team and the project schedule were defined. A survey was designed in order to understand the opinion of the client about the alert system in the program. Based on the surveys collected (n = 136), the critical characteristics and the quanti/qualitative indicators were defined. Sixty (60) fields in the alert system were modified, corresponding to 32 molecules, and this led to a 28% reduction in the total number of alerts. Regarding quality indicators, false po sitive results were reduced by 25% (p < 0.05), 100% of those alerts ignored with justification were sustained, and there were no significant differences in user adherence to the system. The project improvements and outcomes were reviewed by the work team. LSS methodology has demonstrated being a valid tool for the quantitative and qualitative improvement of the alert system in an Assisted Electronic Prescription Program, thus reducing alert fatigue. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  2. The Second SWIFT Burst Alert Telescope (BAT) Gamma-Ray Burst Catalog

    NASA Technical Reports Server (NTRS)

    Sakamoto, T.; Barthelmy, S. D.; Baumgartner, W. H.; Cummings, J. R.; Fenimore, E. E.; Gehrels, N.; Krimm, H. A.; Markwardt, C. B.; Palmer, D. M.; Parsons, A. M.; hide

    2012-01-01

    We present the second Swift Burst Alert Telescope (BAT) catalog of gamma-ray bursts. (GRBs), which contains 476 bursts detected by the BAT between 2004 December 19 and 2009 December 21. This catalog (hereafter the BAT2 catalog) presents burst trigger time, location, 90% error radius, duration, fluence, peak flux, time-averaged spectral parameters and time-resolved spectral parameters measured by the BAT. In the correlation study of various observed parameters extracted from the BAT prompt emission data, we distinguish among long-duration GRBs (L-GRBs), short-duration GRBs (S-GRBs), and short-duration GRBs with extended emission (S-GRBs with E.E.) to investigate differences in the prompt emission properties. The fraction of L-GRBs, S-GRBs and S-GRBs with E.E. in the catalog are 89%, 8% and 2% respectively. We compare the BAT prompt emission properties with the BATSE, BeppoSAX and HETE-2 GRB samples.. We also correlate the observed prompt emission properties with the redshifts for the GRBs with known redshift. The BAT T(sub 90) and T(sub 50) durations peak at 70 s and 30 s, respectively. We confirm that the spectra of the BAT S-GRBs are generally harder than those of the L-GRBs.

  3. 76 FR 80780 - Review of the Emergency Alert System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-27

    ... Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule. SUMMARY: In this document, the Commission amends its rules governing the Emergency Alert System (EAS) rules to extend the deadline for EAS Participants to be able to receive Common Alerting Protocol (CAP)- formatted EAS alerts to...

  4. NOAA Weather Wire Service

    Science.gov Websites

    & Imagery; includes NWS alerts and warnings No 6 Wireless Emergency Alerts (WEA) Mobile Phone Alerts & Warnings only No 7 Interactive NWS (iNWS) - NOTE 1 https://inws.ncep.noaa.gov/ Mobile Phone $$$$) Internet/ Mobile Phone Alerts and Warnings No 15 County or Local Emergency Management Telephone alert

  5. 75 FR 26196 - Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers AGENCY: Office of Inspector... Special Fraud Alert. Specifically, the Updated Special Fraud Alert addressed the statutory provision...) 205-0007. SUPPLEMENTARY INFORMATION: In our publication of the OIG Updated Special Fraud Alert on...

  6. Physician Perspectives of CYP2C19 and Clopidogrel Drug-Gene Interaction Active Clinical Decision Support Alerts

    PubMed Central

    Nishimura, Adam A.; Shirts, Brian H.; Salama, Joseph; Smith, Joe W.; Devine, Beth; Tarczy-Hornoch, Peter

    2015-01-01

    Objective To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness. Materials and Methods 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction. Results Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts. Principal Conclusions Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways. PMID:26642939

  7. Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts.

    PubMed

    Nishimura, Adam A; Shirts, Brian H; Salama, Joseph; Smith, Joe W; Devine, Beth; Tarczy-Hornoch, Peter

    2016-02-01

    To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness. 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction. Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts. Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Preventing dispensing errors by alerting for drug confusions in the pharmacy information system—A survey of users

    PubMed Central

    Campmans, Zizi; van Rhijn, Arianne; Dull, René M.; Santen-Reestman, Jacqueline; Taxis, Katja

    2018-01-01

    Introduction Drug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system. Objective To evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion. Methods In May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire. Results Of the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. ‘Alert fatigue’ was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences. Conclusion Pharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue. PMID:29813099

  9. Primary Care Providers' Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets.

    PubMed

    Cutrona, Sarah L; Fouayzi, Hassan; Burns, Laura; Sadasivam, Rajani S; Mazor, Kathleen M; Gurwitz, Jerry H; Garber, Lawrence; Sundaresan, Devi; Houston, Thomas K; Field, Terry S

    2017-11-01

    Time-sensitive alerts are among the many types of clinical notifications delivered to physicians' secure InBaskets within commercial electronic health records (EHRs). A delayed alert review can impact patient safety and compromise care. To characterize factors associated with opening of non-interruptive time-sensitive alerts delivered into primary care provider (PCP) InBaskets. We analyzed data for 799 automated alerts. Alerts highlighted actionable medication concerns for older patients post-hospital discharge (2010-2011). These were study-generated alerts sent 3 days post-discharge to InBaskets for 75 PCPs across a multisite healthcare system, and represent a subset of all urgent InBasket notifications. Using EHR access and audit logs to track alert opening, we performed bivariate and multivariate analyses calculating associations between patient characteristics, provider characteristics, contextual factors at the time of alert delivery (number of InBasket notifications, weekday), and alert opening within 24 h. At the time of alert delivery, the PCPs had a median of 69 InBasket notifications and had received a median of 379.8 notifications (IQR 295.0, 492.0) over the prior 7 days. Of the 799 alerts, 47.1% were opened within 24 h. Patients with longer hospital stays (>4 days) were marginally more likely to have alerts opened (OR 1.48 [95% CI 1.00-2.19]). Alerts delivered to PCPs whose InBaskets had a higher number of notifications at the time of alert delivery were significantly less likely to be opened within 24 h (top quartile >157 notifications: OR 0.34 [95% CI 0.18-0.61]; reference bottom quartile ≤42). Alerts delivered on Saturdays were also less likely to be opened within 24 h (OR 0.18 [CI 0.08-0.39]). The number of total InBasket notifications and weekend delivery may impact the opening of time-sensitive EHR alerts. Further study is needed to support safe and effective approaches to care team management of InBasket notifications.

  10. Pilot evaluation of a method to assess prescribers' information processing of medication alerts.

    PubMed

    Russ, Alissa L; Melton, Brittany L; Daggy, Joanne K; Saleem, Jason J

    2017-02-01

    Prescribers commonly receive alerts during medication ordering. Prescribers work in a complex, time-pressured environment; to enhance the effectiveness of safety alerts, the effort needed to cognitively process these alerts should be minimized. Methods to evaluate the extent to which computerized alerts support prescribers' information processing are lacking. To develop a methodological protocol to assess the extent to which alerts support prescribers' information processing at-a-glance; specifically, the incorporation of information into their working memory. We hypothesized that the method would be feasible and that we would be able to detect a significant difference in prescribers' information processing with a revised alert display that incorporates warning design guidelines compared to the original alert display. A counterbalanced, within-subject study was conducted with 20 prescribers in a human-computer interaction laboratory. We tested a single alert that was displayed in two different ways. Prescribers were informed that an alert would appear for 10s. After the alert was shown, a white screen was displayed, and prescribers were asked to verbally describe what they saw; indicate how many total warnings; and describe anything else they remembered about the alert. We measured information processing via the accuracy of prescribers' free recall and their ability to identify that three warning messages were present. Two analysts independently evaluated participants' responses against a comprehensive catalog of alert elements and then discussed discrepancies until reaching consensus. This feasibility study demonstrated that the method seemed to be effective for evaluating prescribers' information processing of medication alert displays. With this method, we were able to detect significant differences in prescribers' recall of alert information. The proportion of total data elements that prescribers were able to accurately recall was significantly greater for the revised versus original alert display (p=0.006). With the revised display, more prescribers accurately reported that three warnings were shown (p=0.002). The methodological protocol was feasible for evaluating the alert display and yielded important findings on prescribers' information processing. Study methods supplement traditional usability evaluation methods and may be useful for evaluating information processing of other healthcare technologies. Published by Elsevier Inc.

  11. Short Communication: Analysis of Minor Populations of Human Immunodeficiency Virus by Primer Identification and Insertion-Deletion and Carry Forward Correction Pipelines.

    PubMed

    Hughes, Paul; Deng, Wenjie; Olson, Scott C; Coombs, Robert W; Chung, Michael H; Frenkel, Lisa M

    2016-03-01

    Accurate analysis of minor populations of drug-resistant HIV requires analysis of a sufficient number of viral templates. We assessed the effect of experimental conditions on the analysis of HIV pol 454 pyrosequences generated from plasma using (1) the "Insertion-deletion (indel) and Carry Forward Correction" (ICC) pipeline, which clusters sequence reads using a nonsubstitution approach and can correct for indels and carry forward errors, and (2) the "Primer Identification (ID)" method, which facilitates construction of a consensus sequence to correct for sequencing errors and allelic skewing. The Primer ID and ICC methods produced similar estimates of viral diversity, but differed in the number of sequence variants generated. Sequence preparation for ICC was comparably simple, but was limited by an inability to assess the number of templates analyzed and allelic skewing. The more costly Primer ID method corrected for allelic skewing and provided the number of viral templates analyzed, which revealed that amplifiable HIV templates varied across specimens and did not correlate with clinical viral load. This latter observation highlights the value of the Primer ID method, which by determining the number of templates amplified, enables more accurate assessment of minority species in the virus population, which may be relevant to prescribing effective antiretroviral therapy.

  12. An investigation of immune system disorder as a "marker" for anomalous dominance.

    PubMed

    Rich, D A; McKeever, W F

    1990-01-01

    Geschwind and Galaburda (1987) proposed that immune disorder (ID) susceptibility, along with left handedness and familial sinistrality (FS), is a "marker" for anomalous dominance. The theory predicts lesser left lateralization for language processes, lessened left hemisphere abilities, and enhanced right hemisphere abilities. We assessed language laterality (dichotic consonant vowel task) and performances on spatial and verbal tasks. Subjects were 128 college students. The factors of handedness, sex, FS, and immune disorder history (negative or positive) were perfectly counterbalanced. Left-handers were significantly less lateralized for language and scored lower than right-handers on the spatial tasks. Females scored lower on mental rotation than males, but performed comparably to males on the spatial relations task. The only effect of ID was by way of interaction with FS on both spatial tasks--subjects who were either negative or positive on both FS and ID status factors scored significantly higher than subjects negative for one but positive for the other factor. A speculative explanatory model for this interaction was proposed. The model incorporates the notion that FS and ID factors are comparably correlated, but in opposite directions, with hormonal factors implicated by other research as relevant for spatial ability differences. Finally, no support for the "anomalous dominance" hypothesis predictions was found.

  13. Iron isotopic composition of blood serum in anemia of chronic kidney disease.

    PubMed

    Anoshkina, Yulia; Costas-Rodríguez, Marta; Speeckaert, Marijn; Van Biesen, Wim; Delanghe, Joris; Vanhaecke, Frank

    2017-05-24

    Chronic kidney disease (CKD) is a general term for disorders that affect the structure and function of the kidneys. Iron deficiency (ID) and anemia occur in the vast majority of CKD patients, most of whom are elderly. However, establishing the cause of anemia in CKD, and therefore making an informed decision concerning the corresponding therapeutic treatment, is still a challenge. High-precision Fe isotopic analysis of blood serum samples of CKD patients with and without ID/anemia was performed via multi-collector inductively coupled plasma-mass spectrometry (MC-ICP-MS) for such a purpose. Patients with CKD and/or iron disorders showed a heavier serum Fe isotopic composition than controls. Many clinical parameters used for the diagnosis and follow-up of anemia correlated significantly with the serum Fe isotopic composition. In contrast, no relation was observed between the serum Fe isotopic composition and the estimated glomerular filtration rate as a measure of kidney function. Among the CKD patients, the serum Fe isotopic composition was substantially heavier in the occurrence of ID anemia, while erythropoietin-related anemia did not exert this effect. The Fe isotopic composition can thus be useful for distinguishing these different types of anemias in CKD patients, i.e. ID anemia vs. erythropoietin-related anemia.

  14. Autocorrel I: A Neural Network Based Network Event Correlation Approach

    DTIC Science & Technology

    2005-05-01

    which concern any component of the network. 2.1.1 Existing Intrusion Detection Systems EMERALD [8] is a distributed, scalable, hierarchal, customizable...writing this paper, the updaters of this system had not released their correlation unit to the public. EMERALD ex- plicitly divides statistical analysis... EMERALD , NetSTAT is scalable and composi- ble. QuidSCOR [12] is an open-source IDS, though it requires a subscription from its publisher, Qualys Inc

  15. Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit.

    PubMed

    Balasuriya, Lilanthi; Vyles, David; Bakerman, Paul; Holton, Vanessa; Vaidya, Vinay; Garcia-Filion, Pamela; Westdorp, Joan; Sanchez, Christine; Kurz, Rhonda

    2017-09-01

    An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit. An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed. Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written. Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.

  16. Hemochromatosis

    MedlinePlus

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  17. Bronchiectasis

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  18. Tracheostomy

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  19. Palpitations

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  20. Thalassemias

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  1. Cardioversion

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  2. 16 CFR 613.1 - Duration of active duty alerts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

  3. 16 CFR 613.1 - Duration of active duty alerts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

  4. 16 CFR 613.1 - Duration of active duty alerts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

  5. 47 CFR 80.277 - Ship Security Alert System (SSAS).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Ship Security Alert System (SSAS). 80.277... Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety..., “RTCM Standard 11020.0—Ship Security Alert Systems (SSAS) using the Cospas-Sarsat System,” Version 1.0...

  6. Relationship Between Temperament and Character Traits, Mood, and Medications in Bipolar I Disorder.

    PubMed

    Chavez, Sergio B; Alvarado, Luis A; Gonzalez, Robert

    2016-01-01

    Bipolar I disorder is an illness causing mood shifts that can result in personality and character trait alterations. The relationship between mood and personality and character traits in bipolar I disorder is unclear at this time. We conducted a study from February 2009 to March 2010 that included 42 subjects with bipolar I disorder, which was confirmed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Mood was assessed via the Young Mania Rating Scale (YMRS) and the 30-item Clinician-rated Inventory of Depressive Symptomatology (IDS-C). Temperament and character traits were assessed via the Temperament and Character Inventory (TCI). Multivariate analysis was used to test relationships between mood and temperament and character traits with the effects of possible cofactors taken into account (eg, age, gender, medications). We noted a positive correlation between YMRS scores and persistence ( P = .046) and a trend toward positive correlation with novelty seeking ( P = .054). There was a positive correlation between higher IDS-C scores and harm avoidance ( P < .001) and a negative correlation with self-directedness scores ( P < .001). Antipsychotic use was positively correlated with the character trait self-directedness ( P = .008), with a trend toward a positive correlation with reward dependence ( P = .056). Lithium was negatively correlated with reward dependence ( P = .047) and self-transcendence ( P = .028), with a trend toward a negative correlation with novelty seeking ( P = .053). The findings of our study suggest that some personality and character traits may vary according to mood state and medications in patients with bipolar I disorder. Prospective and longitudinal studies are required to fully characterize the relationships between personality and character traits and mood state in bipolar I disorder.

