Competitive Advantage of PET/MRI

PubMed Central

Jadvar, Hossein; Colletti, Patrick M.

2013-01-01

Multimodality imaging has made great strides in the imaging evaluation of patients with a variety of diseases. Positron emission tomography/computed tomography (PET/CT) is now established as the imaging modality of choice in many clinical conditions, particularly in oncology. While the initial development of combined PET/magnetic resonance imaging (PET/MRI) was in the preclinical arena, hybrid PET/MR scanners are now available for clinical use. PET/MRI combines the unique features of MRI including excellent soft tissue contrast, diffusion-weighted imaging, dynamic contrast-enhanced imaging, fMRI and other specialized sequences as well as MR spectroscopy with the quantitative physiologic information that is provided by PET. Most evidence for the potential clinical utility of PET/MRI is based on studies performed with side-by-side comparison or software-fused MRI and PET images. Data on distinctive utility of hybrid PET/MRI are rapidly emerging. There are potential competitive advantages of PET/MRI over PET/CT. In general, PET/MRI may be preferred over PET/CT where the unique features of MRI provide more robust imaging evaluation in certain clinical settings. The exact role and potential utility of simultaneous data acquisition in specific research and clinical settings will need to be defined. It may be that simultaneous PET/MRI will be best suited for clinical situations that are disease-specific, organ-specific, related to diseases of the children or in those patients undergoing repeated imaging for whom cumulative radiation dose must be kept as low as reasonably achievable. PET/MRI also offers interesting opportunities for use of dual modality probes. Upon clear definition of clinical utility, other important and practical issues related to business operational model, clinical workflow and reimbursement will also be resolved. PMID:23791129

Competitive advantage of PET/MRI.

PubMed

Jadvar, Hossein; Colletti, Patrick M

2014-01-01

Multimodality imaging has made great strides in the imaging evaluation of patients with a variety of diseases. Positron emission tomography/computed tomography (PET/CT) is now established as the imaging modality of choice in many clinical conditions, particularly in oncology. While the initial development of combined PET/magnetic resonance imaging (PET/MRI) was in the preclinical arena, hybrid PET/MR scanners are now available for clinical use. PET/MRI combines the unique features of MRI including excellent soft tissue contrast, diffusion-weighted imaging, dynamic contrast-enhanced imaging, fMRI and other specialized sequences as well as MR spectroscopy with the quantitative physiologic information that is provided by PET. Most evidence for the potential clinical utility of PET/MRI is based on studies performed with side-by-side comparison or software-fused MRI and PET images. Data on distinctive utility of hybrid PET/MRI are rapidly emerging. There are potential competitive advantages of PET/MRI over PET/CT. In general, PET/MRI may be preferred over PET/CT where the unique features of MRI provide more robust imaging evaluation in certain clinical settings. The exact role and potential utility of simultaneous data acquisition in specific research and clinical settings will need to be defined. It may be that simultaneous PET/MRI will be best suited for clinical situations that are disease-specific, organ-specific, related to diseases of the children or in those patients undergoing repeated imaging for whom cumulative radiation dose must be kept as low as reasonably achievable. PET/MRI also offers interesting opportunities for use of dual modality probes. Upon clear definition of clinical utility, other important and practical issues related to business operational model, clinical workflow and reimbursement will also be resolved. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Preclinical and clinical experience in vascular gene therapy: advantages over conservative/standard therapy.

PubMed

Nikol, S; Huehns, T Y

2001-04-01

No systemic pharmacological treatment has been shown to convincingly reduce the incidence of restenosis after angioplasty or increase the formation of collaterals in ischemic tissue in patients. The lack of success of many pharmaceutical agents in reducing restenosis rates or in inducing angiogenesis post-angioplasty and following stent implantation has encouraged the development of new technological treatment approaches. Gene therapy is a novel strategy with the potential to prevent some of the sequelae after arterial injury, particularly cell proliferation, and to induce growth of new vessels or remodeling of pre-existing vessel branches, which may help patients with critical ischemia. Gene therapy strategies have the advantage of minimizing systemic side effects and may have a long-term effect as the encoded protein is released. Most clinical trials investigating gene therapy for vascular disease have been uncontrolled phase I and IIa trials. Gene therapy into vessels with the genes for growth factors has been demonstrated to be feasible and efficient. Local drug delivery devices have been used in combination with gene therapy in several trials to maximize safety and efficiency. Data from experimental animal work indicates that gene therapy may modify intimal hyperplasia after arterial injury, but there are few clinical trials on restenosis in patients. Preliminary clinical results show only limited success in altering restenosis rates. In vitro and experimental in vivo investigations into gene therapy for angiogenesis demonstrate increased formation of collaterals and functional improvement of limb ischemia. There is some evidence of increased collateral formation and clinical improvement in patients with critical limb ischemia. Results of placebo-controlled and double-blind trials of gene therapy for vascular disease are awaited.

Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

PubMed

Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan

2015-01-01

The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

[Importance of clinical trial design and standardized implementation in ophthalmology].

PubMed

Xu, Xun

2013-06-01

Clinical trial is an important medical research method, as well as the bridge of translational medicine. The results of scientific evidences are useful to make clinical practice guidelines. At present,much experience of carrying out ophthalmology clinical trials has been obtained and achieved, but there are still some scientific, practical and ethical problems to be solved,because of their impact on the authenticity and reliability of the results. Therefore, attaching great importance to design of the clinical research and implement of the standardization would be the goal and the development direction. Clinical trial design rely on objective, follow international design principles on the ethics,randomization, blinding and placebo setting. During the trial implementation, personnel training,project management and monitoring would help to reduce protocol deviation and ensure data authenticity.

Clinical advantages of single port laparoscopic hepatectomy.

PubMed

Han, Jae Hyun; You, Young Kyoung; Choi, Ho Joong; Hong, Tae Ho; Kim, Dong Goo

2018-01-21

To evaluate the clinical advantages of single-port laparoscopic hepatectomy (SPLH) compare to multi-port laparoscopic hepatectomy (MPLH). We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated. Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH ( P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group ( P = 0.962). Mean operative time was 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group ( P < 0.001). The amount of blood loss was 385.1 ± 409.3 mL in the SPLH group and 559.9 ± 624.9 mL in the MPLH group ( P = 0.016). The safety resection margin did not show a significant difference (0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group (1.06 ± 0.27 d after operation) than in the MPLH group (1.63 ± 1.27 d) ( P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group (7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different ( P = 0.397) and there was no major perioperative complication or mortality case in both

The importance of intuition in the occupational medicine clinical consultation.

PubMed

Philipp, R; Philipp, E; Thorne, P

1999-01-01

Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

The Importance of Calibration in Clinical Psychology.

PubMed

Lindhiem, Oliver; Petersen, Isaac T; Mentch, Lucas K; Youngstrom, Eric A

2018-02-01

Accuracy has several elements, not all of which have received equal attention in the field of clinical psychology. Calibration, the degree to which a probabilistic estimate of an event reflects the true underlying probability of the event, has largely been neglected in the field of clinical psychology in favor of other components of accuracy such as discrimination (e.g., sensitivity, specificity, area under the receiver operating characteristic curve). Although it is frequently overlooked, calibration is a critical component of accuracy with particular relevance for prognostic models and risk-assessment tools. With advances in personalized medicine and the increasing use of probabilistic (0% to 100%) estimates and predictions in mental health research, the need for careful attention to calibration has become increasingly important.

Importance of population-based studies in clinical practice

PubMed Central

Ronnie, George; Ve, Ramesh Sathyamangalam; Velumuri, Lokapavani; Asokan, Rashima; Vijaya, Lingam

2011-01-01

In the last decade, there have been reports on the prevalence of glaucoma from the Vellore Eye Survey, Andhra Pradesh Eye Diseases Survey, Aravind Comprehensive Eye Survey, Chennai Glaucoma Study and West Bengal Glaucoma Study. Population-based studies provide important information regarding the prevalence and risk factors for glaucoma. They also highlight regional differences in the prevalence of various types of glaucoma. It is possible to gather important insights regarding the number of persons affected with glaucoma and the proportion with undiagnosed disease. We reviewed the different population-based studies from India and compare their findings. The lacunae in ophthalmic care that can be inferred from these studies are identified and possible reasons and solutions are discussed. We also discuss the clinical relevance of the various findings, and how it reflects on clinical practice in the country. Since India has a significantly high disease burden, we examine the possibility of population-based screening for disease in the Indian context. PMID:21150021

The importance of Good Clinical Practice guidelines and its role in clinical trials

PubMed Central

Vijayananthan, A; Nawawi, O

2008-01-01

Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the reasons and the need for doing so. In this paper, we address the historical background and the events that led up to the formation of these guidelines. Today, the ICH-GCP guidelines are used in clinical trials throughout the globe with the main aim of protecting and preserving human rights. PMID:21614316

Clinical supervision: an important part of every nurse's practice.

PubMed

Bifarin, Oladayo; Stonehouse, David

2017-03-23

Clinical supervision involves a supportive relationship between supervisor and supervisee that facilitates reflective learning and is part of professional socialisation. Clinical supervision can take many different forms and may be adapted to suit local circumstances. A working agreement is required between the parties to the supervision and issues surrounding confidentiality must be understood. High-quality clinical supervision leads to greater job satisfaction and less stress. When it is absent or inadequate, however, the results can be serious and it is particularly important that student nurses are well supported in this way. Further research in this area is necessary.

[Clinical importance of thyroid gland cytology].

PubMed

Ting, S; Synoracki, S; Bockisch, A; Führer, D; Schmid, K W

2015-11-01

The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.

A Study to Investigate the Advantages and Disadvantages of a Consolidated Troop Medical Clinic in the Custer Hill Area of Fort Riley, Kansas from the Viewpoint of Line Commanders and Selected Medical Personnel.

DTIC Science & Technology

1980-08-01

ADVANTAGES AND DISADVANTAGES OF A CONSOLIDATED TROOP MEDICAL ’ _0 CLINIC IN THE CUSTER HILL AREA OF FORT RILEY, KANSAS FROM THE VIEWPOINT OF LINE...A STUDY TO INVESTIGATE THE ADVANTAGES AND DISADVANTAGES OF A CONSOLIDATED TROOP MEDICAL CLINIC IN THE CUSTER HILL AREA OF FORT RILEY, KANSAS FROM THE...Continue on reverse if necessary and identify by block number) -* This study analyzes the advantages and disadvantages of combining eight area Troop

The Importance of Early Experiences: Clinical, Research, and Policy Perspectives

ERIC Educational Resources Information Center

Zeanah, Charles H.

2009-01-01

The degree to which early adverse experiences exert long term effects on development and how much early adversity may be overcome through subsequent experiences are important mental health questions. The clinical, research and policy perspectives on these questions lead to different answers. From a clinical perspective, change is always possible,…

The atypical pneumonias: clinical diagnosis and importance.

PubMed

Cunha, B A

2006-05-01

The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are

Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome.

PubMed

Kim, Jae Kwang; Park, Eun Soo

2013-05-01

Patient-reported questionnaires have been widely used to predict symptom severity and functional disability in musculoskeletal disease. Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome. We asked (1) which of Patient-Rated Wrist Evaluation (PRWE), DASH, and other physical measures was more responsive to clinical improvements, and (2) what was the minimal clinically important difference for the PRWE and DASH after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. All patients who underwent ulnar shortening osteotomy between March 2008 and February 2011 for idiopathic ulnar impaction syndrome were enrolled in this study. All patients completed the PRWE and DASH questionnaires, and all were evaluated for grip strength and wrist ROM, preoperatively and 12 months postoperatively. We compared the effect sizes observed by each of these instruments. Effect size is calculated by dividing the mean change in a score of each instrument during a specified interval by the standard deviation of the baseline score. In addition, patient-perceived overall improvement was used as the anchor to determine the minimal clinically important differences on the PRWE and DASH 12 months after surgery. The average score of each item except for wrist flexion and supination improved after surgery. The PRWE was more sensitive than the DASH or than physical measurements in detecting clinical changes. The effect sizes and standardized response means of the outcome measures were as follows: PRWE (1.51, 1.64), DASH (1.12, 1.24), grip strength (0.59, 0.68), wrist pronation (0.33, 0.41), and wrist extension (0.28, 0.36). Patient-perceived overall improvement and score changes of the PRWE and DASH correlated significantly. Minimal clinically important differences were 17 points (of a possible 100) for the PRWE and 13.5 for the DASH (also of 100), and minimal detectable changes were 7.7 points

[Diagnosing imported helminthiasis].

PubMed

Pardo, Javier; Pérez-Arellano, José Luis; Galindo, Inmaculada; Belhassen, Moncef; Cordero, Miguel; Muro, Antonio

2007-05-01

In recent years, there has been an increase in cases of imported helminthiasis in Spain because of two complementary causes: immigration and international travel. Although the prevalence of helminthiasis is high in the immigrant population, the risk of transmission to the Spanish population is low. In this review, we provide clues to aid in the diagnosis of the helminthiasis, highlighting the geographic characteristics, clinical findings and analytical results of the most frequent types. The low sensitivity of the classic parasitological diagnostic test, mainly in tissue helminthiasis, is described. In addition, the advantages and limitations of the common serological methods for detecting related circulating antigens and antibodies are presented. Certain molecular methods used in the diagnosis of imported helminthiasis and the best strategies for screening of this condition are discussed.

Linking the Tinnitus Questionnaire and the subjective Clinical Global Impression: Which differences are clinically important?

PubMed Central

2012-01-01

Background Development of new tinnitus treatments requires prospective placebo-controlled randomized trials to prove their efficacy. The Tinnitus Questionnaire (TQ) is a validated and commonly used instrument for assessment of tinnitus severity and has been used in many clinical studies. Defining the Minimal Clinically Important Difference (MCID) for TQ changes is an important step to a better interpretation of the clinical relevance of changes observed in clinical trials. In this study we aimed to estimate the minimum change of the TQ score that could be considered clinically relevant. Methods 757 patients with chronic tinnitus were pooled from the TRI database and the RESET study. An anchor-based approach using the Clinical Global Impression (CGI) scale and distributional approaches were used to estimate MCID. Receiver Operating Characteristic (ROC) curves were calculated to define optimal TQ change cutoffs discriminating between minimally changed and unchanged subjects. Results The relationship between TQ change scores and CGI ratings of change was good (r = 0.52, p < 0.05). Mean change scores associated with minimally better and minimally worse CGI categories were −6.65 and +2.72 respectively. According to the ROC method MCID for improvement was −5 points and for deterioration +1 points. Conclusion Distribution and anchor-based methods yielded comparable results in identifying MCIDs. ΔTQ scores of −5 and +1 points were identified as the minimal clinically relevant change for improvement and worsening respectively. The asymmetry of the MCIDs for improvement and worsening may be related to expectation effects. PMID:22781703

Loneliness: Clinical Import and Interventions

PubMed Central

Cacioppo, Stephanie; Grippo, Angela J.; London, Sarah; Goossens, Luc; Cacioppo, John T.

2014-01-01

In 1978, when the Task Panel report to the US President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. A meta-analysis (Masi et al., 2011) on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation of maladaptive social cognition. We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, there is increasing evidence for the potential efficacy of integrated interventions that combine (social) cognitive behavioral therapy with short-term adjunctive pharmacological treatments. PMID:25866548

77 FR 72409 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

... Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34 (a), this is notice that on October 16, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... import the listed controlled substance for analytical research and clinical trials. The import of the...

Approaches for estimating minimal clinically important differences in systemic lupus erythematosus.

PubMed

Rai, Sharan K; Yazdany, Jinoos; Fortin, Paul R; Aviña-Zubieta, J Antonio

2015-06-03

A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research.

Importance of Pharmaceutical Training and Clinical Research at Medical Facilities.

PubMed

Myotoku, Michiaki

2017-01-01

To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

Advantages of semiconductor CZT for medical imaging

NASA Astrophysics Data System (ADS)

Wagenaar, Douglas J.; Parnham, Kevin; Sundal, Bjorn; Maehlum, Gunnar; Chowdhury, Samir; Meier, Dirk; Vandehei, Thor; Szawlowski, Marek; Patt, Bradley E.

2007-09-01

Cadmium zinc telluride (CdZnTe, or CZT) is a room-temperature semiconductor radiation detector that has been developed in recent years for a variety of applications. CZT has been investigated for many potential uses in medical imaging, especially in the field of single photon emission computed tomography (SPECT). CZT can also be used in positron emission tomography (PET) as well as photon-counting and integration-mode x-ray radiography and computed tomography (CT). The principal advantages of CZT are 1) direct conversion of x-ray or gamma-ray energy into electron-hole pairs; 2) energy resolution; 3) high spatial resolution and hence high space-bandwidth product; 4) room temperature operation, stable performance, high density, and small volume; 5) depth-of-interaction (DOI) available through signal processing. These advantages will be described in detail with examples from our own CZT systems. The ability to operate at room temperature, combined with DOI and very small pixels, make the use of multiple, stationary CZT "mini-gamma cameras" a realistic alternative to today's large Anger-type cameras that require motion to obtain tomographic sampling. The compatibility of CZT with Magnetic Resonance Imaging (MRI)-fields is demonstrated for a new type of multi-modality medical imaging, namely SPECT/MRI. For pre-clinical (i.e., laboratory animal) imaging, the advantages of CZT lie in spatial and energy resolution, small volume, automated quality control, and the potential for DOI for parallax removal in pinhole imaging. For clinical imaging, the imaging of radiographically dense breasts with CZT enables scatter rejection and hence improved contrast. Examples of clinical breast images with a dual-head CZT system are shown.

Multipotent Mesenchymal Stromal Stem Cell Expansion by Plating Whole Bone Marrow at a Low Cellular Density: A More Advantageous Method for Clinical Use

PubMed Central

Mareschi, Katia; Rustichelli, Deborah; Calabrese, Roberto; Gunetti, Monica; Sanavio, Fiorella; Castiglia, Sara; Risso, Alessandra; Ferrero, Ivana; Tarella, Corrado; Fagioli, Franca

2012-01-01

Mesenchymal stem cells (MSCs) are a promising source for cell therapy due to their pluripotency and immunomodulant proprieties. As the identification of “optimal” conditions is important to identify a standard procedure for clinical use. Percoll, Ficoll and whole bone marrow directly plated were tested from the same sample as separation methods. The cells were seeded at the following densities: 100 000, 10 000, 1000, 100, 10 cells/cm2. After reaching confluence, the cells were detached, pooled and re-plated at 1000, 500, 100, and 10 cells/cm2. Statistical analyses were performed. Cumulative Population Doublings (PD) did not show significant differences for the separation methods and seeding densities but only for the plating density. Some small quantity samples plated in T25 flasks at plating densities of 10 and 100 cells/cm2 did not produce any expansion. However, directly plated whole bone marrow resulted in a more advantageous method in terms of CFU-F number, cellular growth and minimal manipulation. No differences were observed in terms of gross morphology, differentiation potential or immunophenotype. These data suggest that plating whole bone marrow at a low cellular density may represent a good procedure for MSC expansion for clinical use. PMID:23715383

Mobile Device-Based Electronic Data Capture System Used in a Clinical Randomized Controlled Trial: Advantages and Challenges.

PubMed

Zhang, Jing; Sun, Lei; Liu, Yu; Wang, Hongyi; Sun, Ningling; Zhang, Puhong

2017-03-08

Electronic data capture (EDC) systems have been widely used in clinical research, but mobile device-based electronic data capture (mEDC) system has not been well evaluated. The aim of our study was to evaluate the feasibility, advantages, and challenges of mEDC in data collection, project management, and telemonitoring in a randomized controlled trial (RCT). We developed an mEDC to support an RCT called "Telmisartan and Hydrochlorothiazide Antihypertensive Treatment (THAT)" study, which was a multicenter, double-blinded, RCT, with the purpose of comparing the efficacy of telmisartan and hydrochlorothiazide (HCTZ) monotherapy in high-sodium-intake patients with mild to moderate hypertension during a 60 days follow-up. Semistructured interviews were conducted during and after the trial to evaluate the feasibility, advantage, and challenge of mEDC. Nvivo version 9.0 (QSR International) was used to analyze records of interviews, and a thematic framework method was used to obtain outcomes. The mEDC was successfully used to support the data collection and project management in all the 14 study hospitals. A total of 1333 patients were recruited with support of mEDC, of whom 1037 successfully completed all 4 visits. Across all visits, the average time needed for 141 questions per patient was 53 min, which were acceptable to both doctors and patients. All the interviewees, including 24 doctors, 53 patients, 1 clinical research associate (CRA), 1 project manager (PM), and 1 data manager (DM), expressed their satisfaction to nearly all the functions of the innovative mEDC in randomization, data collection, project management, quality control, and remote monitoring in real time. The average satisfaction score was 9.2 (scale, 0-10). The biggest challenge came from the stability of the mobile or Wi-Fi signal although it was not a problem in THAT study. The innovative mEDC has many merits and is well acceptable in supporting data collection and project management in a timely

Birth cohorts in Asia: The importance, advantages, and disadvantages of different-sized cohorts.

PubMed

Kishi, Reiko; Araki, Atsuko; Minatoya, Machiko; Itoh, Sachiko; Goudarzi, Houman; Miyashita, Chihiro

2018-02-15

Asia contains half of the world's children, and the countries of Asia are the most rapidly industrializing nations on the globe. Environmental threats to the health of children in Asia are myriad. Several birth cohorts were started in Asia in early 2000, and currently more than 30 cohorts in 13 countries have been established for study. Cohorts can contain from approximately 100-200 to 20,000-30,000 participants. Furthermore, national cohorts targeting over 100,000 participants have been launched in Japan and Korea. The aim of this manuscript is to discuss the importance of Asian cohorts, and the advantages and disadvantages of different-sized cohorts. As for case, one small-sized (n=514) cohort indicate that even relatively low level exposure to dioxin in utero could alter birth size, neurodevelopment, and immune and hormonal functions. Several Asian cohorts focus prenatal exposure to perfluoroalkyo substances and reported associations with birth size, thyroid hormone levels, allergies and neurodevelopment. Inconsistent findings may possibly be explained by the differences in exposure levels and target chemicals, and by possible statistical errors. In a smaller cohort, novel hypotheses or preliminary examinations are more easily verifiable. In larger cohorts, the etiology of rare diseases, such as birth defects, can be analyzed; however, they require a large cost and significant human resources. Therefore, conducting studies in only one large cohort may not always be the best strategy. International collaborations, such as the Birth Cohort Consortium of Asia, would cover the inherent limitation of sample size in addition to heterogeneity of exposure, ethnicity, and socioeconomic conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

Home advantage in Greek football.

PubMed

Armatas, Vasilis; Pollard, Richard

2014-01-01

Home advantage as it relates to team performance at football was examined in Superleague Greece using nine seasons of game-by-game performance data, a total of 2160 matches. After adjusting for team ability and annual fluctuations in home advantage, there were significant differences between teams. Previous findings regarding the role of territorial protection were strengthened by the fact that home advantage was above average for the team from Xanthi (P =0.015), while lower for teams from the capital city Athens (P =0.008). There were differences between home and away teams in the incidence of most of the 13 within-game match variables, but associated effect sizes were only moderate. In contrast, outcome ratios derived from these variables, and measuring shot success, had negligible effect sizes. This supported a previous finding that home and away teams differed in the incidence of on-the-ball behaviours, but not in their outcomes. By far the most important predictor of home advantage, as measured by goal difference, was the difference between home and away teams in terms of kicked shots from inside the penalty area. Other types of shots had little effect on the final score. The absence of a running track between spectators and the playing field was also a significant predictor of goal difference, worth an average of 0.102 goals per game to the home team. Travel distance did not affect home advantage.

Teaching Medical Students the Important Connection between Communication and Clinical Reasoning

PubMed Central

Windish, Donna M; Price, Eboni G; Clever, Sarah L; Magaziner, Jeffrey L; Thomas, Patricia A

2005-01-01

Background Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. Objective To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. Design In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. Participants Second-year medical students. Measurements All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. Results Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing ≥1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. Conclusions Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical

The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory.

PubMed

Malec, James F; Kean, Jacob; Monahan, Patrick O

To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.

Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes.

PubMed

Fernandes, Ricardo M; Andrade, Maria Gabriela; Constant, Carolina; Malveiro, Duarte; Magalhães, Manuel; Abreu, Daisy; Azevedo, Inês; Sousa, Eduarda; Salgado, Rizério; Bandeira, Teresa

2016-07-01

Two key limitations hamper intervention research in bronchiolitis: the absence of a clear definition of disease, and the heterogeneous choice of outcome measures in current clinical trials. We assessed how paediatricians and general practitioners (GPs) perceived definition and clinically important outcomes in bronchiolitis. A nationwide online survey (ABBA study) was conducted through the Portuguese Society of Paediatrics and GPs' mailing lists. We assessed agreement with statements on bronchiolitis definition, and participants were asked to score the relative importance of several outcomes. Principal component analysis (PCA) explored dimensions underlying disease definition. Outcomes were ranked by mean score and proportion given highest score. We included 514 paediatricians and 165 GPs (overall 59% were board-certified). Most paediatricians (76.5%) agreed with a definition based on coryza, wheezing and/or crackles/rales, compared to 38.1% GPs (P < 0.001). Less than 5% physicians agreed with a definition commonly used in clinical trials (<12 months, first episode of wheeze). We retained three dimensions on PCA: one based on coryza, rales/crepitations and no sudden onset; another on number of episodes and age; and a third on wheeze. Dimensions varied by physician specialization and training (P < 0.01). Hospital admission and respiratory distress were top rated outcomes by both groups of physicians. Physician definitions of bronchiolitis have considerable variability and often mismatch those of clinical trials. Rating of important outcomes was consistent. Our results highlight the need for a robust standardized definition of acute bronchiolitis in infants and support the development of a core outcome set for future clinical trials. Pediatr Pulmonol. 2016;51:724-732. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Investigative safety science as a competitive advantage for Pharma.

PubMed

Moggs, Jonathan; Moulin, Pierre; Pognan, Francois; Brees, Dominique; Leonard, Michele; Busch, Steve; Cordier, Andre; Heard, David J; Kammüller, Michael; Merz, Michael; Bouchard, Page; Chibout, Salah-Dine

2012-09-01

Following a US National Academy of Sciences report in 2007 entitled "Toxicity Testing of the 21st Century: a Vision and a Strategy," significant advances within translational drug safety sciences promise to revolutionize drug discovery and development. The purpose of this review is to outline why investigative safety science is a competitive advantage for the pharmaceutical industry. The article discusses the essential goals for modern investigative toxicologists including: cross-species target biology; molecular pathways of toxicity; and development of predictive tools, models and biomarkers that allow discovery researchers and clinicians to anticipate safety problems and plan ways to address them, earlier than ever before. Furthermore, the article emphasizes the importance of investigating unanticipated clinical safety signals through a combination of mechanistic preclinical studies and/or molecular characterization of clinical samples from affected organs. The traditional boundaries between pharma industry teams focusing on safety/efficacy and preclinical/clinical development are rapidly disappearing in favor of translational safety science-centric organizations with a vision of bringing more effective medicines forward safely and quickly. Comparative biology and mechanistic toxicology approaches facilitate: i) identifying translational safety biomarkers; ii) identifying new drug targets/indications; and iii) mitigating off-target toxicities. These value-adding safety science contributions will change traditional toxicologists from side-effect identifiers to drug development enablers.

Optimizer convergence and local minima errors and their clinical importance

NASA Astrophysics Data System (ADS)

Jeraj, Robert; Wu, Chuan; Mackie, Thomas R.

2003-09-01

Two of the errors common in the inverse treatment planning optimization have been investigated. The first error is the optimizer convergence error, which appears because of non-perfect convergence to the global or local solution, usually caused by a non-zero stopping criterion. The second error is the local minima error, which occurs when the objective function is not convex and/or the feasible solution space is not convex. The magnitude of the errors, their relative importance in comparison to other errors as well as their clinical significance in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP) were investigated. Two inherently different optimizers, a stochastic simulated annealing and deterministic gradient method were compared on a clinical example. It was found that for typical optimization the optimizer convergence errors are rather small, especially compared to other convergence errors, e.g., convergence errors due to inaccuracy of the current dose calculation algorithms. This indicates that stopping criteria could often be relaxed leading into optimization speed-ups. The local minima errors were also found to be relatively small and typically in the range of the dose calculation convergence errors. Even for the cases where significantly higher objective function scores were obtained the local minima errors were not significantly higher. Clinical evaluation of the optimizer convergence error showed good correlation between the convergence of the clinical TCP or NTCP measures and convergence of the physical dose distribution. On the other hand, the local minima errors resulted in significantly different TCP or NTCP values (up to a factor of 2) indicating clinical importance of the local minima produced by physical optimization.

Optimizer convergence and local minima errors and their clinical importance.

PubMed

Jeraj, Robert; Wu, Chuan; Mackie, Thomas R

2003-09-07

Two of the errors common in the inverse treatment planning optimization have been investigated. The first error is the optimizer convergence error, which appears because of non-perfect convergence to the global or local solution, usually caused by a non-zero stopping criterion. The second error is the local minima error, which occurs when the objective function is not convex and/or the feasible solution space is not convex. The magnitude of the errors, their relative importance in comparison to other errors as well as their clinical significance in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP) were investigated. Two inherently different optimizers, a stochastic simulated annealing and deterministic gradient method were compared on a clinical example. It was found that for typical optimization the optimizer convergence errors are rather small, especially compared to other convergence errors, e.g., convergence errors due to inaccuracy of the current dose calculation algorithms. This indicates that stopping criteria could often be relaxed leading into optimization speed-ups. The local minima errors were also found to be relatively small and typically in the range of the dose calculation convergence errors. Even for the cases where significantly higher objective function scores were obtained the local minima errors were not significantly higher. Clinical evaluation of the optimizer convergence error showed good correlation between the convergence of the clinical TCP or NTCP measures and convergence of the physical dose distribution. On the other hand, the local minima errors resulted in significantly different TCP or NTCP values (up to a factor of 2) indicating clinical importance of the local minima produced by physical optimization.

Graduate admissions in clinical neuropsychology: the importance of undergraduate training.

PubMed

Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W

2013-11-01

Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

Lipoprotein(a): Biology and Clinical Importance

PubMed Central

McCormick, Sally P A

2004-01-01

Lipoprotein(a) [Lp(a)] is a unique lipoprotein that has emerged as an independent risk factor for developing vascular disease. Plasma Lp(a) levels above the common cut-off level of 300 mg/L place individuals at risk of developing heart disease particularly if combined with other lipid and thrombogenic risk factors. Studies in humans have shown Lp(a) levels to be hugely variable and under strict genetic control, largely by the apolipoprotein(a) [apo(a)] gene. In general, Lp(a) levels have proven difficult to manipulate, although some factors have been identified that can influence levels. Research has shown that Lp(a) has a high affinity for the arterial wall and displays many athero-thrombogenic properties. While a definite function for Lp(a) has not been identified, the last two decades of research have provided much information on the biology and clinical importance of Lp(a). PMID:18516206

Testosterone, territoriality, and the 'home advantage'.

PubMed

Neave, Nick; Wolfson, Sandy

2003-02-01

The consistently better performance seen by teams in various sporting contexts when playing at home is referred to as the 'home advantage'. Various explanations have been put forward to account for this robust phenomenon, though none has yet focussed on possible hormonal factors. In an initial study, we showed that salivary testosterone levels in soccer players were significantly higher before a home game than an away game.In a second study involving a different group of soccer players, this finding was replicated over two home games, two away games, and three training sessions. Perceived rivalry of the opposing team was important as testosterone levels were higher before playing an 'extreme' rival than a 'moderate' rival. Self-reported measures of mood in both studies were not linked to testosterone level. The present results corroborate and extend earlier findings on the relationships between testosterone, territoriality, and dominance in human competitive encounters and further suggest an important role for testosterone in the home advantage seen in various team sports.

Advantages of Aging.

ERIC Educational Resources Information Center

Palmore, Erdman

1979-01-01

There are at least 14 advantages of aging. Advantages to society of older persons include their lower criminal activity; greater political participation; increasing voluntary organization participation; work abilities; and visual perception abilities. Advantages for the individual include less criminal victimization; fewer accidents; social…

HOW MUCH FAVORABLE SELECTION IS LEFT IN MEDICARE ADVANTAGE?

PubMed Central

PRICE, MARY; MCWILLIAMS, J. MICHAEL; HSU, JOHN; MCGUIRE, THOMAS G.

2015-01-01

The health economics literature contains two models of selection, one with endogenous plan characteristics to attract good risks and one with fixed plan characteristics; neither model contains a regulator. Medicare Advantage, a principal example of selection in the literature, is, however, subject to anti-selection regulations. Because selection causes economic inefficiency and because the historically favorable selection into Medicare Advantage plans increased government cost, the effectiveness of the anti-selection regulations is an important policy question, especially since the Medicare Advantage program has grown to comprise 30 percent of Medicare beneficiaries. Moreover, similar anti-selection regulations are being used in health insurance exchanges for those under 65. Contrary to earlier work, we show that the strengthened anti-selection regulations that Medicare introduced starting in 2004 markedly reduced government overpayment attributable to favorable selection in Medicare Advantage. At least some of the remaining selection is plausibly related to fixed plan characteristics of Traditional Medicare versus Medicare Advantage rather than changed selection strategies by Medicare Advantage plans. PMID:26389127

Connecting Classroom, Clinic, and Context: Clinical Reasoning Strategies for Clinical Instructors and Academic Faculty.

PubMed

Furze, Jennifer; Kenyon, Lisa K; Jensen, Gail M

2015-01-01

Clinical reasoning is an essential skill in pediatric physical therapist (PT) practice. As such, explicit instruction in clinical reasoning should be emphasized in PT education. This article provides academic faculty and clinical instructors with an overview of strategies to develop and expand the clinical reasoning capacity of PT students within the scope of pediatric PT practice. Achieving a balance between deductive reasoning strategies that provide a framework for thinking and inductive reasoning strategies that emphasize patient factors and the context of the clinical situation is an important variable in educational pedagogy. Consideration should be given to implementing various teaching and learning approaches across the curriculum that reflect the developmental level of the student(s). Deductive strategies may be helpful early in the curriculum, whereas inductive strategies are often advantageous after patient interactions; however, exposure to both is necessary to fully develop the learner's clinical reasoning abilities. For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A87.

Polyhexamethylene guanidine hydrochloride shows bactericidal advantages over chlorhexidine digluconate against ESKAPE bacteria.