  7. Lung Transplant

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  8. Carotid Endarterectomy

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  9. Pulmonary Embolism

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  10. Pernicious Anemia

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  11. Catheter Ablation

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  12. Immune Thrombocytopenia

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  13. Chest MRI

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  14. Cardiac Rehabilitation

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  15. Cardiac MRI

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  16. Oxygen Therapy

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  17. Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system.

    PubMed Central

    Kuperman, G. J.; Teich, J. M.; Bates, D. W.; Hiltz, F. L.; Hurley, J. M.; Lee, R. Y.; Paterno, M. D.

    1996-01-01

    We developed and evaluated a system to automatically identify serious clinical conditions in inpatients. The system notifies the patient's covering physician via his pager that an alert is present and offers potential therapies for the patient's condition (action items) at the time he views the alert information. Over a 6 month period, physicians responded to 1214 (70.2%) of 1730 alerts for which they were paged; they responded to 1002 (82.5% of the 1214) in less than 15 minutes. They said they would take action in 71.5% of the alerts, and they placed an order directly from the alert display screen in 39.4%. Further study is needed to determine if this alerting system improves processes or outcomes of care. PMID:8947756

  18. Revealing the functional neuroanatomy of intrinsic alertness using fMRI: methodological peculiarities.

    PubMed

    Clemens, Benjamin; Zvyagintsev, Mikhail; Sack, Alexander T; Sack, Alexander; Heinecke, Armin; Willmes, Klaus; Sturm, Walter

    2011-01-01

    Clinical observations and neuroimaging data revealed a right-hemisphere fronto-parietal-thalamic-brainstem network for intrinsic alertness, and additional left fronto-parietal activity during phasic alertness. The primary objective of this fMRI study was to map the functional neuroanatomy of intrinsic alertness as precisely as possible in healthy participants, using a novel assessment paradigm already employed in clinical settings. Both the paradigm and the experimental design were optimized to specifically assess intrinsic alertness, while at the same time controlling for sensory-motor processing. The present results suggest that the processing of intrinsic alertness is accompanied by increased activity within the brainstem, thalamus, anterior cingulate gyrus, right insula, and right parietal cortex. Additionally, we found increased activation in the left hemisphere around the middle frontal gyrus (BA 9), the insula, the supplementary motor area, and the cerebellum. Our results further suggest that rather minute aspects of the experimental design may induce aspects of phasic alertness, which in turn might lead to additional brain activation in left-frontal areas not normally involved in intrinsic alertness. Accordingly, left BA 9 activation may be related to co-activation of the phasic alertness network due to the switch between rest and task conditions functioning as an external warning cue triggering the phasic alertness network. Furthermore, activation of the intrinsic alertness network during fixation blocks due to enhanced expectancy shortly before the switch to the task block might, when subtracted from the task block, lead to diminished activation in the typical right hemisphere intrinsic alertness network. Thus, we cautiously suggest that--as a methodological artifact--left frontal activations might show up due to phasic alertness involvement and intrinsic alertness activations might be weakened due to contrasting with fixation blocks, when assessing the functional neuroanatomy of intrinsic alertness with a block design in fMRI studies.

  19. Revealing the Functional Neuroanatomy of Intrinsic Alertness Using fMRI: Methodological Peculiarities

    PubMed Central

    Clemens, Benjamin; Zvyagintsev, Mikhail; Sack, Alexander; Heinecke, Armin; Willmes, Klaus; Sturm, Walter

    2011-01-01

    Clinical observations and neuroimaging data revealed a right-hemisphere fronto-parietal-thalamic-brainstem network for intrinsic alertness, and additional left fronto-parietal activity during phasic alertness. The primary objective of this fMRI study was to map the functional neuroanatomy of intrinsic alertness as precisely as possible in healthy participants, using a novel assessment paradigm already employed in clinical settings. Both the paradigm and the experimental design were optimized to specifically assess intrinsic alertness, while at the same time controlling for sensory-motor processing. The present results suggest that the processing of intrinsic alertness is accompanied by increased activity within the brainstem, thalamus, anterior cingulate gyrus, right insula, and right parietal cortex. Additionally, we found increased activation in the left hemisphere around the middle frontal gyrus (BA 9), the insula, the supplementary motor area, and the cerebellum. Our results further suggest that rather minute aspects of the experimental design may induce aspects of phasic alertness, which in turn might lead to additional brain activation in left-frontal areas not normally involved in intrinsic alertness. Accordingly, left BA 9 activation may be related to co-activation of the phasic alertness network due to the switch between rest and task conditions functioning as an external warning cue triggering the phasic alertness network. Furthermore, activation of the intrinsic alertness network during fixation blocks due to enhanced expectancy shortly before the switch to the task block might, when subtracted from the task block, lead to diminished activation in the typical right hemisphere intrinsic alertness network. Thus, we cautiously suggest that – as a methodological artifact – left frontal activations might show up due to phasic alertness involvement and intrinsic alertness activations might be weakened due to contrasting with fixation blocks, when assessing the functional neuroanatomy of intrinsic alertness with a block design in fMRI studies. PMID:21984928

  20. ToxAlerts: a Web server of structural alerts for toxic chemicals and compounds with potential adverse reactions.

    PubMed

    Sushko, Iurii; Salmina, Elena; Potemkin, Vladimir A; Poda, Gennadiy; Tetko, Igor V

    2012-08-27

    The article presents a Web-based platform for collecting and storing toxicological structural alerts from literature and for virtual screening of chemical libraries to flag potentially toxic chemicals and compounds that can cause adverse side effects. An alert is uniquely identified by a SMARTS template, a toxicological endpoint, and a publication where the alert was described. Additionally, the system allows storing complementary information such as name, comments, and mechanism of action, as well as other data. Most importantly, the platform can be easily used for fast virtual screening of large chemical datasets, focused libraries, or newly designed compounds against the toxicological alerts, providing a detailed profile of the chemicals grouped by structural alerts and endpoints. Such a facility can be used for decision making regarding whether a compound should be tested experimentally, validated with available QSAR models, or eliminated from consideration altogether. The alert-based screening can also be helpful for an easier interpretation of more complex QSAR models. The system is publicly accessible and tightly integrated with the Online Chemical Modeling Environment (OCHEM, http://ochem.eu). The system is open and expandable: any registered OCHEM user can introduce new alerts, browse, edit alerts introduced by other users, and virtually screen his/her data sets against all or selected alerts. The user sets being passed through the structural alerts can be used at OCHEM for other typical tasks: exporting in a wide variety of formats, development of QSAR models, additional filtering by other criteria, etc. The database already contains almost 600 structural alerts for such endpoints as mutagenicity, carcinogenicity, skin sensitization, compounds that undergo metabolic activation, and compounds that form reactive metabolites and, thus, can cause adverse reactions. The ToxAlerts platform is accessible on the Web at http://ochem.eu/alerts, and it is constantly growing.

  1. ToxAlerts: A Web Server of Structural Alerts for Toxic Chemicals and Compounds with Potential Adverse Reactions

    PubMed Central

    2012-01-01

    The article presents a Web-based platform for collecting and storing toxicological structural alerts from literature and for virtual screening of chemical libraries to flag potentially toxic chemicals and compounds that can cause adverse side effects. An alert is uniquely identified by a SMARTS template, a toxicological endpoint, and a publication where the alert was described. Additionally, the system allows storing complementary information such as name, comments, and mechanism of action, as well as other data. Most importantly, the platform can be easily used for fast virtual screening of large chemical datasets, focused libraries, or newly designed compounds against the toxicological alerts, providing a detailed profile of the chemicals grouped by structural alerts and endpoints. Such a facility can be used for decision making regarding whether a compound should be tested experimentally, validated with available QSAR models, or eliminated from consideration altogether. The alert-based screening can also be helpful for an easier interpretation of more complex QSAR models. The system is publicly accessible and tightly integrated with the Online Chemical Modeling Environment (OCHEM, http://ochem.eu). The system is open and expandable: any registered OCHEM user can introduce new alerts, browse, edit alerts introduced by other users, and virtually screen his/her data sets against all or selected alerts. The user sets being passed through the structural alerts can be used at OCHEM for other typical tasks: exporting in a wide variety of formats, development of QSAR models, additional filtering by other criteria, etc. The database already contains almost 600 structural alerts for such endpoints as mutagenicity, carcinogenicity, skin sensitization, compounds that undergo metabolic activation, and compounds that form reactive metabolites and, thus, can cause adverse reactions. The ToxAlerts platform is accessible on the Web at http://ochem.eu/alerts, and it is constantly growing. PMID:22876798

  2. Alert status of nuclear weapons

    NASA Astrophysics Data System (ADS)

    Kristensen, Hans M.

    2017-11-01

    Nuclear Alert Forces. Four nuclear-armed states deploy nuclear warheads on alert, ready to be used on relatively short notice: United States, Russia, France and Britain. Combined, the four countries deploy an estimated 1,869 nuclear alert warheads. Russia and the United States deploy 1,749 alert warheads combined, or 94% of all alert warheads. Despite some debate about possible need to increase readiness of nuclear forces (China, Pakistan), the five other nuclear-armed states (China, Pakistan, India, Israel and North Korea) are thought to store their warheads separate from launchers under normal circumstances. The overall number of alert warheads has remained relatively stable during the past five years.

  3. Geo-targeted Weather Alerts Coming to Millions of Mobile Devices

    NASA Astrophysics Data System (ADS)

    Gerber, M.

    2011-12-01

    The Personal Localized Alert Network (PLAN), aka Commercial Mobile Alert System (CMAS), is readying for roll out and will be broadcasting emergency public alerts to millions of cell phones by the middle of 2012. Learn how the National Weather Serivce (NWS) is supplying PLAN with geo-referenced weather alert information in the industry standard Common Alerting Protocol (CAP) format and how you can access this same information for integration with mobile devices, other consumer electronics, and decision support systems. Information will also be provided on the NWS' new collaborative venue that encourages wide participation in the evolution and use of NWS CAP alerts in a variety of applications.

  4. Automated External Defibrillator

    MedlinePlus

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  5. Thrombocythemia and Thrombocytosis

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  6. von Willebrand Disease

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  7. Chest X-Ray

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  8. What Is Cardiomyopathy?

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  9. Long QT Syndrome

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  10. Percutaneous Coronary Intervention

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  11. What is Hemophilia?

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  12. Thrombotic Thrombocytopenic Purpura

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  13. What Is Anemia?

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  14. Cardiac CT Scan

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  15. Coronary Calcium Scan

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  16. Patent Ductus Arteriosus

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  17. What is Bronchoscopy?

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  18. Regulatory alerts for dietary supplements in Canada and the United States, 2005-13.

    PubMed

    Abe, Andrew M; Hein, Darren J; Gregory, Philip J

    2015-06-01

    Dietary supplement regulatory alerts published by the Food and Drug Administration (FDA) and Health Canada were evaluated and characterized. FDA MedWatch and Health Canada websites were reviewed to identify regulatory alerts regarding dietary supplements from January 1, 2005, through December 31, 2013. Alerts were analyzed to identify product characteristics that may be predictive of product quality issues and potential patient harm. A total of 1560 dietary supplement-related regulatory alerts were identified. Of those, 1287 (83%) were identified through Health Canada, and 273 (18%) were identified through FDA MedWatch. The country of origin of dietary supplements associated with regulatory alerts was not provided in most regulatory alerts; however, when their origin was provided, the United States was the most common. Dietary supplements intended for sexual enhancement were the subject of 33% of all regulatory alerts identified. Products purchased online were the most likely to be associated with a regulatory alert. Dietary supplements intended for sexual enhancement, weight loss, and bodybuilding or athletic performance appeared to pose the greatest risk for patient harm due to product contamination with a pharmaceutical such as a phosphodiesterase-5 inhibitor or sibutramine. Analysis of Canadian and U.S. regulatory alerts concerning dietary supplements revealed that more than 80% of the composite alerts were issued by Health Canada. The most common intended uses of supplements for which alerts were issued were sexual enhancement, weight loss, and bodybuilding or athletic performance. The most common reason for alerts was the presence of a pharmaceutical contaminant. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  19. Alertness and cognitive control: Testing the early onset hypothesis.

    PubMed

    Schneider, Darryl W

    2018-05-01

    Previous research has revealed a peculiar interaction between alertness and cognitive control in selective-attention tasks: Congruency effects are larger on alert trials (on which an alerting cue is presented briefly in advance of the imperative stimulus) than on no-alert trials, despite shorter response times (RTs) on alert trials. One explanation for this finding is the early onset hypothesis, which is based on the assumptions that increased alertness shortens stimulus-encoding time and that cognitive control involves gradually focusing attention during a trial. The author tested the hypothesis in 3 experiments by manipulating alertness and stimulus quality (which were intended to shorten and lengthen stimulus-encoding time, respectively) in an arrow-based flanker task involving congruent and incongruent stimuli. Replicating past findings, the alerting manipulation led to shorter RTs but larger congruency effects on alert trials than on no-alert trials. The stimulus-quality manipulation led to longer RTs and larger congruency effects for degraded stimuli than for intact stimuli. These results provide mixed support for the early onset hypothesis, but the author discusses how data and theory might be reconciled if stimulus quality affects stimulus-encoding time and the rate of evidence accumulation in the decision process. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  20. Holter and Event Monitors

    MedlinePlus

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  1. CHEMICAL SAFETY ALERTS-

    EPA Science Inventory

    Chemical Safety Alerts are short publications which explain specific hazards that have become evident through chemical accident investigation efforts. EPA has produced over a dozen Alerts to date. This year's Alert: Managing Chemical Reactivity Hazards

  2. What Is Heart Failure?

    MedlinePlus

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  3. What Is Bronchopulmonary Dysplasia?

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  4. What Is Cardiac Catheterization?

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  5. What Is a Ventilator?

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  6. What Are Sleep Studies?

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  7. What Are the Lungs?

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  8. What Is Sudden Cardiac Arrest?

    MedlinePlus

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  9. Blood and Bone Marrow Transplant?

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  10. What Is Respiratory Distress Syndrome?

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  11. What Is a Heart Transplant?

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  12. What is Broken Heart Syndrome

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  13. ARDS (Acute Respiratory Distress Syndrome)

    MedlinePlus

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  14. What Are Bone Marrow Tests?

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  15. Auditory alert systems with enhanced detectability

    NASA Technical Reports Server (NTRS)

    Begault, Durand R. (Inventor)

    2008-01-01

    Methods and systems for distinguishing an auditory alert signal from a background of one or more non-alert signals. In a first embodiment, a prefix signal, associated with an existing alert signal, is provided that has a signal component in each of three or more selected frequency ranges, with each signal component in each of three or more selected level at least 3-10 dB above an estimated background (non-alert) level in that frequency range. The alert signal may be chirped within one or more frequency bands. In another embodiment, an alert signal moves, continuously or discontinuously, from one location to another over a short time interval, introducing a perceived spatial modulation or jitter. In another embodiment, a weighted sum of background signals adjacent to each ear is formed, and the weighted sum is delivered to each ear as a uniform background; a distinguishable alert signal is presented on top of this weighted sum signal at one ear, or distinguishable first and second alert signals are presented at two ears of a subject.

  16. 47 CFR 10.300 - Alert aggregator. [Reserved

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 1 2013-10-01 2013-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.300 Alert aggregator. [Reserved] ...

  17. 47 CFR 10.300 - Alert aggregator. [Reserved

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 1 2014-10-01 2014-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.300 Alert aggregator. [Reserved] ...

  18. 49 CFR 229.140 - Alerters.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... alerters shall provide an audio alarm upon expiration of the timing cycle interval. An alerter on a... indication to the operator at least five seconds prior to an audio alarm. The visual indication on an alerter...

  19. What Is a Total Artificial Heart?

    MedlinePlus

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  20. What Is a Ventricular Assist Device?

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  1. Resting cerebral blood flow, attention, and aging.

    PubMed

    Bertsch, Katja; Hagemann, Dirk; Hermes, Michael; Walter, Christof; Khan, Robina; Naumann, Ewald

    2009-04-24

    Aging is accompanied by a decline of fluid cognitive functions, e.g., a slowing of information processing, working memory, and division of attention. This is at least partly due to structural and functional changes in the aging brain. Although a decrement of resting cerebral blood flow (CBF) has been positively associated with cognitive functions in patients with brain diseases, studies with healthy participants have revealed inconsistent results. Therefore, we investigated the relation between resting cerebral blood flow and cognitive functions (tonic and phasic alertness, selective and divided attention) in two samples of healthy young and older participants. We found higher resting CBF and better cognitive performances in the young than in the older sample. In addition, resting CBF was inversely correlated with selective attention in the young and with tonic alertness in the elderly participants. This finding is discussed with regard to the neural efficiency hypothesis of human intelligence.

  2. Wearable vital parameters monitoring system

    NASA Astrophysics Data System (ADS)

    Caramaliu, Radu Vadim; Vasile, Alexandru; Bacis, Irina

    2015-02-01

    The system we propose monitors body temperature, heart rate and beside this, it tracks if the person who wears it suffers a faint. It uses a digital temperature sensor, a pulse sensor and a gravitational acceleration sensor to monitor the eventual faint or small heights free falls. The system continuously tracks the GPS position when available and stores the last valid data. So, when measuring abnormal vital parameters the module will send an SMS, using the GSM cellular network , with the person's social security number, the last valid GPS position for that person, the heart rate, the body temperature and, where applicable, a valid fall alert or non-valid fall alert. Even though such systems exist, they contain only faint detection or heart rate detection. Usually there is a strong correlation between low/high heart rate and an eventual faint. Combining both features into one system results in a more reliable detection device.

  3. Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

    PubMed

    Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

    2016-06-01

    BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

  4. The Use of Angiotensin-I Converting Enzyme I/D Genetic Polymorphism as a Biomarker of Athletic Performance in Humans

    PubMed Central

    De Mello Costa, Maria Fernanda; Slocombe, Ron

    2012-01-01

    Angiotensin II is a key regulator of blood pressure and cardiovascular function in mammals. The conversion of angiotensin into its active form is carried out by Angiotensin I-Converting Enzyme (ACE). The measurement of ACE concentration in plasma or serum, its enzymatic activity, and the correlation between an insertion/deletion (I/D) genetic polymorphism of the ACE gene have been investigated as possible indicators of superior athletic performance in humans. In this context, other indicators of superior adaptation to exercise resulting in better athletic performance (such as ventricular hypertrophy, VO2 max, and competition results) were mostly used to study the association between ACE I/D polymorphism and improved performance. Despite the fact that the existing literature presents little consensus, there is sufficient scientific evidence to warrant further investigation on the usage of ACE activity and the I/D ACE gene polymorphism as biomarkers of superior athletic performance in humans of specific ethnicities or in athletes involved in certain sports. In this sense, a biomarker would be a substance or genetic component that could be measured to provide a degree of certainty, or an indication, of the presence of a certain trait or characteristic that would be beneficial to the athlete’s performance. Difficulties in interpreting and comparing the results of scientific research on the topic arise from dissimilar protocols and variation in study design. This review aims to investigate the current literature on the use of ACE I/D polymorphism as a biomarker of performance in humans through the comparison of scientific publications. PMID:25586030

  5. The use of Angiotensin-I converting enzyme i/d genetic polymorphism as a biomarker of athletic performance in humans.

    PubMed

    De Mello Costa, Maria Fernanda; Slocombe, Ron

    2012-10-09

    Angiotensin II is a key regulator of blood pressure and cardiovascular function in mammals. The conversion of angiotensin into its active form is carried out by Angiotensin I-Converting Enzyme (ACE). The measurement of ACE concentration in plasma or serum, its enzymatic activity, and the correlation between an insertion/deletion (I/D) genetic polymorphism of the ACE gene have been investigated as possible indicators of superior athletic performance in humans. In this context, other indicators of superior adaptation to exercise resulting in better athletic performance (such as ventricular hypertrophy, VO2 max, and competition results) were mostly used to study the association between ACE I/D polymorphism and improved performance. Despite the fact that the existing literature presents little consensus, there is sufficient scientific evidence to warrant further investigation on the usage of ACE activity and the I/D ACE gene polymorphism as biomarkers of superior athletic performance in humans of specific ethnicities or in athletes involved in certain sports. In this sense, a biomarker would be a substance or genetic component that could be measured to provide a degree of certainty, or an indication, of the presence of a certain trait or characteristic that would be beneficial to the athlete's performance. Difficulties in interpreting and comparing the results of scientific research on the topic arise from dissimilar protocols and variation in study design. This review aims to investigate the current literature on the use of ACE I/D polymorphism as a biomarker of performance in humans through the comparison of scientific publications.

  6. Online Ozonolysis Combined with Ion Mobility-Mass Spectrometry Provides a New Platform for Lipid Isomer Analyses

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

    Poad, Berwyck L. J.; Zheng, Xueyun; Mitchell, Todd W.

    One of the most significant challenges in contemporary lipidomics lies in the separation and identification of lipid isomers that differ only in site(s) of unsaturation or geometric configuration of the carbon-carbon double bonds. While analytical separation techniques including ion mobility spectrometry (IMS) and liquid chromatography (LC) can separate isomeric lipids under appropriate conditions, conventional tandem mass spectrometry cannot provide unequivocal identification. To address this challenge, we have implemented ozone-induced dissociation (OzID) in-line with LC, IMS and high resolution mass spectrometry. Modification of an IMS- capable quadrupole time-of-flight mass spectrometer was undertaken to allow the introduction of ozone into the high-pressuremore » trapping ion funnel region preceding the IMS cell. This enabled the novel LC-OzID-IMS-MS configuration where ozonolysis of ionized lipids occurred rapidly (10 ms) without prior mass-selection. LC-elution time alignment combined with accurate mass and arrival time extraction of ozonolysis products facilitated correlation of precursor and product ions without mass-selection (and associated reductions in duty cycle). Unsaturated lipids across 11 classes were examined using this workflow in both positive and negative ion modalities and in all cases the positions of carbon-carbon double bonds were unequivocally assigned based on predictable OzID transitions. Under these conditions geometric isomers exhibited different IMS arrival time distributions and distinct OzID product ion ratios providing a means for discrimination of cis/trans double bonds in complex lipids. The combination of OzID with multidimensional separations shows significant promise for facile profiling of unsaturation patterns within complex lipidomes.« less

  7. Validation of the attitudes toward intellectual disability: ATTID questionnaire.

    PubMed

    Morin, D; Crocker, A G; Beaulieu-Bergeron, R; Caron, J

    2013-03-01

    Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. The present study describes the development of a new questionnaire for tapping into the general population's attitudes toward individuals with ID and addresses its psychometric properties. Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. The ATTID yielded a five-factor structure overlapping the tri-partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbach's alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test-retest reliability yielded correlations from 0.62 to 0.83 for the five factors. The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de-stigmatising ID. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.

  8. The relationship between ACE polymorphism and panic disorder.

    PubMed

    Gulec-Yılmaz, Seda; Gulec, Huseyın; Dalan, Altay Burak; Cetın, Bugra; Tımırcı-Kahraman, Ozlem; Ogut, Dıcle Bılge; Atasoy, Hande; Dırımen, Gulız Arikan; Gultekın, Guldal Inal; Isbır, Turgay

    2014-01-01

    The angiotensin converting enzyme (ACE) gene, which has been found to have an insertion and deletion polymorphism (I/D), is of increasing interest in etiology and treatment of various psychiatric disorders such as panic disorder. The present study aimed to investigate the relationship between ACE polymorphism and panic disorder. In this study, 43 patients diagnosed with panic disorder at the Erenköy Mental and Neurological Diseases Training and Research Hospital, Istanbul and 41 healthy controls were enrolled. The ACE gene insertion/deletion polymorphism of exon 16 was evaluated using the polymerase chain reaction method. There was a significant association between I/D genotype and panic disorder (p=0.003). However, the frequency of the I allele was found to be significantly higher in patients compared to controls (p=0.002). In addition, we recognized a significant association between I/D polymorphism and respiratory-type panic disorder in patients. Carriers of the D allele also had an increased risk of respiratory type panic disorder patients (p=0.034). Moreover, the result of Spearman correlation analysis showed an association with ACE D allele and severity of panic disorder (p<0.001). We suggest that the I/D polymorphism of the ACE gene is associated with panic disorder and particularly respiratory-type panic disorder in patients. The I/D polymorphism of the ACE gene seems to influence therapeutic outcome in patients suffering from panic disorder. Our results indicate that ACE D allele is associated with the severity of panic disorder. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  9. Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis.

    PubMed

    Polyak, Andrew; Kubina, Richard M; Girirajan, Santhosh

    2015-10-01

    While recent studies suggest a converging role for genetic factors towards risk for nosologically distinct disorders including autism, intellectual disability (ID), and epilepsy, current estimates of autism prevalence fail to take into account the impact of comorbidity of these disorders on autism diagnosis. We aimed to assess the effect of comorbidity on the diagnosis and prevalence of autism by analyzing 11 years (2000-2010) of special education enrollment data on approximately 6.2 million children per year. We found a 331% increase in the prevalence of autism from 2000 to 2010 within special education, potentially due to a diagnostic recategorization from frequently comorbid features such as ID. The decrease in ID prevalence equaled an average of 64.2% of the increase of autism prevalence for children aged 3-18 years. The proportion of ID cases potentially undergoing recategorization to autism was higher (P = 0.007) among older children (75%) than younger children (48%). Some US states showed significant negative correlations between the prevalence of autism compared to that of ID while others did not, suggesting state-specific health policy to be a major factor in categorizing autism. Further, a high frequency of autistic features was observed when individuals with classically defined genetic syndromes were evaluated for autism using standardized instruments. Our results suggest that current ascertainment practices are based on a single facet of autism-specific clinical features and do not consider associated comorbidities that may confound diagnosis. Longitudinal studies with detailed phenotyping and deep molecular genetic analyses are necessary to completely understand the cause of this complex disorder. © 2015 Wiley Periodicals, Inc.

  10. Development and implementation of sepsis alert systems

    PubMed Central

    Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian W.; Herasevich, Vitaly

    2016-01-01

    Synopsis/Summary Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Important barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload & alert fatigue, due to suboptimal alert performance. Outside the ICU, additional barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Currently available evidence does not support routine use of sepsis alert systems in clinical practice. However, continuous improvement in both the afferent (data availability and accuracy of detection algorithms) and efferent (evidence-based decision support and smoother integration into clinical workflow) limbs of sepsis alert systems will help translate theoretical advantages into measurable patient benefit. PMID:27229639

  11. NAS-Wide Fast-Time Simulation Study for Evaluating Performance of UAS Detect-and-Avoid Alerting and Guidance Systems

    NASA Technical Reports Server (NTRS)

    Lee, Seung Man; Park, Chunki; Cone, Andrew Clayton; Thipphavong, David P.; Santiago, Confesor

    2016-01-01

    This presentation contains the analysis results of NAS-wide fast-time simulations with UAS and VFR traffic for a single day for evaluating the performance of Detect-and-Avoid (DAA) alerting and guidance systems. This purpose of this study was to help refine and validate MOPS alerting and guidance requirements. In this study, we generated plots of all performance metrics that are specified by RTCA SC-228 Minimum Operational Performance Standards (MOPS): 1) to evaluate the sensitivity of alerting parameters on the performance metrics of each DAA alert type: Preventive, Corrective, and Warning alerts and 2) to evaluate the effect of sensor uncertainty on DAA alerting and guidance performance.

  12. Wireless clinical alerts for physiologic, laboratory and medication data.

    PubMed Central

    Shabot, M. M.; LoBue, M.; Chen, J.

    2000-01-01

    A fully interfaced clinical information system (CIS) contains physiologic, laboratory, blood gas, medication and other data that can be used as the information base for a comprehensive alerting system. Coupled with an event driven rules engine, a CIS can generate clinical alerts which may both prevent medical errors and assist caregivers in responding to critical events in a timely way. The authors have developed a clinical alerting system which delivers alerts and reminders to clinicians in real time via a alphanumeric display pagers. This paper will describe the system, the type and number of alerts generated, and the impact on clinical practice. A major issue remains in measuring the impact of wireless alerts on patient outcomes. PMID:11079992

  13. Alerts in mobile healthcare applications: requirements and pilot study.

    PubMed

    Kafeza, Eleanna; Chiu, Dickson K W; Cheung, S C; Kafeza, Marina

    2004-06-01

    Recent advances in mobile technologies have greatly extended traditional communication technologies to mobile devices. At the same time, healthcare environments are by nature "mobile" where doctors and nurses do not have fixed workspaces. Irregular and exceptional events are generated in daily hospital routines, such as operations rescheduling, laboratory/examination results, and adverse drug events. These events may create requests that should be delivered to the appropriate person at the appropriate time. Those requests that are classified as urgent are referred to as alerts. Efficient routing and monitoring of alerts are keys to quality and cost-effective healthcare services. Presently, these are generally handled in an ad hoc manner. In this paper, we propose the use of a healthcare alert management system to handle these alert messages systematically. We develop a model for specifying alerts that are associated with medical tasks and a set of parameters for their routing. We design an alert monitor that matches medical staff and their mobile devices to receive alerts, based on the requirements of these alerts. We also propose a mechanism to handle and reroute, if necessary, an alert message when it has not been acknowledged within a specific deadline.

  14. Wearable PPG sensor based alertness scoring system.

    PubMed

    Dey, Jishnu; Bhowmik, Tanmoy; Sahoo, Saswata; Tiwari, Vijay Narayan

    2017-07-01

    Quantifying mental alertness in today's world is important as it enables the person to adopt lifestyle changes for better work efficiency. Miniaturized sensors in wearable devices have facilitated detection/monitoring of mental alertness. Photoplethysmography (PPG) sensors through Heart Rate Variability (HRV) offer one such opportunity by providing information about one's daily alertness levels without requiring any manual interference from the user. In this paper, a smartwatch based alertness estimation system is proposed. Data collected from PPG sensor of smartwatch is processed and fed to machine learning based model to get a continuous alertness score. Utility functions are designed based on statistical analysis to give a quality score on different stages of alertness such as awake, long sleep and short duration power nap. An intelligent data collection approach is proposed in collaboration with the motion sensor in the smartwatch to reduce battery drainage. Overall, our proposed wearable based system provides a detailed analysis of alertness over a period in a systematic and optimized manner. We were able to achieve an accuracy of 80.1% for sleep/awake classification along with alertness score. This opens up the possibility for quantifying alertness levels using a single PPG sensor for better management of health related activities including sleep.

  15. Closing the Loop in ICU Decision Support: Physiologic Event Detection, Alerts, and Documentation

    PubMed Central

    Norris, Patrick R.; Dawant, Benoit M.