PubMed

Zhou, Zhongxin; Wei, Dafu; Lu, Yanhua

2015-01-01

More information regarding the bactericidal properties of polyhexamethylene guanidine hydrochloride (PHMG) against clinically important antibiotic-resistant ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens needs to be provided for its uses in infection control. The bactericidal properties of PHMG and chlorhexidine digluconate (CHG) were compared based on their minimum inhibitory concentrations (MICs), minimum bactericidal concentrations, and time-course-killing curves against clinically important antibiotic-susceptible and antibiotic-resistant ESKAPE pathogens. Results showed that PHMG exhibited significantly higher bactericidal activities against methicillin-resistant Staphylococcus aureus, carbapenem-resistant Klebsiella pneumoniae, and ceftazidime-resistant Enterobacter spp. than CHG. A slight bactericidal advantage over CHG was obtained against vancomycin-resistant Enterococcus faecium, ciprofloxacin- and levofloxacin-resistant Acinetobacter spp., and multidrug-resistant Pseudomonas aeruginosa. In previous reports, PHMG had higher antimicrobial activity against almost all tested Gram-negative bacteria and several Gram-positive bacteria than CHG using MIC test. These studies support the further development of covalently bound PHMG in sterile-surface materials and the incorporation of PHMG in novel disinfectant formulas. © 2014 International Union of Biochemistry and Molecular Biology, Inc.

Minimal clinically important difference in the fibromyalgia impact questionnaire.

PubMed

Bennett, Robert M; Bushmakin, Andrew G; Cappelleri, Joseph C; Zlateva, Gergana; Sadosky, Alesia B

2009-06-01

The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories. Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor. A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to <39 was found to represent a mild effect, >or= 39 to <59 a moderate effect, and >or=59 to 100 a severe effect. The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

Head and Neck Cancers: Advantages of Advanced Radiation Therapy and Importance of Supportive Care.

PubMed

Spencer, Sharon

2018-05-01

For more than a decade, the incidence of head and neck cancers has been increasing in the United States. Worldwide, they are the ninth most common cancer. Today, newer advances in radiotherapy (RT), such as fractionation, 4-dimensional cone-beam CT, and intensity-modulated RT, have provided clinicians with the opportunity for improved patient outcomes. At the NCCN 23rd Annual Conference, Sharon Spencer, MD, described the advantages of advances in RT and the means to mitigate untoward side effects. Copyright © 2018 by the National Comprehensive Cancer Network.

78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... Registration; Fisher Clinical Services, Inc. By Notice dated November 1, 2012, and published in the Federal Register on November 9, 2012, 77 FR 67396, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... plans to import the listed controlled substance to conduct clinical trials. No comments or objections...

The attitudes of medical students in Europe toward the clinical importance of embryology.

PubMed

Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Standley, Henrietta; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Chirculescu, Andy

2016-03-01

Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession. © 2015 Wiley Periodicals, Inc.

77 FR 75670 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services,Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-21

... Registration; Fisher Clinical Services,Inc. By Notice dated September 20, 2012, and published in the Federal Register on October 2, 2012, 77 FR 60143, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... company plans to import the listed substances for analytical research and clinical trials. No comments or...

The attitudes of medical students in Europe toward the clinical importance of histology.

PubMed

Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Kucera, Tomas; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Scholz, Michael; Paulsen, Friedrich; Luis Bueno-López, José; Alfonso Arraez Aybar, Luis; De Caro, Raffaele; Arsic, Stojanka; Lignier, Baptiste; Chirculescu, Andy

2017-07-01

Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Inquiry: the pedagogical importance of a skill central to clinical practice.

PubMed

Barrows, H S

1990-01-01

The skill of inquiry is central to the task of the doctor confronted with a patient problem. Despite its importance this skill is not given appropriate emphasis in the education of medical students or in research concerning the clinical reasoning skills of doctors.

Women's Heart Advantage Program: the impact 3 years later.

PubMed

Gombeski, William R; Kramer, R Kyle; Freed, Lisa; Foody, JoAnne; Parkosewich, Janet; Wilson, Tammi; Wack, Jeffery T; D'Onofrio, Gail

2005-01-01

Yale-New Haven Hospital, in partnership with Voluntary Hospital Association (VHA Inc), launched the Women's Heart Advantage program in March 2001. Major program components implemented include (1) a comprehensive initial and ongoing internal communication program; (2) a health promotion initiative including a 24-hour, 7-days-a-week women's heart line staffed by nurses and an Internet health question-and-answer forum; (3) significant ongoing communication with nurses and physicians; (4) a community outreach effort to educate poor and minority women; and (5) an aggressive effort to secure financial partners to underwrite the cost of the program. Before launching the program, a telephone survey of 300 randomly selected New Haven County women ages 40 to 70 years was initiated in January 2001 and repeated in January 2002, 2003, and 2004. Findings include (1) the percentage of women who recognize heart disease as the number-one killer of women their age increased from 26% in 2001 to 59% in 2004, (2) the percentage of women who would call 9-1-1 or go directly to a hospital emergency department increased from 63% in 2002 to 83% in 2004, and (3) the percentage of women aware of recent Women's Heart Advantage program promotion grew from 33% in 2002 to 50% in 2004. Perhaps most importantly, the number of women with heart problems admitted through the hospital's emergency department increased from 1528 per year in 2001 to 1870 per year in 2004 (7.5% annual increase), whereas the number of men with heart problems admitted through the emergency department during the same time period has been relatively low (0.8% annual increase). By linking clinical, public health, and marketing expertise along with finding ways to partner with other organizations, the Women's Heart Advantage program has contributed to remarkable changes in women's awareness, knowledge, and behaviors, suggesting a model for approaching similar health-related problems.

Clinically important drug interactions with zopiclone, zolpidem and zaleplon.

PubMed

Hesse, Leah M; von Moltke, Lisa L; Greenblatt, David J

2003-01-01

Insomnia, an inability to initiate or maintain sleep, affects approximately one-third of the American population. Conventional benzodiazepines, such as triazolam and midazolam, were the treatment of choice for short-term insomnia for many years but are associated with adverse effects such as rebound insomnia, withdrawal and dependency. The newer hypnosedatives include zolpidem, zaleplon and zopiclone. These agents may be preferred over conventional benzodiazepines to treat short-term insomnia because they may be less likely to cause significant rebound insomnia or tolerance and are as efficacious as the conventional benzodiazepines. This review aims to summarise the published clinical drug interaction studies involving zolpidem, zaleplon and zopiclone. The pharmacokinetic and pharmacodynamic interactions that may be clinically important are highlighted. Clinical trials have studied potential interactions of zaleplon, zolpidem and zopiclone with the following types of drugs: cytochrome P450 (CYP) inducers (rifampicin), CYP inhibitors (azoles, ritonavir and erythromycin), histamine H(2) receptor antagonists (cimetidine and ranitidine), antidepressants, antipsychotics, antagonists of benzodiazepines and drugs causing sedation. Rifampicin significantly induced the metabolism of the newer hypnosedatives and decreased their sedative effects, indicating that a dose increase of these agents may be necessary when they are administered with rifampicin. Ketoconazole, erythromycin and cimetidine inhibited the metabolism of the newer hypnosedatives and enhanced their sedative effects, suggesting that a dose reduction may be required. Addition of ethanol to treatment with the newer hypnosedatives resulted in additive sedative effects without altering the pharmacokinetic parameters of the drugs. Compared with some of the conventional benzodiazepines, fewer clinically important interactions appear to have been reported in the literature with zaleplon, zolpidem and zopiclone. The

Home Field Advantage Calculation for Physical Education and Sport Students

ERIC Educational Resources Information Center

Inan, Tugbay

2018-01-01

It is a well-established fact that playing at home field is an advantageous condition for professional sport teams. For this reason, the home field advantage in team sports is an important issue to be explored. It is also one of the different topics that physical education and sports students can use when they want to perform performance analysis…

Publicly funded practice-oriented clinical trials: of importance for healthcare payers.

PubMed

Neyt, Mattias; Christiaens, Thierry; Demotes, Jacques; Walley, Tom; Hulstaert, Frank

2016-11-01

Many questions of relevance to patients/society are not answered by industry-sponsored clinical trials. We consider whether there are benefits to governments in funding practice-oriented clinical trials. A literature search including publications on institutions' websites was performed and supplemented with information gathered from (inter)national stakeholders. Areas were identified where public funding of clinical trials is of importance for society, such as head-to-head comparisons or medical areas where companies have no motivation to invest. The available literature suggests publicly funded research programs could provide a positive return on investment. The main hurdles (e.g., sufficient funding and absence of equipoise) and success factors (e.g., selection of research questions and research infrastructure) for the successful conduct of publicly funded trials were identified. Governments should see public funding of pragmatic practice-oriented clinical trials as a good opportunity to improve the selection and quality of treatments and stimulate efficient use of limited resources.

Minimal Clinically Important Difference: A Review of Outcome Measure Score Interpretation.

PubMed

Engel, Lisa; Beaton, Dorcas E; Touma, Zahi

2018-05-01

Clinicians, researchers, and outcome stakeholders have the crucial, albeit difficult, task of quantifying when a person or group experiences important change or difference on any given outcome measure, often in response to a specific intervention. The minimal clinically important difference (MCID) provides this quantified value of change/difference for a measure. There are many methods for MCID derivation, which can result in multiple values for the same measure. Thus, it is important for potential users of MCID values to be aware of the nuances of MCID development and cautions for interpreting values. This review outlines MCID-related definitions, methods, and guidelines. Copyright © 2018 Elsevier Inc. All rights reserved.

Emerging souvenirs-clinical presentation of the returning traveller with imported arbovirus infections in Europe.

PubMed

Eckerle, I; Briciu, V T; Ergönül, Ö; Lupşe, M; Papa, A; Radulescu, A; Tsiodras, S; Tsitou, C; Drosten, C; Nussenblatt, V R; Reusken, C B; Sigfrid, L A; Beeching, N J

2018-03-01

Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a nonspecific febrile illness that may be accompanied by rash, arthralgia and arthritis, with or without neurological or haemorrhagic syndromes. The range of differential diagnoses of other infectious and noninfectious aetiologies is broad, presenting a challenge for physicians. While knowledge of the geographical distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the nonspecific and variable clinical presentation can delay final diagnosis. This narrative review aims to summarize the main clinical and laboratory-based findings of the three most common imported arboviruses in Europe. Evidence is extracted from published literature and clinical expertise of European arbovirus experts. We present three cases that highlight similarities and differences between some of the most common travel-related arboviruses imported to Europe. These include a patient with chikungunya virus infection presenting in Greece, a case of dengue fever in Turkey and a travel-related case of Zika virus infection in Romania. Early diagnosis of travel-imported cases is important to reduce the risk of localized outbreaks of tropical arboviruses such as dengue and chikungunya and the risk of local transmission from body fluids or vertical transmission. Given the global relevance of arboviruses and the continuous risk of (re)emerging arbovirus events, clinicians should be aware of the clinical syndromes of arbovirus fevers and the potential pitfalls in diagnosis. Copyright © 2018. Published by Elsevier Ltd.

Decision support and data warehousing tools boost competitive advantage.

PubMed

Waldo, B H

1998-01-01

The ability to communicate across the care continuum is fast becoming an integral component of the successful health enterprise. As integrated delivery systems are formed and patient care delivery is restructured, health care professionals must be able to distribute, access, and evaluate information across departments and care settings. The Aberdeen Group, a computer and communications research and consulting organization, believes that "the single biggest challenge for next-generation health care providers is to improve on how they consolidate and manage information across the continuum of care. This involves building a strategic warehouse of clinical and financial information that can be shared and leveraged by health care professionals, regardless of the location or type of care setting" (Aberdeen Group, Inc., 1997). The value and importance of data and systems integration are growing. Organizations that create a strategy and implement DSS tools to provide decision-makers with the critical information they need to face the competition and maintain quality and costs will have the advantage.

Advantages of robotics in benign gynecologic surgery.

PubMed

Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin

2016-08-01

The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes. Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign

The challenges, advantages and future of phenome-wide association studies.

PubMed

Hebbring, Scott J

2014-02-01

Over the last decade, significant technological breakthroughs have revolutionized human genomic research in the form of genome-wide association studies (GWASs). GWASs have identified thousands of statistically significant genetic variants associated with hundreds of human conditions including many with immunological aetiologies (e.g. multiple sclerosis, ankylosing spondylitis and rheumatoid arthritis). Unfortunately, most GWASs fail to identify clinically significant associations. Identifying biologically significant variants by GWAS also presents a challenge. The GWAS is a phenotype-to-genotype approach. As a complementary/alternative approach to the GWAS, investigators have begun to exploit extensive electronic medical record systems to conduct a genotype-to-phenotype approach when studying human disease - specifically, the phenome-wide association study (PheWAS). Although the PheWAS approach is in its infancy, this method has already demonstrated its capacity to rediscover important genetic associations related to immunological diseases/conditions. Furthermore, PheWAS has the advantage of identifying genetic variants with pleiotropic properties. This is particularly relevant for HLA variants. For example, PheWAS results have demonstrated that the HLA-DRB1 variant associated with multiple sclerosis may also be associated with erythematous conditions including rosacea. Likewise, PheWAS has demonstrated that the HLA-B genotype is not only associated with spondylopathies, uveitis, and variability in platelet count, but may also play an important role in other conditions, such as mastoiditis. This review will discuss and compare general PheWAS methodologies, describe both the challenges and advantages of the PheWAS, and provide insight into the potential directions in which PheWAS may lead. © 2013 The Authors. Immunology Published by John Wiley & Sons Ltd.

Physiological advantages of C4 grasses in the field: a comparative experiment demonstrating the importance of drought

PubMed Central

Taylor, Samuel H; Ripley, Brad S; Martin, Tarryn; De-Wet, Leigh-Ann; Woodward, F Ian; Osborne, Colin P

2014-01-01

are important for understanding the advantages of C4 photosynthesis under field conditions. PMID:24677339

Physiological advantages of C4 grasses in the field: a comparative experiment demonstrating the importance of drought.

PubMed

Taylor, Samuel H; Ripley, Brad S; Martin, Tarryn; De-Wet, Leigh-Ann; Woodward, F Ian; Osborne, Colin P

2014-06-01

important for understanding the advantages of C4 photosynthesis under field conditions. © 2014 The Authors Global Change Biology Published by John Wiley & Sons Ltd.

Medicare Advantage Plans

MedlinePlus

... enrollment Find & compare doctors, hospitals, & other providers Medicare Advantage Plans A type of Medicare health plan offered ... a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and ...

Launching a medicare advantage plan: smart planning saves headaches.

PubMed

Abrams, Robert J; Mullaney, Teri L

2007-11-01

If you're considering setting up a Medicare Advantage plan, the following are important considerations: Financial analysis. Payment rates. Medical costs. Marketing and operational costs. Technology infrastructure. Staffing.

Continuous quality improvement for the clinical decision unit.

PubMed

Mace, Sharon E

2004-01-01

Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

[Clinical analysis of two cases of imported children Zika virus infection in China].

PubMed

Zheng, C G; Xu, Y; Jiang, H Q; Yin, Y X; Zhang, J H; Zhu, W J; Liang, X J; Chen, M X; Ye, J W; Tan, L M; Luo, D; Gong, S T

2016-05-01

To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China. A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong. Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome. At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

Rural Development: Problems and Advantages of Rural Locations for Industrial Plants.

ERIC Educational Resources Information Center

Bishop, C. E.; And Others

The problems and advantages of locating industry in a rural setting were discussed in this conference report. The 10 individual speeches covered: changes in employment and the labor force; problems and advantages of rural locations, rural labor, and site selection; the importance of involving the Black community; the nature of the food processing…

The Importance of Considering Clinical Utility in the Construction of a Diagnostic Manual.

PubMed

Mullins-Sweatt, Stephanie N; Lengel, Gregory J; DeShong, Hilary L

2016-01-01

The development of major diagnostic manuals primarily has been guided by construct validity rather than clinical utility. The purpose of this article is to summarize recent research and theory examining the importance of clinical utility when constructing and evaluating a diagnostic manual. We suggest that construct validity is a necessary but not sufficient criterion for diagnostic constructs. This article discusses components of clinical utility and how these have applied to the current and forthcoming diagnostic manuals. Implications and suggestions for future research are provided.

Determination of minimal clinically important change in early and advanced Parkinson's disease.

PubMed

Hauser, Robert A; Auinger, Peggy

2011-04-01

Two common primary efficacy outcome measures in Parkinson's disease (PD) are change in Unified Parkinson's Disease Rating Scale (UPDRS) scores in early PD and change in "off" time in patients with motor fluctuations. Defining the minimal clinically important change (MCIC) in these outcome measures is important to interpret the clinical relevance of changes observed in clinical trials and other situations. We analyzed data from 2 multicenter, placebo-controlled, randomized clinical trials of rasagiline; TEMPO studied 404 early PD subjects, and PRESTO studied 472 levodopa-treated subjects with motor fluctuations. An anchor-based approach using clinical global impression of improvement (CGI-I) was used to determine MCIC for UPDRS scores and daily "off" time. MCIC was defined as mean change in actively treated subjects rated minimally improved on CGI-I. Receiver operating characteristic (ROC) curves defined optimal cutoffs discriminating between changed and unchanged subjects. MCIC for improvement in total UPDRS score (parts I-III) in early PD was determined to be -3.5 points based on mean scores and -3.0 points based on ROC curves. In addition, we found an MCIC for reduction in "off" time of 1.0 hours as defined by mean reduction in "off" time in active treated subjects self-rated as minimally improved on CGI-I minus mean reduction in "off" time in placebo-treated subjects self-rated as unchanged (1.9-0.9 hours). We hypothesize that many methodological factors can influence determination of the MCIC, and a range of values is likely to emerge from multiple studies. Copyright © 2011 Movement Disorder Society.

78 FR 59064 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations (CFR) 1301.34 (a), this is notice that on June 21, 2013, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

Clinical Applications of Resting State Functional Connectivity

PubMed Central

Fox, Michael D.; Greicius, Michael

2010-01-01

During resting conditions the brain remains functionally and metabolically active. One manifestation of this activity that has become an important research tool is spontaneous fluctuations in the blood oxygen level-dependent (BOLD) signal of functional magnetic resonance imaging (fMRI). The identification of correlation patterns in these spontaneous fluctuations has been termed resting state functional connectivity (fcMRI) and has the potential to greatly increase the translation of fMRI into clinical care. In this article we review the advantages of the resting state signal for clinical applications including detailed discussion of signal to noise considerations. We include guidelines for performing resting state research on clinical populations, outline the different areas for clinical application, and identify important barriers to be addressed to facilitate the translation of resting state fcMRI into the clinical realm. PMID:20592951

Important considerations when applying for a postdoctoral fellowship.

PubMed

Sherry, Daisy; Fennessy, Michelle M; Benavente, Viola G; Ruppar, Todd M; Collins, Eileen G

2013-06-01

To examine important decision points that graduates should consider before applying for a postdoctoral fellowship. A literature review was performed. A synthesis of the present data on the postdoctoral fellowship, eligibility criteria, application process, and important considerations was provided. Experiential knowledge from four present postdoctoral fellows was included. The goals, advantages, and disadvantages of the fellowship were discussed. In conclusion, the postdoctoral fellowship was examined to offer important considerations in the decision to pursue this opportunity. The clinical relevance of this article is related to the training and education of nurses to become the next generation of independent, successful scholars and scientists. Postdoctoral training adds valuable contributions and quality to the field of nursing. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

78 FR 54913 - Importer of Controlled Substances; Notice of Application; Clinical Supplies Management, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Clinical Supplies Management, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34 (a), this is notice that on July 22, 2013, Clinical Supplies Management, Inc., 342 42nd Street South, Fargo...

[Imported malaria in adults. Clinical, epidemiological and analytical features].

PubMed

Ramírez-Olivencia, G; Herrero, M D; Subirats, M; de Juanes, J R; Peña, J M; Puente, S

2012-01-01

Up to now, the epidemiological and clinical features of imported malaria in Spain have been described in small series from general hospitals. Almost all diagnosis had been made based on symptomatic patients. The aim of this study has been to determine the epidemiological, clinical and laboratorial characteristics of imported malaria in a Reference Unit for Tropical Diseases. We performed a cross-sectional, observational and retrospective study. The series consisted of patients diagnosed of malaria who had been attended at the Hospital Carlos III from January 1, 2002 to December 31, 2007. We identified 484 episodes of malaria, of which 398 cases were included in the analysis. Almost 50% of the patients were natives of endemic areas, while the rest were native-travelers or travelers. Most cases (88-98% according to the group) had not taken malaria chemoprophylaxis correctly when indicated. At the time of diagnosis, 30.4% of patients were asymptomatic and 28.1% of asymptomatic patients had anemia, 19.8% thrombocytopenia, 14% leukopenia, 5% hypocholesterolemia, 5% renal failure and 4.1% hypoglycemia. Low parasitemia was present in 97.5% of asymptomatic individuals compared to 80.5% of the symptomatic patients (P<0.001). Absence of chemoprophylaxis (or poor compliance) is the main reason for malaria in individuals traveling to endemic areas. Malaria must be ruled out in individuals coming from tropical countries with compatible symptoms, and it also should be suspected in certain groups of asymptomatic individuals with abnormal laboratorial parameters. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Advantages of virulotyping foodborne pathogens over traditional identification and characterization methods

USDA-ARS?s Scientific Manuscript database

This chapter provides an overview regarding the advantages of virulotyping over historic serology-based, PCR-based on genes that identify an organism, or enzymatic and biochemical-based analyses of foodborne pathogens in clinical diagnostics and food industry microbiology testing. Traditional ident...

[Advantages and disadvantages of composite tissue allotransplantation].

PubMed

Yang, Yang; Lu, Binglun; Zhang, Hui; Xia, Wei; Yi, Chenggang; Guo, Shuzhong

2009-12-01

To review the research progress of composite tissue allotransplantation (CTA), analyze the superiority and the inferiority, and inform the possible direction of further research. Literature concerning CTA was reviewed and analyzed in terms of the limits of conventional reparative and reconstructive surgery, the definition of CTA, potential advantages, and treatment risks. The clinical research of CTA both at home and abroad proved that the therapeutic effect of CTA was better than that of conventional reparative and reconstructive surgery. However, the risks resulting from immunosuppressive therapy were still the primary factors restraining the wide clinical application of CTA. The development of immunosuppressive therapy explores a great development potential for the CTA, and how to decrease the treatment risk of immunosuppressive therapy will be the main research direction in the field of CTA.

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

PubMed

Yildiz, M Said; Khan, M Mahmud

2016-08-12

The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

Contextual Advantage for State Discrimination

NASA Astrophysics Data System (ADS)

Schmid, David; Spekkens, Robert W.

2018-02-01

Finding quantitative aspects of quantum phenomena which cannot be explained by any classical model has foundational importance for understanding the boundary between classical and quantum theory. It also has practical significance for identifying information processing tasks for which those phenomena provide a quantum advantage. Using the framework of generalized noncontextuality as our notion of classicality, we find one such nonclassical feature within the phenomenology of quantum minimum-error state discrimination. Namely, we identify quantitative limits on the success probability for minimum-error state discrimination in any experiment described by a noncontextual ontological model. These constraints constitute noncontextuality inequalities that are violated by quantum theory, and this violation implies a quantum advantage for state discrimination relative to noncontextual models. Furthermore, our noncontextuality inequalities are robust to noise and are operationally formulated, so that any experimental violation of the inequalities is a witness of contextuality, independently of the validity of quantum theory. Along the way, we introduce new methods for analyzing noncontextuality scenarios and demonstrate a tight connection between our minimum-error state discrimination scenario and a Bell scenario.

Micrometastases in neuroblastoma: are they clinically important?

PubMed Central

Burchill, S A

2004-01-01

Despite advances in the treatment of neuroblastoma (NBL), recurrence and metastases continue to pose major problems in clinical management. The relation between micrometastases and the development of secondary disease is not fully understood. However, accurate methods to detect low numbers of tumour cells may allow the evaluation of their role in the disease process, and by implication the possible benefits of eliminating them. Although there is substantial evidence for the increased sensitivity of current molecular methods for the detection of NBL cells compared with more conventional cytology, the clinical relevance and usefulness of detecting this disease remain controversial. The primary goal of current translational research must be to evaluate the clinical relevance of micrometastatic disease detected by these methods in multicentre prospective clinical outcome studies. Only then can the clinical usefulness of these methods be defined so that they may be introduced into relevant clinical practice. PMID:14693828

Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology.

PubMed

Andersson, Lars; Andreasen, Jens O

2011-08-01

The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology. Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized. © 2011 John Wiley & Sons A/S.

Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

PubMed Central

Kocks, JWH; Tuinenga, MG; Uil, SM; van den Berg, JWK; Ståhl, E; van der Molen, T

2006-01-01

Background Patient-reported outcomes (PRO) questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID). This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ) in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM). Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC) assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4. PMID:16603063

Importance of a specialty clinic for individuals with fragile X syndrome.

PubMed

Visootsak, Jeannie; Kidd, Sharon A; Anderson, Tovi; Bassell, Julia L; Sherman, Stephanie L; Berry-Kravis, Elizabeth M

2016-12-01

Advances in human genetics have identified a significant number of genetic disorders associated with intellectual disability. As a result, appropriate clinical management of these affected individuals and their family members have become critical in addressing medical needs to improve quality of life. We examine the importance of a Fragile X Clinic for individuals with fragile X syndrome (FXS) and their family members by conducting a retrospective chart review of 123 new patients with FXS evaluated at the Fragile X Clinic at Emory University. After the initial diagnosis of a proband with FXS with cascade testing, there were 345 family members identified with a mutation (70% with premutations; 30% with full mutations). In terms of the impact of the clinic visit, males had a substantial number of new diagnoses in all behavioral disorders (P < 0.001), with anxiety (62%) being the most common. For female probands, the most frequent diagnosis was also anxiety (87%). Prior to the clinic visit, very few patients were prescribed psychotropic medications. After the clinic visit, the most frequently prescribed psychotropic medications for males were stimulants (41%; P < 0.001) and SSRIs (40%; P < 0.001). For females, only stimulants (33%; P = 0.03) and SSRIs (44%; P = 0.008) were statistically significantly prescribed. Our results revealed that there is a gap in care to address the co-morbid behavioral issues, psychopharmacologic medication management, and genetic counseling needs regarding FXS. A multidisciplinary setting and approach, such as that offered by a Fragile X Clinic, is one method of treating the complex needs of patients with FXS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Abnormal uterine bleeding: advantages of formal classification to patients, clinicians and researchers.

PubMed

Madhra, Mayank; Fraser, Ian S; Munro, Malcolm G; Critchley, Hilary O D

2014-07-01

To highlight the advantages of formal classification of causes of abnormal uterine bleeding from a clinical and scientific perspective. Review and recommendations for local implementation. In the past, research in the field of menstrual disorders has not been funded adequately with respect to the impact of symptoms on individuals, healthcare systems and society. This was confounded by a diverse terminology, which lead to confusion between clinical and scientific groups, ultimately harming the underlying evidence base. To address this, a formal classification system (PALM-COEIN) for the causes of abnormal uterine bleeding has been published for worldwide use by FIGO (International Federation of Gynecology and Obstetrics). This commentary explains problems created by the prior absence of such a system, the potential advantages stemming from its use, and practical suggestions for local implementation. The PALM-COEIN classification is applicable globally and, as momentum gathers, will ameliorate recurrence of historic problems, and harmonise reporting of clinical and scientific research to facilitate future progress in women's health. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.

PubMed

Vischer, N; Pfeiffer, C; Joller, A; Klingmann, I; Ka, A; Kpormegbe, S K; Burri, C

2016-08-01

To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Clinical importance of voluntary and induced Bennett movement.

PubMed

Tupac, R G

1978-07-01

A total of 136 dentulous patients were divided into three groups for purposes of quantitative pantographic comparison of voluntary and induced Bennett movement. The effects of patient age and operator experience on recording the Bennett movement were also studied. The results indicates that for patients studied with Bennett movement iduced in the manner described: 1. Experienced operators can obtain more induced Bennett movement that inexperienced operators. 2. Inducing Bennett movement has a greater effect on the immediate side shift component than it has on the progressive side shift component. 3. For older individuals the amount and direction of induced immediate side shift is greater than for younger patients, statistically highly significant, and therefore clinically important. In conclusion, if the objective of a pantographic survey is to record the complete capacity of the joint to move, *lateral jaw movements must be induced.

Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.

PubMed

Rosenzweig, James L; Taitel, Michael S; Norman, Gordon K; Moore, Tim J; Turenne, Wendy; Tang, Pei

2010-07-01

To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD). Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007. High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group. Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group. A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.

The comparative importance of books: clinical psychology in the health sciences library.

PubMed Central

Wehmeyer, J M; Wehmeyer, S

1999-01-01

Clinical psychology has received little attention as a subject in health sciences library collections. This study seeks to demonstrate the relative importance of the monographic literature to clinical psychology through the examination of citations in graduate student theses and dissertations at the Fordham Health Sciences Library, Wright State University. Dissertations and theses were sampled randomly; citations were classified by format, counted, and subjected to statistical analysis. Books and book chapters together account for 35% of the citations in clinical psychology dissertations, 25% in nursing theses, and 8% in biomedical sciences theses and dissertations. Analysis of variance indicates that the citations in dissertations and theses in the three areas differ significantly (F = 162.2 with 2 and 253 degrees of freedom, P = 0.0001). Dissertations and theses in biomedical sciences and nursing theses both cite significantly more journals per book than the dissertations in clinical psychology. These results support the hypothesis that users of clinical psychology literature rely more heavily on books than many other users of a health sciences library. Problems with using citation analyses in a single subject to determine a serials to monographs ratio for a health sciences library are pointed out. PMID:10219478

Clinical importance of IL-22 cascade in IBD.

PubMed

Mizoguchi, Atsushi; Yano, Arisa; Himuro, Hidetomo; Ezaki, Yui; Sadanaga, Takayuki; Mizoguchi, Emiko

2018-04-01

IL-22 is a relatively new cytokine that is characterized by several unique biological properties. In the intestines, the effect of IL-22 is restricted mainly to non-lymphoid cells such as epithelial cells. Interestingly, the expression pattern and major cellular source of IL-22 have distinct difference between large and small intestines. IL-22 possesses an ability to constitutively activate STAT3 for promoting epithelial cell regeneration and reinforcing mucosal barrier integrity through stimulating the expression of anti-bacterial peptide and mucins. Of note, IL-22 is characterized as a two-faced cytokine that can play not only protective but also deleterious roles in the intestinal inflammation depending on the cytokine environment such as the expression levels of IL-23, T-bet, and IL-22 binding protein. Most importantly, clinical relevance of IL-22 to inflammatory bowel disease has been well highlighted. Mucosal healing, which represents the current therapeutic goal for IBD, can be induced by IL-22. Indeed, indigo naturalis, which can activate IL-22 pathway through Ahr, has been shown in a clinical trial to exhibit a strong therapeutic effect on ulcerative colitis. Despite the beneficial effect of IL-22, continuous activation of the IL-22 pathway increases the risk of colitis-associated cancer, particularly in patients with an extended history of IBD. This review article discusses how IL-22 regulates colitis, how beneficial versus deleterious effects of IL-22 is determined, and why IL-22 represents a promising target for IBD therapy.

Automated realtime data import for the i2b2 clinical data warehouse: introducing the HL7 ETL cell.

PubMed

Majeed, Raphael W; Röhrig, Rainer

2012-01-01

Clinical data warehouses are used to consolidate all available clinical data from one or multiple organizations. They represent an important source for clinical research, quality management and controlling. Since its introduction, the data warehouse i2b2 gathered a large user base in the research community. Yet, little work has been done on the process of importing clinical data into data warehouses using existing standards. In this article, we present a novel approach of utilizing the clinical integration server as data source, commonly available in most hospitals. As information is transmitted through the integration server, the standardized HL7 message is immediately parsed and inserted into the data warehouse. Evaluation of import speeds suggest feasibility of the provided solution for real-time processing of HL7 messages. By using the presented approach of standardized data import, i2b2 can be used as a plug and play data warehouse, without the hurdle of customized import for every clinical information system or electronic medical record. The provided solution is available for download at http://sourceforge.net/projects/histream/.

Immediately sequential bilateral cataract surgery: advantages and disadvantages.

PubMed

Singh, Ranjodh; Dohlman, Thomas H; Sun, Grace

2017-01-01

The number of cataract surgeries performed globally will continue to rise to meet the needs of an aging population. This increased demand will require healthcare systems and providers to find new surgical efficiencies while maintaining excellent surgical outcomes. Immediately sequential bilateral cataract surgery (ISBCS) has been proposed as a solution and is increasingly being performed worldwide. The purpose of this review is to discuss the advantages and disadvantages of ISBCS. When appropriate patient selection occurs and guidelines are followed, ISBCS is comparable with delayed sequential bilateral cataract surgery in long-term patient satisfaction, visual acuity and complication rates. In addition, the risk of bilateral postoperative endophthalmitis and concerns of poorer refractive outcomes have not been supported by the literature. ISBCS is cost-effective for the patient, healthcare payors and society, but current reimbursement models in many countries create significant financial barriers for facilities and surgeons. As demand for cataract surgery rises worldwide, ISBCS will become increasingly important as an alternative to delayed sequential bilateral cataract surgery. Advantages include potentially decreased wait times for surgery, patient convenience and cost savings for healthcare payors. Although they are comparable in visual acuity and complication rates, hurdles that prevent wide adoption include liability concerns as ISBCS is not an established standard of care, economic constraints for facilities and surgeons and inability to fine-tune intraocular lens selection in the second eye. Given these considerations, an open discussion regarding the advantages and disadvantages of ISBCS is important for appropriate patient selection.

Robot decisions: on the importance of virtuous judgment in clinical decision making.

PubMed

Gelhaus, Petra

2011-10-01

The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills. Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non-emotional, non-human being. Because

Occurrence and Diversity of Clinically Important Vibrio Species in the Aquatic Environment of Georgia

PubMed Central

Kokashvili, Tamar; Whitehouse, Chris A.; Tskhvediani, Ana; Grim, Christopher J.; Elbakidze, Tinatin; Mitaishvili, Nino; Janelidze, Nino; Jaiani, Ekaterine; Haley, Bradd J.; Lashkhi, Nino; Huq, Anwar; Colwell, Rita R.; Tediashvili, Marina

2015-01-01

Among the more than 70 different Vibrio species inhabiting marine, estuarine, and freshwater ecosystems, 12 are recognized as human pathogens. The warm subtropical climate of the Black Sea coastal area and inland regions of Georgia likely provides a favorable environment for various Vibrio species. From 2006 to 2009, the abundance, ecology, and diversity of clinically important Vibrio species were studied in different locations in Georgia and across seasons. Over a 33-month period, 1,595 presumptive Vibrio isolates were collected from the Black Sea (n = 657) and freshwater lakes around Tbilisi (n = 938). Screening of a subset of 440 concentrated and enriched water samples by PCR-electrospray ionization/mass spectrometry (PCR-ESI/MS) detected the presence of DNA from eight clinically important Vibrio species: V. cholerae, V. parahaemolyticus, V. vulnificus, V. mimicus, V. alginolyticus, V. harveyi, V. metschnikovii, and V. cincinnatiensis. Almost 90% of PCR/ESI-MS samples positive for Vibrio species were collected from June through November. Three important human-pathogenic Vibrio species (V. cholerae, V. parahaemolyticus, and V. vulnificus) were detected in 62.8, 37.8, and 21.4% of samples testing positive for Vibrios, respectively. The results of these activities suggest that natural reservoirs for human-pathogenic Vibrios exist in Georgian aquatic environments. Water temperature at all sampling sites was positively correlated with the abundance of clinically important Vibrio spp. (except V. metschnikovii), and salinity was correlated with species composition at particular Black Sea sites as well as inland reservoirs. PMID:26528464

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review.

PubMed

Turner, Anthony D; Stawicki, Stanislaw P; Guo, Weidun Alan

2018-06-01

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

The clinical and economic burden of newly diagnosed Alzheimer's disease in a medicare advantage population.

PubMed

Suehs, Brandon T; Davis, Cralen D; Alvir, Jose; van Amerongen, Derek; Pharmd, Nick C Patel; Joshi, Ashish V; Faison, Warachal E; Shah, Sonali N

2013-06-01

Alzheimer's disease (AD) represents a serious public health issue affecting approximately 5.4 million individuals in the United States and is projected to affect up to 16 million by 2050. This study examined health care resource utilization (HCRU), costs, and comorbidity burden immediately preceding new diagnosis of AD and 2 years after diagnosis. This study utilized a claims-based, retrospective cohort design. Medicare Advantage members newly diagnosed with AD (n = 3374) were compared to matched non-AD controls (n = 6748). All patients with AD were required to have 12 months of continuous enrollment prior to AD diagnosis (International Classification of Diseases, Clinical Modification [ICD-9] 331.0), during which time no diagnosis of AD, a related dementia, or an AD medication was observed. Non-AD controls demonstrated no diagnosis of AD, a related dementia, or a prescription claim for an AD medication treatment during their health plan enrollment. Medical and pharmacy claims data were used to measure HCRU, costs, and comorbidity burden over a period of 36 months (12 months pre-diagnosis and 24 months post-diagnosis). The HCRU and costs were greater for AD members during the year prior to diagnosis and during postdiagnosis years 1 and 2 compared to controls. The AD members also displayed greater comorbidity than their non-AD counterparts during postdiagnosis years 1 and 2, as measured by 2 different comorbidity indices. Members newly diagnosed with AD demonstrated greater HCRU, health care costs, and comorbidity burden compared to matched non-AD controls.

The Critical Advantage: Developing Critical Thinking Skills in School

ERIC Educational Resources Information Center

Gormley, William T., Jr.

2017-01-01

In "The Critical Advantage," noted scholar and early childhood expert William T. Gormley, Jr. takes a wide ranging look at the important role of critical thinking in preparing students for college, careers, and civic life. Drawing on research from psychology, philosophy, business, political science, neuroscience, and other disciplines,…

Electrophysiological explorations of the bilingual advantage: evidence from a Stroop task.

PubMed

Coderre, Emily L; van Heuven, Walter J B

2014-01-01

Bilinguals have been shown to exhibit a performance advantage on executive control tasks, outperforming their monolingual counterparts. Although a wealth of research has investigated this 'bilingual advantage' behaviourally, electrophysiological correlates are lacking. Using EEG with a Stroop task that manipulated the stimulus onset asynchrony (SOA) of word and colour presentation, the current study addressed two facets of the bilingual advantage. The possibility that bilinguals experience superior conflict processing relative to monolinguals (a 'conflict-specific advantage') was investigated by comparing behavioural interference effects as well as the amplitude of the Ninc, a conflict-related ERP component occurring from approximately 300-500 ms after the onset of conflict. In contrast, the hypothesis that bilinguals experience domain-general, conflict-independent enhancements in executive processing (a 'non-conflict-specific advantage') was evaluated by comparing the control condition (symbol strings) between groups. There was some significant, but inconsistent, evidence for a conflict-specific bilingual advantage. In contrast, strong evidence emerged for a non-conflict-specific advantage, with bilinguals demonstrating faster RTs and reduced ERP amplitudes on control trials compared to monolinguals. Importantly, when the control stimulus was presented before the colour, ERPs to control trials revealed group differences before the onset of conflict, suggesting differences in the ability to ignore or suppress distracting irrelevant information. This indicates that bilinguals experience superior executive processing even in the absence of conflict and semantic salience, and suggests that the advantage extends to more efficient proactive management of the environment.

Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall?

PubMed

Ozan, Ebru; Atac, Gokce Kaan; Gundogdu, Sadi

2016-07-01

The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.

Clinical protein mass spectrometry.

PubMed

Scherl, Alexander

2015-06-15

Quantitative protein analysis is routinely performed in clinical chemistry laboratories for diagnosis, therapeutic monitoring, and prognosis. Today, protein assays are mostly performed either with non-specific detection methods or immunoassays. Mass spectrometry (MS) is a very specific analytical method potentially very well suited for clinical laboratories. Its unique advantage relies in the high specificity of the detection. Any protein sequence variant, the presence of a post-translational modification or degradation will differ in mass and structure, and these differences will appear in the mass spectrum of the protein. On the other hand, protein MS is a relatively young technique, demanding specialized personnel and expensive instrumentation. Many scientists and opinion leaders predict MS to replace immunoassays for routine protein analysis, but there are only few protein MS applications routinely used in clinical chemistry laboratories today. The present review consists of a didactical introduction summarizing the pros and cons of MS assays compared to immunoassays, the different instrumentations, and various MS protein assays that have been proposed and/or are used in clinical laboratories. An important distinction is made between full length protein analysis (top-down method) and peptide analysis after enzymatic digestion of the proteins (bottom-up method) and its implication for the protein assay. The document ends with an outlook on what type of analyses could be used in the future, and for what type of applications MS has a clear advantage compared to immunoassays. Copyright © 2015 Elsevier Inc. All rights reserved.

Seven-day human biological rhythms: An expedition in search of their origin, synchronization, functional advantage, adaptive value and clinical relevance.

PubMed

Reinberg, Alain E; Dejardin, Laurence; Smolensky, Michael H; Touitou, Yvan

2017-01-01

This fact-finding expedition explores the perspectives and knowledge of the origin and functional relevance of the 7 d domain of the biological time structure, with special reference to human beings. These biological rhythms are displayed at various levels of organization in diverse species - from the unicellular sea algae of Acetabularia and Goniaulax to plants, insects, fish, birds and mammals, including man - under natural as well as artificial, i.e. constant, environmental conditions. Nonetheless, very little is known about their derivation, functional advantage, adaptive value, synchronization and potential clinical relevance. About 7 d cosmic cycles are seemingly too weak, and the 6 d work/1 d rest week commanded from G-d through the Laws of Mosses to the Hebrews is too recent an event to be the origin in humans. Moreover, human and insect studies conducted under controlled constant conditions devoid of environmental, social and other time cues report the persistence of 7 d rhythms, but with a slightly different (free-running) period (τ), indicating their source is endogenous. Yet, a series of human and laboratory rodent studies reveal certain mainly non-cyclic exogenous events can trigger 7 d rhythm-like phenomena. However, it is unknown whether such triggers unmask, amplify and/or synchronize previous non-overtly expressed oscillations. Circadian (~24 h), circa-monthly (~30 d) and circannual (~1 y) rhythms are viewed as genetically based features of life forms that during evolution conferred significant functional advantage to individual organisms and survival value to species. No such advantages are apparent for endogenous 7 d rhythms, raising several questions: What is the significance of the 7 d activity/rest cycle, i.e. week, storied in the Book of Genesis and adopted by the Hebrews and thereafter the residents of nearby Mediterranean countries and ultimately the world? Why do humans require 1 d off per 7 d span? Do 7 d rhythms bestow functional

Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction.

PubMed

New, Peter Wayne; Eriks-Hoogland, Inge; Scivoletto, Giorgio; Reeves, Ronald K; Townson, Andrea; Marshall, Ruth; Rathore, Farooq A

2017-01-01

Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.

Minimal Clinically Important Difference of Berg Balance Scale in People With Multiple Sclerosis.

PubMed

Gervasoni, Elisa; Jonsdottir, Johanna; Montesano, Angelo; Cattaneo, Davide

2017-02-01

To identify the minimal clinically important difference (MCID) to define clinically meaningful patient's improvement on the Berg Balance Scale (BBS) in people with multiple sclerosis (PwMS) in response to rehabilitation. Cohort study. Neurorehabilitation institute. PwMS (N=110). This study comprised inpatients and outpatients who participated in research on balance and gait rehabilitation. All received 20 rehabilitation sessions with different intensities. Inpatients received daily treatments over a period of 4 weeks, while outpatients received 2 to 3 treatments per week for 10 weeks. An anchor-based approach using clinical global impression of improvement in balance (Activities-specific Balance Confidence [ABC] Scale) was used to determine the MCID of the BBS. The MCID was defined as the minimum change in the BBS total score (postintervention - preintervention) that was needed to perceive at least a 10% improvement on the ABC Scale. Receiver operating characteristic curves were used to define the cutoff of the optimal MCID of the BBS discriminating between improved and not improved subjects. The MCID for change on the BBS was 3 points for the whole sample, 3 points for the inpatients, and 2 points for the outpatients. The area under the curve was .65 for the whole sample, .64 for inpatients, and .68 for outpatients. The MCID for improvement in balance as measured by the BBS was 3 points, meaning that PwMS are likely to perceive that as a reproducible and clinically important change in their balance performance. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Comparative Advantages in Microelectronics,

DTIC Science & Technology

The initial point of departure for analyzing comparative advantages in microelectronics is to make certain explicit assumptions. First, technology...changes conditions but does not determine comparative advantages . Secondly, the entire industrial infrastructure is becoming increasingly abstract...that informatics will profoundly affect the productive infrastructure and the international division of labour.

Fear of hypoglycaemia: defining a minimum clinically important difference in patients with type 2 diabetes

PubMed Central

Stargardt, Tom; Gonder-Frederick, Linda; Krobot, Karl J; Alexander, Charles M

2009-01-01

Background To explore the concept of the Minimum Clinically Important Difference (MID) of the Worry Scale of the Hypoglycaemia Fear Survey (HFS-II) and to quantify the clinical importance of different types of patient-reported hypoglycaemia. Methods An observational study was conducted in Germany with 392 patients with type 2 diabetes mellitus treated with combinations of oral anti-hyperglycaemic agents. Patients completed the HFS-II, the Treatment Satisfaction Questionnaire for Medication (TSQM), and reported on severity of hypoglycaemia. Distribution- and anchor-based methods were used to determine MID. In turn, MID was used to determine if hypoglycaemia with or without need for assistance was clinically meaningful compared to having had no hypoglycaemia. Results 112 patients (28.6%) reported hypoglycaemic episodes, with 15 patients (3.8%) reporting episodes that required assistance from others. Distribution- and anchor-based methods resulted in MID between 2.0 and 5.8 and 3.6 and 3.9 for the HFS-II, respectively. Patients who reported hypoglycaemia with (21.6) and without (12.1) need for assistance scored higher on the HFS-II (range 0 to 72) than patients who did not report hypoglycaemia (6.0). Conclusion We provide MID for HFS-II. Our findings indicate that the differences between having reported no hypoglycaemia, hypoglycaemia without need for assistance, and hypoglycaemia with need for assistance appear to be clinically important in patients with type 2 diabetes mellitus treated with oral anti-hyperglycaemic agents. PMID:19849828

Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy.

PubMed

Nwachukwu, Benedict U; Chang, Brenda; Rotter, Ben-Zion; Kelly, Bryan T; Ranawat, Anil S; Nawabi, Danyal H

2018-06-01

To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in revision hip arthroscopy. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients. At 1 year postoperatively, patients graded their hip function based on anchor responses. SCB was defined as both a net change and an absolute value. Receiver operating characteristic analysis with area under the curve was used to confirm psychometric values. A distribution-based method was used for MCID. Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common indication for revision hip arthroscopy was residual femoroacetabular impingement (FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up, 34 patients reported feeling improved. Outcome score change corresponding to MCID and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports, and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher proportion of patients with residual FAI achieved MCID compared with patients with other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas 43% met the SCB criteria. MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports. SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular management were the most common indications for revision surgery with patients who underwent surgery for the former found to be most likely to achieve clinically significant

Antibacterial effect of bioactive glasses on clinically important anaerobic bacteria in vitro.

PubMed

Leppäranta, Outi; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Hupa, Mikko; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki

2008-02-01

Bioactive glasses (BAGs) of different compositions have been studied for decades for clinical use and they have found many dental and orthopaedic applications. Particulate BAGs have also been shown to have antibacterial properties. This large-scale study shows that two bioactive glass powders (S53P4 and 13-93) and a sol-gel derived material (CaPSiO II) have an antibacterial effect on 17 clinically important anaerobic bacterial species. All the materials tested demonstrated growth inhibition, although the concentration and time needed for the effect varied depending on the BAG. Glass S53P4 had a strong growth-inhibitory effect on all pathogens tested. Glass 13-93 and sol-gel derived material CaPSiO II showed moderate antibacterial properties.

Importance of Building Confidence in Patient Communication and Clinical Skills Among Chiropractic Students

PubMed Central

Hecimovich, Mark D.; Volet, Simone E.

2009-01-01

Purpose: One important objective of chiropractic education is to foster student professional confidence and competence in patient communication and clinical skills. Therefore, the aim of this article is to review the extant literature on this topic, stressing the significance of building students' confidence for effective practice and the need for more research in this area. Methods: The authors reviewed MEDLINE and ERIC from 1980 through 2008 using several key words pertinent to confidence and health care. Three distinct, but interrelated, bodies of literature were assessed, including professional confidence in health care research, the nature and development of confidence in educational psychology research, and fostering professional confidence in chiropractic education. Results: It was apparent through the review that chiropractic education has developed educational methods and opportunities that may help develop and build student confidence in patient communication and clinical skills. However, there has not been sufficient research to provide empirical evidence of the impact. Conclusion: Fostering chiropractic students' development of confidence in what they say and do is of paramount importance not only to them as new practitioners but more importantly to the patient. There is no doubt that a better understanding of how confidence can be developed and consolidated during tertiary study should be a major goal of chiropractic education PMID:19826543

Bactericidal effects of bioactive glasses on clinically important aerobic bacteria.

PubMed

Munukka, Eveliina; Leppäranta, Outi; Korkeamäki, Mika; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki

2008-01-01

Bioactive glasses (BAGs) have been studied for decades for clinical use, and they have found many dental and orthopedic applications. BAGs have also been shown to have an antibacterial effect e.g., on some oral microorganisms. In this extensive work we show that six powdered BAGs and two sol-gel derived materials have a clear antibacterial effect on 29 clinically important bacterial species. We also incorporated a rapid and accurate flow cytometric (FCM) method to calculate and standardize the numbers of viable bacteria inoculated in the suspensions used in the tests for antibacterial activity. In all materials tested growth inhibition could be demonstrated, although the concentration and time needed for the effect varied depending on the BAG. The most effective glass was S53P4, which had a clear growth-inhibitory effect on all pathogens tested. The sol-gel derived materials CaPSiO and CaPSiO II also showed a strong antibacterial effect. In summary, BAGs were found to clearly inhibit the growth of a wide selection of bacterial species causing e.g., infections on the surfaces of prostheses in the body after implantation.

Quasi-independence, fitness, and advantageousness.

PubMed

Brosnan, Kevin

2009-09-01

I argue that the idea of 'quasi-independence' [Lewontin, R. C. (1978). Adaptation. Scientific American, 239(3), 212-230] cannot be understood without attending to the distinction between fitness and advantageousness [Sober, E. (1993). Philosophy of biology. Boulder: Westview Press]. Natural selection increases the frequency of fitter traits, not necessarily of advantageous ones. A positive correlation between an advantageous trait and a disadvantageous one may prevent the advantageous trait from evolving. The quasi-independence criterion is aimed at specifying the conditions under which advantageous traits will evolve by natural selection in this type of situation. Contrary to what others have argued [Sterelny, K. (1992). Evolutionary explanations of human behavior. Australian Journal of Philosophy, 70(2), 156-172, and Sterelny, K., & Griffiths, P. (1999). Sex and death. Chicago: University of Chicago Press], these conditions must involve a precise quantitative measure of (a) the extent to which advantageous traits are beneficial, and (b) the degree to which they are correlated with other traits. Driscoll (2004) [Driscoll, C. (2004). Can behaviors be adaptations? Philosophy of Science, 71, 16-35] recognizes the need for such a measure, but I argue that she does not provide the correct formulation. The account of quasi-independence that I offer clarifies this point.

Telepsychotherapy and the Therapeutic Relationship: Principles, Advantages, and Case Examples.

PubMed

Kocsis, Barbara J; Yellowlees, Peter

2018-05-01

As the use of technology continues to expand within our mental healthcare system, there has been an increasing interest in conducting psychotherapy online using videoconferencing. Literature pertaining to telepsychotherapy has explored possible drawbacks of this modality on the therapeutic relationship, although several studies have shown that the efficacy of online psychotherapy is equivalent to in-person approaches. Little is written about the potential advantages to the psychotherapeutic relationship when psychotherapy is carried out over videoconferencing. The available literature was reviewed, as were the general principles of telepsychotherapy and the therapeutic relationship, followed by a more in-depth consideration of patient populations for whom telepsychotherapy may offer distinct advantages. The current literature, as well as our own clinical experience, suggests that telepsychotherapy may be effective for a broad range of patients, and it may offer distinct advantages in the building of a trusting psychotherapeutic relationship. Telepsychotherapy offers a novel way to reach and form strong psychotherapeutic relationships with many different types of patients, and it may foster therapeutic intimacy in ways that in-person psychotherapy cannot. More research is needed to further explore this unique modality.

Commentary: Where All Children Blossom--Cultural Advantage, Double Win, and Rich Cultural Learning Environments

ERIC Educational Resources Information Center

Lee, Tiffany S.

2017-01-01

The article, ''Mohala i ka wai: Cultural Advantage as a Framework for Indigenous Culture-Based Education and Student Outcomes,'' by Shawn Malia Kana'iaupuni, Brandon Ledward, and Nolan Malone, represents an important story and study in Indigenous educational self-determination. Their positioning and findings of culture as an advantage in regard to…

Advantages and Limitations of Wearable Activity Trackers: Considerations for Patients and Clinicians.

PubMed

Walker, Rachel K; Hickey, Amanda M; Freedson, Patty S

2016-12-01

Exercise, light physical activity, and decreased sedentary time all have been associated with health benefits following cancer diagnoses. Commercially available wearable activity trackers may help patients monitor and self-manage their behaviors to achieve these benefits. This article highlights some advantages and limitations clinicians should be aware of when discussing the use of activity trackers with cancer survivors. Limited research has assessed the accuracy of commercially available activity trackers compared to research-grade devices. Because most devices use confidential, proprietary algorithms to convert accelerometry data to meaningful output like total steps, assessing whether these algorithms account for differences in gait abnormalities, functional limitations, and different body morphologies can be difficult. Quantification of sedentary behaviors and light physical activities present additional challenges. The global market for activity trackers is growing, which presents clinicians with a tremendous opportunity to incorporate these devices into clinical practice as tools to promote activity. This article highlights important considerations about tracker accuracy and usage by cancer survivors.

Potential advantages of solar electric propulsion for outer planet orbiters.

NASA Technical Reports Server (NTRS)

Sauer, C. G.; Atkins, K. L.

1972-01-01

Past studies of solar electric propulsion for outer planet orbiters have generally emphasized the advantages of flight time reduction and payload increases. However, several subtle advantages exist, which may become important in an environment of increasingly difficult requirements as ways to extend current technology are sought. These advantages accrue primarily because of the inherent capability, unique to electric propulsion, to efficiently shape a trajectory while enroute. Stressed in this paper are: the ability to meet orbital constraints due to assumed radiation belts, science flexibility in a dual launch program, increased numbers of observational passes, and the lengthening of launch periods. These are examined for years representative of relatively easy and difficult ballistic missions. The results indicate that an early investment in solar electric technology will provide a strong performance foundation for a long range outer planet exploration program which evolves from current spacecraft technology.

Understanding the 'Silver Book' - An important reference for standardised nomenclature in clinical laboratory sciences.

PubMed

Flatman, Robert; Férard, Georges; Dybkaer, René

2017-04-01

Clinical laboratories perform a wide menu of testing (examinations). Successful requesting, examination, and ordering in this environment requires clear standardised nomenclature. The Silver Book (SB) is an IUPAC (International Union of Pure and Applied Chemistry) publication, produced with the support of both IUPAC and the IFCC (International Federation of Clinical Chemistry and Laboratory Medicine), that makes recommendations on logical standardised nomenclature, symbols, properties, and units in many disciplines of the clinical laboratory sciences. These recommendations are founded on and in agreement with the principles and work of the International Organization for Standardization (ISO), Bureau International des Poids et Mesures (BIPM), IUPAC, and the IFCC. Practical applications described are based on those scientific principles. The SB recommendations apply to all types of examination, not only to measurement of quantities but also examination of nominal properties where no magnitude is involved. The SB is applicable not only to clinical chemistry, but to many other clinical laboratory disciplines. For examples, reports regarding haemostasis, toxicology, clinical microbiology, reproduction and fertility, clinical pharmacology, clinical allergology, clinical molecular biology, and clinical immunohaematology have been published by the IUPAC and the IFCC. Peak scientific bodies such as the IUPAC and the IFCC have important roles in the development of sound international standards for nomenclature of examinations. Such standards support safe and effective representation of patient health information, foster portability, and empower future decision support systems. Copyright © 2016. Published by Elsevier B.V.

Escitalopram—translating molecular properties into clinical benefit: reviewing the evidence in major depression

PubMed Central

Leonard, Brian; Taylor, David

2010-01-01

The majority of currently marketed drugs contain a mixture of enantiomers; however, recent evidence suggests that individual enantiomers can have pharmacological properties that differ importantly from enantiomer mixtures. Escitalopram, the S-enantiomer of citalopram, displays markedly different pharmacological activity to the R-enantiomer. This review aims to evaluate whether these differences confer any significant clinical advantage for escitalopram over either citalopram or other frequently used antidepressants. Searches were conducted using PubMed and EMBASE (up to January 2009). Abstracts of the retrieved studies were reviewed independently by both authors for inclusion. Only those studies relating to depression or major depressive disorder were included. The search identified over 250 citations, of which 21 studies and 18 pooled or meta-analyses studies were deemed suitable for inclusion. These studies reveal that escitalopram has some efficacy advantage over citalopram and paroxetine, but no consistent advantage over other selective serotonin reuptake inhibitors. Escitalopram has at least comparable efficacy to available serotonin-norepinephrine reuptake inhibitors, venlafaxine XR and duloxetine, and may offer some tolerability advantages over these agents. This review suggests that the mechanistic advantages of escitalopram over citalopram translate into clinical efficacy advantages. Escitalopram may have a favourable benefit-risk ratio compared with citalopram and possibly with several other antidepressant agents. PMID:20147575

Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

PubMed

Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

2012-04-01

To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus.

PubMed

Nasri, Tuba; Hedayati, Mohammad Taghi; Abastabar, Mahdi; Pasqualotto, Alessandro C; Armaki, Mojtaba Taghizadeh; Hoseinnejad, Akbar; Nabili, Mojtaba

2015-10-01

Aspergillus species are important agents of life-threatening infections in immunosuppressed patients. Proper speciation in the Aspergilli has been justified based on varied fungal virulence, clinical presentations, and antifungal resistance. Accurate identification of Aspergillus species usually relies on fungal DNA sequencing but this requires expensive equipment that is not available in most clinical laboratories. We developed and validated a discriminative low-cost PCR-based test to discriminate Aspergillus isolates at the species level. The Beta tubulin gene of various reference strains of Aspergillus species was amplified using the universal fungal primers Bt2a and Bt2b. The PCR products were subjected to digestion with a single restriction enzyme AlwI. All Aspergillus isolates were subjected to DNA sequencing for final species characterization. The PCR-RFLP test generated unique patterns for six clinically important Aspergillus species, including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus terreus, Aspergillus clavatus and Aspergillus nidulans. The one-enzyme PCR-RFLP on Beta tubulin gene designed in this study is a low-cost tool for the reliable and rapid differentiation of the clinically important Aspergillus species. Copyright © 2015 Elsevier B.V. All rights reserved.

Widening Life Expectancy Advantage of Hispanics in the United States: 1990-2010.

PubMed

Fenelon, Andrew; Blue, Laura

2015-08-01

We examine trends in the Hispanic longevity advantage between 1990 and 2010, focusing on the contribution of cigarette smoking. We calculate life expectancy at age 50 for Hispanics and non-Hispanic whites between 1990 and 2010. We use an indirect method to calculate the contribution of smoking to changes over time in life expectancy. Among women, the Hispanic advantage in life expectancy grows from 2.14 years in 1990 (95 % CI 1.99-2.30 years) to 3.53 years in 2010 (3.42-3.64 years). More than 40 % of this increase reflects widening differences in smoking-attributable mortality. The advantage for Hispanic men increases from 2.27 years (2.14-2.41 years) to 2.91 years (2.81-3.01 years), although smoking makes only a small contribution. Despite persistent disadvantage, US Hispanics have increased their longevity advantage over non-Hispanic whites since 1990, much of which reflects the continuing importance of cigarette smoking to the Hispanic advantage.

Mechanistic Basis of Cocrystal Dissolution Advantage.

PubMed

Cao, Fengjuan; Amidon, Gordon L; Rodríguez-Hornedo, Naír; Amidon, Gregory E

2018-01-01

Current interest in cocrystal development resides in the advantages that the cocrystal may have in solubility and dissolution compared with the parent drug. This work provides a mechanistic analysis and comparison of the dissolution behavior of carbamazepine (CBZ) and its 2 cocrystals, carbamazepine-saccharin (CBZ-SAC) and carbamazepine-salicylic acid (CBZ-SLC) under the influence of pH and micellar solubilization. A simple mathematical equation is derived based on the mass transport analyses to describe the dissolution advantage of cocrystals. The dissolution advantage is the ratio of the cocrystal flux to drug flux and is defined as the solubility advantage (cocrystal to drug solubility ratio) times the diffusivity advantage (cocrystal to drug diffusivity ratio). In this work, the effective diffusivity of CBZ in the presence of surfactant was determined to be different and less than those of the cocrystals. The higher effective diffusivity of drug from the dissolved cocrystals, the diffusivity advantage, can impart a dissolution advantage to cocrystals with lower solubility than the parent drug while still maintaining thermodynamic stability. Dissolution conditions where cocrystals can display both thermodynamic stability and a dissolution advantage can be obtained from the mass transport models, and this information is useful for both cocrystal selection and formulation development. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

77 FR 50162 - Importer of Controlled Substances; Notice of Application; Clinical Supplies Management, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-20

... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Clinical Supplies Management, Inc. Correction In notice document 2012-19197 appearing on pages 47109-47110 in the issue of Tuesday, August 7, 2012, make the following corrections: 1. On page 47109...

Robustness of the sequential lineup advantage.

PubMed

Gronlund, Scott D; Carlson, Curt A; Dailey, Sarah B; Goodsell, Charles A

2009-06-01

A growing movement in the United States and around the world involves promoting the advantages of conducting an eyewitness lineup in a sequential manner. We conducted a large study (N = 2,529) that included 24 comparisons of sequential versus simultaneous lineups. A liberal statistical criterion revealed only 2 significant sequential lineup advantages and 3 significant simultaneous advantages. Both sequential advantages occurred when the good photograph of the guilty suspect or either innocent suspect was in the fifth position in the sequential lineup; all 3 simultaneous advantages occurred when the poorer quality photograph of the guilty suspect or either innocent suspect was in the second position. Adjusting the statistical criterion to control for the multiple tests (.05/24) revealed no significant sequential advantages. Moreover, despite finding more conservative overall choosing for the sequential lineup, no support was found for the proposal that a sequential advantage was due to that conservative criterion shift. Unless lineups with particular characteristics predominate in the real world, there appears to be no strong preference for conducting lineups in either a sequential or a simultaneous manner. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Airmen: Delivering Decision Advantage

DTIC Science & Technology

2012-12-01

Senior Leader Perspective November–December 2012 Air & Space Power Journal | 4 ISR Focus Airmen Delivering Decision Advantage Lt Gen Larry D. James...Air Force, the joint war fighter, and our nation. Our mission, in defense of America’s interests, is to enable de- cision advantage by operating...integrated, cross-domain ISR capabilities with joint, national, and international partners. Our Air Force ISR vi- sion is to be the preeminent ISR

Friendship fosters learning: The importance of friendships in clinical practice.

PubMed

Roberts, Debbie

2009-11-01

This paper reports on one of the key findings from a recent ethnographic study (Roberts, D., 2007. Friendships and the community of students: peer learning amongst a group of pre-registration student nurses. Unpublished PhD Thesis, University of Salford, UK) and aims to highlight the importance of friendships for student nurses in clinical practice. An interpretive ethnographic approach was taken in order to reveal the student experience during their pre registration programme. Data was collected using ethnographic interviewing (Sorrell, J.M., Redmond, G.M., 1995. Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing 21, 1117-1122.) and participant observation. Within this paper I argue that student nurses exist on the edge of the community of practice (of the qualified staff) and therefore form their own parallel community where students are all seen as being in the same boat. In particular students use the friendships they develop in clinical practice to enable them to learn; developing an 'ask anything' culture where all students are perceived as valuable sources of knowledge. Furthermore, it appears that knowledge is contextually bound and not therefore linked to seniority, or length of time served on the course.

Informal leadership support: an often overlooked competitive advantage.

PubMed

Peters, L H; O'Connor, E J

2001-01-01

As environmental pressures mount, the advantage of using the same strategies and tactics employed by competitors continues to shrink. An alternative is adapting and applying answers successfully employed in other industries to health care organizations. Working with informal influence leaders to share your change management efforts represents one such example. Informal influence leaders offer an often-overlooked source of competitive advantage--they have already earned credibility and respect from others, who regularly look to them for guidance. When sharing their views, they significantly influence the acceptance or rejection of new initiatives. Influence leaders reach into every conversation, every meeting, and every decision made in an organization. The important question is whether they will exert their leadership in support or in opposition to changes you propose. By identifying influence leaders and inviting them to join a group to discuss change initiatives, physician executives can create a positive force for change.

Home advantage in retractable-roof baseball stadia.

PubMed

Romanowich, Paul

2012-10-01

This study examined whether the home advantage varies for open-air, domed, or retractable-roof baseball stadia, and whether having the roof open or closed affects the home advantage in retractable-roof baseball stadia. Data from Major League Baseball (MLB) games played between 2001 and 2009 were analyzed for whether or not the presence of a home-advantage was dependent on the type of home stadium used. Home advantage was robust for all three types of stadia. A significant effect of stadium type on home advantage was found, with a greater home advantage for teams playing home games in domed stadia relative to open-air stadia, replicating a previous study. There was a greater home advantage for teams playing home games in domed stadia relative to retractable-roof stadia. No other differences in the home advantage were found; results are discussed in terms of familiarity with the facility.

Does cultural integration explain a mental health advantage for adolescents?

PubMed Central

Bhui, Kamaldeep S; Lenguerrand, Erik; Maynard, Maria J; Stansfeld, Stephen A; Harding, Seeromanie

2012-01-01

Background A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents. Methods A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a ‘total difficulties score’ and by classification as a ‘probable clinical case’. Results A total of 6643 pupils in first and second years of secondary school (ages 11–13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005–06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health. Conclusions Cultural integration was associated with better mental health, independent of the mental health advantage

Does cultural integration explain a mental health advantage for adolescents?

PubMed

Bhui, Kamaldeep S; Lenguerrand, Erik; Maynard, Maria J; Stansfeld, Stephen A; Harding, Seeromanie

2012-06-01

A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents. A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a 'total difficulties score' and by classification as a 'probable clinical case'. A total of 6643 pupils in first and second years of secondary school (ages 11-13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005-06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health. Cultural integration was associated with better mental health, independent of the mental health advantage found among specific ethnic groups: Black Caribbean and

Child-Rearing Practices toward Children with Hemophilia: The Relative Importance of Clinical Characteristics and Parental Emotional Reactions.

ERIC Educational Resources Information Center

Banis, S.; Suurmeijer, Th. P. B. M.; van Peer, D. R.

1999-01-01

Addresses the relative importance of clinical characteristics of the child and parental emotional reactions, to child-rearing practices towards children with hemophilia. Results indicate that mother's emotional reactions appear to have a stronger influence on child-rearing uncertainty and overprotection than clinical characteristics of the child.…

Hiring & Retaining More Women: The Advantages to Law Enforcement Agencies.

ERIC Educational Resources Information Center

Lonsway, Kimberly A.

Hiring and retaining more women provides numerous important advantages to law enforcement agencies. Research conducted in the United States and internationally has clearly documented that following facts: (1) female officers are as competent as their male counterparts and even excel in certain areas of police performance; (2) female officers are…

Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients.

PubMed

Park, Ki Byung; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Lee, Jun-Hwan; Shin, Kyung-Min; Shin, Byung-Cheul; Cho, Jae-Heung; Ha, In-Hyuk

2017-04-15

.: Prospective observational 1-year study. .: To determine minimum clinically important difference (MCID) and substantial clinical benefit (SCB) of outcome measures in failed back surgery syndrome (FBSS) patients, as these metrics enable assessment of whether and when an intervention produces clinically meaningful effects in a patient. .: Several methods have been devised to quantify clinically important difference, but MCID and SCB for FBSS patients has yet to be determined. .: Patients with persisting/recurrent low back pain (LBP) and/or leg pain after lumbar surgery who completed 16 weeks of treatment (n = 105) at two hospitals in Korea from November 2011 to September 2014 were analyzed. Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale (VAS), Oswestry disability index (ODI), and short form-36 (SF-36) in an anchor-based approach. .: MCIDs for ODI, LBP and leg pain VAS, physical component summary, mental health component summary (MCS), and overall health scores of SF-36 were 9.0, 22.5, 27.5, 10.2, 4.0, and 8.9, and SCBs were 15.0, 32.5, 37.0, 19.7, 19.3, and 21.1, respectively. MCID and SCB area under the curve was ≥0.8, and ≥0.7, respectively. .: LBP and leg pain VAS, ODI, and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients. 3.

[Advantages and disadvantages of femtosecond laser assisted LASIK and SMILE].

PubMed

Zhang, F J; Sun, M S

2018-01-11

With the development of excimer laser and femtosecond laser equipment, application of diversified and customized surgical decision in modern corneal refractive surgery has been an inevitable trend. However, how to make a personalized decision with an accurate surgical design to achieve better visual quality becomes the main focus in clinical applications. Small-incision lenticule extraction (SMILE) and femtosecond assisted laser in situ keratomileusis (FS-LASIK) have been commonly acknowledged as the mainstream of corneal refractive surgery for ametropia correction nowadays. Both methods have been verified by clinical practice for many years. This article compares and elaborates the different characteristics with advantages and disadvantages of the two methods so as to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2018, 54: 7-10) .

Clinical importance of caffeine dependence and abuse.