    2002-01-01

    Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. This paper describes recent efforts on the Simon project to capture information from ICU care providers about patient state and therapy in response to alerts, in order to assess the value of event definitions and progressively refine alerting algorithms. Event definitions for intracranial pressure and cerebral perfusion pressure were studied by implementing a reliable system to automatically deliver alerts to clinical users’ alphanumeric pagers, and to capture associated documentation about patient state and therapy when the alerts occurred. During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility.

  16. Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes

    PubMed Central

    Los, Evan A.; Ramsey, Katrina L.; Guttmann-Bauman, Ines; Ahmann, Andrew J.

    2016-01-01

    Background: We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes. Methods: Patients with type 1 diabetes who currently used diabetes alert dogs participated in this exploratory study. Subjects reported satisfaction, perceived dog glucose sensing ability and reasons for obtaining a trained dog. Reliability of dog alerts was assessed using capillary blood glucose (CBG) and blinded continuous glucose monitoring (CGM) as comparators in 8 subjects (age 4-48). Hypoglycemia was defined as CBG or CGM <70 mg/dL. Results: Dog users were very satisfied (8.9/10 on a Likert-type scale) and largely confident (7.9/10) in their dog’s ability to detect hypoglycemia. Detection of hypoglycemia was the primary reason for obtaining a trained dog. During hypoglycemia, spontaneous dog alerts occurred at a rate 3.2 (2.0-5.2, 95% CI) times higher than during euglycemia (70-179 mg/dL). Dogs provided timely alerts in 36% (sensitivity) of all hypoglycemia events (n = 45). Due to inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. When there was concurrence of a hypoglycemic event between the dog alert and CGM (n = 30), CGM would have alerted prior to the dog in 73% of events (median 22-minute difference). Conclusions: This is the first study evaluating reliability of trained dogs to alert to hypoglycemia under real-life conditions. Trained dogs often alert a human companion to otherwise unknown hypoglycemia; however due to high false-positive rate, a dog alert alone is unlikely to be helpful in differentiating hypo-/hyper-/euglycemia. CGM often detects hypoglycemia before a trained dog by a clinically significant margin. PMID:27573791

  17. Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes.

    PubMed

    Los, Evan A; Ramsey, Katrina L; Guttmann-Bauman, Ines; Ahmann, Andrew J

    2017-05-01

    We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes. Patients with type 1 diabetes who currently used diabetes alert dogs participated in this exploratory study. Subjects reported satisfaction, perceived dog glucose sensing ability and reasons for obtaining a trained dog. Reliability of dog alerts was assessed using capillary blood glucose (CBG) and blinded continuous glucose monitoring (CGM) as comparators in 8 subjects (age 4-48). Hypoglycemia was defined as CBG or CGM <70 mg/dL. Dog users were very satisfied (8.9/10 on a Likert-type scale) and largely confident (7.9/10) in their dog's ability to detect hypoglycemia. Detection of hypoglycemia was the primary reason for obtaining a trained dog. During hypoglycemia, spontaneous dog alerts occurred at a rate 3.2 (2.0-5.2, 95% CI) times higher than during euglycemia (70-179 mg/dL). Dogs provided timely alerts in 36% (sensitivity) of all hypoglycemia events (n = 45). Due to inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. When there was concurrence of a hypoglycemic event between the dog alert and CGM (n = 30), CGM would have alerted prior to the dog in 73% of events (median 22-minute difference). This is the first study evaluating reliability of trained dogs to alert to hypoglycemia under real-life conditions. Trained dogs often alert a human companion to otherwise unknown hypoglycemia; however due to high false-positive rate, a dog alert alone is unlikely to be helpful in differentiating hypo-/hyper-/euglycemia. CGM often detects hypoglycemia before a trained dog by a clinically significant margin.

  18. 47 CFR 10.300 - Alert aggregator. [Reserved

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

  19. 47 CFR 10.300 - Alert aggregator. [Reserved

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

  20. 47 CFR 10.300 - Alert aggregator. [Reserved

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 1 2011-10-01 2011-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

  1. Aspirin to Prevent a First Heart Attack or Stroke

    MedlinePlus

    ... Learn more about getting to NIH Get Email Alerts Receive automatic alerts about NHLBI related news and ... Connect With Us Contact Us Directly Get Email Alerts Receive automatic alerts about NHLBI related news and ...

  2. How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial.

    PubMed

    Wipfli, Rolf; Ehrler, Frederic; Bediang, Georges; Bétrancourt, Mireille; Lovis, Christian

    2016-06-02

    As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria.

  3. Comparing technical proficiency of elite table tennis players with intellectual disability: simulation testing versus game play.

    PubMed

    Van Biesen, Debbie; Mactavish, Jennifer J; Vanlandewijck, Yves C

    2014-04-01

    Technical skill proficiency among elite table tennis players with intellectual disabilities (ID) was investigated in this study using two approaches: an off-court simulation testing protocol and an on-court, standardized observational framework during game play. Participants included 24 players with ID (M age = 25 yr., SD = 6; M IQ = 61, SD = 9), the top 16 performers, 13 men and 11 women, at the International Federation for sport for para-athletes with an intellectual disability (Inas) World Championships. Self-reported table tennis training experience of the players was 13 +/- 5 yr. In the Simulation Testing condition, players were instructed to play five sets of basic and five sets of advanced skills, which were subsequently assessed by experts using a standardized and validated observational protocol. The same protocol was used to assess the same skills during Game Play. Ratings of overall technical proficiency were not significantly different between Simulation Testing and Game Play conditions. There was a strong positive correlation between technical proficiency measured during Game Play vs Simulation Testing for the variables flick, topspin forehand, and topspin backhand. No correlations were found for the variables contra, block, and push. Insight into this relationship is important for future development of classification systems for ID athletes in the Paralympic Games, because comparing competition observation with the athlete's potential shown during the classification session is essential information for classifiers to confirm the athlete's competition class.

  4. Five-year longitudinal study of dental caries risk associated with Streptococcus mutans and Streptococcus sobrinus in individuals with intellectual disabilities.

    PubMed

    Oda, Yuki; Hayashi, Fumiko; Wakita, Atsuko; Nagatani, Yukiko; Okada, Mitsugi

    2017-03-31

    Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus) are important etiologic agents in human dental caries. Using quantitative real-time polymerase chain reaction assays for the presence of those strains, we examined 145 outpatients with intellectual disability (ID), calculated the proportion of each of these strains to total bacteria, and compared dental caries incidence over 5 years. Plaque samples were collected from all erupted tooth sites, and dental examinations were performed annually to determine numbers of decayed, missing, and filled teeth (DMFT score; World Health Organization caries diagnostic criteria). Elevated DMFT scores were calculated as ∆DMFT, and sites of newly affected caries (∆SNAC) were identified. Sixty-six patients had both strains. The proportion of S. mutans to total bacteria was moderately correlated with DMFT in year 2, ∆DMFT in years 2 and 5, and ∆SNAC in years 2 and 5 (correlation coefficient = 0.470, P < 0.001), while the proportion of S. sobrinus to total bacteria was moderately correlated with DMFT in years 2 and 5, ∆DMFT in years 1, 2, and 5, and ∆SNAC in years 2 and 5 (correlation coefficient = 0.695, P < 0.001). Individuals with ID who harbored both bacterial strains had a higher risk of dental caries and a significantly higher proportion of S. sobrinus to total bacteria.

  5. Pilot Non-Conformance to Alerting System Commands During Closely Spaced Parallel Approaches

    NASA Technical Reports Server (NTRS)

    Pritchett, Amy Ruth; Hansman, R. John; Corker, Kevin (Technical Monitor)

    1997-01-01

    Cockpit alerting systems monitor potentially hazardous situations, both inside and outside the aircraft. When a hazard is projected to occur, the alerting system displays alerts and/or command decisions to the pilot. However, pilots have been observed to not conform to alerting system commands by delaying their response or by not following the automatic commands exactly. This non-conformance to the automatic alerting system can reduce its benefit. Therefore, a need exists to understand the causes and effects of pilot non-conformance in order to develop automatic alerting systems whose commands the pilots are more likely to follow. These considerations were examined through flight simulator evaluations of the collision avoidance task during closely spaced parallel approaches. This task provided a useful case-study because the effects of non-conformance can be significant, given the time-critical nature of the task. A preliminary evaluation of alerting systems identified non-conformance in over 40% of the cases and a corresponding drop in collision avoidance performance. A follow-on experiment found subjects' alerting and maneuver selection criteria were consistent with different strategies than those used by automatic systems, indicating the pilot may potentially disagree with the alerting system if the pilot attempts to verify automatic alerts and commanded avoidance maneuvers. A final experiment found supporting automatic alerts with the explicit display of its underlying criteria resulted in more consistent subject reactions. In light of these experimental results, a general discussion of pilot non-conformance is provided. Contributing factors in pilot non-conformance include a lack of confidence in the automatic system and mismatches between the alerting system's commands and the pilots' own decisions based on the information available to them. The effects of non-conformance on system performance are discussed. Possible methods of reconciling mismatches are given, and design considerations for alerting systems which alleviate the problem of non-conformance are provided.

  6. Real-time data acquisition and alerts may reduce reaction time and improve perfusionist performance during cardiopulmonary bypass.

    PubMed

    Beck, J R; Fung, K; Lopez, H; Mongero, L B; Argenziano, M

    2015-01-01

    Delayed perfusionist identification and reaction to abnormal clinical situations has been reported to contribute to increased mortality and morbidity. The use of automated data acquisition and compliance safety alerts has been widely accepted in many industries and its use may improve operator performance. A study was conducted to evaluate the reaction time of perfusionists with and without the use of compliance alert. A compliance alert is a computer-generated pop-up banner on a pump-mounted computer screen to notify the user of clinical parameters outside of a predetermined range. A proctor monitored and recorded the time from an alert until the perfusionist recognized the parameter was outside the desired range. Group one included 10 cases utilizing compliance alerts. Group 2 included 10 cases with the primary perfusionist blinded to the compliance alerts. In Group 1, 97 compliance alerts were identified and, in group two, 86 alerts were identified. The average reaction time in the group using compliance alerts was 3.6 seconds. The average reaction time in the group not using the alerts was nearly ten times longer than the group using computer-assisted, real-time data feedback. Some believe that real-time computer data acquisition and feedback improves perfusionist performance and may allow clinicians to identify and rectify potentially dangerous situations. © The Author(s) 2014.

  7. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

    PubMed Central

    Engels, Melanie J.

    2015-01-01

    Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

  8. Towards full citizenship: correlates of engagement with the gender identity law among transwomen in Argentina.

    PubMed

    Socías, María Eugenia; Marshall, Brandon D L; Arístegui, Inés; Zalazar, Virginia; Romero, Marcela; Sued, Omar; Kerr, Thomas

    2014-01-01

    In May 2012, Argentina passed its "Gender Identity" Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina. Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law. Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27-3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58-5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06-3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06-0.33). More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreign-born status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina.

  9. The Impact of Number of Cycles of Neoadjuvant Chemotherapy on Survival of Patients Undergoing Interval Debulking Surgery for Stage IIIC-IV Unresectable Ovarian Cancer: Results From a Multi-Institutional Study.

    PubMed

    Bogani, Giorgio; Matteucci, Laura; Tamberi, Stefano; Arcangeli, Valentina; Ditto, Antonino; Maltese, Giuseppa; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Perotto, Stefania; Scaffa, Cono; Comerci, Giuseppe; Stefanetti, Marco; Raspagliesi, Francesco; Lorusso, Domenica

    2017-11-01

    Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

  10. Towards Full Citizenship: Correlates of Engagement with the Gender Identity Law among Transwomen in Argentina

    PubMed Central

    Socías, María Eugenia; Marshall, Brandon D. L.; Arístegui, Inés; Zalazar, Virginia; Romero, Marcela; Sued, Omar; Kerr, Thomas

    2014-01-01

    Introduction In May 2012, Argentina passed its “Gender Identity” Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina. Methods Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law. Results Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27–3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58–5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06–3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06–0.33). Conclusions More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreign-born status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina. PMID:25133547

  11. Precipitation thresholds for landslide occurrence near Seattle, Mukilteo, and Everett, Washington

    USGS Publications Warehouse

    Scheevel, Caroline R.; Baum, Rex L.; Mirus, Benjamin B.; Smith, Joel B.

    2017-04-27

    Shallow landslides along coastal bluffs frequently occur in the railway corridor between Seattle and Everett, Washington. These slides disrupt passenger rail service, both because of required track maintenance and because the railroad owner, Burlington Northern Santa Fe Railway, does not allow passenger travel for 48 hours after a disruptive landslide. Sound Transit, which operates commuter trains in the corridor, is interested in a decision-making tool to help preemptively cancel passenger railway service in dangerous conditions and reallocate resources to alternative transportation.Statistical analysis showed that a majority of landslides along the Seattle-Everett Corridor are strongly correlated with antecedent rainfall, but that 21-37 percent of recorded landslide dates experienced less than 1 inch of precipitation in the 3 days preceding the landslide and less than 4 inches of rain in the 15 days prior to the preceding 3 days. We developed two empirical thresholds to identify precipitation conditions correlated with landslide occurrence. The two thresholds are defined as P3 = 2.16-0.44P15 and P3 = 2.16-0.22P32, where P3 is the cumulative precipitation in the 3 days prior to the considered date and P15 or P32 is the cumulative precipitation in the 15 days or 32 days prior to P3 (all measurements given in inches). The two thresholds, when compared to a previously developed threshold, quantitatively improve the prediction rate.We also investigated rainfall intensity-duration (ID) thresholds to determine whether revision would improve identification of moderate-intensity, landslide-producing storms. New, optimized ID thresholds evaluate rainstorms lasting at least 12 hours and identify landslide-inducing storms that were typically missed by previously published ID thresholds. The main advantage of the ID thresholds appears when they are combined with recent-antecedent thresholds because rainfall conditions that exceed both threshold types are more likely to induce two or more landslides than conditions that exceed only one threshold type.

  12. The Deformity Angular Ratio: Does It Correlate With High-Risk Cases for Potential Spinal Cord Monitoring Alerts in Pediatric 3-Column Thoracic Spinal Deformity Corrective Surgery?

    PubMed

    Lewis, Noah D H; Keshen, Sam G N; Lenke, Lawrence G; Zywiel, Michael G; Skaggs, David L; Dear, Taylor E; Strantzas, Samuel; Lewis, Stephen J

    2015-08-01

    A retrospective analysis. The purpose of this study was to determine whether the deformity angular ratio (DAR) can reliably assess the neurological risks of patients undergoing deformity correction. Identifying high-risk patients and procedures can help ensure that appropriate measures are taken to minimize neurological complications during spinal deformity corrections. Subjectively, surgeons look at radiographs and evaluate the riskiness of the procedure. However, 2 curves of similar magnitude and location can have significantly different risks of neurological deficit during surgery. Whether the curve spans many levels or just a few can significantly influence surgical strategies. Lenke et al have proposed the DAR, which is a measure of curve magnitude per level of deformity. The data from 35 pediatric spinal deformity correction procedures with thoracic 3-column osteotomies were reviewed. Measurements from preoperative radiographs were used to calculate the DAR. Binary logistic regression was used to model the relationship between DARs (independent variables) and presence or absence of an intraoperative alert (dependent variable). In patients undergoing 3-column osteotomies, sagittal curve magnitude and total curve magnitude were associated with increased incidence of transcranial motor evoked potential changes. Total DAR greater than 45° per level and sagittal DAR greater than 22° per level were associated with a 75% incidence of a motor evoked potential alert, with the incidence increasing to 90% with sagittal DAR of 28° per level. In patients undergoing 3-column osteotomies for severe spinal deformities, the DAR was predictive of patients developing intraoperative motor evoked potential alerts. Identifying accurate radiographical, patient, and procedural risk factors in the correction of severe deformities can help prepare the surgical team to improve safety and outcomes when carrying out complex spinal corrections. 3.