PubMed

Ogawa, Naoshi; Ueki, Hirofumi

2007-06-01

Caffeine is the most widely consumed psychoactive substance and is a legal stimulant that is readily available to children. Caffeine has occasionally been considered a drug of abuse and the potential for dependence on caffeine has been debated. Presently, due to a paucity of clinical evidence on caffeine dependence or abuse, no such diagnosis is included in the Diagnostic and Statistical Manual of Mental Disorder-fourth edition. The authors present two cases of abuse or dependence on the caffeine contained in 'eutrophic' (energy/nutritional) beverages or caffeine preparations, followed by a review of clinical studies demonstrating evidence that some people can manifest a clinical syndrome of caffeine dependence or abuse. The cases suggest that caffeine can produce a clinical dependence syndrome similar to those produced by other psychoactive substances and has a potential for abuse. In a recent study using a structured interview and the Diagnostic and Statistical Manual of Mental Disorder-fourth edition criteria for substance dependence and abuse, a subset of the general population was found to demonstrate caffeine dependence or caffeine abuse. Therefore, the authors propose that companies or businesses manufacturing or marketing caffeine or products containing caffeine must meet the following guidelines: (i) clearly indicate the caffeine content of products containing comparatively higher quantities of caffeine; (ii) warn that such products should be avoided by infants and children wherever possible, and inform adult consumers about the precise quantity of caffeine that is considered safe for consumption; and (iii) clearly state that consuming large quantities of caffeine and the long-term use of caffeine carry health risks.

High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages.

PubMed

Galli, Claudio; Lippi, Giuseppe

2016-07-01

Very seldom, if ever, a single laboratory test has provided such a paradigm shift in the managed care as cardiac troponin (cTn) testing. More than twenty years of improvements in test design and analytical features have contributed to revolutionize the clinical recommendations and guidelines, and the diagnosis of myocardial infarction (MI) is now highly dependent upon the kinetics of cTn within a suggestive clinical setting. Despite the advent of high-sensitivity cTn (HS-cTn) immunoassays has allowed a more accurate and timely diagnosis as well as a higher prognostic accuracy, the focus is now shifting on the most suitable algorithms and on a comprehensive approach to the clinical management of acute coronary syndrome (ACS). In this article we aim to discuss the implications of HS-cTn testing for ruling out and ruling in ACS. In the latter instance, main improvements are related to ACS diagnosis in women, in whom this pathology is still often underdiagnosed or misdiagnosed. A quick and accurate rule out will also regarded as a great advantage from both an organizational and economic standpoint. The advantages that will stem from this new approach have been recently assessed, and shortening of repeated testing 1 or 2 h from conventional algorithms entailing blood sampling at 3 and 6 h seems attainable. The larger benefits will definitely occur in clinical settings where the actual diagnosis rate of MI among patients with suspect ACS is lower and, consequently, the negative predictive value (NPV) of HS-cTn is the highest.

Implementation of new clinical programs in the VHA healthcare system: the importance of early collaboration between clinical leadership and research.

PubMed

Wu, R Ryanne; Kinsinger, Linda S; Provenzale, Dawn; King, Heather A; Akerly, Patricia; Barnes, Lottie K; Datta, Santanu K; Grubber, Janet M; Katich, Nicholas; McNeil, Rebecca B; Monte, Robert; Sperber, Nina R; Atkins, David; Jackson, George L

2014-12-01

Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal collaboration involves partnership from the very beginning of a new clinical program, so that the program is designed in a way that ensures quality, validity, and puts into place the infrastructure necessary for a reliable evaluation. This paper will give an example of one such project, the Lung Cancer Screening Demonstration Project (LCSDP). We will outline the ways that clinical, policy, and research partners collaborated in design, planning, and implementation in order to create a sustainable model that could be rigorously evaluated for efficacy and fidelity. We will describe the use of the Donabedian quality matrix to determine the necessary characteristics of a quality program and the importance of the linkage with engineering, information technology, and clinical paradigms to connect the development of an on-the-ground clinical program with the evaluation goal of a learning healthcare organization. While the LCSDP is the example given here, these partnerships and suggestions are salient to any healthcare organization seeking to implement new scientifically proven care in a useful and reliable way.

[Simultaneous bilateral cataract surgery--advantages and disadvantages].

PubMed

Obuchowska, Iwona; Mariak, Zofia

2006-01-01

During the past decade, advances in techniques and technology led to major changes in cataract surgical practice patterns. In this progression towards ever faster eye rehabilitation after surgery, simultaneous bilateral cataract surgery (SBCS) may be the next and ultimate step. It is not routinely performed: however, there are certain situations in which SBCS might be beneficial to the patients. It has been considered a good option in patients who have significant cataract in both eyes and are not good candidates for having anesthesia and surgery twice. The question is, if the benefits by bilateral surgery justify the risk of simultaneous complications, in particular endophthalmitis. In this perspective we present the clinical, social and economic advantages and disadvantages of such surgical procedures.

Advantages and disadvantages of technologies for HER2 testing in breast cancer specimens.

PubMed

Furrer, Daniela; Sanschagrin, François; Jacob, Simon; Diorio, Caroline

2015-11-01

Human epidermal growth factor receptor 2 (HER2) plays a central role as a prognostic and predictive marker in breast cancer specimens. Reliable HER2 evaluation is central to determine the eligibility of patients with breast cancer to targeted anti-HER2 therapies such as trastuzumab and lapatinib. Presently, several methods exist for the determination of HER2 status at different levels (protein, RNA, and DNA level). In this review, we discuss the main advantages and disadvantages of the techniques developed so far for the evaluation of HER2 status in breast cancer specimens. Each technique has its own advantages and disadvantages. It is therefore not surprising that no consensus has been reached so far on which technique is the best for the determination of HER2 status. Currently, emphasis must be put on standardization of procedures, internal and external quality control assessment, and competency evaluation of already existing methods to ensure accurate, reliable, and clinically meaningful test results. Development of new robust and accurate diagnostic assays should also be encouraged. In addition, large clinical trials are warranted to identify the technique that most reliably predicts a positive response to anti-HER2 drugs. Copyright© by the American Society for Clinical Pathology.

Prochlorococcus: Advantages and Limits of Minimalism

NASA Astrophysics Data System (ADS)

Partensky, Frédéric; Garczarek, Laurence

2010-01-01

Prochlorococcus is the key phytoplanktonic organism of tropical gyres, large ocean regions that are depleted of the essential macronutrients needed for photosynthesis and cell growth. This cyanobacterium has adapted itself to oligotrophy by minimizing the resources necessary for life through a drastic reduction of cell and genome sizes. This rarely observed strategy in free-living organisms has conferred on Prochlorococcus a considerable advantage over other phototrophs, including its closest relative Synechococcus, for life in this vast yet little variable ecosystem. However, this strategy seems to reach its limits in the upper layer of the S Pacific gyre, the most oligotrophic region of the world ocean. By losing some important genes and/or functions during evolution, Prochlorococcus has seemingly become dependent on co-occurring microorganisms. In this review, we present some of the recent advances in the ecology, biology, and evolution of Prochlorococcus, which because of its ecological importance and tiny genome is rapidly imposing itself as a model organism in environmental microbiology.

Prochlorococcus: advantages and limits of minimalism.

PubMed

Partensky, Frédéric; Garczarek, Laurence

2010-01-01

Prochlorococcus is the key phytoplanktonic organism of tropical gyres, large ocean regions that are depleted of the essential macronutrients needed for photosynthesis and cell growth. This cyanobacterium has adapted itself to oligotrophy by minimizing the resources necessary for life through a drastic reduction of cell and genome sizes. This rarely observed strategy in free-living organisms has conferred on Prochlorococcus a considerable advantage over other phototrophs, including its closest relative Synechococcus, for life in this vast yet little variable ecosystem. However, this strategy seems to reach its limits in the upper layer of the S Pacific gyre, the most oligotrophic region of the world ocean. By losing some important genes and/or functions during evolution, Prochlorococcus has seemingly become dependent on co-occurring microorganisms. In this review, we present some of the recent advances in the ecology, biology, and evolution of Prochlorococcus, which because of its ecological importance and tiny genome is rapidly imposing itself as a model organism in environmental microbiology.

Enforced Clonality Confers a Fitness Advantage

PubMed Central

Martínková, Jana; Klimešová, Jitka

2016-01-01

In largely clonal plants, splitting of a maternal plant into potentially independent plants (ramets) is usually spontaneous; however, such fragmentation also occurs in otherwise non-clonal species due to application of external force. This process might play an important yet largely overlooked role for otherwise non-clonal plants by providing a mechanism to regenerate after disturbance. Here, in a 5-year garden experiment on two short-lived, otherwise non-clonal species, Barbarea vulgaris and Barbarea stricta, we compared the fitness of plants fragmented by simulated disturbance (“enforced ramets”) both with plants that contemporaneously originate in seed and with individuals unscathed by the disturbance event. Because the ability to regrow from fragments is related to plant age and stored reserves, we compared the effects of disturbance applied during three different ontogenetic stages of the plants. In B. vulgaris, enforced ramet fitness was higher than the measured fitness values of both uninjured plants and plants established from seed after the disturbance. This advantage decreased with increasing plant age at the time of fragmentation. In B. stricta, enforced ramet fitness was lower than or similar to fitness of uninjured plants and plants grown from seed. Our results likely reflect the habitat preferences of the study species, as B. vulgaris occurs in anthropogenic, disturbed habitats where body fragmentation is more probable and enforced clonality thus more advantageous than in the more natural habitats preferred by B. stricta. Generalizing from our results, we see that increased fitness yielded by enforced clonality would confer an evolutionary advantage in the face of disturbance, especially in habitats where a seed bank has not been formed, e.g., during invasion or colonization. Our results thus imply that enforced clonality should be taken into account when studying population dynamics and life strategies of otherwise non-clonal species in disturbed

The ADVANTAGE seeding trial: a review of internal documents.

PubMed

Hill, Kevin P; Ross, Joseph S; Egilman, David S; Krumholz, Harlan M

2008-08-19

Seeding trials, clinical studies conducted by pharmaceutical companies that are designed to seem as if they answer a scientific question but primarily fulfill marketing objectives, have not been described in detail. To describe a known seeding trial, ADVANTAGE (Assessment of Differences between Vioxx and Naproxen To Ascertain Gastrointestinal Tolerability and Effectiveness), through documents of the trial sponsor, Merck & Co. (Whitehouse Station, New Jersey). Merck internal and external correspondence, reports, and presentations elicited to inform legal proceedings of Cona v Merck and Co., Inc., and McDarby v Merck and Co., Inc. The documents were created between 1998 and 2006. An iterative case-study process of review, discussion, and re-review of documents to identify themes relevant to the design and conduct of ADVANTAGE. To supplement the case-study review, the authors did a systematic review of the literature to identify published manuscripts focused on seeding trials and their conduct. Review of the documents revealed 3 key themes: The trial was designed by Merck's marketing division to fulfill a marketing objective; Merck's marketing division handled both the scientific and the marketing data, including collection, analysis, and dissemination; and Merck hid the marketing nature of the trial from participants, physician investigators, and institutional review board members. Although the systematic review of the literature identified 6 articles that focused on the practice of seeding trials, none provided documentary evidence of their existence or conduct. The legal documents in these cases provide useful, but limited, information about the practices of the pharmaceutical industry. This description of 1 company's actions is incomplete and may have limited generalizability. Documentary evidence shows that ADVANTAGE is an example of marketing framed as science. The documents indicate that ADVANTAGE was a seeding trial developed by Merck's marketing division to

Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar.

PubMed

L'Esperance, Shaun T; Perry, Donna J

2016-06-01

Telemedicine is an evolving field that holds great potential to improve patient outcomes. The National Organization of Nurse Practitioner Faculties core competencies now require all nurse practitioners (NPs) to be competent utilizing telemedicine to address various patient and healthcare system needs. While telemedicine offers advantages to patient care, adoption of new technologies can be challenging. An assessment of perceived advantages and barriers to MyCareTeam, an online diabetes management system, was conducted at an adult diabetes clinic. Two survey questionnaires were developed based on the Diffusion of Innovations (DOI) theory. The surveys were administered to patients in the clinic waiting room and sent to all clinical staff via an e-mail link. The findings of this project suggested a novel way to classify patients with regard to their use of the technology with implications for practice. Recommendations include outreach to enhance knowledge and awareness of MyCareTeam, reinforcing the full scope of the system, and improved technical support. DOI theory is a framework that may be utilized by NPs as a tool for assessing advantages and barriers to telemedicine applications in the practice setting in order to identify strategies to promote adoption and use. ©2015 American Association of Nurse Practitioners.

Clinical and scientific importance of source control in abdominal infections: summary of a symposium

PubMed Central

Bohnen, John M.A.; Marshall, John C.; Fry, Donald E.; Johnson, Steven B.; Solomkin, Joseph S.

1999-01-01

In May 1997, a panel of surgeon-investigators met to discuss the clinical importance and research implications of controlling the source of abdominal infections. It was concluded that source control is critical to therapeutic success and that antimicrobial therapy and other adjunctive interventions will fail if the source of infection is not controlled by resection, exteriorization or other means. The panelists presented different definitions of source control, depending on the scientific purpose of the definition. All participants agreed that failure to consider the adequacy of source control of infection has limited the value of most clinical trials of therapeutic anti-infective agents. Besides recognizing source control as an essential goal of patient care, the panelists emphasized the need for further investigative work to define, record and stratify the adequacy of source control in clinical trials of therapeutic agents for abdominal infections. PMID:10223073

The importance of clinical research skills according to PharmD students, first-year residents, and residency directors.

PubMed

Anderson, Heather D; Saseen, Joseph J

Research has a prominent role within the field of pharmacy practice. However, no studies have assessed the importance of research methods in pharmacy education from the perspective of students, residents, or residency directors. Questionnaires were administered online in spring 2014 to four respondent groups: University of Colorado fourth year PharmD (P4) students, post graduate year 1 (PGY1) residents, and PGY1 and post-graduate year 2 (PGY2) residency directors. Descriptive statistics were used to characterize respondents; t-tests and chi-square tests were used to compare groups of respondents. Respondents included 255 PGY1 residency directors, 155 PGY2 residency directors, 35 PGY1 residents, and 87 P4 students. Response rates ranged from 26% (residency directors) to nearly 60% (P4 students and PGY1 residents). PGY1 residents and PGY1/PGY2 residency directors ranked research experience lowest among ten characteristics with respect to their importance when competing for a residency or being a successful resident. Among six specific clinical research skills, PGY1 residents and PGY1/PGY2 residency directors ranked "identifying and writing a research question" as the most important for successfully completing a residency research project or when selecting a PGY1/PGY2 resident. Perceived importance of clinical research skills by P4 students, current residents, and residency program directors is low. This is in opposition to opinions from several national organizations that proclaim the importance of clinical research skills in doctor of pharmacy curricula. Pharmacy programs must continue to further develop clinical research skills and abilities of future graduates while being cognizant of these perception barriers when developing strategies to enhance research experiences within their curricular programs. Copyright © 2017 Elsevier Inc. All rights reserved.

A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important.

PubMed

Giesinger, Johannes M; Aaronson, Neil K; Arraras, Juan I; Efficace, Fabio; Groenvold, Mogens; Kieffer, Jacobien M; Loth, Fanny L; Petersen, Morten Aa; Ramage, John; Tomaszewski, Krzysztof A; Young, Teresa; Holzner, Bernhard

2018-02-01

In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group project focusing on the development of thresholds for clinical importance for the EORTC QLQ-C30 questionnaire and its corresponding computer-adaptive version. We conducted interviews with cancer patients and HCPs in 6 European countries. Participants were asked to name aspects of a symptom or problem that make it clinically important and to provide importance ratings for a predefined set of aspects (eg, need for help and limitations of daily functioning). We conducted interviews with 83 cancer patients (mean age, 60.3 y; 50.6% men) and 67 HCPs. Participants related clinical importance to limitations of everyday life (patients, 65.1%; HCPs, 77.6%), the emotional impact of a symptom/problem (patients, 53.0%; HCPs, 64.2%), and duration/frequency (patients, 51.8%; HCPs, 49.3%). In the patient sample, importance ratings were highest for worries by partner or family, limitations in everyday life, and need for help from the medical staff. Health care professionals rated limitations in everyday life and need for help from the medical staff to be most important. Limitations in everyday life, need for (medical) help, and emotional impact on the patient or family/partner were found to be relevant aspects of clinical importance. Based on these findings, we will define anchor items for the development of thresholds for clinical importance for the EORTC measures in a Europe-wide field study. Copyright © 2017 John Wiley & Sons, Ltd.

Nanoparticles in the clinic

PubMed Central

Anselmo, Aaron C.

2016-01-01

Abstract Nanoparticle/microparticle‐based drug delivery systems for systemic (i.e., intravenous) applications have significant advantages over their nonformulated and free drug counterparts. For example, nanoparticle systems are capable of delivering therapeutics and treating areas of the body that other delivery systems cannot reach. As such, nanoparticle drug delivery and imaging systems are one of the most investigated systems in preclinical and clinical settings. Here, we will highlight the diversity of nanoparticle types, the key advantages these systems have over their free drug counterparts, and discuss their overall potential in influencing clinical care. In particular, we will focus on current clinical trials for nanoparticle formulations that have yet to be clinically approved. Additional emphasis will be on clinically approved nanoparticle systems, both for their currently approved indications and their use in active clinical trials. Finally, we will discuss many of the often overlooked biological, technological, and study design challenges that impact the clinical success of nanoparticle delivery systems. PMID:29313004

Small and Large Animal Models in Cardiac Contraction Research: Advantages and Disadvantages

PubMed Central

Milani-Nejad, Nima; Janssen, Paul M.L.

2013-01-01

The mammalian heart is responsible for not only pumping blood throughout the body but also adjusting this pumping activity quickly depending upon sudden changes in the metabolic demands of the body. For the most part, the human heart is capable of performing its duties without complications; however, throughout many decades of use, at some point this system encounters problems. Research into the heart’s activities during healthy states and during adverse impacts that occur in disease states is necessary in order to strategize novel treatment options to ultimately prolong and improve patients’ lives. Animal models are an important aspect of cardiac research where a variety of cardiac processes and therapeutic targets can be studied. However, there are differences between the heart of a human being and an animal and depending on the specific animal, these differences can become more pronounced and in certain cases limiting. There is no ideal animal model available for cardiac research, the use of each animal model is accompanied with its own set of advantages and disadvantages. In this review, we will discuss these advantages and disadvantages of commonly used laboratory animals including mouse, rat, rabbit, canine, swine, and sheep. Since the goal of cardiac research is to enhance our understanding of human health and disease and help improve clinical outcomes, we will also discuss the role of human cardiac tissue in cardiac research. This review will focus on the cardiac ventricular contractile and relaxation kinetics of humans and animal models in order to illustrate these differences. PMID:24140081

Small and large animal models in cardiac contraction research: advantages and disadvantages.

PubMed

Milani-Nejad, Nima; Janssen, Paul M L

2014-03-01

The mammalian heart is responsible for not only pumping blood throughout the body but also adjusting this pumping activity quickly depending upon sudden changes in the metabolic demands of the body. For the most part, the human heart is capable of performing its duties without complications; however, throughout many decades of use, at some point this system encounters problems. Research into the heart's activities during healthy states and during adverse impacts that occur in disease states is necessary in order to strategize novel treatment options to ultimately prolong and improve patients' lives. Animal models are an important aspect of cardiac research where a variety of cardiac processes and therapeutic targets can be studied. However, there are differences between the heart of a human being and an animal and depending on the specific animal, these differences can become more pronounced and in certain cases limiting. There is no ideal animal model available for cardiac research, the use of each animal model is accompanied with its own set of advantages and disadvantages. In this review, we will discuss these advantages and disadvantages of commonly used laboratory animals including mouse, rat, rabbit, canine, swine, and sheep. Since the goal of cardiac research is to enhance our understanding of human health and disease and help improve clinical outcomes, we will also discuss the role of human cardiac tissue in cardiac research. This review will focus on the cardiac ventricular contractile and relaxation kinetics of humans and animal models in order to illustrate these differences. © 2013.

Clinical Importance of Steps Taken per Day among Persons with Multiple Sclerosis

PubMed Central

Motl, Robert W.; Pilutti, Lara A.; Learmonth, Yvonne C.; Goldman, Myla D.; Brown, Ted

2013-01-01

Background The number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in persons with multiple sclerosis (MS). Objective This study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS. Methods This study was a secondary analysis of de-identified data from 15 investigations totaling 786 persons with MS and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences. Results The mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample). Conclusion The change in motion sensor output of ∼800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS. PMID:24023843

The entry-level occupational therapy clinical doctorate: advantages, challenges, and international issues to consider.

PubMed

Brown, Ted; Crabtree, Jeffrey L; Mu, Keli; Wells, Joe

2015-04-01

Internationally, occupational therapy education has gone through several paradigm shifts during the last few decades, moving from certificate to diploma to bachelors to masters and now in some instances to clinical doctorate as the entry-level professional credential to practice. In the United States there is a recommendation under consideration by the American Occupational Therapy Association (AOTA) that by 2025, all occupational therapy university programs will move to the clinical doctorate level. It should be noted, however, that the AOTA Board can only make recommendations and it is the Accreditation Council for Occupational Therapy Education (ACOTE) who has regulatory authority to approve such a change. What are the potential implications for the profession, our clients, and funders of occupational therapy services? What are the primary drivers for the move towards the clinical doctorate being the educational entry point? Is the next step in the evolution of occupational therapy education globally a shift to the entry-level clinical doctorate? This article reviews current literature and discusses issues about the occupational therapy entry-level clinical doctorate. The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to the clinical doctorate as the singular entry point to occupational therapy practice are considered. The potential impacts of the introduction of the clinical doctorate as the entry-to-practice qualification across the United States on the occupational therapy community internationally will be briefly discussed. If the United States moves toward the entry-level clinical doctorate as the only educational starting point for the profession, will other jurisdictions follow suit? Further discourse and investigation of this issue both inside and outside of the United States is needed so that informed decisions can be made.

Preparing clinical pharmacy scientists for careers in clinical/translational research: can we meet the challenge?: ACCP Research Affairs Committee Commentary.

PubMed

Parker, Robert B; Ellingrod, Vicki; DiPiro, Joseph T; Bauman, Jerry L; Blouin, Robert A; Welage, Lynda S

2013-12-01

Developing clinical pharmacists' research skills and their ability to compete for extramural funding is an important component of the American College of Clinical Pharmacy's (ACCP) vision for pharmacists to play a prominent role in generating the new knowledge used to guide patient pharmacotherapy. Given the recent emphasis on clinical/translational research at the National Institutes of Health (NIH) and the key role of drug therapy in the management of many diseases, there is an unprecedented opportunity for the profession to contribute to this enterprise. A crucial question facing the profession is whether we can generate enough appropriately trained scientists to take advantage of these opportunities to generate the new knowledge to advance drug therapy. Since the 2009 publication of the ACCP Research Affairs Committee editorial recommending the Ph.D. degree (as opposed to fellowship training) as the optimal method for preparing pharmacists as clinical/translational scientists, significant changes have occurred in the economic, professional, political, and research environments. As a result, the 2012 ACCP Research Affairs Committee was charged with reexamining the college's position on training clinical pharmacy scientists in the context of these substantial environmental changes. In this commentary, the potential impact of these changes on opportunities for pharmacists in clinical/translational research are discussed as are strategies for ACCP, colleges of pharmacy, and the profession to increase the number and impact of clinical pharmacy scientists. Failure of our profession to take advantage of these opportunities risks our ability to contribute substantively to the biomedical research enterprise and ultimately improve the pharmacotherapy of our patients. © 2013 Pharmacotherapy Publications, Inc.

3D molecular descriptors important for clinical success.

PubMed

Kombo, David C; Tallapragada, Kartik; Jain, Rachit; Chewning, Joseph; Mazurov, Anatoly A; Speake, Jason D; Hauser, Terry A; Toler, Steve

2013-02-25

The pharmacokinetic and safety profiles of clinical drug candidates are greatly influenced by their requisite physicochemical properties. In particular, it has been shown that 2D molecular descriptors such as fraction of Sp3 carbon atoms (Fsp3) and number of stereo centers correlate with clinical success. Using the proteomic off-target hit rate of nicotinic ligands, we found that shape-based 3D descriptors such as the radius of gyration and shadow indices discriminate off-target promiscuity better than do Fsp3 and the number of stereo centers. We have deduced the relevant descriptor values required for a ligand to be nonpromiscuous. Investigating the MDL Drug Data Report (MDDR) database as compounds move from the preclinical stage toward the market, we have found that these shape-based 3D descriptors predict clinical success of compounds at preclinical and phase1 stages vs compounds withdrawn from the market better than do Fsp3 and LogD. Further, these computed 3D molecular descriptors correlate well with experimentally observed solubility, which is among well-known physicochemical properties that drive clinical success. We also found that about 84% of launched drugs satisfy either Shadow index or Fsp3 criteria, whereas withdrawn and discontinued compounds fail to meet the same criteria. Our studies suggest that spherical compounds (rather than their elongated counterparts) with a minimal number of aromatic rings may exhibit a high propensity to advance from clinical trials to market.

Virtual online consultations: advantages and limitations (VOCAL) study

PubMed Central

Greenhalgh, Trisha; Vijayaraghavan, Shanti; Wherton, Joe; Shaw, Sara; Byrne, Emma; Campbell-Richards, Desirée; Bhattacharya, Satya; Hanson, Philippa; Ramoutar, Seendy; Gutteridge, Charles; Hodkinson, Isabel; Collard, Anna; Morris, Joanne

2016-01-01

Introduction Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. Methods To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel—audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel—interviews, ethnographic observations and analysis of documents within the trust; macrolevel—key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. Ethics approval City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. Planned outputs We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: ‘what to expect in your virtual consultation’. Discussion The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they

Advantageous Inequity Aversion Does Not Always Exist: The Role of Determining Allocations Modulates Preferences for Advantageous Inequity.

PubMed

Li, Ou; Xu, Fuming; Wang, Lei

2018-01-01

Previous studies have shown that people would like to sacrifice benefits to themselves in order to avoid inequitable outcomes, not only when they receive less than others (disadvantageous inequity aversion) but also when they receive more (advantageous inequity aversion). This feature is captured by the theory of inequity aversion. The present study was inspired by what appears to be asymmetry in the research paradigm toward advantageous inequity aversion. Specifically, studies that supported the existence of advantageous inequity aversion always relied on the paradigm in which participants can determine allocations. Thus, it is interesting to know what would occur if participants could not determine allocations or simply passed judgment on predetermined allocations. To address this, a behavioral experiment ( N = 118) and a skin conductance response (SCR) experiment ( N = 29) were adopted to compare participants' preferences for advantageous inequity directly when allocations were determined and when allocations were predetermined in an allocating task. In the determined condition, participants could divide by themselves a sum of money between themselves and a matched person, whereas in the predetermined condition, they could simply indicate their satisfaction with an equivalent program-generated allocation. It was found that, compared with those in the determined condition, participants in the predetermined condition behaved as if they liked the advantageous inequity and equity to the same degree (Experiment One) and that the SCRs elicited by advantageous inequity had no differences from those elicited by equity, suggesting that participants did not feel negatively toward advantageous inequity in this situation (Experiment Two). The present study provided mutual corroboration (behavioral and electrophysiological data) to document that advantageous inequity aversion may differ as a function of the individual's role in determining allocations, and it would disappear

The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner.

PubMed

Sanfilippo, Paul G; Hewitt, Alex W; Mackey, David A

2017-04-01

To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

Building Networks for Global Clinical Research: The Basics.

PubMed

Shearer, David W; Volberding, Paul A; Schemitsch, Emil H; Cook, Gillian E; Slobogean, Gerard P; Morshed, Saam

2015-12-01

Over the last several decades, interest in global health across all fields of medicine, including orthopaedic surgery, has grown markedly. Cross-national collaborations are an effective means of conducting high-quality clinical research and offer many advantages over single-center investigations. Successful collaboration requires a well-designed research protocol, development of an effective team structure, and the funding to ensure the project is sustained to completion. Equally important, investigators must consider the social, linguistic, and cultural context in which the study is being undertaken. Although randomized clinical trials are the highest level of evidence, study designs may have to be adapted to accommodate available resources, expertise, and local contextual factors. With appropriate planning, these collaborative endeavors can generate changes in clinical practice and positively impact health policy.

Determining the Minimal Clinically Important Difference for Six-Minute Walk Distance in Fibromyalgia

PubMed Central

Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.

2016-01-01

Objective To estimate the minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) in patients with fibromyalgia (FM). Design Data from a recently completed trial that included 187 patients who completed the 6-minute walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 weeks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain (SF36-PF) as clinical anchors. Results The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (p<0.001). The anchor-based MCID’s for the 6MWD were 156 m and 167 m for the FIQ and SF36-PF, respectively. These MCID’s correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-PF (10 point increase). Conclusion The MCID for 6MWD in patients with FM was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with FM. PMID:27003201

Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia.

PubMed

Kaleth, Anthony S; Slaven, James E; Ang, Dennis C

2016-10-01

The aim of this study was to estimate the minimal clinically important difference (MCID) for 6-min walk distance (6MWD) in patients with fibromyalgia. Data from a recently completed trial that included 187 patients who completed the 6-min walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 wks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain as clinical anchors. The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (P < 0.001). The anchor-based MCIDs for the 6MWD were 156 and 167 m for the FIQ and SF36-physical function domain, respectively. These MCIDs correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-physical function domain (10-point increase). The MCID for 6MWD in patients with fibromyalgia was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with fibromyalgia.

76 FR 56262 - Community Advantage Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... SMALL BUSINESS ADMINISTRATION [Docket No. SBA 2011-0003] Community Advantage Pilot Program AGENCY: U.S. Small Business Administration (SBA). ACTION: Notice of change to Community Advantage Pilot... Community Advantage Pilot Program. In that notice, SBA modified or waived as appropriate certain regulations...

Clinical importance of pharmacogenetics in the treatment of hepatitis C virus infection.

PubMed

Kamal, Adina Maria; MitruŢ, Paul; Kamal, Kamal Constantin; Tica, Oana Sorina; Niculescu, Mihaela; Alexandru, Dragoş Ovidiu; Tica, Andrei Adrian

2016-01-01

Globally, over 4% of the world population is affected by hepatitis C virus (HCV) infection. The current standard of care for hepatitis C infection is combination therapy with pegylated interferon and ribavirin for 48 weeks, which yield a sustained virological response in only a little over half of the patients with genotype 1 HCV. We investigated the clinical importance of pharmacogenetics in treatment efficacy and prediction of hematotoxicity. A total of 148 patients infected with HCV were enrolled. All patients were treated for a period of 48 weeks or less with pegylated interferon and ribavirin. Four genotypes were investigated: inosine triphosphatase (ITPA) rs1127354, C20orf194 rs6051702, interferon lambda (IFNL)3 rs8099917, IFNL3÷4 rs12979860 in the population from southwestern Romania. Genetic variants for rs129798660 and rs6051702 proved once more to represent an indisputable clinical tool for predicting sustained virological response (SVR) (69.23%, chi-square p=0.007846, p<0.05 and 63.29%, chi-square p=0.007846, p<0.05, respectively). ITPA genetic variants protect against ribavirin-induced hemolytic anemia and C20orf194 also proved to be protective against thrombocytopenia. These clinical findings strengthen the belief that pharmacogenetics should play a constant role in treatment decisions for patients infected with hepatitis C virus.

Core Competence, Distinctive Competence, and Competitive Advantage: What Is the Difference?

ERIC Educational Resources Information Center

Mooney, Ann

2007-01-01

Core competence, distinctive competence, and competitive advantage are 3 of the most important business concepts that managers, researchers, and educators rely on for decision making, pedagogy, and research. However, little attention has been paid to defining these concepts. As a result, they have become buzzwords that are used so frequently that…

[New intensifying screens in clinical radiology. II. Examinations in clinical practice].

PubMed

Freyschmidt, J; Saure, D; Hagemann, G

1976-09-01

A clinically applicable procedure for testing new intensifying rare earth screens, as well as the special Siemens' screen is described. The results are related to universal screens. The film-screen combination alpha 4XD (gadolinium oxysulphide with normal, green sensitive film) results in a reduction of radiation dose to half with detail comparable with universal screens. The Siemens' special screen has similar advantages. Screens with a higher intensification factor and reduction of the mAs to one sixth results in loss of detail. This does not necessarily reduce their clinical use if they are used for appropriate purposes. The results of this clinically orientated technique agreed well with physically objective methods using lead grids. The advantages of the new screens are discussed in terms of their practical application.

Electrophysiological Explorations of the Bilingual Advantage: Evidence from a Stroop Task

PubMed Central

Coderre, Emily L.; van Heuven, Walter J. B.

2014-01-01

Bilinguals have been shown to exhibit a performance advantage on executive control tasks, outperforming their monolingual counterparts. Although a wealth of research has investigated this ‘bilingual advantage’ behaviourally, electrophysiological correlates are lacking. Using EEG with a Stroop task that manipulated the stimulus onset asynchrony (SOA) of word and colour presentation, the current study addressed two facets of the bilingual advantage. The possibility that bilinguals experience superior conflict processing relative to monolinguals (a ‘conflict-specific advantage’) was investigated by comparing behavioural interference effects as well as the amplitude of the Ninc, a conflict-related ERP component occurring from approximately 300–500 ms after the onset of conflict. In contrast, the hypothesis that bilinguals experience domain-general, conflict-independent enhancements in executive processing (a ‘non-conflict-specific advantage’) was evaluated by comparing the control condition (symbol strings) between groups. There was some significant, but inconsistent, evidence for a conflict-specific bilingual advantage. In contrast, strong evidence emerged for a non-conflict-specific advantage, with bilinguals demonstrating faster RTs and reduced ERP amplitudes on control trials compared to monolinguals. Importantly, when the control stimulus was presented before the colour, ERPs to control trials revealed group differences before the onset of conflict, suggesting differences in the ability to ignore or suppress distracting irrelevant information. This indicates that bilinguals experience superior executive processing even in the absence of conflict and semantic salience, and suggests that the advantage extends to more efficient proactive management of the environment. PMID:25068723

Does the advantage of the upper part of words occur at the lexical level?

PubMed

Perea, Manuel; Comesaña, Montserrat; Soares, Ana P

2012-11-01

Several recent studies have shown that the upper part of words is more important than the lower part in visual word recognition. Here, we examine whether or not this advantage arises at the lexical or at the letter (letter feature) level. To examine this issue, we conducted two lexical decision experiments in which words/pseudowords were preceded by a very brief (50-ms) presentation of their upper or lower parts (e.g., ). If the advantage for the upper part of words arises at the letter (letter feature) level, the effect should occur for both words and pseudowords. Results revealed an advantage for the upper part of words, but not for pseudowords. This suggests that the advantage for the upper part of words occurs at the lexical level, rather than at the letter (or letter feature) level.

Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol.

PubMed

Singh, Dave; Maleki-Yazdi, M Reza; Tombs, Lee; Iqbal, Ahmar; Fahy, William A; Naya, Ian

2016-01-01

Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations) of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI) reduces clinically important deteriorations (CIDs) in COPD versus placebo or bronchodilator monotherapy. This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650), or UMEC/VI 62.5/25 µg with tiotropium (TIO) 18 µg (Study B; NCT01777334) in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George's Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation. In Study A, fewer patients experienced a first CID with UMEC/VI (44%) versus UMEC (50%), VI (56%), and placebo (75%). The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45]), UMEC (HR: 0.46 [95% CI: 0.38, 0.56]), and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001) versus placebo, and with UMEC/VI versus UMEC (HR: 0.80 [95% CI: 0.65, 0.97]; P<0.05) and versus VI (HR: 0.67 [95% CI: 0.55, 0.81]; P<0.001). In Study B, fewer patients experienced a first CID with UMEC/VI (41%) versus TIO (59%). UMEC/VI reduced the risk of a first composite CID by 43% versus TIO (HR: 0.57 [95% CI: 0.47, 0.69]; P<0.001). This exploratory analysis, using a new assessment of clinical deterioration in COPD, revealed that a majority of symptomatic patients with low exacerbation risk experienced a deterioration during the 24-week study periods

Epidemiology and clinical features of imported malaria in East London.

PubMed

Francis, Benjamin C; Gonzalo, Ximena; Duggineni, Sirisha; Thomas, Janice M; NicFhogartaigh, Caoimhe; Babiker, Zahir Osman Eltahir

2016-06-01

Malaria is the most common imported tropical disease in the United Kingdom (UK). The overall mortality is low but inter-regional differences have been observed. We conducted a 2-year retrospective review of clinical and laboratory records of patients with malaria attending three acute hospitals in East London from 1 April 2013 through 31 March 2015. Epidemiological and clinical characteristics of imported malaria were described and risk factors associated with severe falciparum malaria were explored. In total, 133 patients with laboratory-confirmed malaria were identified including three requiring critical care admission but no deaths. The median age at presentation was 41 years (IQR 30-50). The majority of patients were males (64.7%, 86/133) and had Black or Black British ethnicity (67.5%, 79/117). West Africa was the most frequent region of travel (70.4%, 76/108). Chemoprophylaxis use was poor (25.3%, 20/79). The interval between arriving in the UK and presenting to hospital was short (median 10 days; IQR 5-15.5, n = 84). July-September was the peak season of presentation (34.6%, 46/133). Plasmodium falciparum was the commonest species (76.7%, 102/133) and 31.4% (32/102) of these patients had parasitaemia >2%. Severe falciparum malaria was documented in 36.3% (37/102) of patients and the October-March season presentation was associated with an increased risk of severity (OR 3.00; 95% CI 1.30-6.93). Black patients appeared to have reduced risk of severe falciparum malaria (OR 0.46; 95% CI 0.16-1.35) but this was not statistically significant. HIV sero-status was determined in only 27.1% (36/133) of cases. Only 8.5% (10/117) of all malaria patients were treated as outpatients. Clinicians need to raise awareness on malaria prevention strategies, improve rates of HIV testing in tropical travellers, and familiarise themselves with ambulatory management of malaria. The relationship between season of presentation, ethnicity and severity of falciparum malaria

Gardnerella infection as distinguished from cervical dysbacteriosis: the advantageous spin-off of cervical screening.

PubMed

Klomp, Johanna M; Ouwerkerk-Noordam, Elisabeth; Boon, Mathilde E; van Haaften, Maarten; Heintz, A Peter M

2009-01-01

To evaluate cytologic diagnoses of dysbacteriosis and Gardnerella infection and to obtain insight into the diagnostic problems of Gardnerella. One hundred randomly selected samples of each of 3 diagnostic series were rescreened by 2 pathologists, resulting in 2 rescreening diagnoses and a consensus diagnosis. A smear was considered unequivocal when the original O code and the O code of the consensus diagnoses were equal and discordant when the flora diagnoses of the 2 pathologists differed. Discordance was highest in the dysbacteriotic series (20%) and lowest in the healthy group (4%). Unequivocal diagnoses were established in 65% of the dysbacteriotic smears, 80% of the Gardnerella smears and 93% of the healthy smears. Misclassification of Gardnerella occurred in the presence of clusters of bacteria mixed with spermatozoa. Blue mountain cells in Gardnerella infection can be identified unequivocally in cervical smears. Because of the clinical importance of treating Gardnerella, such advantageous spin-offs of cervical screening should be exploited.

Integrated Medical Curriculum: Advantages and Disadvantages

PubMed Central

Quintero, Gustavo A.; Vergel, John; Arredondo, Martha; Ariza, María-Cristina; Gómez, Paula; Pinzon-Barrios, Ana-Maria

2016-01-01

Most curricula for medical education have been integrated horizontally and vertically–-vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups. PMID:29349303

[Imported malaria and HIV infection in Madrid. Clinical and epidemiological features].

PubMed

Ramírez-Olivencia, G; Herrero, M D; Subirats, M; de Juanes, J R; Peña, J M; Puente, S

2012-01-01

Few data are available in Spain data on human immunodeficiency virus (HIV) patients coinfected with malaria. This study has aimed to determine the epidemiological and clinical characteristics of imported malaria in patients coinfected with HIV. A case-series retrospective study was performed using the patient's medical records. The study population consisted on patients diagnosed with malaria attended in our center from january 1, 2002 to december 31, 2007. A total of 484 episodes of malaria, 398 of which were included in this study, were identified. Co-infection with HIV was described in 32 cases. All of them occurred in individuals presumably with some degree of semi-immunity. In the coinfected group, there were 13 cases (40.6%) asymptomatic, whereas this event occurred in 99 cases of patients not coinfected (37.2%) (P=0.707). The greater presence of anemia in co-infected patients (62.5% vs 32.3% in non-coinfected [P=0.001]) stands out. In present study, the clinical presentation forms were similar, regardless of the presence or absence of HIV infection. Although the study population does not reflect all possible scenarios of malaria and HIV coinfection, our results indicate the reality of patients attended in the Autonomous Community of Madrid. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Advantages of Science Cubesat and Microsat Deployment Using DSG Deep Space Exploration Robotics

NASA Astrophysics Data System (ADS)

Shaw, A.; Rembala, R.; Fulford, P.

2018-02-01

Important scientific missions can be accomplished with cubesats/microsats. These missions would benefit from advantages offered by having an independent cubesat/microsat deployment capability as part of Deep Space Gateway's Deep Space Exploration Robotics system.

Clinic expert information extraction based on domain model and block importance model.

PubMed

Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng

2015-11-01

To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method. Copyright © 2015 Elsevier Ltd. All rights reserved.

Important clinical uses for digital photography.

PubMed

Christensen, Gordon J

2005-01-01

Digital photography almost has overtaken the conventional photographic film industry. Most professional photographers are using either digital photography alone or a combination of digital and conventional film photography. The trend toward digital photography is not likely to change. Using digital photography in the dental office is fast, easy and highly useful for documenting treatment, carrying out patient education and accomplishing clinical research. Supervision and use of this new technology can be delegated to staff members, and it will provide many benefits to dentists and patients.

Perceptions of the importance and control of professional problems in the clinical setting.

PubMed

Maupomé, G; Borges-Yáñez, S A; Dáez-de-Bonilla, F J; Pineda-Cruz, A

2001-01-01

The objective of this study was to identify the relative importance of culturally relevant professional problems and the degree of control over them, as perceived by dentists and dental students in Mexico City, Mexico. The dentists and students ranked 13 problems according to importance and then according to the perceived degree of control over each one. Novice clinicians were less secure about their ability to cope with the legal, financial, and clinical performance problems, whereas experienced clinicians were more concerned about occupational hazards and the dental market and culture. Both reported similar perceptions of their control of the problems. This preliminary information should support introducing into dental schools relevant practice-management courses, targeting continuing education efforts, and instituting professional counseling measures to meet the challenges posed by these problems.

The survival advantage of olfaction in a competitive environment.

PubMed

Asahina, Kenta; Pavlenkovich, Viktoryia; Vosshall, Leslie B

2008-08-05

Olfaction is generally assumed to be critical for survival because this sense allows animals to detect food and pheromonal cues. Although the ability to sense sex pheromones [1, 2, 3] is likely to be important for insects, the contribution of general odor detection to survival is unknown. We investigated the extent to which the olfactory system confers a survival advantage on Drosophila larvae foraging for food under conditions of limited resources and competition from other larvae.

Large- and small-size advantages in sneaking behaviour in the dusky frillgoby Bathygobius fuscus.

PubMed

Takegaki, Takeshi; Kaneko, Takashi; Matsumoto, Yukio

2012-04-01

Sneaking tactic, a male alternative reproductive tactic involving sperm competition, is generally adopted by small individuals because of its inconspicuousness. However, large size has an advantage when competition occurs between sneakers for fertilization of eggs. Here, we suggest that both large- and small-size advantages of sneaker males are present within the same species. Large sneaker males of the dusky frillgoby Bathygobius fuscus showed a high success rate in intruding into spawning nests because of their advantage in competition among sneaker males in keeping a suitable position to sneak, whereas small sneakers had few chances to sneak. However, small sneaker males were able to stay in the nests longer than large sneaker males when they succeeded in sneak intrusion. This suggests the possibility of an increase in their paternity. The findings of these size-specific behavioural advantages may be important in considering the evolution of size-related reproductive traits.

Large- and small-size advantages in sneaking behaviour in the dusky frillgoby Bathygobius fuscus

NASA Astrophysics Data System (ADS)

Takegaki, Takeshi; Kaneko, Takashi; Matsumoto, Yukio

2012-04-01

Sneaking tactic, a male alternative reproductive tactic involving sperm competition, is generally adopted by small individuals because of its inconspicuousness. However, large size has an advantage when competition occurs between sneakers for fertilization of eggs. Here, we suggest that both large- and small-size advantages of sneaker males are present within the same species. Large sneaker males of the dusky frillgoby Bathygobius fuscus showed a high success rate in intruding into spawning nests because of their advantage in competition among sneaker males in keeping a suitable position to sneak, whereas small sneakers had few chances to sneak. However, small sneaker males were able to stay in the nests longer than large sneaker males when they succeeded in sneak intrusion. This suggests the possibility of an increase in their paternity. The findings of these size-specific behavioural advantages may be important in considering the evolution of size-related reproductive traits.

Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes.

PubMed

Partington, Andrew; Chew, Derek P; Ben-Tovim, David; Horsfall, Matthew; Hakendorf, Paul; Karnon, Jonathan

2017-03-01

Objective Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients' presenting characteristics and time of presentation. Conclusions The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives. What is known about the topic? Variation in clinical practice is a long-standing issue that has been analysed from many different perspectives. It is neither possible nor desirable to address all forms of variation in clinical practice: the focus should be on identifying important unwarranted variation to inform actions to reduce variation and improve quality. What does this paper add? This paper proposes the

Home advantage in high-level volleyball varies according to set number.

PubMed

Marcelino, Rui; Mesquita, Isabel; Palao Andrés, José Manuel; Sampaio, Jaime

2009-01-01

The aim of the present study was to identify the probability of winning each Volleyball set according to game location (home, away). Archival data was obtained from 275 sets in the 2005 Men's Senior World League and 65,949 actions were analysed. Set result (win, loss), game location (home, away), set number (first, second, third, fourth and fifth) and performance indicators (serve, reception, set, attack, dig and block) were the variables considered in this study. In a first moment, performance indicators were used in a logistic model of set result, by binary logistic regression analysis. After finding the adjusted logistic model, the log-odds of winning the set were analysed according to game location and set number. The results showed that winning a set is significantly related to performance indicators (Chisquare(18)=660.97, p<0.01). Analyses of log-odds of winning a set demonstrate that home teams always have more probability of winning the game than away teams, regardless of the set number. Home teams have more advantage at the beginning of the game (first set) and in the two last sets of the game (fourth and fifth sets), probably due to facilities familiarity and crowd effects. Different game actions explain these advantages and showed that to win the first set is more important to take risk, through a better performance in the attack and block, and to win the final set is important to manage the risk through a better performance on the reception. These results may suggest intra-game variation in home advantage and can be most useful to better prepare and direct the competition. Key pointsHome teams always have more probability of winning the game than away teams.Home teams have higher performance in reception, set and attack in the total of the sets.The advantage of home teams is more pronounced at the beginning of the game (first set) and in two last sets of the game (fourth and fifth sets) suggesting intra-game variation in home advantage.Analysis by sets

Advantages and limitations of teleneurology.

PubMed

Wechsler, Lawrence R

2015-03-01

The growing disparity between the demand for neurological services and the need for neurologists requires new and innovative strategies for delivering care. Teleneurology allows neurological expertise to be delivered to remote locations to supplement or replace in-person neurological care. To summarize the current status of teleneurology. Applications of teleneurology include acute care, outpatient teleneurology, and teleconsultations. Existing barriers to further expansion of teleneurology are also discussed. Published studies pertaining to teleneurology were reviewed. Practical experience with telemedicine in neurological practice contributed to the conclusions. Outcomes after intravenous tissue plasminogen activator treatment via telemedicine (telestroke) are similar to those achieved with in-person evaluations. Other aspects of teleneurology are less established but have demonstrated feasibility, high patient satisfaction, and, in some cases, cost savings. Teleneurology provides neurological expertise to rural areas with limited availability of neurologists and improves care for patients with difficulty traveling owing to neurological disease. It is likely that use of teleneurology will continue to grow and become incorporated into many aspects of neurological practice. Understanding the advantages and limitations of teleneurology is vital to delivering optimal clinical care for patients with neurological disease regardless of the setting.

Importance of placebo effect in cough clinical trials.

PubMed

Eccles, Ron

2010-01-01

Cough is a unique symptom because, unlike sneeze and other symptoms, it can be under voluntary control and this complicates clinical trials on cough medicines. All over-the-counter cough medicines (OTC) are very effective treatments because of their placebo effect. The placebo effect is enhanced by expectancy related to advertising, brand, packaging, and formulation. This placebo effect creates a problem for the conduct of clinical trials on OTC cough medicines that attempt to demonstrate the efficacy of a pharmacological agent above that of any placebo effect. Up to 85% of the efficacy of some cough medicines can be attributed to a placebo effect. The placebo effect apparent in clinical trials consists of several components: natural recovery, regression of cough response toward mean, demulcent effect, effect of sweetness, voluntary control, and effects related to expectancy and meaning of the treatment. The placebo effect has been studied most in the pain model, and placebo analgesia is reported to depend on the activation of endogenous opioid systems in the brain; this model may be applicable to cough. A balanced placebo design may help to control for the placebo effect, but this trial design may not be acceptable due to deception of patients. The placebo effect in clinical trials may be controlled by use of a crossover design, where feasible, and the changes in the magnitude of the placebo effect in this study design are discussed.

Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice.

PubMed

Kroenke, Kurt; Monahan, Patrick O; Kean, Jacob

2015-09-01

Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice. Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs. Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records). Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice. Published by Elsevier Inc.

What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

PubMed Central

McKibbon, Kathleen Ann; Wilczynski, Nancy L; Haynes, Robert Brian

2004-01-01

Background We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional

Clinical and epidemiological characteristics of imported infectious diseases in Spanish travelers.

PubMed

Zamarrón Fuertes, Pilar; Pérez-Ayala, Ana; Pérez Molina, José A; Norman, Francesca F; Monge-Maíllo, Begoña; Navarro, Miriam; López-Vélez, Rogelio

2010-01-01

Spain could be a potential area in Europe for the development and spread of emerging diseases from the tropics due to its geoclimatic characteristics, but there is little information on infectious diseases imported by travelers. The aim of this article was to analyze clinical-epidemiological characteristics of infectious diseases imported by Spanish travelers from the tropics. A retrospective descriptive study of 2,982 travelers seeking medical advice who return ill from the tropics was conducted. Demographic data, details of travel (destination, type, and duration), preventive measures, clinical syndromes, and diagnoses were analyzed. Nearly half (46.5%) the travelers had traveled to sub-Saharan Africa; 46.5% reported a stay exceeding 1 month (and almost a quarter more than 6 months). Following pre-travel advice, 69.1% received at least one vaccine and 35.5% took malarial chemoprophylaxis with variations according to geographical area of travel. In all, 58.8% of this took chemoprophylaxis correctly. Most common syndromes were fever 1,028 (34.5%), diarrhea 872 (29.3%), and cutaneous syndrome 684 (22.9%). Most frequent diagnoses were traveler's diarrhea (17.2%), malaria (17%), and intestinal parasites (10.4%). The three main syndromes in travelers to the Caribbean-Central America, Indian subcontinent-Southeast Asia, and other areas were diarrhea, fever, and cutaneous syndrome (p < 0.05); in sub-Saharan Africa were fever, cutaneous syndrome, and diarrhea (p < 0.05); and in South America were cutaneous syndrome, diarrhea, and fever (p < 0.05). Travelers to sub-Saharan Africa showed a higher frequency of malaria, rickettsiosis, filariasis, and schistosomiasis (p < 0.05); those to South America showed cutaneous larva migrants, other ectoparasitosis, and cutaneous/mucocutaneous leishmaniasis; and those to the Indian subcontinent-Southeast Asia showed intestinal parasitosis, arboviriasis, and enteric fever (p < 0.05). Increased international travel is a key factor for the

Practical advantages of evolutionary computation

NASA Astrophysics Data System (ADS)

Fogel, David B.

1997-10-01

Evolutionary computation is becoming a common technique for solving difficult, real-world problems in industry, medicine, and defense. This paper reviews some of the practical advantages to using evolutionary algorithms as compared with classic methods of optimization or artificial intelligence. Specific advantages include the flexibility of the procedures, as well as their ability to self-adapt the search for optimum solutions on the fly. As desktop computers increase in speed, the application of evolutionary algorithms will become routine.

Advantages and Uses of AMTEC

NASA Astrophysics Data System (ADS)

Lodhi, M. A. K.

2012-10-01

Static conversion systems are gaining importance in recent times because of newer applications of electricity like in spacecraft, hybrid-electric vehicles, military uses and domestic purposes. Of the many new static energy conversion systems that are being considered, one is the Alkali Metal Thermal Electric Converter (AMTEC). It is a thermally regenerative, electrochemical device for the direct conversion of heat to electrical power. As the name suggests, this system uses an alkali metal in its process. The electrochemical process involved in the working of AMTEC is ionization of alkali metal atoms at the interface of electrode and electrolyte. The electrons produced as a result flow through the external load thus doing work, and finally recombine with the metal ions at the cathode. AMTECs convert the work done during the nearly isothermal expansion of metal vapor to produce a high current and low voltage electron flow. Due to its principle of working it has many inherent advantages over other conventional generators. These will be discussed briefly.

The importance of professional values from clinical nurses' perspective in hospitals of a medical university in Iran.

PubMed

Poorchangizi, Batool; Farokhzadian, Jamileh; Abbaszadeh, Abbas; Mirzaee, Moghaddameh; Borhani, Fariba

2017-03-01

Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses' perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses' perspective. The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised (NPVS-R) by Weis and Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study. Results indicated that the total score of the nurses' professional values was high. (102.57 ± 11.94). From nurses' perspective items such as "Maintaining confidentiality of patients" and "Safeguarding patients' right to privacy" had more importance; however, "Recognizing role of professional nursing associations in shaping healthcare policy" and "Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses' age, work experience as well as participation in professional ethical training (P < 0.05). Although the total score related to the clinical nurses' perspective on professional values was high, the importance of certain values was at a lower level. Owing to the emerging ethical challenges, it is indispensable to design educational programs in order to improve nurses' awareness and understanding of the comprehensive importance of professional values. Furthermore, it is recommended that mixed methods studies should be conducted in order to design an instrument to evaluate the use of values in nursing practice.

Insufficient sleep syndrome: An unrecognized but important clinical entity.

PubMed

Kohyama, Jun; Anzai, Yuki; Ono, Makoto; Kishino, Ai; Tamanuki, Keita; Takada, Kazuma; Inoue, Kento; Horiuchi, Maho; Hatai, Yoshiho

2018-04-01

A sleep clinic for adults and children was established in the Tokyo Bay Urayasu Ichikawa Medical Centre, in August 2012. Given that few sleep clinics are available in Japan specifically for children, this clinic provides the opportunity to provide data on child patients with sleep problems. Records of patients who visited the sleep clinic at the Tokyo Bay Urayasu Ichikawa Medical Centre aged ≤20 years at the first visit were retrospectively examined, along with the initial and final diagnoses. Of 2,157 patients who visited the sleep clinic at Tokyo Bay Urayasu Ichikawa Medical Centre between August 2012 and March 2017, 181 were ≤20 years old. In these 181 patients, the most frequent final diagnosis was insufficient sleep syndrome (ISS), n = 56, followed by circadian rhythm sleep-wake disorder, n = 28; insomnia, n = 28; and sleep-related movement disorder, n = 15. Insufficient sleep produces various brain dysfunctions in both adults and children, and is associated with behavioral, cognitive and physical problems, as well as with atypical early development. Insufficient sleep has also been reported to cause obesity. Insufficient sleep-induced obesity is often associated with the occurrence of metabolic syndrome. More effort is needed to ensure that children are receiving sufficient sleep. © 2018 Japan Pediatric Society.

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders.

PubMed

Karukivi, Max; Vahlberg, Tero; Horjamo, Kalle; Nevalainen, Minna; Korkeila, Jyrki

2017-01-14

Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but

Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

PubMed Central

Singh, Dave; Maleki-Yazdi, M Reza; Tombs, Lee; Iqbal, Ahmar; Fahy, William A; Naya, Ian

2016-01-01

Background Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations) of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI) reduces clinically important deteriorations (CIDs) in COPD versus placebo or bronchodilator monotherapy. Methods This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650), or UMEC/VI 62.5/25 µg with tiotropium (TIO) 18 µg (Study B; NCT01777334) in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation. Results In Study A, fewer patients experienced a first CID with UMEC/VI (44%) versus UMEC (50%), VI (56%), and placebo (75%). The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45]), UMEC (HR: 0.46 [95% CI: 0.38, 0.56]), and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001) versus placebo, and with UMEC/VI versus UMEC (HR: 0.80 [95% CI: 0.65, 0.97]; P<0.05) and versus VI (HR: 0.67 [95% CI: 0.55, 0.81]; P<0.001). In Study B, fewer patients experienced a first CID with UMEC/VI (41%) versus TIO (59%). UMEC/VI reduced the risk of a first composite CID by 43% versus TIO (HR: 0.57 [95% CI: 0.47, 0.69]; P<0.001). Conclusion This exploratory analysis, using a new assessment of clinical deterioration in COPD, revealed that a majority of symptomatic patients with low exacerbation risk experienced a

Virtual online consultations: advantages and limitations (VOCAL) study.

PubMed

Greenhalgh, Trisha; Vijayaraghavan, Shanti; Wherton, Joe; Shaw, Sara; Byrne, Emma; Campbell-Richards, Desirée; Bhattacharya, Satya; Hanson, Philippa; Ramoutar, Seendy; Gutteridge, Charles; Hodkinson, Isabel; Collard, Anna; Morris, Joanne

2016-01-29

Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel--audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel--interviews, ethnographic observations and analysis of documents within the trust; macrolevel--key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: 'what to expect in your virtual consultation'. The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We

Importance of clinical microbiologists for U.S. healthcare infrastructure.

PubMed

Carvalho, John

2011-01-01

Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

Hepatitis E in Qatar imported by expatriate workers from Nepal: epidemiological characteristics and clinical manifestations.

PubMed

Ibrahim, Abdulsalam Saif; Alkhal, Abdulatif; Jacob, Joyal; Ghadban, Wisam; Almarri, Ajayeb

2009-06-01

Prompted by cases of acute hepatitis in expatriate workers presenting at Alkhor Hospital, Qatar, a limited prospective observational study was conducted from July 2005 to June 2006 to determine the epidemiological and clinical features of patients (predominantly Nepalese) presenting with acute hepatitis. Countrywide during that period samples from 86 Nepalese presenting at different centers were found to be anti-HEV IgG positive and 50 of these were also positive for anti-HEV IgM. Fifty-eight of those Nepalese were seen and treated at Alkhor Hospital and of them 43 were confirmed as cases of acute HEV, being positive for both anti-HEV IgM and IgG. The remaining 15 were diagnosed as probable cases of acute HEV on the basis of clinical and epidemiological similarity. It seems likely that transit in Kathmandu in reportedly unsanitary conditions was the focus of infection. In some of those examined at Alkhor, ultrasound detected a thickened gallbladder wall in 30 of 39 (76.9%) with two cases having clinical acalcular cholecystitis. Higher levels of alanine aminotransferase and aspartate aminotransferase were associated with severe disease and derangement in coagulation. On the available evidence hepatitis E was imported by expatriate workers and it is clear that medical screening of these workers pre- and post-arrival must be improved to prevent further outbreaks. It is also essential that health care workers in Qatar are made aware of this ongoing problem of imported HEV and understand the variable presentation of the condition.

The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

PubMed

Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

2013-11-01

Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference.

PubMed

du Bois, Roland M; Weycker, Derek; Albera, Carlo; Bradford, Williamson Z; Costabel, Ulrich; Kartashov, Alex; Lancaster, Lisa; Noble, Paul W; Sahn, Steven A; Szwarcberg, Javier; Thomeer, Michiel; Valeyre, Dominique; King, Talmadge E

2011-05-01

The 6-minute-walk test (6MWT) is a practical and clinically meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases. Performance characteristics in patients with idiopathic pulmonary fibrosis (IPF) have not been systematically evaluated. To assess the reliability, validity, and responsiveness of the 6MWT and estimate the minimal clinically important difference (MCID) in patients with IPF. The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b (n = 822). Six-minute walk distance (6MWD) and other parameters were measured at baseline and at 24-week intervals using a standardized protocol. Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function, dyspnea, and health-related quality of life. Both distribution-based and anchor-based methods were used to estimate the MCID. Comparison of two proximal measures of 6MWD (mean interval, 24 d) demonstrated good reliability (coefficient = 0.83; P < 0.001). 6MWD was weakly correlated with measures of physiologic function and health-related quality of life; however, values were consistently and significantly lower for patients with the poorest functional status, suggesting good construct validity. Importantly, change in 6MWD was highly predictive of mortality; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year (hazard ratio, 4.27; 95% confidence interval, 2.57- 7.10; P < 0.001). The estimated MCID was 24-45 m. The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF.

The advantage of being slow: The quasi-neutral contact process.

PubMed

de Oliveira, Marcelo Martins; Dickman, Ronald

2017-01-01

According to the competitive exclusion principle, in a finite ecosystem, extinction occurs naturally when two or more species compete for the same resources. An important question that arises is: when coexistence is not possible, which mechanisms confer an advantage to a given species against the other(s)? In general, it is expected that the species with the higher reproductive/death ratio will win the competition, but other mechanisms, such as asymmetry in interspecific competition or unequal diffusion rates, have been found to change this scenario dramatically. In this work, we examine competitive advantage in the context of quasi-neutral population models, including stochastic models with spatial structure as well as macroscopic (mean-field) descriptions. We employ a two-species contact process in which the "biological clock" of one species is a factor of α slower than that of the other species. Our results provide new insights into how stochasticity and competition interact to determine extinction in finite spatial systems. We find that a species with a slower biological clock has an advantage if resources are limited, winning the competition against a species with a faster clock, in relatively small systems. Periodic or stochastic environmental variations also favor the slower species, even in much larger systems.

A Twin Protection Effect? Explaining Twin Survival Advantages with a Two-Process Mortality Model

PubMed Central

2016-01-01

Twin studies that focus on the correlation in age-at-death between twin pairs have yielded important insights into the heritability and role of genetic factors in determining lifespan, but less attention is paid to the biological and social role of zygosity itself in determining survival across the entire life course. Using data from the Danish Twin Registry and the Human Mortality Database, we show that monozygotic twins have greater cumulative survival proportions at nearly every age compared to dizygotic twins and the Danish general population. We examine this survival advantage by fitting these data with a two-process mortality model that partitions survivorship patterns into extrinsic and intrinsic mortality processes roughly corresponding to acute, environmental and chronic, biological origins. We find intrinsic processes confer a survival advantage at older ages for males, while at younger ages, all monozygotic twins show a health protection effect against extrinsic death akin to a marriage protection effect. While existing research suggests an increasingly important role for genetic factors at very advanced ages, we conclude that the social closeness of monozygotic twins is a plausible driver of the survival advantage at ages <65. PMID:27192433

Modelling home advantage in the Summer Olympic Games.

PubMed

Balmer, N J; Nevill, A M; Williams, A M

2003-06-01

Home advantage in team games is well proven and the influence of the crowd upon officials' decisions has been identified as a plausible cause. The aim of this study was to assess the significance of home advantage for five event groups selected from the Summer Olympic Games between 1896 and 1996, and put home advantage in team games in context with other sports. The five event groups were athletics and weightlifting (predominantly objectively judged), boxing and gymnastics (predominantly subjectively judged) and team games (involving subjective decisions). The proportion of points won was analysed as a binomial response variable using generalized linear interactive modelling. Preliminary exploration of the data highlighted the need to control for the proportion of competitors entered and to split the analysis pre- and post-war. Highly significant home advantage was found in event groups that were either subjectively judged or rely on subjective decisions. In contrast, little or no home advantage (and even away advantage) was observed for the two objectively judged groups. Officiating system was vital to both the existence and extent of home advantage. Our findings suggest that crowd noise has a greater influence upon officials' decisions than players' performances, as events with greater officiating input enjoyed significantly greater home advantage.

Enhancing predictive accuracy and reproducibility in clinical evaluation research: Commentary on the special section of the Journal of Evaluation in Clinical Practice.

PubMed

Bryant, Fred B

2016-12-01

This paper introduces a special section of the current issue of the Journal of Evaluation in Clinical Practice that includes a set of 6 empirical articles showcasing a versatile, new machine-learning statistical method, known as optimal data (or discriminant) analysis (ODA), specifically designed to produce statistical models that maximize predictive accuracy. As this set of papers clearly illustrates, ODA offers numerous important advantages over traditional statistical methods-advantages that enhance the validity and reproducibility of statistical conclusions in empirical research. This issue of the journal also includes a review of a recently published book that provides a comprehensive introduction to the logic, theory, and application of ODA in empirical research. It is argued that researchers have much to gain by using ODA to analyze their data. © 2016 John Wiley & Sons, Ltd.

Measuring home advantage in Spanish handball.

PubMed

Gutiérrez Aguilar, Oscar; Saavedra García, Miguel; Fernández Romero, Juan José

2012-02-01

Since Pollard established the system for analysing home advantage in 1986, it has been demonstrated and quantified in various sports, including many team sports. This study aims to assess whether home advantage exists in handball, using a sample of more than 19,000 Spanish handball league games. Results of the games played at home and away, the sex of the players, and the levels of the competition were included as variables. In Spanish handball, there was a home advantage of 61%, which means, on average, the team playing at home wins 61% of points available. This value varies according to sex and according to competition level, increasing as competition level decreases and season rank improves.

A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance.

PubMed

Goel, Dimple; Gupta, Pankaj; Cooper, Stephen; Klimek, Jan

2018-06-05

Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point of care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. Medline, PubMed, EMBASE, and the internet were searched up to November 2017 for papers in English which included SPCs in preterm infants without CHD. This comprised title, abstract and full-text screening of relevant data. A total of 10 studies which included case reports, retrospective observational studies, and one small prospective cohort study were identified and analysed in detail. The studies had varying focus such as variable incidence, clinical presentation, association with chronic lung disease, pathophysiology and clinical importance of SPCs. SPCs were overall thought to be prevalent, underdiagnosed and of clinical significance in preterm infants. SPCs are a potential left to right shunt in preterm infants and may contribute to worsening chronic lung disease (CLD) or heart failure. They should be carefully looked for when performing bedside cardiac ultrasound as the findings can mimic those seen in patent ductus arteriosus (PDA). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

History, ethics, advantages and limitations of experimental models for hepatic ablation.

PubMed

Ong, Seok Ling; Gravante, Gianpiero; Metcalfe, Matthew S; Dennison, Ashley R

2013-01-14

Numerous techniques developed in medicine require careful evaluation to determine their indications, limitations and potential side effects prior to their clinical use. At present this generally involves the use of animal models which is undesirable from an ethical standpoint, requires complex and time-consuming authorization, and is very expensive. This process is exemplified in the development of hepatic ablation techniques, starting experiments on explanted livers and progressing to safety and efficacy studies in living animals prior to clinical studies. The two main approaches used are ex vivo isolated non-perfused liver models and in vivo animal models. Ex vivo non perfused models are less expensive, easier to obtain but not suitable to study the heat sink effect or experiments requiring several hours. In vivo animal models closely resemble clinical subjects but often are expensive and have small sample sizes due to ethical guidelines. Isolated perfused ex vivo liver models have been used to study drug toxicity, liver failure, organ transplantation and hepatic ablation and combine advantages of both previous models.

The Persistence of Wives' Income Advantage

ERIC Educational Resources Information Center

Winslow-Bowe, Sarah

2006-01-01

Recent reports using cross-sectional data indicate an increase in the percentage of wives who outearn their husbands, yet we know little about the persistence of wives' income advantage. The present analyses utilize the 1990-1994 waves of the National Longitudinal Survey of Youth 1979 (N = 3,481) to examine wives' long-term earnings advantage.…

THE HOME ADVANTAGE IN MAJOR LEAGUE BASEBALL.

PubMed

Jones, Marshall B

2015-12-01

Home advantage is smaller in baseball than in other major professional sports for men, specifically football, basketball, or soccer. This paper advances an explanation. It begins by reviewing the main observations to support the view that there is little or no home advantage in individual sports. It then presents the case that home advantage originates in impaired teamwork among the away players. The need for teamwork and the extent of it vary from sport to sport. To the extent that a sport requires little teamwork it is more like an individual sport, and the home team would be expected to enjoy only a small advantage. Interactions among players on the same side (teamwork) are much less common in baseball than in the other sports considered.

Fluorescence characterization of clinically-important bacteria.

PubMed

Dartnell, Lewis R; Roberts, Tom A; Moore, Ginny; Ward, John M; Muller, Jan-Peter

2013-01-01

Healthcare-associated infections (HCAI/HAI) represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs) over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of potential problems

Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

PubMed

Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

2015-10-01

The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Differences between the non-steroidal aromatase inhibitors anastrozole and letrozole--of clinical importance?