  13. 3-minute smartphone-based and tablet-based psychomotor vigilance tests for the assessment of reduced alertness due to sleep deprivation.

    PubMed

    Grant, Devon A; Honn, Kimberly A; Layton, Matthew E; Riedy, Samantha M; Van Dongen, Hans P A

    2017-06-01

    The psychomotor vigilance test (PVT) is widely used to measure reduced alertness due to sleep loss. Here, two newly developed, 3-min versions of the psychomotor vigilance test, one smartphone-based and the other tablet-based, were validated against a conventional 10-min laptop-based PVT. Sixteen healthy participants (ages 22-40; seven males, nine females) completed a laboratory study, which included a practice and a baseline day, a 38-h total sleep deprivation (TSD) period, and a recovery day, during which they performed the three different versions of the PVT every 3 h. For each version of the PVT, the number of lapses, mean response time (RT), and number of false starts showed statistically significant changes across the sleep deprivation and recovery days. The number of lapses on the laptop was significantly correlated with the numbers of lapses on the smartphone and tablet. The mean RTs were generally faster on the smartphone and tablet than on the laptop. All three versions of the PVT exhibited a time-on-task effect in RTs, modulated by time awake and time of day. False starts were relatively rare on all three PVTs. For the number of lapses, the effect sizes across 38 h of TSD were large for the laptop PVT and medium for the smartphone and tablet PVTs. These results indicate that the 3-min smartphone and tablet PVTs are valid instruments for measuring reduced alertness due to sleep deprivation and restored alertness following recovery sleep. The results also indicate that the loss of sensitivity on the 3-min PVTs may be mitigated by modifying the threshold defining lapses.

  14. Effects on subjective and objective alertness and sleep in response to evening light exposure in older subjects

    PubMed Central

    Münch, M; Scheuermaier, KD; Zhang, R; Dunne, SP; Guzik, AM; Silva, EJ; Ronda, JM; Duffy, JF

    2011-01-01

    Evening bright light exposure is reported to ameliorate daytime sleepiness and age-related sleep complaints, and also delays the timing of circadian rhythms. We tested whether evening light exposure given to older adults with sleep-wake complaints would delay the timing of their circadian rhythms with respect to their sleep timing, thereby reducing evening sleepiness and improving subsequent sleep quality. We examined the impact of evening light exposure from two different light sources on subjective alertness, EEG activity during wakefulness, and sleep stages. Ten healthy older adults with sleep complaints (mean age=63.3 yrs; 6F) participated in a 13-day study. After three baseline days, circadian phase was assessed. On the evening of days 5–8 the subjects were exposed for 2 h to either polychromatic blue-enriched white light or standard white fluorescent light, and on the following day circadian phase was re-assessed. Subjects were allowed to leave the laboratory during all but the two days when the circadian phase assessment took place. Evening assessments of subjective alertness, and wake and sleep EEG data were analyzed. Subjective alertness and wake EEG activity in the alpha range (9.75–11.25 Hz) were significantly higher during light exposures when compared to the pre-light exposure evening (p<0.05). The light exposures produced circadian phase shifts and significantly prolonged latency to rapid eye-movement (REM) sleep for both light groups (p<0.05). The increase in wake EEG alpha activity during the light exposures was negatively correlated with REM sleep duration (p<0.05). Evening light exposure could benefit older adults with early evening sleepiness, without negatively impacting the subsequent sleep episode. PMID:21664380

  15. 47 CFR 10.310 - Federal alert gateway. [Reserved

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

  16. 47 CFR 10.310 - Federal alert gateway. [Reserved

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 1 2013-10-01 2013-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.310 Federal alert gateway. [Reserved] ...

  17. 47 CFR 10.310 - Federal alert gateway. [Reserved

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 1 2014-10-01 2014-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.310 Federal alert gateway. [Reserved] ...

  18. 47 CFR 10.310 - Federal alert gateway. [Reserved

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

  19. 47 CFR 10.310 - Federal alert gateway. [Reserved

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 1 2011-10-01 2011-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

  20. AmberAlert / DPS / DHSEM / AAB

    Science.gov Websites

    cooperative public service alert to aid in the safe recovery of abducted children. The Alaska AMBER Alert children to aid in their safe return. AMBER Alert Hotline: 866-AKAMBER - (866-252-6237) State of Alaska

  1. Analysis of Alerting System Failures in Commercial Aviation Accidents

    NASA Technical Reports Server (NTRS)

    Mumaw, Randall J.

    2017-01-01

    The role of an alerting system is to make the system operator (e.g., pilot) aware of an impending hazard or unsafe state so the hazard can be avoided or managed successfully. A review of 46 commercial aviation accidents (between 1998 and 2014) revealed that, in the vast majority of events, either the hazard was not alerted or relevant hazard alerting occurred but failed to aid the flight crew sufficiently. For this set of events, alerting system failures were placed in one of five phases: Detection, Understanding, Action Selection, Prioritization, and Execution. This study also reviewed the evolution of alerting system schemes in commercial aviation, which revealed naive assumptions about pilot reliability in monitoring flight path parameters; specifically, pilot monitoring was assumed to be more effective than it actually is. Examples are provided of the types of alerting system failures that have occurred, and recommendations are provided for alerting system improvements.

  2. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.

    PubMed

    Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

    2010-01-01

    The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.

  3. Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

    PubMed Central

    Krall, M. A.; Sittig, D. F.

    2001-01-01

    There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use". PMID:11825206

  4. Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

    PubMed

    Krall, M A; Sittig, D F

    2001-01-01

    There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use".

  5. Correlates of Restraint and Seclusion for Adults with Intellectual Disabilities in Community Services

    ERIC Educational Resources Information Center

    Merineau-Cote, J.; Morin, D.

    2013-01-01

    Background: Some individuals with intellectual disabilities (IDs) exhibit aggressive behaviour directed towards themselves, others or the environment. Displaying aggressive behaviour is associated with a number of negative consequences such as the exposure to restrictive interventions. This study aims to identify personal and environmental factors…

  6. Thriving in Youth with Autism Spectrum Disorder and Intellectual Disability

    ERIC Educational Resources Information Center

    Weiss, Jonathan A.; Burnham Riosa, Priscilla

    2015-01-01

    Most research on mental health in individuals with autism spectrum disorder (ASD) and intellectual disability (ID) has focused on deficits. We examined individual (i.e., sociocommunicative skills, adaptive behavior, functional cognitive skills) and contextual (i.e., home, school, and community participation) correlates of thriving in 330 youth…

  7. Spray ignition measurements in a constant volume combustion vessel under engine-relevant conditions

    NASA Astrophysics Data System (ADS)

    Ramesh, Varun

    Pressure-based and optical diagnostics for ignition delay (ID) measurement of a diesel spray from a multi-hole nozzle were investigated in a constant volume combustion vessel (CVCV) at conditions similar to those in a conventional diesel engine at the start of injection (SOI). It was first hypothesized that compared to an engine, the shorter ID in a CVCV was caused by NO, a byproduct of premixed combustion. The presence of a significant concentration of NO+NO2 was confirmed experimentally and by using a multi-zone model of premixed combustion. Experiments measuring the effect of NO on ID were performed at conditions relevant to a conventional diesel engine. Depending on the temperature regime and the nature of the fuel, NO addition was found to advance or retard ignition. Constant volume ignition simulations were capable of describing the observed trends; the magnitudes were different due to the physical processes involved in spray ignition, not modeled in the current study. The results of the study showed that ID is sensitive to low NO concentrations (<100 PPM) in the low-temperature regime. A second source of uncertainty in pressure-based ID measurement is the systematic error associated with the correction used to account for the speed of sound. Simultaneous measurements of volumetric OH chemiluminescence (OHC) and pressure during spray ignition found the OHC to closely resemble the pressure-based heat release rate for the full combustion duration. The start of OHC was always found to be shorter than the pressure-based ID for all fuels and conditions tested by 100 ms. Experiments were also conducted measuring the location and timing of high-temperature ignition and the steady-state lift-off length by high-speed imaging of OHC during spray ignition. The delay period calculated using the measured ignition location and the bulk average speed of sound was in agreement with the delay between OHC and the pressure-based ID. Results of the study show that start of OHC is coupled to detectable heat release and the two measurements are correlated by the time required for the pressure wave to propagate at the speed of sound between the ignition site and the transducer.

  8. Efficient strategy for the molecular diagnosis of intellectual disability using targeted high-throughput sequencing.

    PubMed

    Redin, Claire; Gérard, Bénédicte; Lauer, Julia; Herenger, Yvan; Muller, Jean; Quartier, Angélique; Masurel-Paulet, Alice; Willems, Marjolaine; Lesca, Gaétan; El-Chehadeh, Salima; Le Gras, Stéphanie; Vicaire, Serge; Philipps, Muriel; Dumas, Michaël; Geoffroy, Véronique; Feger, Claire; Haumesser, Nicolas; Alembik, Yves; Barth, Magalie; Bonneau, Dominique; Colin, Estelle; Dollfus, Hélène; Doray, Bérénice; Delrue, Marie-Ange; Drouin-Garraud, Valérie; Flori, Elisabeth; Fradin, Mélanie; Francannet, Christine; Goldenberg, Alice; Lumbroso, Serge; Mathieu-Dramard, Michèle; Martin-Coignard, Dominique; Lacombe, Didier; Morin, Gilles; Polge, Anne; Sukno, Sylvie; Thauvin-Robinet, Christel; Thevenon, Julien; Doco-Fenzy, Martine; Genevieve, David; Sarda, Pierre; Edery, Patrick; Isidor, Bertrand; Jost, Bernard; Olivier-Faivre, Laurence; Mandel, Jean-Louis; Piton, Amélie

    2014-11-01

    Intellectual disability (ID) is characterised by an extreme genetic heterogeneity. Several hundred genes have been associated to monogenic forms of ID, considerably complicating molecular diagnostics. Trio-exome sequencing was recently proposed as a diagnostic approach, yet remains costly for a general implementation. We report the alternative strategy of targeted high-throughput sequencing of 217 genes in which mutations had been reported in patients with ID or autism as the major clinical concern. We analysed 106 patients with ID of unknown aetiology following array-CGH analysis and other genetic investigations. Ninety per cent of these patients were males, and 75% sporadic cases. We identified 26 causative mutations: 16 in X-linked genes (ATRX, CUL4B, DMD, FMR1, HCFC1, IL1RAPL1, IQSEC2, KDM5C, MAOA, MECP2, SLC9A6, SLC16A2, PHF8) and 10 de novo in autosomal-dominant genes (DYRK1A, GRIN1, MED13L, TCF4, RAI1, SHANK3, SLC2A1, SYNGAP1). We also detected four possibly causative mutations (eg, in NLGN3) requiring further investigations. We present detailed reasoning for assigning causality for each mutation, and associated patients' clinical information. Some genes were hit more than once in our cohort, suggesting they correspond to more frequent ID-associated conditions (KDM5C, MECP2, DYRK1A, TCF4). We highlight some unexpected genotype to phenotype correlations, with causative mutations being identified in genes associated to defined syndromes in patients deviating from the classic phenotype (DMD, TCF4, MECP2). We also bring additional supportive (HCFC1, MED13L) or unsupportive (SHROOM4, SRPX2) evidences for the implication of previous candidate genes or mutations in cognitive disorders. With a diagnostic yield of 25% targeted sequencing appears relevant as a first intention test for the diagnosis of ID, but importantly will also contribute to a better understanding regarding the specific contribution of the many genes implicated in ID and autism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Efficient strategy for the molecular diagnosis of intellectual disability using targeted high-throughput sequencing

    PubMed Central

    Redin, Claire; Gérard, Bénédicte; Lauer, Julia; Herenger, Yvan; Muller, Jean; Quartier, Angélique; Masurel-Paulet, Alice; Willems, Marjolaine; Lesca, Gaétan; El-Chehadeh, Salima; Le Gras, Stéphanie; Vicaire, Serge; Philipps, Muriel; Dumas, Michaël; Geoffroy, Véronique; Feger, Claire; Haumesser, Nicolas; Alembik, Yves; Barth, Magalie; Bonneau, Dominique; Colin, Estelle; Dollfus, Hélène; Doray, Bérénice; Delrue, Marie-Ange; Drouin-Garraud, Valérie; Flori, Elisabeth; Fradin, Mélanie; Francannet, Christine; Goldenberg, Alice; Lumbroso, Serge; Mathieu-Dramard, Michèle; Martin-Coignard, Dominique; Lacombe, Didier; Morin, Gilles; Polge, Anne; Sukno, Sylvie; Thauvin-Robinet, Christel; Thevenon, Julien; Doco-Fenzy, Martine; Genevieve, David; Sarda, Pierre; Edery, Patrick; Isidor, Bertrand; Jost, Bernard; Olivier-Faivre, Laurence; Mandel, Jean-Louis; Piton, Amélie

    2014-01-01

    Background Intellectual disability (ID) is characterised by an extreme genetic heterogeneity. Several hundred genes have been associated to monogenic forms of ID, considerably complicating molecular diagnostics. Trio-exome sequencing was recently proposed as a diagnostic approach, yet remains costly for a general implementation. Methods We report the alternative strategy of targeted high-throughput sequencing of 217 genes in which mutations had been reported in patients with ID or autism as the major clinical concern. We analysed 106 patients with ID of unknown aetiology following array-CGH analysis and other genetic investigations. Ninety per cent of these patients were males, and 75% sporadic cases. Results We identified 26 causative mutations: 16 in X-linked genes (ATRX, CUL4B, DMD, FMR1, HCFC1, IL1RAPL1, IQSEC2, KDM5C, MAOA, MECP2, SLC9A6, SLC16A2, PHF8) and 10 de novo in autosomal-dominant genes (DYRK1A, GRIN1, MED13L, TCF4, RAI1, SHANK3, SLC2A1, SYNGAP1). We also detected four possibly causative mutations (eg, in NLGN3) requiring further investigations. We present detailed reasoning for assigning causality for each mutation, and associated patients’ clinical information. Some genes were hit more than once in our cohort, suggesting they correspond to more frequent ID-associated conditions (KDM5C, MECP2, DYRK1A, TCF4). We highlight some unexpected genotype to phenotype correlations, with causative mutations being identified in genes associated to defined syndromes in patients deviating from the classic phenotype (DMD, TCF4, MECP2). We also bring additional supportive (HCFC1, MED13L) or unsupportive (SHROOM4, SRPX2) evidences for the implication of previous candidate genes or mutations in cognitive disorders. Conclusions With a diagnostic yield of 25% targeted sequencing appears relevant as a first intention test for the diagnosis of ID, but importantly will also contribute to a better understanding regarding the specific contribution of the many genes implicated in ID and autism. PMID:25167861

  10. Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

    PubMed Central

    Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

    2010-01-01

    Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

  11. Determining Inappropriate Medication Alerts from "Inaccurate Warning" Overrides in the Intensive Care Unit.

    PubMed

    Rehr, Christine A; Wong, Adrian; Seger, Diane L; Bates, David W

    2018-04-01

     This article aims to understand provider behavior around the use of the override reason "Inaccurate warning," specifically whether it is an effective way of identifying unhelpful medication alerts.  We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug-drug interactions (DDI). Override appropriateness was analyzed by two independent reviewers using predetermined criteria.  A total of 268 of 26,501 ICU overrides (1.0%) used the reason "Inaccurate warning," with 93 of these overrides associated with our included alert types. Sixty-one of these overrides (66%) were identified to be appropriate. Twenty-one of 30 (70%) dose alert overrides were appropriate. Forty of 48 drug-allergy alert overrides (83%) were appropriate, for reasons ranging from prior tolerance ( n  = 30) to inaccurate ingredient matches ( n  = 5). None of the 15 DDI overrides were appropriate.  The "Inaccurate warning" reason was selectively used by a small proportion of providers and overrides using this reason identified important opportunities to reduce excess alerts. Potential opportunities include improved evaluation of dosing mechanisms based on patient characteristics, inclusion of institutional dosing protocols to alert logic, and evaluation of a patient's prior tolerance to a medication that they have a documented allergy for. This resource is not yet routinely used for alert tailoring at our institution but may prove to be a valuable resource to evaluate available alerts. Schattauer GmbH Stuttgart.

  12. Speech Alarms Pilot Study

    NASA Technical Reports Server (NTRS)

    Sandor, A.; Moses, H. R.

    2016-01-01

    Currently on the International Space Station (ISS) and other space vehicles Caution & Warning (C&W) alerts are represented with various auditory tones that correspond to the type of event. This system relies on the crew's ability to remember what each tone represents in a high stress, high workload environment when responding to the alert. Furthermore, crew receive a year or more in advance of the mission that makes remembering the semantic meaning of the alerts more difficult. The current system works for missions conducted close to Earth where ground operators can assist as needed. On long duration missions, however, they will need to work off-nominal events autonomously. There is evidence that speech alarms may be easier and faster to recognize, especially during an off-nominal event. The Information Presentation Directed Research Project (FY07-FY09) funded by the Human Research Program included several studies investigating C&W alerts. The studies evaluated tone alerts currently in use with NASA flight deck displays along with candidate speech alerts. A follow-on study used four types of speech alerts to investigate how quickly various types of auditory alerts with and without a speech component - either at the beginning or at the end of the tone - can be identified. Even though crew were familiar with the tone alert from training or direct mission experience, alerts starting with a speech component were identified faster than alerts starting with a tone. The current study replicated the results from the previous study in a more rigorous experimental design to determine if the candidate speech alarms are ready for transition to operations or if more research is needed. Four types of alarms (caution, warning, fire, and depressurization) were presented to participants in both tone and speech formats in laboratory settings and later in the Human Exploration Research Analog (HERA). In the laboratory study, the alerts were presented by software and participants were asked to identify the alert as quickly and as accurately as possible. Reaction time and accuracy were measured. Participants identified speech alerts significantly faster than tone alerts. The HERA study investigated the performance of participants in a flight-like environment. Participants were instructed to complete items on a task list and respond to C&W alerts as they occurred. Reaction time and accuracy were measured to determine if the benefits of speech alarms are still present in an applied setting.

  13. For whom the bell tolls: Silver Alerts raise concerns regarding individual rights and governmental interests.

    PubMed

    Wasser, Tobias D; Fox, Patrick K

    2013-01-01

    The Silver Alert system was initially created to help protect missing persons who have cognitive impairments, particularly the elderly. The Silver Alert is modeled after the Amber Alert, created to help locate and safeguard missing children. Unlike the Amber Alert, however, in most states the Silver Alert applies to the elderly, adults with a mental impairment, or both, depending on the state. The goal of the Silver Alert system is the quick dissemination of information about missing persons to law enforcement personnel as well as to the general public. Previously, states notified law enforcement personnel of missing persons through teletype to other public safety jurisdictions to enlist their assistance in the retrieval of the missing person. Silver Alert programs substantially expand the notification to include the general public, who receive information through radio and television broadcasts as well as highway billboards. The programs serve a legitimate governmental interest by protecting a vulnerable population from possible harm. Yet, the implementation of these alerts can have unintended consequences, including the possible violation of an individual's right to privacy. Such consequences require careful consideration.

  14. Evaluation of Helmet Mounted Display Alerting Symbology

    NASA Technical Reports Server (NTRS)

    DeMaio, Joe; Rutkowski, Michael (Technical Monitor)

    2000-01-01

    Proposed helicopter helmet mounted displays will be used to alert the pilot to a variety of conditions, from threats to equipment problems. The present research was performed under the NASA Safe All-weather Flight Operations Research (SAFOR) program supported by a joint Army/NASA research agreement. The purpose of the research was to examine ways to optimize the alerting effectiveness of helmet display symbology. The research used two approaches to increasing the effectiveness of alerts. One was to increase the ability of the alert to attract attention by using the entire display surface. The other was to include information about the required response in the alert itself. The investigation was conducted using the NASA Ames Research Center's six-degree-of-freedom vertical motion simulator (VMS) with a rotorcraft cockpit. Helmet display symbology was based on the AH-64's pilot night vision system (PNVS), cruise mode symbology. A standardized mission was developed, that consisted of 11 legs. The mission included four tasks, which allowed variation in the frequency of alerts. The general trend in the data points to a small benefit from both the full-screen alert and the partial information alert.

  15. An Analysis of EMS and ED Detection of Stroke.

    PubMed

    Medoro, Ian; Cone, David C

    2017-01-01

    Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify the ED of a "stroke alert" from the field. However, there are few data on the accuracy of these EMS stroke alerts. The goal of this study was to examine diagnostic test performance of EMS and ED stroke alerts and related process measures. The EMS and ED records of all stroke alerts in a large tertiary ED from August 2013-January 2014 were examined and data abstracted by one trained investigator, with data accuracy confirmed by a second investigator for 15% of cases. Stroke alerts called by EMS prior to ED arrival were compared to stroke alerts called by ED physicians and nurses (for walk-in patients, and patients transported by EMS without EMS stroke alerts). Means ± SD, medians, unpaired t-tests (for continuous data), and two-tailed Fisher's exact tests (for categorical data) were used. Of 260 consecutive stroke alerts, 129 were EMS stroke alerts, and 131 were ED stroke alerts (70 called by physicians, 61 by nurses). The mean NIH Stroke Scale was higher in the EMS group (8.1 ± 7.6 vs. 3.0 ± 5.0, p < 0.0001). The positive predictive value of EMS stroke alerts was 0.60 (78/129), alerts by ED nurses was 0.25 (15/61), and alerts by ED physicians was 0.31 (22/70). The PPV for EMS was better than for nurses or physicians (both p < 0.001), and more patients in the EMS group had final diagnoses of stroke (62/129 vs. 24/131, p < 0.001). The positive likelihood ratio was 1.53 for EMS personnel, 0.45 for physicians, and 0.77 for nurses. The mean time to order the CT (8.5 ± 7.1 min vs. 23.1 ± 18.2 min, p < 0.0001) and the mean ED length of stay (248 ± 116 min vs. 283 ± 128 min, p = 0.022) were shorter for the EMS stroke alert group. More EMS stroke alert patients received tPA (16/129 vs. 6/131, p = 0.027). EMS stroke alerts have better diagnostic test performance than stroke alerts by ED staff, likely due to higher NIH Stroke Scale scores (more obvious presentations) and are associated with better process measures. The fairly low PPV suggests room for improvement in prehospital stroke protocols.

  16. 47 CFR 10.240 - Notification to new subscribers of non-participation in CMAS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-participation in CMAS. 10.240 Section 10.240 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Election to Participate in Commercial Mobile Alert System § 10.240... EMERGENCY ALERTS (Commercial Mobile Alert Service) [[CMS provider

  17. 47 CFR 10.320 - Provider alert gateway requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 1 2014-10-01 2014-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

  18. 47 CFR 10.320 - Provider alert gateway requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 1 2013-10-01 2013-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

  19. 47 CFR 10.410 - Prioritization.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false Prioritization. 10.410 Section 10.410 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Alert Message... required to transmit Imminent Threat Alerts and AMBER Alerts on a first in-first out (FIFO) basis. ...

  20. Commercial Motor Vehicle Driver Fatigue And Alertness Study Executive Summary

    DOT National Transportation Integrated Search

    1996-11-01

    THE DRIVER FATIGUE AND ALERTNESS STUDY (DFAS) WAS THE LARGEST AND MOST COMPREHENSIVE OVER-THE-ROAD STUDY EVER CONDUCTED ON DRIVER FATIGUE AND ALERTNESS IN NORTH AMERICA. IT PROVIDES EXTENSIVE INFORMATION ON THE ALERTNESS, DRIVING PERFORMANCE, AND PHY...

  1. 47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

  2. 47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

  3. 47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

  4. Development and Implementation of Sepsis Alert Systems.

    PubMed

    Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

    2016-06-01

    Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Analysis of UAS DAA Alerting in Fast-Time Simulations without DAA Mitigation

    NASA Technical Reports Server (NTRS)

    Thipphavong, David P.; Santiago, Confesor; Isaacson, Douglas R.; Lee, Seung Man; Park, Chunki; Refai, Mohamad Said; Snow, James

    2015-01-01

    Realization of the expected proliferation of Unmanned Aircraft System (UAS) operations in the National Airspace System (NAS) depends on the development and validation of performance standards for UAS Detect and Avoid (DAA) Systems. The RTCA Special Committee 228 is charged with leading the development of draft Minimum Operational Performance Standards (MOPS) for UAS DAA Systems. NASA, as a participating member of RTCA SC-228 is committed to supporting the development and validation of draft requirements for DAA alerting system performance. A recent study conducted using NASA's ACES (Airspace Concept Evaluation System) simulation capability begins to address questions surrounding the development of draft MOPS for DAA alerting systems. ACES simulations were conducted to study the performance of alerting systems proposed by the SC-228 DAA Alerting sub-group. Analysis included but was not limited to: 1) correct alert (and timeliness), 2) false alert (and severity and duration), 3) missed alert, and 4) probability of an alert type at the time of loss of well clear. The performance of DAA alerting systems when using intent vs. dead-reckoning for UAS ownship trajectories was also compared. The results will be used by SC-228 to inform decisions about the surveillance standards of UAS DAA systems and future requirements development and validation efforts.

  6. Closing the loop in ICU decision support: physiologic event detection, alerts, and documentation.

    PubMed Central

    Norris, P. R.; Dawant, B. M.

    2001-01-01

    Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. This paper describes recent efforts on the Simon project to capture information from ICU care providers about patient state and therapy in response to alerts, in order to assess the value of event definitions and progressively refine alerting algorithms. Event definitions for intracranial pressure and cerebral perfusion pressure were studied by implementing a reliable system to automatically deliver alerts to clinical users alphanumeric pagers, and to capture associated documentation about patient state and therapy when the alerts occurred. During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility. PMID:11825238

  7. A matter of life and death: knowledge about the body and concept of death in adults with intellectual disabilities.

    PubMed

    McEvoy, J; Treacy, B; Quigley, J

    2017-01-01

    An increased awareness of how people with intellectual disabilities (ID) understand death and dying is necessary in supporting life-long learning, post-bereavement support and planning end-of-life care. Previous research suggests that adults with ID have a limited or 'patchy' understanding of the basic biological components of death. However, the relationship between biological understanding of how the body works and conceptualisation of death remains unexplored in this population. Thirty adults with ID were interviewed to assess their knowledge of human body function and their understanding of the concept of death. Using pictures, participants were asked if they recognised certain organs, asked to explain the function of various body parts and what would happen if certain body parts were missing or did not work. Participants who referred to 'life' or 'not dying' as the goal of body function were categorised as 'Life Theorisers'. In addition, participants were asked about the causes of death, whether all things die and the status of the body after death. The results support previous studies suggesting that understanding of death in adults with ID varies from partial to full comprehension and is associated with level of ID. Also, death comprehension was positively correlated with total body interview scores and 'Life Theorisers' who understood that body parts maintain life and who spontaneously appealed to 'vitalistic' concepts when reasoning about the human body were also more sophisticated in their understanding of death. The study highlights the relationship between knowledge about the goal of human body functioning and death comprehension in adults with ID. The potential that learning to adopt a 'vitalistic' approach to human functioning may have on the acquisition of a greater understanding of death and dying, understanding illness and supporting end-of-life planning is discussed. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  8. Collective dynamics of cell migration and cell rearrangements

    NASA Astrophysics Data System (ADS)

    Kabla, Alexandre

    Understanding multicellular processes such as embryo development or cancer metastasis requires to decipher the contributions of local cell autonomous behaviours and long range interactions with the tissue environment. A key question in this context concerns the emergence of large scale coordination in cell behaviours, a requirement for collective cell migration or convergent extension. I will present a few examples where physical and mechanical aspects play a significant role in driving tissue scale dynamics.

  9. Evaluation of bilirubin interference and accuracy of six creatinine assays compared with isotope dilution-liquid chromatography mass spectrometry.

    PubMed

    Nah, Hyunjin; Lee, Sang-Guk; Lee, Kyeong-Seob; Won, Jae-Hee; Kim, Hyun Ok; Kim, Jeong-Ho

    2016-02-01

    The aim of this study was to estimate bilirubin interference and accuracy of six routine methods for measuring creatinine compared with isotope dilution-liquid chromatography mass spectrometry (ID-LC/MS). A total of 40 clinical serum samples from 31 patients with serum total bilirubin concentration >68.4μmol/L were collected. Serum creatinine was measured using two enzymatic reagents and four Jaffe reagents as well as ID-LC/MS. Correlations between bilirubin concentration and percent difference in creatinine compared with ID-LC/MS were analyzed to investigate bilirubin interference. Bias estimations between the six reagents and ID-LC/MS were performed. Recovery tests using National Institute of Standards and Technology (NIST) Standard Reference Material (SRM) 967a were also performed. Both the enzymatic methods showed no bilirubin interference. However, three of the four Jaffe methods demonstrated significant bilirubin concentration-dependent interference in samples with creatinine levels <53μmol/L, and two of them showed significant bilirubin interference in samples with creatinine levels ranging from 53.0 to 97.2μmol/L. Comparison of these methods with ID-LC/MS using patients' samples with elevated bilirubin revealed that the tested methods failed to achieve the bias goal at especially low levels of creatinine. In addition, recovery test using NIST SRM 967a showed that bias in one Jaffe method and two enzymatic methods did not achieve the bias goal at either low or high level of creatinine, indicating they had calibration bias. One enzymatic method failed to achieve all the bias goals in both comparison experiment and recovery test. It is important to understand that both bilirubin interference and calibration traceability to ID-LC/MS should be considered to improve the accuracy of creatinine measurement. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  10. Contribution of permeability and sensitivity to inhibition of DNA synthesis in determining susceptibilities of Escherichia coli, Pseudomonas aeruginosa, and Alcaligenes faecalis to ciprofloxacin.