PubMed

Geisler, J

2011-03-29

Aromatase inhibition is the gold standard for treatment of early and advanced breast cancer in postmenopausal women suffering from an estrogen receptor-positive disease. The currently established group of anti-aromatase compounds comprises two reversible aromatase inhibitors (anastrozole and letrozole) and on the other hand, the irreversible aromatase inactivator exemestane. Although exemestane is the only widely used aromatase inactivator at this stage, physicians very often have to choose between either anastrozole or letrozole in general practice. These third-generation aromatase inhibitors (letrozole/Femara (Novartis Pharmaceuticals, Basel, Switzerland) and anastrozole/Arimidex (AstraZeneca, Pharmaceuticals, Macclesfield, Cheshire, UK)), have recently demonstrated superior efficacy compared with tamoxifen as initial therapy for early breast cancer improving disease-free survival. However, although anastrozole and letrozole belong to the same pharmacological class of agents (triazoles), an increasing body of evidence suggests that these aromatase inhibitors are not equipotent when given in the clinically established doses. Preclinical and clinical evidence indicates distinct pharmacological profiles. Thus, this review focuses on the differences between the non-steroidal aromatase inhibitors allowing physicians to choose between these compounds based on scientific evidence. Although we are waiting for the important results of a still ongoing head-to-head comparison in patients with early breast cancer at high risk for relapse (Femara Anastrozole Clinical Evaluation trial; 'FACE-trial'), clinicians have to make their choices today. On the basis of available evidence summarised here and until FACE-data become available, letrozole seems to be the best choice for the majority of breast cancer patients whenever a non-steroidal aromatase inhibitor has to be chosen in a clinical setting. The background for this recommendation is discussed in the following chapters.

Home advantage in the Winter Olympics (1908-1998).

PubMed

Balmer, N J; Nevill, A M; Williams, A M

2001-02-01

We obtained indices of home advantage, based on the medals won by competing nations, for each event held at the Winter Olympics from 1908 to 1998. These indices were designed to assess home advantage while controlling for nation strength, changes in the number of medals on offer and the performance of 'non-hosting' nations. Some evidence of home advantage was found in figure skating, freestyle skiing, ski jumping, alpine skiing and short track speed skating. In contrast, little or no home advantage was observed in ice hockey, Nordic combined, Nordic skiing, bobsled, luge, biathlon or speed skating. When all events were combined, a significant home advantage was observed (P = 0.029), although no significant differences in the extent of home advantage were found between events (P > 0.05). When events were grouped according to whether they were subjectively assessed by judges, significantly greater home advantage was observed in the subjectively assessed events (P = 0.037). This was a reflection of better home performances, suggesting that judges were scoring home competitors disproportionately higher than away competitors. Familiarity with local conditions was shown to have some effect, particularly in alpine skiing, although the bobsled and luge showed little or no advantage over other events. Regression analysis showed that the number of time zones and direction of travel produced no discernible trends or differences in performance.

Transcriptomics in human blood incubation reveals the importance of oxidative stress response in Saccharomyces cerevisiae clinical strains.

PubMed

Llopis, Silvia; Querol, Amparo; Heyken, Antje; Hube, Bernhard; Jespersen, Lene; Fernández-Espinar, M Teresa; Pérez-Torrado, Roberto

2012-08-23

In recent years an increasing number of yeast infections in humans have been related to certain clinical isolates of Saccharomyces cerevisiae. Some clinical strains showed in vivo and in vitro virulence traits and were able to cause death in mice whereas other clinical strains were avirulent. In this work, we studied the transcriptional profiles of two S. cerevisiae clinical strains showing virulent traits and two control non-virulent strains during a blood incubation model and detected a specific transcriptional response of clinical strains. This response involves an mRNA levels increase of amino acid biosynthesis genes and especially oxidative stress related genes. We observed that the clinical strains were more resistant to reactive oxygen species in vitro. In addition, blood survival of clinical isolates was high, reaching similar levels to pathogenic Candida albicans strain. Furthermore, a virulent strain mutant in the transcription factor Yap1p, unable to grow in oxidative stress conditions, presented decreased survival levels in human blood compared with the wild type or YAP1 reconstituted strain. Our data suggest that this enhanced oxidative stress response in virulent clinical isolates, presumably induced in response to oxidative burst from host defense cells, is important to increase survival in human blood and can help to infect and even produce death in mice models.

An integrated model of clinical reasoning: dual-process theory of cognition and metacognition.

PubMed

Marcum, James A

2012-10-01

Clinical reasoning is an important component for providing quality medical care. The aim of the present paper is to develop a model of clinical reasoning that integrates both the non-analytic and analytic processes of cognition, along with metacognition. The dual-process theory of cognition (system 1 non-analytic and system 2 analytic processes) and the metacognition theory are used to develop an integrated model of clinical reasoning. In the proposed model, clinical reasoning begins with system 1 processes in which the clinician assesses a patient's presenting symptoms, as well as other clinical evidence, to arrive at a differential diagnosis. Additional clinical evidence, if necessary, is acquired and analysed utilizing system 2 processes to assess the differential diagnosis, until a clinical decision is made diagnosing the patient's illness and then how best to proceed therapeutically. Importantly, the outcome of these processes feeds back, in terms of metacognition's monitoring function, either to reinforce or to alter cognitive processes, which, in turn, enhances synergistically the clinician's ability to reason quickly and accurately in future consultations. The proposed integrated model has distinct advantages over other models proposed in the literature for explicating clinical reasoning. Moreover, it has important implications for addressing the paradoxical relationship between experience and expertise, as well as for designing a curriculum to teach clinical reasoning skills. © 2012 Blackwell Publishing Ltd.

Existing data sources for clinical epidemiology: Aarhus University Clinical Trial Candidate Database, Denmark.

PubMed

Nørrelund, Helene; Mazin, Wiktor; Pedersen, Lars

2014-01-01

Denmark is facing a reduction in clinical trial activity as the pharmaceutical industry has moved trials to low-cost emerging economies. Competitiveness in industry-sponsored clinical research depends on speed, quality, and cost. Because Denmark is widely recognized as a region that generates high quality data, an enhanced ability to attract future trials could be achieved if speed can be improved by taking advantage of the comprehensive national and regional registries. A "single point-of-entry" system has been established to support collaboration between hospitals and industry. When assisting industry in early-stage feasibility assessments, potential trial participants are identified by use of registries to shorten the clinical trial startup times. The Aarhus University Clinical Trial Candidate Database consists of encrypted data from the Danish National Registry of Patients allowing an immediate estimation of the number of patients with a specific discharge diagnosis in each hospital department or outpatient specialist clinic in the Central Denmark Region. The free access to health care, thorough monitoring of patients who are in contact with the health service, completeness of registration at the hospital level, and ability to link all databases are competitive advantages in an increasingly complex clinical trial environment.

Advantage and choice: social relationships and staff assistance in assisted living.

PubMed

Burge, Stephanie; Street, Debra

2010-05-01

OBJECTIVES. To understand how "cumulative inequality" (CI), expressed as individual advantage and choice, and "external social supports" contribute to the quality of social relationships and perceptions of staff assistance for older individuals in different assisted living (AL) settings. Data are from 429 cognitively intact AL residents aged 60 years and older interviewed for the Florida Study of Assisted Living. Bivariate and multivariate statistical analyses show how individual advantage and choice and external social networks influence respondents' social relationships and staff assistance in AL. Controlling for resident and facility characteristics, being able to pay privately enhances resident satisfaction with staff assistance and having control over the move to AL is positively associated with perceptions of staff relationships and assistance. Maintaining contact with pre-AL friends predicts quality of coresident relationships, as does family contact. Regular contact with family buffers some of the disadvantages associated with CI for perceptions of staff relationships but not perceptions of staff assistance. Discussion. Individual advantage and choice influence the quality of staff relationships and assistance for AL residents but matter little for coresident relationships. External social relationships buffer some of the risks associated with CI for perceptions of staff relationships but not perceived quality of staff assistance. Findings highlight outcomes associated with CI, including predictable risks that disadvantaged elders face in particular types of AL settings, differential advantages others enjoy that influence positive perceptions of staff relationships and staff assistance, and the enduring importance of supportive social relationships.

Quality of Life After Cardiac Surgery Based on the Minimal Clinically Important Difference Concept.

PubMed

Grand, Nathalie; Bouchet, Jean Baptiste; Zufferey, Paul; Beraud, Anne Marie; Awad, Sahar; Sandri, Fabricio; Campisi, Salvator; Fuzellier, Jean François; Molliex, Serge; Vola, Marco; Morel, Jerome

2018-03-23

Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS). We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac surgery were included. 326 patients completed the preoperative and postoperative SF-36 questionnaires and 24 patients died before completing follow-up questionnaires. Based on the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for PCS and 99 patients (28.2%) for MCS. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for PCS and MCS worsening or death. Although our study showed overall improvement of QOL after cardiac surgery, over a quarter of the patients manifested deterioration of HRQOL at 6 months post-surgery. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life. Copyright © 2018. Published by Elsevier Inc.

Exploring the sequential lineup advantage using WITNESS.

PubMed

Goodsell, Charles A; Gronlund, Scott D; Carlson, Curt A

2010-12-01

Advocates claim that the sequential lineup is an improvement over simultaneous lineup procedures, but no formal (quantitatively specified) explanation exists for why it is better. The computational model WITNESS (Clark, Appl Cogn Psychol 17:629-654, 2003) was used to develop theoretical explanations for the sequential lineup advantage. In its current form, WITNESS produced a sequential advantage only by pairing conservative sequential choosing with liberal simultaneous choosing. However, this combination failed to approximate four extant experiments that exhibited large sequential advantages. Two of these experiments became the focus of our efforts because the data were uncontaminated by likely suspect position effects. Decision-based and memory-based modifications to WITNESS approximated the data and produced a sequential advantage. The next step is to evaluate the proposed explanations and modify public policy recommendations accordingly.

Ubiquitous Multicriteria Clinic Recommendation System.

PubMed

Chen, Toly

2016-05-01

Advancements in information, communication, and sensor technologies have led to new opportunities in medical care and education. Patients in general prefer visiting the nearest clinic, attempt to avoid waiting for treatment, and have unequal preferences for different clinics and doctors. Therefore, to enable patients to compare multiple clinics, this study proposes a ubiquitous multicriteria clinic recommendation system. In this system, patients can send requests through their cell phones to the system server to obtain a clinic recommendation. Once the patient sends this information to the system, the system server first estimates the patient's speed according to the detection results of a global positioning system. It then applies a fuzzy integer nonlinear programming-ordered weighted average approach to assess four criteria and finally recommends a clinic with maximal utility to the patient. The proposed methodology was tested in a field experiment, and the experimental results showed that it is advantageous over two existing methods in elevating the utilities of recommendations. In addition, such an advantage was shown to be statistically significant.

Minimal clinically important difference of the Modified Fatigue Impact Scale in Parkinson's disease.

PubMed

Kluger, Benzi M; Garimella, Sanjana; Garvan, Cynthia

2017-10-01

Fatigue is a common and debilitating symptom of Parkinson's disease (PD) with no evidence-based treatments. While several fatigue scales are partially validated in PD the minimal clinically important difference (MCID) is unknown for any scale but is an important psychometric value to design and interpret therapeutic trials. We thus sought to determine the MCID for the Modified Fatigue Impact Scale (MFIS). This is a secondary data analysis from 94 PD participants in an acupuncture trial for PD fatigue. Standard psychometric approaches were used to establish validity and an anchor-based approach was used to determine the MCID. The MFIS demonstrated good concurrent validity with other outcome measures and high internal consistency. MCIDs values were found to be 13.8, 6.8 and 6.2 for the MFIS total, MFIS cognitive, and MFIS physical subscores respectively. The MFIS is a valid multidimensional measure of fatigue in PD with demonstrable MCID. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Antibacterial and antifungal activity of Salvia apiana against clinically important microorganisms].

PubMed

Córdova-Guerrero, Iván; Aragon-Martinez, Othoniel H; Díaz-Rubio, Laura; Franco-Cabrera, Santiago; Serafín-Higuera, Nicolas A; Pozos-Guillén, Amaury; Soto-Castro, Tely A; Martinez-Morales, Flavio; Isiordia-Espinoza, Mario

Due to the great global concern regarding bacterial resistance to antibiotics, an ongoing search for new molecules having antibacterial activity is necessary. This study evaluated the antibacterial and anticandidal effects of a hexane extract from the root of Salvia apiana. Salvia extracts at concentrations of 27, 13.5, 6.8 and 3.4mg/ml caused growth inhibition of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis and Candida albicans. However, no significant effect was observed on Escherichia coli and Candida tropicalis in comparison to vehicle. It was here demonstrated for the first time that Salvia apiana has an important antimicrobial effect on human pathogens of great clinical value, thus opening the field to continue the evaluation of this lamiaceous plant for its future use as a therapeutic agent. Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

Value-based contracting innovated Medicare advantage healthcare delivery and improved survival.

PubMed

Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C

2017-02-01

In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P <.001), estimating $2,519,544 per 1000 members of additional revenue. The intervention increased office-based visits (P <.001). Emergency department visits (P <.001) and inpatient hospital admissions (P = .002) decreased. This change in utilization saved $2,071,293 per 1000 enrollees. By intensifying office-based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P <.001) was achieved. Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.

Shared decision making in mental health: the importance for current clinical practice.

PubMed

Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David

2017-12-01

We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

Not lost in translation: Emerging clinical importance of the G protein-coupled estrogen receptor GPER.

PubMed

Barton, Matthias

2016-07-01

It has been 20years that the G protein-coupled estrogen receptor (GPER) was cloned as the orphan receptor GPR30 from multiple cellular sources, including vascular endothelial cells. Here, I will provide an overview of estrogen biology and the historical background leading to the discovery of rapid vascular estrogen signaling. I will also review the recent advances in the understanding of the mechanisms underlying GPER function, its role in physiology and disease, some of the currently available GPER-targeting drugs approved for clinical use such as SERMs (selective estrogen receptor modulators) and SERDs (selective estrogen receptor downregulators). Many of currently used drugs such as tamoxifen, raloxifene, or faslodex™/fulvestrant were discovered targeting GPER many years after they had been introduced to the clinics for entirely different purposes. This has important implications for the clinical use of these drugs and their modes of action, which I have termed 'reverse translational medicine'. In addition, environmental pollutants known as 'endocrine disruptors' have been found to bind to GPER. This article also discusses recent evidence in these areas as well as opportunities in translational clinical medicine and GPER research, including medical genetics, personalized medicine, prevention, and its theranostic use. Copyright © 2016 Elsevier Inc. All rights reserved.

[Breastfeeding: the importance of intervening].

PubMed

Aguiar, Hélder; Silva, Ana Isabel

2011-12-01

Breast milk is considered by the WHO the ideal food for the first months of life. Although health professionals are aware of recommendations, high rates of drop-outs have been identified in Portugal. A false notion of hypogalactia is the major factor for early termination, which is allied to the technical difficulties of the feeding. Health professionals, often lacking training in the area, may have difficulty in reassuring mothers in these situations. In Portugal, at the 3rd month, most mothers stop breastfeeding by indication of their medical assistant. Gather evidence about the advantages of breast-feeding compared to artificial milk, and establish useful strategies in clinical practice to avoid early withdrawal. A survey was conducted for articles from the last six years in the major sites of evidence-based medicine and reference sites (Pubmed, Cochrane, National Guideline Clearinghouse, Tripdatabase, WHO). Breast-feeding is clearly associated with benefits to the infant, including significant protective effects for gastrointestinal infections (64%), middle ear (23- 50%), severe respiratory infections (73%) and for acute lymphocytic leukemia (19%) and sudden death syndrome in infants (36%). We also found long-term benefits, such as for obesity (7-24%) and other cardiovascular risk factors in adulthood. The mother also benefits from its protective effect for cancers of the breast and ovary, and diabetes mellitus type 2 as also, proportionate to the duration of breastfeeding. Health professionals have an important role in the initiation and continuation of breastfeeding. The notion of its advantages, the communication prior to delivery, accessibility support and training in technical aspects of correct picks are the proven strategies for evidence explored in the article. Breast milk contains several unique and exclusive elements, orchestrators of its health benefits. Postnatal period is critical to the development of neuro--hypothalamic circuits involved in

Home advantage in Turkish professional soccer.

PubMed

Seçkin, Aylin; Pollard, Richard

2008-08-01

Home advantage is known to play an important role in the outcome of professional soccer games and to vary considerably worldwide. In the Turkish Super League over the last 12 years, 61.5% of the total points gained have been won by the home team, a figure similar to the worldwide average and to the Premier League in England. It is lower (57.7%) for games played between teams from Istanbul and especially high for games involving teams from cities in the more remote and ethnically distinct parts of Turkey (Van and Diyarbakir). Match performance data show that although home teams in Turkey take 26% more shots at goal than away teams, the success rates for shots do not differ. For fouls and disciplinary cards, home and away teams do not differ significantly in Turkey, a finding that differs from games in England, perhaps due to less referee bias.

Multicenter Evaluation of the Bruker MALDI Biotyper CA System for the Identification of Clinically Important Bacteria and Yeasts.

PubMed

Wilson, Deborah A; Young, Stephen; Timm, Karen; Novak-Weekley, Susan; Marlowe, Elizabeth M; Madisen, Neil; Lillie, Jennifer L; Ledeboer, Nathan A; Smith, Rebecca; Hyke, Josh; Griego-Fullbright, Christen; Jim, Patricia; Granato, Paul A; Faron, Matthew L; Cumpio, Joven; Buchan, Blake W; Procop, Gary W

2017-06-01

A report on the multicenter evaluation of the Bruker MALDI Biotyper CA System (MBT-CA; Bruker Daltonics, Billerica, MA) for the identification of clinically important bacteria and yeasts. In total, 4,399 isolates of medically important bacteria and yeasts were assessed in the MBT-CA. These included 2,262 aerobic gram-positive (AGP) bacteria, 792 aerobic gram-negative (AGN) bacteria 530 anaerobic (AnA) bacteria, and 815 yeasts (YSTs). Three processing methods were assesed. Overall, 98.4% (4,329/4,399) of all bacterial and yeast isolates were correctly identified to the genus and species/species complex level, and 95.7% of isolates were identified with a high degree of confidence. The percentage correctly identified and the percentage identified correctly with a high level of confidence, respectively, were as follows: AGP bacteria (98.6%/96.5%), AGN bacteria (98.5%/96.8%), AnA bacteria (98.5%/97.4%), and YSTs (97.8%/87.6%). The extended direct transfer method was only minimally superior to the direct transfer method for bacteria (89.9% vs 86.8%, respectively) but significantly superior for yeast isolates (74.0% vs 48.9%, respectively). The Bruker MALDI Biotyper CA System accurately identifies most clinically important bacteria and yeasts and has optional processing methods to improve isolate characterization. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Clinically important FEV1 declines among coal miners: an exploration of previously unrecognised determinants

PubMed Central

Wang, M. L.; Petsonk, E. L.; Beeckman, L. A.; Wagner, G. R.

1999-01-01

OBJECTIVES: The relation between occupational exposure to dust and loss of ventilatory lung function is now well established. However, many exposures during work and other activities might also have important roles in determining clinically important losses of lung function. In this study, we attempted to explore additional plausible determinants of exposures and other potential risk factors for clinically important decline in forced expiratory volume in 1 second (FEV1) during work in dusty trades. METHODS: The study was performed in 264 underground coal miners whose lung function had been followed up for an average of 11 years. With an extensive follow up questionnaire, miners were asked about their occupational and non-occupational exposures, smoking, personal and family medical history, and living conditions during childhood. RESULTS: Several variables of the mine environment (as well as previously recognised effects of mining work and region) were found to be associated with excess decline in FEV1, including work in roof bolting, exposure to explosive blasting, and to control dust spraying water that had been stored in holding tanks. Use of respiratory protection seemed to reduce the risk of decline in FEV1. Other factors that were found to be associated with declines in pulmonary function included smoking, body mass, weight gain, childhood pneumonia, and childhood exposure in the home to passive tobacco smoke and possibly smoke due to wood and coal fuels. Miners with excessive decline in FEV1 were less likely to be working in mining jobs at follow up. CONCLUSIONS: These findings suggest the existence of additional risk factors for decline in lung function in dusty trades, and may be useful in developing additional approaches to the prevention of chronic respiratory disease.   PMID:10658541

Fluorescence Characterization of Clinically-Important Bacteria

PubMed Central

Dartnell, Lewis R.; Roberts, Tom A.; Moore, Ginny; Ward, John M.; Muller, Jan-Peter

2013-01-01

Healthcare-associated infections (HCAI/HAI) represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs) over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of potential problems

Transcriptomics in human blood incubation reveals the importance of oxidative stress response in Saccharomyces cerevisiae clinical strains

PubMed Central

2012-01-01

Background In recent years an increasing number of yeast infections in humans have been related to certain clinical isolates of Saccharomyces cerevisiae. Some clinical strains showed in vivo and in vitro virulence traits and were able to cause death in mice whereas other clinical strains were avirulent. Results In this work, we studied the transcriptional profiles of two S. cerevisiae clinical strains showing virulent traits and two control non-virulent strains during a blood incubation model and detected a specific transcriptional response of clinical strains. This response involves an mRNA levels increase of amino acid biosynthesis genes and especially oxidative stress related genes. We observed that the clinical strains were more resistant to reactive oxygen species in vitro. In addition, blood survival of clinical isolates was high, reaching similar levels to pathogenic Candida albicans strain. Furthermore, a virulent strain mutant in the transcription factor Yap1p, unable to grow in oxidative stress conditions, presented decreased survival levels in human blood compared with the wild type or YAP1 reconstituted strain. Conclusions Our data suggest that this enhanced oxidative stress response in virulent clinical isolates, presumably induced in response to oxidative burst from host defense cells, is important to increase survival in human blood and can help to infect and even produce death in mice models. PMID:22916735

Information technology for competitive advantage: the case of learning and innovation in behavioural healthcare service.

PubMed

Hsieh, Chang-tseh; Lin, Binshan

2011-01-01

The utilisation of IS/IT could offer a substantial competitive advantage to healthcare service providers through the realisation of improved clinical, financial, and administrative outcomes. In this study, 42 journal articles were reviewed and summarised with respect to identified benefits and challenges of the development and implementation of electronic medical records, tele-health, and electronic appointment reminders. Results of this study help pave the knowledge foundation for management of the behavioural healthcare to learn how to apply state-of-the-art information technology to offer higher quality, clinically proven effective services at lower costs than those of their competitors.

[Big data from clinical routine].

PubMed

Mansmann, U

2018-04-01

Over the past 100 years, evidence-based medicine has undergone several fundamental changes. Through the field of physiology, medical doctors were introduced to the natural sciences. Since the late 1940s, randomized and epidemiological studies have come to provide the evidence for medical practice, which led to the emergence of clinical epidemiology as a new field in the medical sciences. Within the past few years, big data has become the driving force behind the vision for having a comprehensive set of health-related data which tracks individual healthcare histories and consequently that of large populations. The aim of this article is to discuss the implications of data-driven medicine, and to examine how it can find a place within clinical care. The EU-wide discussion on the development of data-driven medicine is presented. The following features and suggested actions were identified: harmonizing data formats, data processing and analysis, data exchange, related legal frameworks and ethical challenges. For the effective development of data-driven medicine, pilot projects need to be conducted to allow for open and transparent discussion on the advantages and challenges. The Federal Ministry of Education and Research ("Bundesministerium für Bildung und Forschung," BMBF) Arthromark project is an important example. Another example is the Medical Informatics Initiative of the BMBF. The digital revolution affects clinic practice. Data can be generated and stored in quantities that are almost unimaginable. It is possible to take advantage of this for development of a learning healthcare system if the principles of medical evidence generation are integrated into innovative IT-infrastructures and processes.

An Update on the Epidemiology of Schizophrenia with a Special Reference to Clinically Important Risk Factors

ERIC Educational Resources Information Center

El-Missiry, Ahmed; Aboraya, Ahmed Sayed; Manseur, Hader; Manchester, Johnna; France, Cheryl; Border, Katherine

2011-01-01

Schizophrenia is a chronic mental illness which poses a tremendous burden on the families, caregivers and the society. The purpose of this paper is to provide an updated review of the epidemiology of schizophrenia with a special attention to the clinically important risk factors such as drug abuse, hormonal factors and the new advances in genetic…

Tooth color measurement using Chroma Meter: techniques, advantages, and disadvantages.

PubMed

Li, Yiming

2003-01-01

Tooth whitening has become a popular and routine dental procedure, and its efficacy and safety have been well documented. However, the measurement of tooth color, particularly in the evaluation of the efficacy of a system intended to enhance tooth whiteness, remains a challenge. One of the instruments used for assessing tooth color in clinical whitening studies is the Minolta Chroma Meter CR-321 (Minolta Corporation USA, Ramsey, NJ, USA). This article describes the instrument and discusses various measuring procedures and the Chroma Meter's advantages, limitations, and disadvantages. The available information indicates that, although Minolta Chroma Meter CR-321 provides quantitative and objective measurements of tooth color, it can be tedious to use with a custom alignment device. The Chroma Meter data are inconsistent with the commonly used visual instruments such as Vitapan Classical Shade Guide (Vita Zahnfabrik, Bad Säckingen, Germany), although in many cases the general trends are similar. It is also questionable whether the small area measured adequately represents the color of the whole tooth. A more critical challenge is the lack of methods for interpreting the Chroma Meter data regarding tooth color change in studies evaluating the efficacy of whitening systems. Consequently, at present the Chroma Meter data alone do not appear to be adequate for determining tooth color change in whitening research, although the quantitative measurements may be useful as supplemental or supportive data. Research is needed to develop and improve the instrument and technique for quantitative measurement of tooth color and interpretation of the data for evaluating tooth color change. This paper will help readers to understand the advantages and limitations of the Minolta Chroma Meter used for evaluating the efficacy of tooth-whitening systems so that proper judgment can be made in the interpretation of the results of clinical studies.

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

ERIC Educational Resources Information Center

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

2004-01-01

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

[The Psychotherapeutic Evening Clinic: Concept and First Results].

PubMed

Dinger, Ulrike; Komo-Lang, Miriam; Schauenburg, Henning; Herzog, Wolfgang; Nikendei, Christoph

2018-05-30

This article reports about a new treatment setting, the Psychotherapeutic Evening Clinic at the University Hospital Heidelberg. The treatment intensity is ranked between intensive, full-day inpatient and day-clinic programs in hospitals and less frequent outpatient psychotherapy according to the Germany Psychotherapy Guideline. Patients attend the Evening Clinic on 3 evenings per week for 3 hours each. During this time, they receive group therapy, individual therapy, mindfulness exercises and psychotherapeutic ward rounds. The first experiences with the new setting are positive, a specific advantage is the possibility to include daily hassles and everyday stressors as well as patients' strengths and resources into the treatment. Therapeutic challenges are the potential of overburdening patients with an already high impairment. On the structural and political level it will be important to ensure funding for the new treatment setting. © Georg Thieme Verlag KG Stuttgart · New York.

Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study

PubMed Central

White, Daniel K.; Keysor, Julie J.; LaValley, Michael P.; Lewis, Cora E.; Torner, James C.; Nevitt, Michael C.; Felson, David T.

2010-01-01

To calculate the frequency of clinically important improvement in function over 30 months and identify risk factors in people who have or are at risk of knee OA. Subjects were from MOST, a longitudinal study of persons with or at high risk of knee OA. We defined Minimal Clinically Important Improvement (MCII) with WOMAC physical function using three different methods. Baseline risk factors tested for improvement included age, gender, educational attainment, presence of radiographic knee OA (ROA), the number of comorbidities, Body Mass Index (BMI), knee pain, walking speed, isokinetic knee extensor strength, depressive symptoms, physical activity, and medication usage. We used logistic regression to evaluate the association of baseline risk factors with MCII. Of the 1801 subjects (age= 63, BMI= 31, 63% female), most had mild limitations in baseline function (WOMAC = 19 +/− 11). Regardless how defined, a substantial percentage of subjects (24%–39%) reached MCII at 30 months. Compared to their counterparts, people with MCII were less likely to have ROA and to use medications, and were more likely to have a lower BMI, less knee pain, a faster walking speed, more knee strength, and fewer depressive symptoms. After adjustment, MCII was 40% to 50% less likely in those with ROA, and 1.9 to 2.0 times more likely in those walking 1.0 m/s faster than counterparts. Clinically important improvement is frequent in people with or at high risk of knee OA. The absence of ROA and a faster walking speed appear to be associated with clinically important improvements. PMID:20395640

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population.

PubMed

Purcell, Amanda; Fleming, Jennifer; Bennett, Sally; Burmeister, Bryan; Haines, Terry

2010-03-01

The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient's fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population. Two hundred ten patients undergoing radiotherapy were recruited to a single-centre prospective cohort study. Patients were assessed at three time points, at the start of radiotherapy, the end of radiotherapy and 6 weeks after radiotherapy completion. Assessment consisted of four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine MCIDs for each sub-scale of the MFI. Multiple MCIDs were identified, each from a different perspective based on the constructs cited. Researchers seeking to use a generic MCID may wish to use a two-point reference for each MFI sub-scale as it was consistent across the pre- and post-radiotherapy comparison and occupational productivity anchors. MCIDs validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies.

Glycoprotein Enrichment Analytical Techniques: Advantages and Disadvantages.

PubMed

Zhu, R; Zacharias, L; Wooding, K M; Peng, W; Mechref, Y

2017-01-01

Protein glycosylation is one of the most important posttranslational modifications. Numerous biological functions are related to protein glycosylation. However, analytical challenges remain in the glycoprotein analysis. To overcome the challenges associated with glycoprotein analysis, many analytical techniques were developed in recent years. Enrichment methods were used to improve the sensitivity of detection, while HPLC and mass spectrometry methods were developed to facilitate the separation of glycopeptides/proteins and enhance detection, respectively. Fragmentation techniques applied in modern mass spectrometers allow the structural interpretation of glycopeptides/proteins, while automated software tools started replacing manual processing to improve the reliability and throughput of the analysis. In this chapter, the current methodologies of glycoprotein analysis were discussed. Multiple analytical techniques are compared, and advantages and disadvantages of each technique are highlighted. © 2017 Elsevier Inc. All rights reserved.

Clinical and Business Intelligence: Why It's Important to Your Pharmacy.

PubMed

Pinto, Brian; Fox, Brent I

2016-07-01

According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

Importance/performance analysis: a tool for service quality control by clinical laboratories.

PubMed

Scammon, D L; Weiss, R

1991-01-01

A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

Subspecialization in gynecology and obstetrics: advantages and disadvantages.

PubMed

Ludwig, H

1991-08-20

To discuss the problem of subspecialization in our discipline is presently very popular. Whether or not a complete separation into the three subdisciplines: (1) materno-fetal medicine - obstetrics (2) surgical gynecology - gynecologic oncology (3) gynecologic endocrinology - reproductive medicine is recommended remains unclear in most of the statements. Some describe forms of only a supplementary postgraduate education, a kind of prolongation of the basic gynecologic and obstetrical training concentrated on one of the three main fields. The complete separation, i.e., in obstetrical medicine, reproductive medicine, gynecologic pelvic surgery, has the advantage of a more effective concentration on each of the respective subdisciplines in clinical work and in research. On the other hand, the separation will certainly produce several disadvantages: (a) What is inbetween the subdisciplines will be difficult to integrate. (b) The principle of the gynecologist functioning as a primary health care physician for women will be weakened, i.e., his competence for family-planning, pregnancy and delivery of normal cases, for cancer screening of genital and breast tumors, for disorders of the cycle, for pelvic inflammatory diseases and for the care of postmenopausal women will be less integral. (c) The lectures will be more than at present split or overloaded with detailed facts. (d) The need of general gynecologic care - as well cost-effective as widely available - will less frequently be met than now. (e) The opportunities for younger colleagues to settle with an office of their own will be restricted. The disadvantages outweigh the advantages.(ABSTRACT TRUNCATED AT 250 WORDS)

LASIK vs LASEK vs PRK: advantages and indications.

PubMed

Ambrósio, Renato; Wilson, Steven

2003-03-01

The advent of the excimer laser as an instrument for use in reshaping the corneal stroma was a great step forward in refractive surgery. Laser energy can be delivered on the stromal surface in the photorefractive keratectomy (PRK) procedure or deeper on the corneal stroma by the means of a lamellar surgery in which a flap is created with the microkeratome in the laser in situ keratomileusis (LASIK) procedure. LASIK is currently the dominant procedure in refractive surgery. The main advantage of LASIK over PRK is related to maintaining the central corneal epithelium. This increases comfort during the early post-operative period, allows for rapid visual recovery, and reduces the wound healing response. Reduced wound healing correlates with less regression for high corrections and a lower rate of complications such as significant stromal opacity (haze). PRK, however, remains as an excellent option for mild to moderate corrections, particularly for cases associated with thin corneas, recurrent erosions, or a predisposition for trauma (Martial arts, military, etc.). Recently, a modification of PRK, laser subepithelial keratomileusis (LASEK), was introduced. In the LASEK procedure, an epithelial flap is created and replaced after the ablation. The benefits, if any, of the creation of an epithelial flap compared to traditional PRK are not fully appreciated. Advocates of LASEK suggest that there is less discomfort in the early postoperative period, faster visual recovery, and less haze compared to standard PRK for correction of similar levels of refractive error. Additional long-term clinical studies, along with laboratory research, will be crucial to validate these potential advantages of LASEK procedure.

Advantages of III-nitride laser diodes in solid-state lighting: Advantages of III-nitride laser diodes in solid-state lighting

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

Wierer, Jonathan J.; Tsao, Jeffrey Y.

2015-01-14

III-nitride laser diodes (LDs) are an interesting light source for solid-state lighting (SSL). Modelling of LDs is performed to reveal the potential advantages over traditionally used light-emitting diodes (LEDs). The first, and most notable, advantage is LDs have higher efficiency at higher currents when compared to LEDs. This is because Auger recombination that causes efficiency droop can no longer grow after laser threshold. Second, the same phosphor-converted methods used with LEDs can also be used with LDs to produce white light with similar color rendering and color temperature. Third, producing white light from color mixed emitters is equally challenging formore » both LEDs and LDs, with neither source having a direct advantage. Fourth, the LD emission is directional and can be more readily captured and focused, leading to the possibility of novel and more compact luminaires. Finally, the smaller area and higher current density operation of LDs provides them with a potential cost advantage over LEDs. These advantages make LDs a compelling source for future SSL.« less

Taking advantage of an unerupted third molar: a case report.

PubMed

Pereira, Igor Figueiredo; Santiago, Fernando Zander Mucci; Sette-Dias, Augusto Cesar; Noronha, Vladimir Reimar Augusto de Souza

2017-01-01

Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. To report a clinical case that took advantage of an unerupted third molar. A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. After 12 months, the third molar reached the proper position. When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket.