    PubMed Central

    Bedard, J; Chamberland, S; Wong, S; Schollaardt, T; Bryan, L E

    1989-01-01

    To examine the correlation between bacterial cell susceptibility to ciprofloxacin and the magnitude of uptake and cell target sensitivity, the relative contribution of ciprofloxacin accumulation in intact cells and its ability to inhibit DNA synthesis were investigated among strains of Escherichia coli, Pseudomonas aeruginosa, and Alcaligenes faecalis. Uptake studies of [14C]ciprofloxacin demonstrated diffusion kinetics for P. aeruginosa and E. coli. Ciprofloxacin was more readily removed from E. coli J53 and A. faecalis ATCC 19018 by washing than from P. aeruginosa PAO503. These results indicate that the process of cell accumulation is different for P. aeruginosa in that the drug is firmly bound at an extracellular site. Whatever the washing conditions, A. faecalis accumulated less drug than either of the other two bacteria. Magnesium chloride (10 mM) caused a substantial decrease of ciprofloxacin accumulated and an increase in the MIC, depending upon the nature of the medium. The addition of carbonyl cyanide m-chlorophenylhydrazone caused a variable increase in drug accumulated, depending on the medium and the bacterial strain. The concentration of ciprofloxacin required to obtain 50% inhibition (ID50) of DNA synthesis for P. aeruginosa PAO503 and A. faecalis ATCC 19018 did not correlate with their corresponding MICs but did for E. coli J53. Treatment with EDTA decreased the ID50 of ciprofloxacin for P. aeruginosa PAO503 and its gyrA derivative by 5- and 2-fold, respectively, and decreased the ID50 for E. coli JB5R, a strain with a known decrease in OmpF, by 1.4-fold but did not decrease the ID50 for the normally susceptible E. coli J53. The ID(50) for P. aeruginosa obtained after EDTA treatment or in ether-permeabilized cells was higher than that obtained for the other two strains. The protonophore carbonyl cyanide m-chlorophenylhydrazone prevented killing by low ciprofloxacin concentrtaions, but sodium azide did not. The latter compound did not enhance killing in association with inhibition of a previously described energy-dependent efflux of ciprofloxacin susceptibility being the susceptibility to inhibition of DNA synthesis in E. coli, poor premeability associated with the small pore size of A. faecalis, and a combination of low permeability and reduced susceptibility of DNA synthesis to inhibition for P. aeruginosa. PMID:2510591

  11. Evaluation of anhedonia with the Snaith-Hamilton Pleasure Scale (SHAPS) in adult outpatients with major depressive disorder.

    PubMed

    Nakonezny, Paul A; Morris, David W; Greer, Tracy L; Byerly, Matthew J; Carmody, Thomas J; Grannemann, Bruce D; Bernstein, Ira H; Trivedi, Madhukar H

    2015-06-01

    Anhedonia or inability to experience pleasure not only is a core symptom of major depressive disorder (MDD), but also is identified as an important component of the positive valence system in the NIMH Research Domain Criteria. The Snaith-Hamilton Pleasure Scale (SHAPS) has been developed for the assessment of hedonic experience or positive valence, but has not been well-studied in depressed outpatient populations. The current study examined the reliability and validity of the SHAPS using a sample of adult outpatients with treatment resistant MDD. Data for the current study were obtained from 122 adult outpatients with a diagnosis of MDD and non-response to adequate treatment with an SSRI and who participated in Project TReatment with Exercise Augmentation for Depression (TREAD). A Principal Components Analysis was used to define the dimensionality of the SHAPS. Convergent and discriminant validity were evaluated via correlations of the SHAPS total score with "gold standard" measures of depression severity and quality of life. The SHAPS was found to have high internal consistency (Cronbach's coefficient α = .82). A Principal Components Analysis suggests that the SHAPS is mainly "unidimensional" and limited to hedonic experience among adult outpatients with MDD. Convergent and discriminant validity were assessed by examining the Spearman rank-order correlation coefficient between the SHAPS total score and the HRSD17 (rs = 0.22, p < .03), IDS-C30 (rs = 0.26, p < .01), IDS-SR30 (rs = 0.23, p < .02), QIDS-C16 (rs = 0.22, p < .03), QIDS-SR16 (rs = 0.17, p < .10), QLES-Q (rs = -0.32, p < .002), and the pleasure/enjoyment item (sub-item 21) of the IDS-C (rs = 0.44, p < .0001) and IDS-SR (rs = 0.38, p < .0002). The self-administered SHAPS showed modest sensitivity (76%) and specificity (54%) with the self-administered pleasure/enjoyment single item (sub-item 21) of IDS-SR30. The current study shows that the SHAPS is a reliable and valid instrument to assess hedonic experience or positive valence in adult outpatients with MDD and provides a broader assessment of this important domain. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers.

    PubMed

    Gregory, Megan E; Russo, Elise; Singh, Hardeep

    2017-07-05

    Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been understudied. To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload. A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States. Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system. Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.

  13. Wireless clinical alerts and patient outcomes in the surgical intensive care unit.

    PubMed

    Major, Kevin; Shabot, M Michael; Cunneen, Scott

    2002-12-01

    Errors in medicine have gained public interest since the Institute of Medicine published its 1999 report on this subject. Although errors of commission are frequently cited, errors of omission can be equally serious. A computerized surgical intensive care unit (SICU) information system when coupled to an event-driven alerting engine has the potential to reduce errors of omission for critical intensive care unit events. Automated alerts and patient outcomes were prospectively collected for all patients admitted to a tertiary-care SICU for a 2-year period. During the study period 3,973 patients were admitted to the SICU and received 13,608 days of care. A total of 15,066 alert pages were sent including alerts for physiologic condition (6,163), laboratory data (4,951), blood gas (3,774), drug allergy (130), and toxic drug levels (48). Admission Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II score, SICU lengths of stay, and overall mortality rates were significantly higher in patients who triggered the alerting system. Patients triggering the alert paging system were 49.4 times more likely to die in the SICU compared with patients who did not generate an alert. Even after transfer to floor care the patients who triggered the alerting system were 5.7 times more likely to die in the hospital. An alert page identifies patients who will stay in the SICU longer and have a significantly higher chance of death compared with patients who do not trigger the alerting system.

  14. An Investigation of Drug-Drug Interaction Alert Overrides at a Pediatric Hospital.

    PubMed

    Humphrey, Kate; Jorina, Maria; Harper, Marvin; Dodson, Brenda; Kim, Seung-Yeon; Ozonoff, Al

    2018-05-01

    Drug-drug interactions (DDIs) can result in patient harm. DDI alerts are intended to help prevent harm; when the majority of alerts presented to providers are being overridden, their value is diminished. Our objective was to evaluate the overall rates of DDI alert overrides and how rates varied by specialty, clinician type, and patient complexity. A retrospective study of DDI alert overrides that occurred during 2012 and 2013 within the inpatient setting described at the medication-, hospital-, provider-, and patient encounter-specific levels was performed at an urban, quaternary-care, pediatric hospital. There were >41 000 DDI alerts presented to clinicians; ∼90% were overridden. The 5 DDI pairs that were most frequently presented and overridden included the following: potassium chloride-spironolactone, methadone-ondansetron, ketorolac-ibuprofen, cyclosporine-fluconazole, and potassium chloride-enalapril, each with an alert override rate of ≥0.89. Override rates across provider groups ranged between 0.84 and 0.97. In general, patients with high complexity had a higher frequency of alert overrides, but the rates of alert overrides for each DDI pairing did not differ significantly. High rates of DDI alert overrides occur across medications, provider groups, and patient encounters. Methods to decrease DDI alerts which are likely to be overridden exist, but it is also clear that more robust and intelligent tools are needed. Characteristics exist at the medication, hospital, provider, and patient levels that can be used to help specialize and enhance information transmission. Copyright © 2018 by the American Academy of Pediatrics.

  15. 47 CFR 10.320 - Provider alert gateway requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

  16. 77 FR 41331 - Commercial Mobile Alert System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ... Mobile Alert System AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of... with the Commission's Commercial Mobile Alert System (CMS), Second Report and Order (``CMAS Second... Alert System rules contained in the Commission's Second Report and Order, FCC 08- 164, published at 73...

  17. 47 CFR 80.1111 - Distress alerting.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

  18. 47 CFR 80.1111 - Distress alerting.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

  19. 47 CFR 80.1111 - Distress alerting.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

  20. 47 CFR 80.1111 - Distress alerting.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

  1. 47 CFR 80.1111 - Distress alerting.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

  2. Alert Triage v 0.1 beta

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

    Doak, Justin E.; Ingram, Joe; Johnson, Josh

    2016-01-06

    In the cyber security operations of a typical organization, data from multiple sources are monitored, and when certain conditions in the data are met, an alert is generated in an alert management system. Analysts inspect these alerts to decide if any deserve promotion to an event requiring further scrutiny. This triage process is manual, time-consuming, and detracts from the in-depth investigation of events. We have created a software system that uses supervised machine learning to automatically prioritize these alerts. In particular we utilize active learning to make efficient use of the pool of unlabeled alerts, thereby improving the performance ofmore » our ranking models over passive learning. We have demonstrated the effectiveness of our system on a large, real-world dataset of cyber security alerts.« less

  3. Building a Communication, Education, an Outreach Program for the ShakeAlert National Earthquake Early Warning Program - Recommendations for Public Alerts Via Cell Phones

    NASA Astrophysics Data System (ADS)

    DeGroot, R. M.; Long, K.; Strauss, J. A.

    2017-12-01

    The United States Geological Survey (USGS) and its partners are developing the ShakeAlert Earthquake Early Warning System for the West Coast of the United States. To be an integral part of successful implementation, ShakeAlert engagement programs and materials must integrate with and leverage broader earthquake risk programs. New methods and products for dissemination must be multidisciplinary, cost effective, and consistent with existing hazards education and communication efforts. The ShakeAlert Joint Committee for Communication, Education, and Outreach (JCCEO), is identifying, developing, and cultivating partnerships with ShakeAlert stakeholders including Federal, State, academic partners, private companies, policy makers, and local organizations. Efforts include developing materials, methods for delivery, and reaching stakeholders with information on ShakeAlert, earthquake preparedness, and emergency protective actions. It is essential to develop standards to ensure information communicated via the alerts is consistent across the public and private sector and achieving a common understanding of what actions users take when they receive a ShakeAlert warning. In February 2017, the JCCEO convened the Warning Message Focus Group (WMFG) to provide findings and recommendations to the Alliance for Telecommunications Industry Solutions on the use of earthquake early warning message content standards for public alerts via cell phones. The WMFG represents communications, education, and outreach stakeholders from various sectors including ShakeAlert regional coordinators, industry, emergency managers, and subject matter experts from the social sciences. The group knowledge was combined with an in-depth literature review to ensure that all groups who could receive the message would be taken into account. The USGS and the participating states and agencies acknowledge that the implementation of ShakeAlert is a collective effort requiring the participation of hundreds of stakeholders committed to ensuring public accessibility.

  4. Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers.

    PubMed

    Pfeiffer, Yvonne; Schwappach, David

    2016-01-01

    National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented. The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts. Copyright © 2016. Published by Elsevier GmbH.

  5. The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network.

    PubMed

    Benthin, Cody; Pannu, Sonal; Khan, Akram; Gong, Michelle

    2016-10-01

    The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown. To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis. Thirty sites completed the survey (79% response rate). All sites used electronic health record systems. Epic Systems was used at 56% of sites; the others used alternate commercially available vendors or homegrown systems. Respondents at 57% of sites represented in this survey used e-alerts. All but 1 of these 17 sites used an e-alert for early detection of sepsis-related syndromes, and 35% used an e-alert for pneumonia. E-alerts were triggered by abnormal laboratory values (37%), vital signs (37%), or radiology reports (15%) and were used about equally for clinical decision support and research. Only 59% of sites with e-alerts have evaluated them either for accuracy or for validity. A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

  6. Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

    PubMed Central

    Dalal, Anuj K; Sahni, V Anik; Lacson, Ronilda; Khorasani, Ramin

    2016-01-01

    Objective To assess whether integrating critical result management software—Alert Notification of Critical Results (ANCR)—with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). Materials and Methods This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts (“alerts”) within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. Results Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). Conclusions Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts. PMID:26335982

  7. Stimulated reporting: the impact of US food and drug administration-issued alerts on the adverse event reporting system (FAERS).

    PubMed

    Hoffman, Keith B; Demakas, Andrea R; Dimbil, Mo; Tatonetti, Nicholas P; Erdman, Colin B

    2014-11-01

    The US Food and Drug Administration (FDA) uses the Adverse Event Reporting System (FAERS) to support post-marketing safety surveillance programs. Currently, almost one million case reports are submitted to FAERS each year, making it a vast repository of drug safety information. Sometimes cited as a limitation of FAERS, however, is the assumption that "stimulated reporting" of adverse events (AEs) occurs in response to warnings, alerts, and label changes that are issued by the FDA. To determine the extent of "stimulated reporting" in the modern-day FAERS database. One hundred drugs approved by the FDA between 2001 and 2010 were included in this analysis. FDA alerts were obtained by a comprehensive search of the FDA's MedWatch and main websites. Publicly available FAERS data were used to assess the "primary suspect" AE reporting pattern for up to four quarters before, and after, the issuance of an FDA alert. A few drugs did demonstrate "stimulated reporting" trends. A majority of the drugs, however, showed little evidence for significant reporting changes associated with the issuance of alerts. When we compared the percentage changes in reporting after an FDA alert with those after a sham "control alert", the overall reporting trends appeared to be quite similar. Of 100 drugs analyzed for short-term reporting trends, 21 real alerts and 25 sham alerts demonstrated an increase (greater than or equal to 1 %) in reporting. The long-term analysis of 91 drugs showed that 24 real alerts and 28 sham alerts demonstrated a greater than or equal to 1 % increase. Our results suggest that most of modern day FAERS reporting is not significantly affected by the issuance of FDA alerts.

  8. Contralateral Associated Movements Correlate with Poorer Inhibitory Control, Attention and Visual Perception in Preschool Children.

    PubMed

    Kakebeeke, Tanja H; Messerli-Bürgy, Nadine; Meyer, Andrea H; Zysset, Annina E; Stülb, Kerstin; Leeger-Aschmann, Claudia S; Schmutz, Einat A; Arhab, Amar; Puder, Jardena J; Kriemler, Susi; Munsch, Simone; Jenni, Oskar G

    2017-10-01

    Contralateral associated movements (CAMs) frequently occur in complex motor tasks. We investigated whether and to what extent CAMs are associated with inhibitory control among preschool children in the Swiss Preschoolers' Health Study. Participants were 476 healthy, typically developing children (mean age = 3.88 years; 251 boys) evaluated on two consecutive afternoons. The children performed the Zurich Neuromotor Assessment, the statue subtest of the Neuropsychological Assessment for Children (NEPSY), and cognitive tests of the Intelligence and Development Scales-Preschool (IDS-P). CAMs were associated with poor inhibitory control on the statue test and poor selective attention and visual perception on the IDS-P. We attributed these findings to preschoolers' general immaturity of the central nervous system.

  9. Relationship between central and peripheral corneal astigmatism in elderly patients

    NASA Astrophysics Data System (ADS)

    Kawamorita, Takushi; Shimizu, Kimiya; Hoshikawa, Rie; Kamiya, Kazutaka; Shoji, Nobuyuki

    2018-03-01

    Abstract Purpose We investigated the relationship between central and peripheral corneal astigmatism in elderly patients. Methods Seventy-six eyes of 76 elderly subjects (mean age = 72.6 ± 3.0 years) were included in the study. Corneal shape was evaluated using the Pentacam HR (Oculus, Wetzlark, Germany), which is comprised of a rotating Scheimpflug camera and a short-wavelength slit light. The power distribution map was selected and corneal astigmatism was calculated using front K-Readings in zones centered on the pupil. Analyzed zones were 2.0-6.0 mm in diameter. Results Corneal astigmatism decreased as diameter increased, similar to what was observed in eyes with with-the-rule astigmatism and against-the-rule astigmatism (ANOVA, p < 0.01). This effect was more pronounced in eyes with a large central corneal astigmatism (Spearman's rank-correlation coefficient test, r = 0.51, p < 0.01). There was no change as to axis of corneal astigmatism (ANOVA, p = 0.98). Conclusion These results suggest that the relationship between central and peripheral corneal astigmatism should be taken into consideration to optimize vision when astigmatic correction is needed.

  10. Public stigma in intellectual disability: do direct versus indirect questions make a difference?

    PubMed

    Werner, S

    2015-10-01

    Stigma may negatively impact individuals with intellectual disabilities (ID). However, most studies in the field have been based on the use of direct measurement methods for assessing stigma. This study examined public stigma towards individuals with ID within a representative sample of the Israeli public by comparing direct versus indirect questioning. Vignette methodology was utilised with two questionnaire versions. In the direct questionnaire (n = 306), the participants were asked how they would think, feel and behave if a man with ID asked them a question in a public place. In the indirect questionnaire (n = 301), the participants were asked to report how a hypothetical 'other man' would think, feel and behave in the same situation. Higher levels of stigma were reported among participants that answered the indirect questionnaire version. Furthermore, among those participants that answered the indirect questionnaire version, subjective knowledge of ID was a less important correlate of stigma than for those participants that answered the direct questionnaire. Several explanations are suggested for the finding that indirect questioning elicits more negative stigmatic attitudes. Among others, indirect questioning may be a more appropriate methodology for eliciting immediate beliefs. Furthermore, the results call for implementing a comprehensive, multi-level programme to change stigma. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  11. Executive Functions and Adaptive Behaviour in Autism Spectrum Disorders with and without Intellectual Disability

    PubMed Central

    Panerai, Simonetta; Tasca, Domenica; Ferri, Raffaele; Genitori D'Arrigo, Valentina; Elia, Maurizio

    2014-01-01

    Executive functions (EF) in autism spectrum disorders (ASD) have been often investigated, although results seem to be rather inconsistent. The first aim of this study was to detect which EF components are common to the ASD continuum (from high- to low-functioning ASD) and identify a possible EF profile for ASD people. Planning, mental flexibility, inhibition of response, generativity, and ecologic EF were investigated. This study was extended not only to high-functioning ASD, but also to ASD with intellectual disability (ID). The second aim was to find EF aspects correlating with adaptive skills in ASD. A total of 61 children participated in the study (27 ASD with and without ID and 34 controls). Results highlight an executive profile characterised by impaired flexibility and deficient planning; these deficits are associated with decreased adaptive ability, particularly socialization, and a deficient shifting in ecologic conditions. These features are present in all ASD subgroups with and without ID; for this reason, they might be assumed as being specific features in ASD. PMID:24829905

  12. Maternal depression and the learning-promoting effects of infant-directed speech: Roles of maternal sensitivity, depression diagnosis, and speech acoustic cues.

    PubMed

    Kaplan, Peter S; Danko, Christina M; Cejka, Anna M; Everhart, Kevin D

    2015-11-01

    The hypothesis that the associative learning-promoting effects of infant-directed speech (IDS) depend on infants' social experience was tested in a conditioned-attention paradigm with a cumulative sample of 4- to 14-month-old infants. Following six forward pairings of a brief IDS segment and a photographic slide of a smiling female face, infants of clinically depressed mothers exhibited evidence of having acquired significantly weaker voice-face associations than infants of non-depressed mothers. Regression analyses revealed that maternal depression was significantly related to infant learning even after demographic correlates of depression, antidepressant medication use, and extent of pitch modulation in maternal IDS had been taken into account. However, after maternal depression had been accounted for, maternal emotional availability, coded by blind raters from separate play interactions, accounted for significant further increments in the proportion of variance accounted for in infant learning scores. Both maternal depression and maternal insensitivity negatively, and additively, predicted poor learning. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. The evaluation of angiotensin-converting enzyme (ACE) gene I/D and IL-4 gene intron 3 VNTR polymorphisms in coronary artery disease.

    PubMed

    Basol, Nursah; Celik, Atac; Karakus, Nevin; Ozturk, Sibel Demir; Ozsoy, Sibel Demir; Yigit, Serbulent

    2014-01-01

    Genetic polymorphism is a strong risk factor for coronary artery disease (CAD). In the present study, our aim was to evaluate angiotensin-converting enzyme (ACE) gene I/D polymorphism and interleukin-4 (IL-4) gene Intron 3 variable number of tandem repeat (VNTR) polymorphism in CAD. One hundred and twenty-four CAD patients and one hundred and twenty-three controls were enrolled. Genomic DNA was isolated and genotyped using polymerase chain reaction (PCR) analyses. The risk associated with inheriting the combined genotypes for the two polymorphisms were evaluated and it was found that the individuals who were P2P2-homozygous at IL-4 gene intron 3 VNTR and DD-homozygous at ACE gene I/D have a higher risk of developing CAD. Although, there is no correlation between IL4 VNTR polymorphism and ACE gene polymorphism and CAD, there is a strong association between CAD and co-existence of IL-4 VNTR and ACE gene polymorphisms in the Turkish population. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  14. Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds.

    PubMed

    Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L

    2011-02-01

    Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology. © 2011 SAGE Publications.

  15. Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

    PubMed

    O'Connor, Stacy D; Dalal, Anuj K; Sahni, V Anik; Lacson, Ronilda; Khorasani, Ramin

    2016-03-01

    To assess whether integrating critical result management software--Alert Notification of Critical Results (ANCR)--with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts ("alerts") within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Identification of Patients Expected to Benefit from Electronic Alerts for Acute Kidney Injury.

    PubMed

    Biswas, Aditya; Parikh, Chirag R; Feldman, Harold I; Garg, Amit X; Latham, Stephen; Lin, Haiqun; Palevsky, Paul M; Ugwuowo, Ugochukwu; Wilson, F Perry

    2018-06-07

    Electronic alerts for heterogenous conditions such as AKI may not provide benefit for all eligible patients and can lead to alert fatigue, suggesting that personalized alert targeting may be useful. Uplift-based alert targeting may be superior to purely prognostic-targeting of interventions because uplift models assess marginal treatment effect rather than likelihood of outcome. This is a secondary analysis of a clinical trial of 2278 adult patients with AKI randomized to an automated, electronic alert system versus usual care. We used three uplift algorithms and one purely prognostic algorithm, trained in 70% of the data, and evaluated the effect of targeting alerts to patients with higher scores in the held-out 30% of the data. The performance of the targeting strategy was assessed as the interaction between the model prediction of likelihood to benefit from alerts and randomization status. The outcome of interest was maximum relative change in creatinine from the time of randomization to 3 days after randomization. The three uplift score algorithms all gave rise to a significant interaction term, suggesting that a strategy of targeting individuals with higher uplift scores would lead to a beneficial effect of AKI alerting, in contrast to the null effect seen in the overall study. The prognostic model did not successfully stratify patients with regards to benefit of the intervention. Among individuals in the high uplift group, alerting was associated with a median reduction in change in creatinine of -5.3% ( P =0.03). In the low uplift group, alerting was associated with a median increase in change in creatinine of +5.3% ( P =0.005). Older individuals, women, and those with a lower randomization creatinine were more likely to receive high uplift scores, suggesting that alerts may benefit those with more slowly developing AKI. Uplift modeling, which accounts for treatment effect, can successfully target electronic alerts for AKI to those most likely to benefit, whereas purely prognostic targeting cannot. Copyright © 2018 by the American Society of Nephrology.

  17. 12 CFR 1022.121 - Active duty alerts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 8 2014-01-01 2014-01-01 false Active duty alerts. 1022.121 Section 1022.121... Consumer Reporting Agencies Regarding Identity Theft § 1022.121 Active duty alerts. (a) Duration. The duration of an active duty alert shall be twelve months. ...

  18. 12 CFR 1022.121 - Active duty alerts.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Active duty alerts. 1022.121 Section 1022.121... Consumer Reporting Agencies Regarding Identity Theft § 1022.121 Active duty alerts. (a) Duration. The duration of an active duty alert shall be twelve months. ...

  19. 78 FR 22270 - Special Fraud Alert: Physician-Owned Entities

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-15

    ...] Special Fraud Alert: Physician-Owned Entities AGENCY: Office of Inspector General (OIG), HHS. ACTION... Physician-Owned Entities. Specifically, the Special Fraud Alert addressed physician-owned entities that... publication of the Special Fraud Alert on Physician-Owned Entities, an inadvertent error appeared in the DATES...

  20. 76 FR 62321 - Airworthiness Directives; Aviation Communication & Surveillance Systems (ACSS) Traffic Alert and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-07

    ... Communication & Surveillance Systems (ACSS) Traffic Alert and Collision Avoidance System (TCAS) Units AGENCY... certain Aviation Communication & Surveillance Systems (ACSS) traffic alert and collision avoidance system...) traffic alert and collision avoidance system (TCAS) units with part numbers identified in ACSS Technical...

  1. 77 FR 26701 - Review of the Emergency Alert System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-07

    ... Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule. SUMMARY: In this document, the Federal Communications Commission (Commission) amends its rules governing the Emergency Alert... the manner in which EAS Participants must be able to receive alert messages formatted in the Common...

  2. Knowledge Integration and Use-Case Analysis for a Customized Drug-Drug Interaction CDS Service

    NASA Astrophysics Data System (ADS)

    Kam, Hye Jin; Park, Man Young; Kim, Woojae; Yoon, Duk Yong; Ahn, Eun Kyoung; Park, Rae Woong

    Clinical decision support systems (CDSSs) are thought to reduce adverse drug events (ADEs) by monitoring drug-drug interactions(DDIs). However, clinically improper or excessive alerts can result in high alert overrides. A tailored CDS service, which is appropriate for clinicians and their ordering situations, is required to increase alert acceptance. In this study, we conducted a 12-week pilot project adopting a tailed CDSS at an emergency department. The new CDSS was conducted via a stepwise integration of additional new rules. The alert status with changes in acceptance rate was analyzed. The most frequent DDI alerts were related to prescriptions of anti-inflammatory drugs. The percentages of alert overrides for each stage were 98.0%, 96.0%, 96.9%, and 98.1%, respectively. 91.5% of overridden alerts were related to discharge medications. To reduce the potential hazards of ADEs, the development of an effective customized DDI CDSS is required, via in-depth analysis on alert patterns and overridden reasons.

  3. Context-Sensitive Clinical Alert Packages Written in Arden Syntax.

    PubMed

    Zeckl, Julia; Adlassnig, Katharina; Fossler, Renate; Blacky, Alexander; de Bruin, Jeroen S; Koller, Walter; Rappelsberger, Andrea; Adlassnig, Klaus-Peter

    2017-01-01

    An increasing body of raw patient data is generated on each day of a patient's stay at a hospital. It is of paramount importance that critical patient information be extracted from these large data volumes and presented to the patient's clinical caregivers as early as possible. Contemporary clinical alert systems attempt to provide this service with moderate success. The efficacy of the systems is limited by the fact that they are too general to fit specific patient populations or healthcare institutions. In this study we present an extendable alerting framework implemented in Arden Syntax, which can be configured to the needs and preferences of healthcare institutions and individual patient caregivers. We illustrate the potential of this alerting framework via an alert package that analyzes hematological laboratory results with data from intensive care units at the Vienna General Hospital, Austria. The results show the effectiveness of this alert package and its ability to generate key alerts while avoiding over-alerting.

  4. Predicting Catastrophic BGP Routing Instabilities

    DTIC Science & Technology

    2004-03-01

    predict a BGP routing instability confine their focus to either macro- or micro -level metrics, but not to both. The inherent limitations of each of...Level and Micro -Level Metrics Correlation; Worm Attack Studies; 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY... micro -level metrics, but not to both. The inherent limitations of each of these forms of metric gives rise to an excessive rate of spurious alerts

  5. Relationship of early infant state measures to behavior over the first year of life in the tufted capuchin monkey (Cebus apella).

    PubMed

    Byrne, G; Suomi, S J

    1998-01-01

    Data on activity states were collected from 29 group-housed capuchin monkey (Cebus apella) infants for 3 h each week from birth to 11 weeks of age. The amounts of time spent in sleeping/drowsy, alert-quiet, and alert-active states were measured in these subjects. Videotaped observations of these infants were recorded 3 times/week in the home cage over the first year of life and were scored for a number of social and exploratory behaviors. The extent to which early infant activity state scores predicted later behavior in the home cage was examined. Infant state measures correlated significantly with home cage behavior during months 2-6 in that infants that had been more active in early infancy spent more time alone, with other animals, and in exploration and play and less time with mothers than did quieter infants. Early state measures were less successful in predicting home cage scores beyond 8 months of age, whereas differences in behavior attributable to housing variables became more salient in the latter part of the first year. There was also a negative correlation between mother and infant activity in months 2 and 3, in that more sedentary mothers tended to have more active infants.

  6. Electroencephalographic correlates of states of concentrative meditation.

    PubMed

    DeLosAngeles, Dylan; Williams, Graham; Burston, John; Fitzgibbon, Sean P; Lewis, Trent W; Grummett, Tyler S; Clark, C Richard; Pope, Kenneth J; Willoughby, John O

    2016-12-01

    Meditative techniques aim for and meditators report states of mental alertness and focus, concurrent with physical and emotional calm. We aimed to determine the electroencephalographic (EEG) correlates of five states of Buddhist concentrative meditation, particularly addressing a correlation with meditative level. We studied 12 meditators and 12 pair-matched meditation-naïve participants using high-resolution scalp-recorded EEG. To maximise reduction of EMG, data were pre-processed using independent component analysis and surface Laplacian transformed data. Two non-meditative and five meditative states were used: resting baseline, mind-wandering, absorptions 1, 2, 3, 4 and 5 (corresponding to four levels of absorption and an absorption with a different object of focus, otherwise equivalent to level 4; these five meditative states produce repeatable, distinctly different experiences for experienced meditators). The experimental protocol required participants to experience the states in the order listed above, followed immediately by the reverse. We then calculated EEG power in standard frequency bands from 1 to 80Hz. We observed decreases of central scalp beta (13-25Hz), and central low gamma (25-48Hz) power in meditators during deeper absorptions. In contrast, we identified increases in frontal midline and temporo-parietal theta power in meditators, again, during deeper absorptions. Alpha activity was increased over all meditative states, not depth-related. This study demonstrates that the subjective experiences of deepening meditation partially correspond to measures of EEG. Our results are in accord with prior studies on non-graded meditative states. These results are also consistent with increased theta correlating with tightness of focus, and reduced beta/gamma with the desynchronization associated with enhanced alertness. Copyright © 2016. Published by Elsevier B.V.

  7. Alert generation and cockpit presentation for an integrated microburst alerting system

    NASA Technical Reports Server (NTRS)

    Wanke, Craig; Hansman, R. John, Jr.

    1991-01-01

    Alert generation and cockpit presentation issues for low level wind shear (microburst) alerts are investigated. Alert generation issues center on the development of a hazard criterion which allows integration of both ground based and airborne wind shear detection systems to form an accurate picture of the aviation hazard posed by a particular wind shear situation. A methodology for the testing of a hazard criteria through flight simulation has been developed, and has been used to examine the effectiveness and feasibility of several possible criteria. Also, an experiment to evaluate candidate graphical cockpit displays for microburst alerts using a piloted simulator has been designed.

  8. See Also:physica status solidi (b)physica status solidi (c)Copyright © 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

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