PubMed

Robin, Brett N; Lubowitz, James H

2014-10-01

Anterior cruciate ligament (ACL) femoral socket techniques have distinct advantages and disadvantages when considering the following techniques: transtibial, anteromedial portal, outside-in, and outside-in retroconstruction. There is no one perfect technique and we have an incomplete understanding of anatomical, biomechanical, isometry, stability, and clinical outcomes. Our primary focus is transtibial technique for creating the ACL femoral socket. Advantages include less invasive, isometric graft placement, stable Lachman exam, and minimal graft impingement with the tunnel and notch. Disadvantages include nonanatomic vertical graft placement that can cause rotational instability and positive pivot shift, interference screw divergence, graft-tunnel length mismatch, femoral socket constraint, posterior cruciate ligament impingement, and a short, oblique tibial tunnel that may undermine the medial plateau in an attempt to achieve anatomic ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hypersensitivity pneumonitis associated with mushroom worker's lung: an update on the clinical significance of the importation of exotic mushroom varieties.

PubMed

Moore, John E; Convery, Rory P; Millar, B Cherie; Rao, Juluri R; Elborn, J Stuart

2005-01-01

Hypersensitivity pneumonitis remains an important industrial disease in mushroom workers. It has a significant morbidity, and early diagnosis and removal from exposure to the antigen are critically important in its management. Recently, several new allergens have been described, particularly those from mushroom species originating in the Far East, which are of clinical significance to workers occupationally exposed to such allergens in cultivation, picking, and packing of commercial mushroom crops. Importing of exotic mushrooms including Shiitake is common in EU countries, and some of the exotic species of mushrooms are cultivated for local markets. This practice may contribute to an increase in clinical cases of mushroom hypersensitivity pneumonitis. This update reviews the recent literature and examines changing trends of mushroom worker's lung, with increased movement of commercial product and labour markets worldwide.

TCR-engineered, customized, antitumor T cells for cancer immunotherapy: advantages and limitations.

PubMed

Chhabra, Arvind

2011-01-05

The clinical outcome of the traditional adoptive cancer immunotherapy approaches involving the administration of donor-derived immune effectors, expanded ex vivo, has not met expectations. This could be attributed, in part, to the lack of sufficient high-avidity antitumor T-cell precursors in most cancer patients, poor immunogenicity of cancer cells, and the technological limitations to generate a sufficiently large number of tumor antigen-specific T cells. In addition, the host immune regulatory mechanisms and immune homeostasis mechanisms, such as activation-induced cell death (AICD), could further limit the clinical efficacy of the adoptively administered antitumor T cells. Since generation of a sufficiently large number of potent antitumor immune effectors for adoptive administration is critical for the clinical success of this approach, recent advances towards generating customized donor-specific antitumor-effector T cells by engrafting human peripheral blood-derived T cells with a tumor-associated antigen-specific transgenic T-cell receptor (TCR) are quite interesting. This manuscript provides a brief overview of the TCR engineering-based cancer immunotherapy approach, its advantages, and the current limitations.

Is There an Islamist Political Advantage?

PubMed Central

Cammett, Melani; Luong, Pauline Jones

2014-01-01

There is a widespread presumption that Islamists have an advantage over their opponents when it comes to generating mass appeal and winning elections. The question remains, however, as to whether these advantages—or, what we refer to collectively as an Islamist political advantage—actually exist. We argue that—to the extent that Islamists have a political advantage—the primary source of this advantage is reputation rather than the provision of social services, organizational capacity, or ideological hegemony. Our purpose is not to dismiss the main sources of the Islamist governance advantage identified in scholarly literature and media accounts, but to suggest a different causal path whereby each of these factors individually and sometimes jointly promotes a reputation for Islamists as competent, trustworthy, and pure. It is this reputation for good governance that enables Islamists to distinguish themselves in the streets and at the ballot box. PMID:25767370

Clinical importance of the anterior choroidal artery: a review of the literature.

PubMed

Yu, Jing; Xu, Ning; Zhao, Ying; Yu, Jinlu

2018-01-01

The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.

The advantages and disadvantages of using high technology in hand rehabilitation.

PubMed

Levanon, Yafi

2013-01-01

A brief review of the history of occupational therapy shows that the relationship between health and activity was of great concern to the founders of the Occupational Therapy (OT) field, and continues to be of concern to today's occupational therapists. Today, computers and Virtual Reality (VR) take the place of clay and the weaving loom. The goal of this article is to describe both known and innovative computerized equipment being used in interventions for hand rehabilitation and evaluations, as well as answer the question: 'what are the advantages and disadvantages of using technology in hand rehabilitation?' Our conclusion, based on clinical experience and supported by the literature, appears to emphasize that advanced technology can enrich treatment and help patients who are unable to visit the clinic regularly, to get appropriate treatment. However, advanced technology has not been found to be superior to traditional treatment and cannot replace the occupational therapist. Copyright © 2013 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Is bilingualism losing its advantage? A bibliometric approach

PubMed Central

López-Penadés, Raúl; Buil-Legaz, Lucía; Aguilar-Mediavilla, Eva; Adrover-Roig, Daniel

2017-01-01

This study uses several bibliometric indices to explore the temporal course of publication trends regarding the bilingual advantage in executive control over a ten-year window. These indices include the number of published papers, numbers of citations, and the journal impact factor. According to the information available in their abstracts, studies were classified into one of four categories: supporting, ambiguous towards, not mentioning, or challenging the bilingual advantage. Results show that the number of papers challenging the bilingual advantage increased notably in 2014 and 2015. Both the average impact factor and the accumulated citations as of June 2016 were equivalent between categories. However, of the studies published in 2014, those that challenge the bilingual advantage accumulated more citations in June 2016 than those supporting it. Our findings offer evidence-based bibliometric information about the current state of the literature and suggest a change in publication trends regarding the literature on the bilingual advantage. PMID:28426797

Distribution, genetic diversity and antibiotic resistance of clinically important bacteria from the environment of a tertiary hospital.

PubMed

Phoon, Hannah Y P; Hussin, Hazilawati; Hussain, Baizurah Mohd; Lim, Shu Yong; Woon, Jia Jie; Er, Yi Xian; Thong, Kwai Lin

2018-03-11

Hospital environments are potential reservoirs of bacteria associated with nosocomial infections. Here, we determined the distribution of cultivable environmental bacteria of clinical importance from a Malaysian tertiary hospital and to investigate their resistotypes and genotypes. Swab and fluid samples (n=358) from healthcare workers' hands, frequently touched surfaces, medical equipment, patients' immediate surroundings, ward sinks and toilets and solutions or fluids of 12 selected wards were collected. Biochemical tests, PCR and 16S rRNA sequencing were used for identification after isolation from CHROMagar TM Orientation medium. Clinically important bacteria such as Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp., Pseudomonas aeruginosa, and Enterobacter spp. were further characterised by disk diffusion method and REP-PCR. The 32 Gram negative and 21 Gram positive bacteria species identified were widely distributed in the hospital environment. Staphylococci were predominant followed by Bacillus spp., and P. aeruginosa. Frequently touched surfaces, medical equipment and ward sinks and toilets were the top three sources of bacterial species. Nine S. aureus, four Acinetobacter spp., one K. pneumoniae, and one Enterobacter spp., were multidrug resistant (MDR). The ESKAPE organisms were genetically diverse and widely dispersed across the hospital wards. An MDR MRSA clone was detected in a surgical ward isolation room. The large variety of cultivable, clinically important bacteria, especially the genetically related MDR S. aureus, K. pneumoniae, Acinetobacter spp., and Enterobacter spp. from various sampling sites indicated that the surfaces and fomites in the hospital were potential exogenous sources of nosocomial infections in the hospital. Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

A Customizable Importer for the Clinical Data Warehouses PaDaWaN and I2B2.

PubMed

Fette, Georg; Kaspar, Mathias; Dietrich, Georg; Ertl, Maximilian; Krebs, Jonathan; Stoerk, Stefan; Puppe, Frank

2017-01-01

In recent years, clinical data warehouses (CDW) storing routine patient data have become more and more popular to support scientific work in the medical domain. Although CDW systems provide interfaces to import new data, these interfaces have to be used by processing tools that are often not included in the systems themselves. In order to establish an extraction-transformation-load (ETL) workflow, already existing components have to be taken or new components have to be developed to perform the load part of the ETL. We present a customizable importer for the two CDW systems PaDaWaN and I2B2, which is able to import the most common import formats (plain text, CSV and XML files). In order to be run, the importer only needs a configuration file with the user credentials for the target CDW and a list of XML import configuration files, which determine how already exported data is indented to be imported. The importer is provided as a Java program, which has no further software requirements.

Sigma metrics used to assess analytical quality of clinical chemistry assays: importance of the allowable total error (TEa) target.

PubMed

Hens, Koen; Berth, Mario; Armbruster, Dave; Westgard, Sten

2014-07-01

Six Sigma metrics were used to assess the analytical quality of automated clinical chemistry and immunoassay tests in a large Belgian clinical laboratory and to explore the importance of the source used for estimation of the allowable total error. Clinical laboratories are continually challenged to maintain analytical quality. However, it is difficult to measure assay quality objectively and quantitatively. The Sigma metric is a single number that estimates quality based on the traditional parameters used in the clinical laboratory: allowable total error (TEa), precision and bias. In this study, Sigma metrics were calculated for 41 clinical chemistry assays for serum and urine on five ARCHITECT c16000 chemistry analyzers. Controls at two analyte concentrations were tested and Sigma metrics were calculated using three different TEa targets (Ricos biological variability, CLIA, and RiliBÄK). Sigma metrics varied with analyte concentration, the TEa target, and between/among analyzers. Sigma values identified those assays that are analytically robust and require minimal quality control rules and those that exhibit more variability and require more complex rules. The analyzer to analyzer variability was assessed on the basis of Sigma metrics. Six Sigma is a more efficient way to control quality, but the lack of TEa targets for many analytes and the sometimes inconsistent TEa targets from different sources are important variables for the interpretation and the application of Sigma metrics in a routine clinical laboratory. Sigma metrics are a valuable means of comparing the analytical quality of two or more analyzers to ensure the comparability of patient test results.

The Down Syndrome Advantage: Fact or Fiction?

ERIC Educational Resources Information Center

Corrice, April M.; Glidden, Laraine Masters

2009-01-01

The "Down syndrome advantage" is the popular conception that children with Down syndrome are easier to rear than children with other developmental disabilities. We assessed whether mothers of children with developmental disabilities would demonstrate a consistent Down syndrome advantage as their children aged from 12 to 18 years. Results did not…

The importance of standard operating procedures in clinical trials.

PubMed

Sajdak, Rebecca; Trembath, Lisaann; Thomas, Kathy S

2013-09-01

This special contribution provides insight into the role that standard operating procedures (SOPs) play in an imaging department and their value in building a high-quality research site. If you have ever participated in a clinical trial, many of the principles described in this article should be familiar. However, this article goes a step further by presenting information from a pharmaceutical or device sponsor's point of view-what the sponsor expects from a site during the course of a research study. This article is intended not to provide a complete set of instructions on how to create a great SOP but, instead, to present guidelines to ensure that the key elements are included. After reading the article, you will be able to define SOPs as they pertain to the clinical trial environment, describe key components of an SOP, list the clinical research SOPs that exist in your institution and imaging department, identify which additional SOPs might improve site performance, and describe how the sponsor relies on SOPs to ensure that the highest quality of research is attained.

Quantitative proteomic view associated with resistance to clinically important antibiotics in Gram-positive bacteria: a systematic review

PubMed Central

Lee, Chang-Ro; Lee, Jung Hun; Park, Kwang Seung; Jeong, Byeong Chul; Lee, Sang Hee

2015-01-01

The increase of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) poses a worldwide and serious health threat. Although new antibiotics, such as daptomycin and linezolid, have been developed for the treatment of infections of Gram-positive pathogens, the emergence of daptomycin-resistant and linezolid-resistant strains during therapy has now increased clinical treatment failures. In the past few years, studies using quantitative proteomic methods have provided a considerable progress in understanding antibiotic resistance mechanisms. In this review, to understand the resistance mechanisms to four clinically important antibiotics (methicillin, vancomycin, linezolid, and daptomycin) used in the treatment of Gram-positive pathogens, we summarize recent advances in studies on resistance mechanisms using quantitative proteomic methods, and also examine proteins playing an important role in the bacterial mechanisms of resistance to the four antibiotics. Proteomic researches can identify proteins whose expression levels are changed in the resistance mechanism to only one antibiotic, such as LiaH in daptomycin resistance and PrsA in vancomycin resistance, and many proteins simultaneously involved in resistance mechanisms to various antibiotics. Most of resistance-related proteins, which are simultaneously associated with resistance mechanisms to several antibiotics, play important roles in regulating bacterial envelope biogenesis, or compensating for the fitness cost of antibiotic resistance. Therefore, proteomic data confirm that antibiotic resistance requires the fitness cost and the bacterial envelope is an important factor in antibiotic resistance. PMID:26322035

A prospective study of medical students' perspective of teaching-learning media: reiterating the importance of feedback.

PubMed

Dhaliwal, Upreet

2007-11-01

To enhance successful communication, medical teachers are increasingly using teaching-learning media. To determine medical students' perception of three such media (blackboard, overhead projector, and slides), and to generate recommendations for their optimal use, a prospective questionnaire-based study was carried out among 7th semester medical students of the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi. Students made a forced choice between: (1) The three media on 8 questions regarding their advantages and disadvantages and (2) four aspects of a lecture (teaching-learning media, topic, teacher and time of day) regarding which made the lecture most engaging. Resulting data was analysed by Chi-square and Fisher's exact tests. Chalk and blackboard was rated as best in allowing interaction and helping recall (p<0.001 each). The overhead projector was best in providing information pointwise (p<0.001; 67 students, 89.3%, considered this an advantage). More subject matter could be covered per lecture (p=0.001; 58 students, 77.3%, considered this a disadvantage). Slides were best in imparting clinical details (p=0.004), but were sleep inducing (p<0.001). The teacher's style of instruction was most important in making the lecture engaging (p<0.001). The teacher's role in the learning process is important. Students enjoy the slow pace and interaction allowed by blackboard, pointwise information presented by the overhead projector, and the clinical details a slide can provide. The results suggest that the lecture could best be a combination of two or more teaching-learning media. Students' interaction should be encouraged whatever the media used.

The data sharing advantage in astrophysics

NASA Astrophysics Data System (ADS)

Dorch, Bertil F.; Drachen, Thea M.; Ellegaard, Ole

2016-10-01

We present here evidence for the existence of a citation advantage within astrophysics for papers that link to data. Using simple measures based on publication data from NASA Astrophysics Data System we find a citation advantage for papers with links to data receiving on the average significantly more citations per paper than papers without links to data. Furthermore, using INSPEC and Web of Science databases we investigate whether either papers of an experimental or theoretical nature display different citation behavior.

An Experimental Investigation of the Functional Hypothesis and Evolutionary Advantage of Stone-Tipped Spears

PubMed Central

Wilkins, Jayne; Schoville, Benjamin J.; Brown, Kyle S.

2014-01-01

Stone-tipped weapons were a significant innovation for Middle Pleistocene hominins. Hafted hunting technology represents the development of new cognitive and social learning mechanisms within the genus Homo, and may have provided a foraging advantage over simpler forms of hunting technology, such as a sharpened wooden spear. However, the nature of this foraging advantage has not been confirmed. Experimental studies and ethnographic reports provide conflicting results regarding the relative importance of the functional, economic, and social roles of hafted hunting technology. The controlled experiment reported here was designed to test the functional hypothesis for stone-tipped weapons using spears and ballistics gelatin. It differs from previous investigations of this type because it includes a quantitative analysis of wound track profiles and focuses specifically on hand-delivered spear technology. Our results do not support the hypothesis that tipped spears penetrate deeper than untipped spears. However, tipped spears create a significantly larger inner wound cavity that widens distally. This inner wound cavity is analogous to the permanent wound cavity in ballistics research, which is considered the key variable affecting the relative ‘stopping power’ or ‘killing power’ of a penetrating weapon. Tipped spears conferred a functional advantage to Middle Pleistocene hominins, potentially affecting the frequency and regularity of hunting success with important implications for human adaptation and life history. PMID:25162397

Urging medical students to publish: Advantages, disadvantages and new challenges.

PubMed

Rached, Gaëlle; Hobeika, Charbel; Karam, Elias; Kourié, Hampig Raphael; Kattan, Joseph

2018-06-01

As soon as they get accepted into medical school, students find themselves facing numerous expectations: coping with tremendous study burden, competing with others for the best rank, completing internships and participating in the race for publishing are only to name a few. This big juggle makes it hard for the medical student to focus on research. It is often easier to postpone publication and involvement in research to "later". In fact there are many advantages to publishing in the current publication system but there are many disadvantages as well. With the widespread of social media and open access systems, new challenges have arisen. The aim of this paper is to discuss the advantages and disadvantages of publishing in the current system while highlighting the new challenges that the students might need to overcome. Its aim is to provide medical students with information to enhance their understanding of the current publication system and thus most importantly, probe their desire to publish. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Differences between the non-steroidal aromatase inhibitors anastrozole and letrozole – of clinical importance?

PubMed Central

Geisler, J

2011-01-01

Aromatase inhibition is the gold standard for treatment of early and advanced breast cancer in postmenopausal women suffering from an estrogen receptor-positive disease. The currently established group of anti-aromatase compounds comprises two reversible aromatase inhibitors (anastrozole and letrozole) and on the other hand, the irreversible aromatase inactivator exemestane. Although exemestane is the only widely used aromatase inactivator at this stage, physicians very often have to choose between either anastrozole or letrozole in general practice. These third-generation aromatase inhibitors (letrozole/Femara (Novartis Pharmaceuticals, Basel, Switzerland) and anastrozole/Arimidex (AstraZeneca, Pharmaceuticals, Macclesfield, Cheshire, UK)), have recently demonstrated superior efficacy compared with tamoxifen as initial therapy for early breast cancer improving disease-free survival. However, although anastrozole and letrozole belong to the same pharmacological class of agents (triazoles), an increasing body of evidence suggests that these aromatase inhibitors are not equipotent when given in the clinically established doses. Preclinical and clinical evidence indicates distinct pharmacological profiles. Thus, this review focuses on the differences between the non-steroidal aromatase inhibitors allowing physicians to choose between these compounds based on scientific evidence. Although we are waiting for the important results of a still ongoing head-to-head comparison in patients with early breast cancer at high risk for relapse (Femara Anastrozole Clinical Evaluation trial; ‘FACE-trial'), clinicians have to make their choices today. On the basis of available evidence summarised here and until FACE-data become available, letrozole seems to be the best choice for the majority of breast cancer patients whenever a non-steroidal aromatase inhibitor has to be chosen in a clinical setting. The background for this recommendation is discussed in the following chapters

Home advantage in the Winter Paralympic Games 1976-2014.

PubMed

Wilson, Darryl; Ramchandani, Girish

2017-01-01

There is a limited amount of home advantage research concerned with winter sports. There is also a distinct lack of studies that investigate home advantage in the context of para sport events. This paper addresses this gap in the knowledge by examining home advantage in the Winter Paralympic Games. Using a standardised measure of success, we compared the performances of host nations at home with their own performances away from home between 1976 and 2014. Both country level and individual sport level analysis is conducted for this time period. Comparisons are also drawn with the Winter Olympic Games since 1992, the point from which both the Winter Olympic Games and the Winter Paralympic Games have been hosted by the same nations and in the same years. Clear evidence of a home advantage effect in the Winter Paralympic Games was found at country level. When examining individual sports, only alpine skiing and cross country skiing returned a significant home advantage effect. When comparing home advantage in the Winter Paralympic Games with the Winter Olympic Games for the last seven host nations (1992-2014), we found that home advantage was generally more pronounced (although not a statistically significant difference) in the case of the former. The causes of home advantage in the Winter Paralympic Games are unclear and should be investigated further.

Modernization of Physical Appearance and Solution Color Tests Using Quantitative Tristimulus Colorimetry: Advantages, Harmonization, and Validation Strategies.

PubMed

Pack, Brian W; Montgomery, Laura L; Hetrick, Evan M

2015-10-01

Color measurements, including physical appearance, are important yet often misunderstood and underappreciated aspects of a control strategy for drug substances and drug products. From a patient safety perspective, color can be an important control point for detecting contamination, impurities, and degradation products, with human visual acuity often more sensitive for colored impurities than instrumental techniques such as HPLC. Physical appearance tests and solution color tests can also serve an important role in ensuring that appropriate steps are taken such that clinical trials do not become unblinded when the active material is compared with another product or a placebo. Despite the importance of color tests, compendial visual tests are not harmonized across the major pharmacopoeias, which results in ambiguous specifications of little value, difficult communication of true sample color, and significant extra work required for global registration. Some pharmacopoeias have not yet recognized or adopted technical advances in the instrumental measurement of color and appearance, whereas others begin to acknowledge the advantage of instrumental colorimetry, yet leave implementation of the technology ambiguous. This commentary will highlight the above-mentioned inconsistencies, provide an avenue toward harmonization and modernization, and outline a scientifically sound approach for implementing quantitative technologies for improved measurement, communication, and control of color and appearance for both solutions and solids. Importantly, this manuscript, for the first time, outlines a color method validation approach that is consistent with the International Conference on Harmonization's guidance on the topic of method validation. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS.

PubMed

Molto, Anna; Gossec, Laure; Meghnathi, Bhowmik; Landewé, Robert B M; van der Heijde, Désirée; Atagunduz, Pamir; Elzorkany, Bassel Kamal; Akkoc, Nurullah; Kiltz, Uta; Gu, Jieruo; Wei, James Cheng Chung; Dougados, Maxime

2018-01-01

In a previous phase, 12 draft definitions for clinically important worsening in axial spondyloarthritis (axSpA) were selected, of which 3 were based on absolute changes in Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP (ASDAS). The objective here was to select the best cut-off for ASDAS for clinically important worsening in axSpA for use in clinical trials and observational studies. An international longitudinal prospective study evaluating stable patients with axSpA was conducted. Data necessary to calculate ASDAS were collected at two consecutive visits (spaced 7 days to 6 months). Sensitivity and specificity of the three cut-offs for change in ASDAS were tested against the patient's subjective assessment of worsening as the external standard (ie, the patient reporting that he had worsened and felt a need for treatment intensification). Final selection was made by a consensus and voting procedure among Assessment of SpondyloArthritis International Society (ASAS) members. In total, 1169 patients with axSpA were analysed: 64.8% were male and had a mean age of 41.7 (SD 12.4) years. At the second visit, 127 (10.9%) patients judged their situation as worsened.Sensitivity and specificity for an increase of at least 0.6, 0.9 and 1.1 ASDAS points to detect patient-reported worsening were 0.55 (Se) and 0.91 (Sp), 0.38 (Se) and 0.96 (Sp), and 0.33 (Se) and 0.98 (Sp), respectively. The ASAS consensus was to define clinically important worsening as an increase in ASDAS of at least 0.9 points. This data-driven ASAS consensus process resulted in an ASDAS-based cut-off value defining clinically important worsening in axSpA for use in trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Beyond Necrotizing Enterocolitis: Other Clinical Advantages of an Exclusive Human Milk Diet.

PubMed

Hair, Amy B; Rechtman, David J; Lee, Martin L; Niklas, Victoria

2018-06-07

Articles previously published by Sullivan et al. and Cristofalo et al. were reanalyzed using the proportion of cow milk-based nutrition received to determine whether that affected clinical outcomes during hospitalization for infants birth weight 500-1250 g. Abrams et al. showed in the same cohort incidences of necrotizing enterocolitis (NEC), NEC requiring surgery and sepsis increased proportionally to the amount of dietary cow milk. The data from the two studies conducted under essentially the same protocol were combined yielding a cohort of 260 infants receiving a diet ranging from 0% to 100% cow milk. Data analysis utilized negative binomial regression which mitigates differences between subjects in terms of their time on study by incorporating that number into the statistical model. The percent of cow milk-based nutrition was the only predictor investigated. For all outcomes the larger the amount of cow's milk in the diet the greater the number of days of that intervention required. A trend toward statistical significance was seen for ventilator days; however, only parenteral nutrition (PN) days and days to full feeds achieved statistical significance. Incorporation of any cow milk-based nutrition into the diet of extremely premature infants correlates with more days on PN and a longer time to achieve full feeds. There was a nonstatistically significant trend toward increased ventilator days. These represent additional clinical consequences of the use of any cow milk-based protein in feeding EP infants.

Possible influences on clinical supervision.

PubMed

Jones, A

This article discusses clinical supervision and suggests that, aside from helping nurses to enhance their clinical effectiveness, it could offer experiential methods of assisting nurses to identify and locate supportive networks in the workplace. The advantages and difficulties of supervision relationships are described in context, including some consideration of authority and control.

Medicare Advantage Enrollees More Likely To Enter Lower-Quality Nursing Homes Compared To Fee-For-Service Enrollees

PubMed Central

Meyers, David J.; Mor, Vincent; Rahman, Momotazur

2018-01-01

Unlike fee-for-service (FFS) Medicare, most Medicare Advantage (MA) plans have a preferred network of care providers that serve most of a plan’s enrollees. Little is known about how the quality of care MA enrollees receive differs from that of FFS Medicare enrollees. This article evaluates the differences in the quality of skilled nursing facilities (SNFs) that Medicare Advantage and FFS beneficiaries entered in the period 2012–14. After we controlled for patients’ clinical, demographic, and residential neighborhood effects, we found that FFS Medicare patients have substantially higher probabilities of entering higher-quality SNFs (those rated four or five stars by Nursing Home Compare) and those with lower readmission rates, compared to MA enrollees. The difference between MA and FFS Medicare SNF selections was less for enrollees in higher-quality MA plans than those in lower-quality plans, but Medicare Advantage still guided patients to lower-quality facilities. PMID:29309215

The need for clinical quantification of combined PET/MRI data in pediatric epilepsy

NASA Astrophysics Data System (ADS)

Muzik, Otto; Pai, Darshan; Juhasz, Csaba; Hua, Jing

2013-02-01

In the past, multimodality integrative analysis of image data has been used to obtain a better understanding of underlying mechanisms of seizure generation and propagation in children with extratemporal lobe epilepsy. However, despite important advances in the combined analysis of PET, MRI, DTI and EEG data, successful surgical outcome is only achieved in about 2/3 of patients undergoing resective surgery. The advent of simultaneous PET/MR data acquisition promises an important advance in neuroimaging through clinical quantification, which will finally translate the strength of PET (which is the ability to absolutely quantify physiological parameters such as metabolic rates and receptor densities) into clinical work. Taking advantage of recently developed integrated PET/MR devices, absolute physiological values will be available in clinical routine, replacing currently used visual assessment of relative tissue tracer uptake. This will allow assessment of global increases/decreases of brain function during critical phases of development and is likely to have a significant impact on patient management in pediatric epilepsy.

Clinical importance of median mandibular flexure in oral rehabilitation: a review.

PubMed

Sivaraman, K; Chopra, A; Venkatesh, S B

2016-03-01

The mandible has a property to flex inwards around the mandibular symphysis with change in shape and decrease in mandibular arch width during opening and protrusion of the mandible. The mandibular deformation may range from a few micrometres to more than 1 mm. The movement occurs because of the contraction of lateral pterygoid muscles that pulls mandibular condyles medially and causes a sagittal movement of the posterior segments. This movement of mandible can have a profound influence on prognosis and treatment outcome for various restorative, endodontics, fixed, removable and implant-related prosthesis. The review unfolds the causes, importance and clinical implications of median mandibular flexure in oral rehabilitation. This review also highlights the appropriate preventive measures and techniques that should be adopted by clinicians to minimise the effect of flexural movement of the jaw during oral rehabilitation. This would not only help clinicians to achieve a good prosthesis with accurate fit and longevity but also maintain the health of the surrounding periodontal or periimplant gingival tissues and bone. © 2015 John Wiley & Sons Ltd.

Cryopreservation of Human Mesenchymal Stem Cells for Clinical Applications: Current Methods and Challenges.

PubMed

Yong, Kar Wey; Wan Safwani, Wan Kamarul Zaman; Xu, Feng; Wan Abas, Wan Abu Bakar; Choi, Jane Ru; Pingguan-Murphy, Belinda

2015-08-01

Mesenchymal stem cells (MSCs) hold many advantages over embryonic stem cells (ESCs) and other somatic cells in clinical applications. MSCs are multipotent cells with strong immunosuppressive properties. They can be harvested from various locations in the human body (e.g., bone marrow and adipose tissues). Cryopreservation represents an efficient method for the preservation and pooling of MSCs, to obtain the cell counts required for clinical applications, such as cell-based therapies and regenerative medicine. Upon cryopreservation, it is important to preserve MSCs functional properties including immunomodulatory properties and multilineage differentiation ability. Further, a biosafety evaluation of cryopreserved MSCs is essential prior to their clinical applications. However, the existing cryopreservation methods for MSCs are associated with notable limitations, leading to a need for new or improved methods to be established for a more efficient application of cryopreserved MSCs in stem cell-based therapies. We review the important parameters for cryopreservation of MSCs and the existing cryopreservation methods for MSCs. Further, we also discuss the challenges to be addressed in order to preserve MSCs effectively for clinical applications.

Advantages and disadvantages of an iron-rich diet.

PubMed

Hallberg, L

2002-03-01

A review by invitation about advantages and disadvantages of an iron-rich diet by analyzing physiological iron requirements, dietary factors influencing iron absorption and the regulatory systems available to control iron absorption according to needs. The control to prevent iron deficiency is good but not perfect, as observed in previously described studies on relationships between individual iron requirements and the probability of iron deficiency developing in relation to diet. The control to prevent iron overload seems to be perfect except in the few subjects being homozygotes for hereditary hemochromatosis. A diet rich in easily available iron is important for covering basal iron losses, menstrual iron losses and the high iron requirements for growth from infancy to adolescence and for pregnancy.

Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control

PubMed Central

Malicki, Julian

2015-01-01

Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine. PMID:25949219

Clinical Named Entity Recognition Using Deep Learning Models.

PubMed

Wu, Yonghui; Jiang, Min; Xu, Jun; Zhi, Degui; Xu, Hua

2017-01-01

Clinical Named Entity Recognition (NER) is a critical natural language processing (NLP) task to extract important concepts (named entities) from clinical narratives. Researchers have extensively investigated machine learning models for clinical NER. Recently, there have been increasing efforts to apply deep learning models to improve the performance of current clinical NER systems. This study examined two popular deep learning architectures, the Convolutional Neural Network (CNN) and the Recurrent Neural Network (RNN), to extract concepts from clinical texts. We compared the two deep neural network architectures with three baseline Conditional Random Fields (CRFs) models and two state-of-the-art clinical NER systems using the i2b2 2010 clinical concept extraction corpus. The evaluation results showed that the RNN model trained with the word embeddings achieved a new state-of-the- art performance (a strict F1 score of 85.94%) for the defined clinical NER task, outperforming the best-reported system that used both manually defined and unsupervised learning features. This study demonstrates the advantage of using deep neural network architectures for clinical concept extraction, including distributed feature representation, automatic feature learning, and long-term dependencies capture. This is one of the first studies to compare the two widely used deep learning models and demonstrate the superior performance of the RNN model for clinical NER.

Clinical Named Entity Recognition Using Deep Learning Models

PubMed Central

Wu, Yonghui; Jiang, Min; Xu, Jun; Zhi, Degui; Xu, Hua

2017-01-01

Clinical Named Entity Recognition (NER) is a critical natural language processing (NLP) task to extract important concepts (named entities) from clinical narratives. Researchers have extensively investigated machine learning models for clinical NER. Recently, there have been increasing efforts to apply deep learning models to improve the performance of current clinical NER systems. This study examined two popular deep learning architectures, the Convolutional Neural Network (CNN) and the Recurrent Neural Network (RNN), to extract concepts from clinical texts. We compared the two deep neural network architectures with three baseline Conditional Random Fields (CRFs) models and two state-of-the-art clinical NER systems using the i2b2 2010 clinical concept extraction corpus. The evaluation results showed that the RNN model trained with the word embeddings achieved a new state-of-the- art performance (a strict F1 score of 85.94%) for the defined clinical NER task, outperforming the best-reported system that used both manually defined and unsupervised learning features. This study demonstrates the advantage of using deep neural network architectures for clinical concept extraction, including distributed feature representation, automatic feature learning, and long-term dependencies capture. This is one of the first studies to compare the two widely used deep learning models and demonstrate the superior performance of the RNN model for clinical NER. PMID:29854252

Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

PubMed

Gambrill, E

1999-03-01

Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

Advantages and applications of CAR-expressing natural killer cells

PubMed Central

Glienke, Wolfgang; Esser, Ruth; Priesner, Christoph; Suerth, Julia D.; Schambach, Axel; Wels, Winfried S.; Grez, Manuel; Kloess, Stephan; Arseniev, Lubomir; Koehl, Ulrike

2015-01-01

In contrast to donor T cells, natural killer (NK) cells are known to mediate anti-cancer effects without the risk of inducing graft-versus-host disease (GvHD). In order to improve cytotoxicity against resistant cancer cells, auspicious efforts have been made with chimeric antigen receptor (CAR) expressing T- and NK cells. These CAR-modified cells express antigen receptors against tumor-associated surface antigens, thus redirecting the effector cells and enhancing tumor-specific immunosurveillance. However, many cancer antigens are also expressed on healthy tissues, potentially leading to off tumor/on target toxicity by CAR-engineered cells. In order to control such potentially severe side effects, the insertion of suicide genes into CAR-modified effectors can provide a means for efficient depletion of these cells. While CAR-expressing T cells have entered successfully clinical trials, experience with CAR-engineered NK cells is mainly restricted to pre-clinical investigations and predominantly to NK cell lines. In this review we summarize the data on CAR expressing NK cells focusing on the possible advantage using these short-lived effector cells and discuss the necessity of suicide switches. Furthermore, we address the compliance of such modified NK cells with regulatory requirements as a new field in cellular immunotherapy. PMID:25729364

Home advantage in the Six Nations Rugby Union tournament.

PubMed

Thomas, Sion; Reeves, Colin; Bell, Andrew

2008-02-01

This study examined whether home advantage occurred in the Six Nations Rugby Union tournament. Data were gathered using the final championship standings from the tournament's inception in 2000 to the recently completed 2007 season. Home advantage for each championship season was defined as the number of points won by teams playing at home, expressed as a percentage of all points gained either at home or away. An analysis of home advantage for each of eight seasons of competition ranged from 53% (2005) to 70% (2006). There was an overall statistically significant home advantage of 61% for 120 matches played in the Six Nations tournament between 2000 and 2007. Also analysed were the percentage of points won at home by each country. Again, evidence supported home advantage amongst all competing nations regardless of the team's quality.

[Recurrent clinical mastitis in dairy cattle - importance and causes].

PubMed

Grieger, A-S; Zoche-Golob, V; Paduch, J-H; Hoedemaker, M; Krömker, V

2014-01-01

Clinical mastitis as a frequently recurrent event can cause substantive economic loss on dairy farms. The reason for recurrent mastitis can be either a persistent infection of the bovine mammary gland by a mastitis pathogen or a reinfection of a quarter or udder after bacteriological cure. The virulence properties of a mastitis pathogen and the cure odds of an individual cow determine the development of persistent infections. Clinical episodes may alternate with periods without symptoms in the course of persistent infections. Strategies to reduce cases of recurrent mastitis have to include improved treatment concepts and measures to decrease new infection rates. The present literature review summarises the knowledge of definitions, frequencies, causes and effects of recurrent mastitis.

Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages.

PubMed

Haraguchi, Naotsugu; Ikeda, Masataka; Miyake, Masakazu; Yamada, Takuya; Sakakibara, Yuko; Mita, Eiji; Doki, Yuichiro; Mori, Masaki; Sekimoto, Mitsugu

2016-11-01

To clarify the advantages and disadvantages of stenting as a bridge to surgery (BTS) by comparing the clinical features and outcomes of patients who underwent BTS with those of patients who underwent emergency surgery (ES). We assessed technical success, clinical success, surgical procedures, stoma formation, complications, clinicopathological features, and Onodera's prognostic nutritional index (OPNI) in patients who underwent BTS and those who underwent ES. Twenty-six patients underwent stenting, which was successful in 22 (BTS group). The remaining four patients with unsuccessful stenting underwent emergency surgery. A total of 22 patients underwent emergency surgery (ES group). The rates of technical and clinical success were 85.0 and 81.0 %, respectively. The proportion of patients able to be treated by laparoscopic surgery (P = 0.0001) and avoid colostomy (P = 0.0042) was significantly higher in the BTS group. Although the incidence of anastomotic leakage in the two groups was not significantly different, it was significantly reduced by colonoscopic evaluation of obstructive colitis (P = 0.0251). The mean number of harvested lymph nodes (P = 0.0056) and the proportion of D3 lymphadenectomy (P = 0.0241) were significantly greater in the BTS group. Perineural invasion (PNI) was noted in 59.1 and 18.2 % of the BTS group and ES group patients, respectively (P = 0.0053). OPNI and serum albumin decreased significantly after stenting (P = 0.0084). The advantages of stenting as a BTS were that it avoided colostomy and allowed for laparoscopic surgery and lymphadenectomy, whereas its disadvantage lay in the decreased PNI and OPNI levels. A larger study including an analysis of prognosis is warranted.

[Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

PubMed

Godény, Sándor

2012-02-05

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

Assessment of Minimum Important Difference and Substantial Clinical Benefit with the Vascular Quality of Life Questionnaire-6 when Evaluating Revascularisation Procedures in Peripheral Arterial Disease.

PubMed

Nordanstig, J; Pettersson, M; Morgan, M; Falkenberg, M; Kumlien, C

2017-09-01

Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. This was a population-based observational cohort study. VQ-6 data from the Swedvasc Registry (January 2014 to September 2016) was analysed for revascularised PAD patients. The minimum important difference was determined using a combination of a distribution based and an anchor-based method, while receiver operating characteristic curve analysis (ROC) was used to determine optimal thresholds for a substantial clinical benefit following revascularisation. A total of 3194 revascularised PAD patients with complete VQ-6 baseline recordings (intermittent claudication (IC) n = 1622 and critical limb ischaemia (CLI) n = 1572) were studied, of which 2996 had complete VQ-6 recordings 30 days and 1092 a year after the vascular intervention. The minimum important difference 1 year after revascularisation for IC patients ranged from 1.7 to 2.2 scale steps, depending on the method of analysis. Among CLI patients, the minimum important difference after 1 year was 1.9 scale steps. ROC analyses demonstrated that the VQ-6 discriminative properties for a substantial clinical benefit was excellent for IC patients (area under curve (AUC) 0.87, sensitivity 0.81, specificity 0.76) and acceptable in CLI (AUC 0.736, sensitivity 0.63, specificity 0.72). An optimal VQ-6 threshold for a substantial clinical benefit was determined at 3.5 scale steps among IC patients and 4.5 in CLI patients. The suggested thresholds for minimum important difference and substantial clinical benefit could be used when evaluating VQ-6 outcomes following

A Dynamic Capabilities View of Employability: Exploring the Drivers of Competitive Advantage for University Graduates

ERIC Educational Resources Information Center

Finch, David J.; Peacock, Melanie; Levallet, Nadege; Foster, William

2016-01-01

Purpose: The increasing demand for post-secondary education, and the ongoing difficulty students' face in securing appropriate work upon program completion, highlight the importance of an enhanced understanding of employability resources for university graduates. Just as organizations achieve a strategic advantage from resources and dynamic…

Information Technology Adoption for Service Innovation Practices and Competitive Advantage: The Case of Financial Firms

ERIC Educational Resources Information Center

Chen, J. S.; Tsou, H. T.

2007-01-01

Background: The importance of information technology to current business practices has long drawn the attention of practitioners and academicians. Aim: This paper aims to broaden understanding about service innovation as a critical organizational capability through which information technology adoption influences the competitive advantage of a…

Project safety as a sustainable competitive advantage.

PubMed

Rechenthin, David

2004-01-01

To be consistently profitable, a construction company must complete projects in scope, on schedule, and on budget. At the same time, the nature of the often high-risk work performed by construction companies can result in high accident rates. Clients and other stakeholders are placing increasing pressure on companies to decrease those accident rates. Clients routinely demand copies of safety plans and evidence of past results at the "pre-qualification" or "request for proposal" stages of the procurement process. Are high accident rates and the associated costs just a part of business? Companies that deliver on scope, schedule, and budget have a competitive advantage. Is it possible for projects with low accident rates to use it as a competitive advantage? Is the value added by safety just a temporary or parity issue, or does a successful safety program offer significant advantage to the company and the client? This article concludes that in the case of a high-risk industry, such as the construction industry, an organization with a successful safety program can promote safety performance as a sustainable competitive advantage. It is a choice the company can make.

Portable and programmable clinical EOG diagnostic system.

PubMed

Chen, S C; Tsai, T T; Luo, C H

2000-01-01

Monitoring eye movements is clinically important in diagnosis of diseases of the central nervous system. Electrooculography (EOG) is one method of obtaining such records which uses skin electrodes, and utilizes the anterior posterior polarization of the eye. A new EOG diagnostic system has been developed that utilizes two off-the-shelf portable notebook computers, one projector and simple electronic hardware. It can be operated under Windows 95, 98, NT, and has significant advantages over any other similar equipment, including programmability, portability, improved safety and low cost. Especially, portability of the instrument is extremely important for acutely ill or handicapped patients. The purpose of this paper is to introduce the techniques of computer animation, data acquisition, real time analysis of measured data, and database management to implement a portable, programmable and inexpensive contacting EOG instrument. It is very convenient to replace the present expensive, inflexible and large-sized commercially available EOG instruments. A lot of interesting stimulation patterns for clinical application can be created easily in different shape, time sequence, and colour by programming in Delphi language. With the help of Winstar (a software package that is used to control I/O and interrupt functions of the computer under Windows 95, 98, NT), the I/O communication between two notebook computers and A/D interface module can be effectively programmed. In addition, the new EOG diagnostic system is battery operated and it has the advantages of low noise as well as isolation from electricity. Two kinds of EOG tests, pursuit and saccade, were performed on 20 normal subjects with this new portable and programmable instrument. Based on the test result, the performance of the new instrument is superior to the other commercially available instruments. In conclusion, we hope that it will be more convenient for doctors and researchers to do the clinical EOG diagnosis

Taking advantage of continuity of care documents to populate a research repository.

PubMed

Klann, Jeffrey G; Mendis, Michael; Phillips, Lori C; Goodson, Alyssa P; Rocha, Beatriz H; Goldberg, Howard S; Wattanasin, Nich; Murphy, Shawn N

2015-03-01

Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology's Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create a low volume standards based import pipeline for the Informatics for Integrating Biology and the Bedside (i2b2) clinical research platform. We validate this approach by creating a small repository at Partners Healthcare automatically from C-CDA documents. We designed an i2b2 extension to import C-CDAs into i2b2. It is extensible to other sites with variances in C-CDA format without requiring custom code. We also designed new ontology structures for querying the imported data. We implemented our methodology at Partners Healthcare, where we developed an adapter to retrieve C-CDAs from Enterprise Services. Our current implementation supports demographics, encounters, problems, and medications. We imported approximately 17 000 clinical observations on 145 patients into i2b2 in about 24 min. We were able to perform i2b2 cohort finding queries and view patient information through SMART apps on the imported data. This low volume import approach can serve small practices with local access to C-CDAs and will allow patient registries to import patient supplied C-CDAs. These components will soon be available open source on the i2b2 wiki. Our approach will lower barriers to entry in implementing i2b2 where informatics expertise or data access are limited. © 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.

The importance of histopathological and clinical variables in predicting the evolution of colon cancer.

PubMed

Diculescu, Mircea; Iacob, Răzvan; Iacob, Speranţa; Croitoru, Adina; Becheanu, Gabriel; Popeneciu, Valentin

2002-09-01

It has been a consensus that prognostic factors should always be taken into account before planning treatment in colorectal cancer. A 5 year prospective study was conducted, in order to assess the importance of several histopathological and clinical prognostic variables in the prediction of evolution in colon cancer. Some of the factors included in the analysis are still subject to dispute by different authors. 46 of 53 screened patients qualified to enter the study and underwent a potentially curative resection of the tumor, followed, when necessary, by adjuvant chemotherapy. Univariate and multivariate analyses were carried out in order to identify independent prognostic indicators. The endpoint of the study was considered the recurrence of the tumor or the detection of metastases. 65.2% of the patients had a good evolution during the follow up period. Multivariate survival analysis performed by Cox proportional hazard model identified 3 independent prognostic factors: Dukes stage (p = 0.00002), the grade of differentiation (p = 0.0009) and the weight loss index, representing the weight loss of the patient divided by the number of months when it was actually lost (p = 0.02). Age under 40 years, sex, microscopic aspect of the tumor, tumor location, anemia degree were not identified by our analysis as having prognostic importance. Histopathological factors continue to be the most valuable source of information regarding the possible evolution of patients with colorectal cancer. Individual clinical symptoms or biological parameters such as erytrocyte sedimentation rate or hemoglobin level are of little or no prognostic value. More research is required relating to the impact of a performance status index (which could include also weight loss index) as another reliable prognostic variable.

Clinical potential of implantable wireless sensors for orthopedic treatments.

PubMed

Karipott, Salil Sidharthan; Nelson, Bradley D; Guldberg, Robert E; Ong, Keat Ghee

2018-04-01

Implantable wireless sensors have been used for real-time monitoring of chemicals and physical conditions of bones, tendons and muscles to diagnose and study orthopedic diseases and injuries. Due to the importance of these sensors in orthopedic care, a critical review, which not only analyzes the underlying technologies but also their clinical implementations and challenges, will provide a landscape view on their current state and their future clinical role. Areas covered: By conducting an extensive literature search and following the leaders of orthopedic implantable wireless sensors, this review covers the battery-powered and battery-free wireless implantable sensor technologies, and describes their implementation for hips, knees, spine, and shoulder stress/strain monitoring. Their advantages, limitations, and clinical challenges are also described. Expert commentary: Currently, implantable wireless sensors are mostly limited for scientific investigations and demonstrative experiments. Although rapid advancement in sensors and wireless technologies will push the reliability and practicality of these sensors for clinical realization, regulatory constraints and financial viability in medical device industry may curtail their continuous adoption for clinical orthopedic applications. In the next five years, these sensors are expected to gain increased interest from researchers, but wide clinical adoption is still unlikely.

Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids

PubMed Central

Giamundo, Paolo

2016-01-01

In the last two decades, hemorrhoidal dearterialization has become universally accepted as a treatment option for symptomatic hemorrhoids. The rationale for this procedure is based on the assumption that arterial blood overflow is mainly responsible for dilatation of the hemorrhoidal plexus due to the absence of capillary interposition between the arterial and venous systems within the anal canal. Dearterialization, with either suture ligation (Doppler-guided hemorrhoid artery ligation/transanal hemorrhoidal dearterialization) or laser (hemorrhoidal laser procedure), may be successfully performed alone or with mucopexy. Although the added value of Doppler-guidance in association with dearterialization has recently been challenged, this imaging method still plays an important role in localizing hemorrhoidal arteries and, therefore, minimizing the effect of anatomic variation among patients. However, it is important to employ the correct Doppler transducer. Some Doppler transducers may not easily detect superficial arteries due to inadequate frequency settings. All techniques of dearterialization have the advantage of preserving the anatomy and physiology of the anal canal, when compared to other surgical treatments for hemorrhoids. This advantage cannot be underestimated as impaired anal function, including fecal incontinence and other defecation disorders, may occur following surgical treatment for hemorrhoids. Furthermore, this potentially devastating problem can occur in patients of all ages, including younger patients. PMID:26843909

Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids.

PubMed

Giamundo, Paolo

2016-01-27

In the last two decades, hemorrhoidal dearterialization has become universally accepted as a treatment option for symptomatic hemorrhoids. The rationale for this procedure is based on the assumption that arterial blood overflow is mainly responsible for dilatation of the hemorrhoidal plexus due to the absence of capillary interposition between the arterial and venous systems within the anal canal. Dearterialization, with either suture ligation (Doppler-guided hemorrhoid artery ligation/transanal hemorrhoidal dearterialization) or laser (hemorrhoidal laser procedure), may be successfully performed alone or with mucopexy. Although the added value of Doppler-guidance in association with dearterialization has recently been challenged, this imaging method still plays an important role in localizing hemorrhoidal arteries and, therefore, minimizing the effect of anatomic variation among patients. However, it is important to employ the correct Doppler transducer. Some Doppler transducers may not easily detect superficial arteries due to inadequate frequency settings. All techniques of dearterialization have the advantage of preserving the anatomy and physiology of the anal canal, when compared to other surgical treatments for hemorrhoids. This advantage cannot be underestimated as impaired anal function, including fecal incontinence and other defecation disorders, may occur following surgical treatment for hemorrhoids. Furthermore, this potentially devastating problem can occur in patients of all ages, including younger patients.

Establishing a clinical cardiac MRI service.

PubMed

O'Regan, D P; Schmitz, S A

2006-03-01

After several years of research development cardiovascular MRI has evolved into a widely accepted clinical tool. It offers important diagnostic and prognostic information for a variety of clinical indications, which include ischaemic heart disease, cardiomyopathies, valvular dysfunction and congenital heart disorders. It is a safe non-invasive technique that employs a variety of imaging sequences optimized for temporal or spatial resolution, tissue-specific contrast, flow quantification or angiography. Cardiac MRI offers specific advantages over conventional imaging techniques for a significant number of patients. The demand for cardiac MRI studies from cardiothoracic surgeons, cardiologists and other referrers is likely to continue to rise with pressure for more widespread local service provision. Setting up a cardiac MRI service requires careful consideration regarding funding issues and how it will be integrated with existing service provision. The purchase of cardiac phased array coils, monitoring equipment and software upgrades must also be considered, as well as the training needs of those involved. The choice of appropriate imaging protocols will be guided by operator experience, clinical indication and equipment capability, and is likely to evolve as the service develops. Post-processing and offline analysis form a significant part of the time taken to report studies and an efficient method of providing quantitative reports is an important requirement. Collaboration between radiologists and cardiologists is needed to develop a successful service and multi-disciplinary meetings are key component of this. This review will explore these issues from our perspective of a new clinical cardiac MRI service operating over its first year in a teaching hospital imaging department.

Comparative advantage: the impact of ISO 14001 environmental certification on exports.

PubMed

Bellesi, Florencia; Lehrer, David; Tal, Alon

2005-04-01

Relative to the enormous acceptance of the ISO 9000 quality standard, the ISO 14001 environmental management certification has been met with only moderate enthusiasm among industrial facilities. The literature on corporate motivation for ISO 14001 participation is relatively modest considering the enormous number of publications reviewing other aspects of its adoption and implementation. It would seem that the present "marketing" package supporting ISO environmental commitments does not seem to offer sufficiently persuasive incentives for increased sales, either domestically or internationally. While researchers assume that a higher export rate of companies is positively associated with higher ISO participation rates, there have been very few empirical studies that support this inference, and conclusions have not been based on data taken from importing countries orfrom a systematic evaluation of expressed corporate preference for products sold by ISO 14001 certified companies. The present study reports the results of a survey to firms in six countries that are Israel's leading trade partners, importing chemicals, textiles, and produce. The survey results confirm that while the international market still considers price and quality as the paramount factors in selection of suppliers, environmental management systems (EMS) are an important feature that is frequently taken into consideration. EMS certification appears to signify a supplier who is managing the business well and exhibiting ethical responsibility. The European market proved to be more environmentally conscious than those in other industrialized parts of the world. EMS offer a particularly valuable advantage for producers wishing to reach European markets. As policy-makers seek to expand the voluntary adoption of EMS, a clear advantage for exporters should be highlighted among national industries.

Clinical assessment and patient-reported outcome measures in low-back pain - a survey among primary health care physiotherapists.

PubMed

Östhols, Sara; Boström, Carina; Rasmussen-Barr, Eva

2018-05-09

We aimed to map the physiotherapy practice in Sweden of clinical tests and patient-reported outcome measures in low-back pain (LBP), and to study advantages and barriers in using patient-reported outcome measures. An online survey was mailed to 4934 physiotherapists in primary health care in Sweden. Multiple choice questions investigated the use of clinical tests and patient-reported outcome measures in assessing patients with LBP. Open questions investigating the advantages and barriers to the use of patient-reported outcome measures were analyzed with content analysis. The response rate was 25% (n = 1217). Clinical tests were used "always/often" by >60% of the participants, while most patient-reported outcome measures were used by <15%. Advantages in using patient-reported outcome measures were: the clinical reasoning process, to increase the quality of assessment, to get the patient's voice, education and motivation of patients, and communication with health professionals. Barriers were lack of time and knowledge, administrative aspects, the interaction between physiotherapist and patient and, the applicability and validity of the patient-reported outcome measures. Our findings show that physiotherapists working in primary health care use clinical testing in LBP to a great extent, while various patient-reported outcome measures are used to a low-to-very-low extent. Several barriers to the use of patient-reported outcome measures were reported such as time, knowledge, and administrative issues, while important findings on advantages were to enhance the clinical reasoning process and to educate and motivate the patient. Barriers might be changed through education or organizational change-work. To enhance the use of patient-reported outcome measures and thus person-centered care in low-back pain, recommendation, and education on various patient-reported outcome measures need to be advocated. Implications for rehabilitation To increase the effects of

Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials.

PubMed

Faries, Mark B; Han, Dale; Reintgen, Michael; Kerivan, Lauren; Reintgen, Douglas; Caracò, Corrado

2018-05-18

While there is no doubt that regional lymph node metastases are an enormously important factor in melanoma staging and treatment, the biology behind this significance and its precise implications for treatment planning have been a leading controversy in melanoma and other solid tumors for over a century. Recent clinical data, including data from prospective randomized clinical trials have refined our understanding of the process of nodal metastases and the advantages and disadvantages of different clinical management strategies. This review presents two points of view in this debate and discusses the results of new data analyses as well as pivotal clinical trials informing the discussion.

Do Medicare Advantage Plans Select Enrollees in Higher Margin Clinical Categories?

PubMed Central

Newhouse, Joseph P.; McWilliams, J. Michael; Price, Mary; Huang, Jie; Fireman, Bruce; Hsu, John

2013-01-01

The CMS-HCC risk adjustment system for Medicare Advantage (MA) plans calculates weights, which are effectively relative prices, for beneficiaries with different observable characteristics. To do so it uses the relative amounts spent per beneficiary with those characteristics in Traditional Medicare (TM). For multiple reasons one might expect relative amounts in MA to differ from TM, thereby making some beneficiaries more profitable to treat than others. Much of the difference comes from differences in how TM and MA treat different diseases or diagnoses. Using data on actual medical spending from two MA-HMO plans, we show that the weights calculated from MA costs do indeed differ from those calculated using TM spending. One of the two plans (Plan 1) is more typical of MA-HMO plans in that it contracts with independent community providers, while the other (Plan 2) is vertically integrated with care delivery. We calculate margins, or Average Revenue/Average Cost, for Medicare beneficiaries in the two plans who have one of 48 different combinations of medical conditions. The two plans’ margins for these 48 conditions are correlated (r=0.39, p<0.01). Both plans have margins that are more positive for persons with conditions that are managed by primary care physicians and where medical management can be effective. Conversely they have lower margins for persons with conditions that tend to be treated by specialists with greater market power than primary care physicians and for acute conditions where little medical management is possible. The two plan’s margins among beneficiaries with different observable characteristics vary over a range of 160 and 98 percentage points, respectively, and thus would appear to offer substantial incentive for selection by HCC. Nonetheless, we find no evidence of overrepresentation of beneficiaries in high margin HCC’s in either plan. Nor, using the margins from Plan 1, the more typical plan, do we find evidence of overrepresentation

Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis.

PubMed

Young, VyVy N; Jeong, Kwonho; Rothenberger, Scott D; Gillespie, Amanda I; Smith, Libby J; Gartner-Schmidt, Jackie L; Rosen, Clark A

2018-06-01

The Voice Handicap Index-10 (VHI-10) is commonly used to measure patients' perception of vocal handicap. Clinical consensus has previously defined clinically meaningful improvement as a decrease ≥5. This study determines the minimal clinically important difference (MCID) for VHI-10 in patients with unilateral vocal fold paralysis (UVFP) using anchor-based methodology. Prospective cohort questionnaire analysis. Two hundred eighty-one UVFP patients completed the VHI-10 on two consecutive visits (within 3 months). At the follow-up visit, patients answered an 11-point Global Rating of Change Questionnaire (GRCQ) scored from -5 to +5. Relationship between the GRCQ and change in VHI-10 was quantified using analysis of variance, and MCID for the VHI-10 was determined using receiver operating characteristic (ROC) curve analysis. Overall mean VHI-10 change was -3.71 (standard deviation [SD] = 8.89) and mean GRCQ was 1.37 (SD = 2.51). Average interval between measurements was 1.73 months (SD = 0.83). Mean changes in VHI-10 scores were -7.45, -0.53, and +4.40 for patients whose GRCQ scores indicated improvement, no change, and worsening, respectively. Differences between mean scores were statistically significant (P < .001). Area under the ROC curve was 0.80, demonstrating the classification accuracy of VHI-10 change scores. A VHI-10 change of -4 was determined to be the optimal threshold that discriminated between improvement and no improvement (sensitivity and specificity 0.62 and 0.88, respectively). The MCID for improvement in VHI-10 in UVFP patients is a decrease of 4. This information improves understanding of patients' response to treatment and allows comparison between different treatments. Future research should determine MCID for VHI-10 across all voice disorders. 4. Laryngoscope, 128:1419-1424, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use

PubMed Central

Kinoshita, Yoshikazu; Ishimura, Norihisa; Ishihara, Shunji

2018-01-01

Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies. PMID:29605975

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use.

PubMed

Kinoshita, Yoshikazu; Ishimura, Norihisa; Ishihara, Shunji

2018-04-30

Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases including gastroesophageal reflux disease and secondary prevention of aspirin/NSAID-induced ulcers. Although clinically important adverse effects of PPIs can occur, just as with other drugs, those are not frequently observed during or after administration. Thus, PPIs are regarded as relatively safe and considered to be clinically beneficial. Recently, PPIs have become frequently administered to patients with functional gastrointestinal diseases or primary prevention of drug-related gastroduodenal damage, even though their beneficial effects for those conditions have not been fully confirmed. PPIs tend to be given for conditions in which the necessity of the drug has not been clarified, thus otherwise rare adverse effects are presented as clinically relevant. Although several PPI-related adverse effects have been reported, their clinical relevance is not yet clear, since the evidence reported in those studies is not at a high enough level, as the majority are based on retrospective observational studies and the reported hazard ratios are low. It is important to administer PPIs only for patients who will gain a substantial clinical benefit and to continue to investigate their adverse effects with high quality prospective studies.

Advantages and Disadvantages of Health Care Accreditation Mod-els.

PubMed

Tabrizi, Jafar S; Gharibi, Farid; Wilson, Andrew J

2011-01-01

This systematic review seeks to define the general advantages and disadvan-tages of accreditation programs to assist in choosing the most appropriate approach. Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve-ment, patient and staff safety, improving health services integration, public's confi-dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can-ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita-tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec-tives and needs.

Clinical education facilitators: a literature review.

PubMed

Lambert, Veronica; Glacken, Michèle

2005-07-01

The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory-practice gap. Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on

Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas.

PubMed

Gorey, Kevin M

2009-12-01

This study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA. Seventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA. Low-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20). More inclusive health care insurance coverage in Canada vs the USA, particularly among each country's relatively poor people, seems the most plausible explanation for such Canadian advantages. Provision of health care for all Americans would likely prevent countless early deaths, particularly among the relatively poor.

Clinical epidemiology in the era of big data: new opportunities, familiar challenges.

PubMed

Ehrenstein, Vera; Nielsen, Henrik; Pedersen, Alma B; Johnsen, Søren P; Pedersen, Lars

2017-01-01

Routinely recorded health data have evolved from mere by-products of health care delivery or billing into a powerful research tool for studying and improving patient care through clinical epidemiologic research. Big data in the context of epidemiologic research means large interlinkable data sets within a single country or networks of multinational databases. Several Nordic, European, and other multinational collaborations are now well established. Advantages of big data for clinical epidemiology include improved precision of estimates, which is especially important for reassuring ("null") findings; ability to conduct meaningful analyses in subgroup of patients; and rapid detection of safety signals. Big data will also provide new possibilities for research by enabling access to linked information from biobanks, electronic medical records, patient-reported outcome measures, automatic and semiautomatic electronic monitoring devices, and social media. The sheer amount of data, however, does not eliminate and may even amplify systematic error. Therefore, methodologies addressing systematic error, clinical knowledge, and underlying hypotheses are more important than ever to ensure that the signal is discernable behind the noise.

Clinical epidemiology in the era of big data: new opportunities, familiar challenges

PubMed Central

Ehrenstein, Vera; Nielsen, Henrik; Pedersen, Alma B; Johnsen, Søren P; Pedersen, Lars

2017-01-01

Routinely recorded health data have evolved from mere by-products of health care delivery or billing into a powerful research tool for studying and improving patient care through clinical epidemiologic research. Big data in the context of epidemiologic research means large interlinkable data sets within a single country or networks of multinational databases. Several Nordic, European, and other multinational collaborations are now well established. Advantages of big data for clinical epidemiology include improved precision of estimates, which is especially important for reassuring (“null”) findings; ability to conduct meaningful analyses in subgroup of patients; and rapid detection of safety signals. Big data will also provide new possibilities for research by enabling access to linked information from biobanks, electronic medical records, patient-reported outcome measures, automatic and semiautomatic electronic monitoring devices, and social media. The sheer amount of data, however, does not eliminate and may even amplify systematic error. Therefore, methodologies addressing systematic error, clinical knowledge, and underlying hypotheses are more important than ever to ensure that the signal is discernable behind the noise. PMID:28490904

[Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction].

PubMed

Liu, Tianzhou; Ma, Zhiming; Sun, Pengda; Li, Jinlong; Fang, Xuedong; Tong, Ti; Zhu, Jiaming

2016-01-01

To investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy. Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared. Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups. As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.

Home advantage in southern hemisphere rugby union: national and international.

PubMed

Morton R, Hugh

2006-05-01

This study evaluates home advantages both for national (Super 12) and international (Tri-nations) rugby union teams from South Africa, Australia and New Zealand, over the five-year period 2000 - 2004 using linear modelling. These home advantages are examined for statistical and practical significance, for variability between teams, for stability over time and for inter-correlation. These data reveal that the overall home advantage in elite rugby union has a mean of +6.7 points, and that this changes little from year to year. Closer scrutiny nevertheless reveals a high degree of variability. Different teams can and do have different home advantages, which ranges from a low of -0.7 to a high of +28.3 points in any one year. Furthermore, some team home advantages change up or down from one year to the next, by as much as -36.5 to +31.4 points at the extremes. There is no evidence that the stronger teams have the higher home advantages, or that a high home advantage leads to a superior finishing position in the competition.

Creating corporate advantage.

PubMed

Collis, D J; Montgomery, C A

1998-01-01

What differentiates truly great corporate strategies from the merely adequate? How can executives at the corporate level create tangible advantage for their businesses that makes the whole more than the sum of the parts? This article presents a comprehensive framework for value creation in the multibusiness company. It addresses the most fundamental questions of corporate strategy: What businesses should a company be in? How should it coordinate activities across businesses? What role should the corporate office play? How should the corporation measure and control performance? Through detailed case studies of Tyco International, Sharp, the Newell Company, and Saatchi and Saatchi, the authors demonstrate that the answers to all those questions are driven largely by the nature of a company's special resources--its assets, skills, and capabilities. These range along a continuum from the highly specialized at one end to the very general at the other. A corporation's location on the continuum constrains the set of businesses it should compete in and limits its choices about the design of its organization. Applying the framework, the authors point out the common mistakes that result from misaligned corporate strategies. Companies mistakenly enter businesses based on similarities in products rather than the resources that contribute to competitive advantage in each business. Instead of tailoring organizational structures and systems to the needs of a particular strategy, they create plain-vanilla corporate offices and infrastructures. The company examples demonstrate that one size does not fit all. One can find great corporate strategies all along the continuum.

Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint

PubMed Central

Badran, Hani; Grad, Roland

2015-01-01

Background Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. PMID:25803184

Operational advantages of using Cyber Electronic Warfare (CEW) in the battlefield

NASA Astrophysics Data System (ADS)

Yasar, Nurgul; Yasar, Fatih M.; Topcu, Yucel

2012-06-01

While cyberspace is emerging as a new battlefield, conventional Electronic Warfare (EW) methods and applications are likely to change. Cyber Electronic Warfare (CEW) concept which merges cyberspace capabilities with traditional EW methods, is a new and enhanced form of the electronic attack. In this study, cyberspace domain of the battlefield is emphazised and the feasibility of integrating Cyber Warfare (CW) concept into EW measures is researched. The SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis method is used to state the operational advantages of using CEW concept in the battlefield. The operational advantages of CEW are assessed by means of its effects on adversary air defense systems, communication networks and information systems. Outstanding technological and operational difficulties are pointed out as well. As a result, a comparison of CEW concept and conventional EW applications is presented. It is concluded that, utilization of CEW concept is feasible at the battlefield and it may yield important operational advantages. Even though the computers of developed military systems are less complex than normal computers, they are not subjected to cyber threats since they are closed systems. This concept intends to show that these closed systems are also open to the cyber threats. As a result of the SWOT analysis, CEW concept provides Air Forces to be used in cyber operations effectively. On the other hand, since its Collateral Damage Criteria (CDC) is low, the usage of cyber electronic attack systems seems to grow up.

Advantages and disadvantages of educational email alerts for family physicians: viewpoint.

PubMed

Badran, Hani; Pluye, Pierre; Grad, Roland

2015-02-27

Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians' knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants' suggestions to improve email alert services for CME. We conducted a qualitative descriptive study using the "Knowledge, Attitude, Behavior" model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

PubMed

Walenkamp, Monique M J; de Muinck Keizer, Robert-Jan; Goslings, J Carel; Vos, Lara M; Rosenwasser, Melvin P; Schep, Niels W L

2015-10-01

The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure. A numerical change in score that is less than the MCID, even when statistically significant, does not represent a true clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have not been determined in patients with distal radius fractures. We asked: (1) What is the MCID of the PRWE score for patients with distal radius fractures? (2) What is the MDC of the PRWE? Our prospective cohort study included 102 patients with a distal radius fracture and a median age of 59 years (interquartile range [IQR], 48-66 years). All patients completed the PRWE questionnaire during each of two separate visits. At the second visit, patients were asked to indicate the degree of clinical change they appreciated since the previous visit. Accordingly, patients were categorized in two groups: (1) minimally improved or (2) no change. The groups were used to anchor the changes observed in the PRWE score to patients' perspectives of what was clinically important. We determined the MCID using an anchor-based receiver operator characteristic method. In this context, the change in the PRWE score was considered a diagnostic test, and the anchor (minimally improved or no change as noted by the patients from visit to visit) was the gold standard. The optimal receiver operator characteristic cutoff point calculated with the Youden index reflected the value of the MCID. In our study, the MCID of the PRWE was 11.5 points

Ocimum basilicum: Antibacterial activity and association study with antibiotics against bacteria of clinical importance.

PubMed

Araújo Silva, Viviane; Pereira da Sousa, Janiere; de Luna Freire Pessôa, Hilzeth; Fernanda Ramos de Freitas, Andrea; Douglas Melo Coutinho, Henrique; Beuttenmuller Nogueira Alves, Larissa; Oliveira Lima, Edeltrudes

2016-01-01

Ocimum basilicum L. (Lamiaceae), popularly known as basil, is part of a group of medicinal plants widely used in cooking and known for its beneficial health properties, possessing significant antioxidant effects, antinociceptive, and others. The objective of this study is to determine the pharmacological effects produced on the bacterial strains Staphylococcus aureus and Pseudomonas aeruginosa when standard antibiotics and O. basilicum essential oil are combined. The extraction of O. basilicum (leaves) components was done by steam distillation. The Minimum inhibitory concentration (MIC) was calculated using microdilution technique, where the oil concentrations varied from 2 to 1024 μg/mL. The combinations of O. basilicum oil with ciprofloxacin or imipenem were analyzed by the checkerboard method where fractional inhibitory concentration (FIC) indices were calculated. Ocimum basilicum essential oil, imipenem, and ciprofloxacin showed respective MIC antibacterial activities of 1024, 4, and 2 μg/mL, against S. aureus. In S. aureus, the oil with imipenem association showed synergistic effect (FIC = 0.0625), while the oil with ciprofloxacin showed antagonism (FIC value = 4.25). In P. aeruginosa, the imipenem/oil association showed additive effect for ATCC strains, and synergism for the clinical strain (FIC values = 0.75 and 0.0625). The association of O. basilicum essential oil with ciprofloxacin showed synergism for clinical strains (FIC value = 0.09). Ocimum basilicum essential oil associated with existing standard antibiotics may increase their antibacterial activity, resulting in a synergistic activity against bacterial strains of clinical importance. The antibacterial activity of O. basilicum essential oil may be associated with linalool.

Durable Clinical and Immunologic Advantage of Living Donor Liver Transplantation in Children.

PubMed

Przybyszewski, Eric M; Verna, Elizabeth C; Lobritto, Steven J; Martinez, Mercedes; Vittorio, Jennifer M; Fox, Alyson N; Samstein, Benjamin; Kato, Tomoaki; Griesemer, Adam D; Emond, Jean C

2018-06-01

Despite high survival in pediatric living donor liver transplantation (LDLT), only 10% of liver transplants in children in the United States are from living donors, reflecting reluctance to embrace this approach. In addition to optimal timing and graft quality, LDLT may offer immunologic benefit because most donors are haploidentical parents. We sought to quantify the benefit of LDLT compared to deceased donor liver transplantation (DDLT) using granular clinical and immunologic outcomes over the long term. A retrospective cohort of children (age <18 years) surviving 1 year or longer posttransplant was evaluated to determine the impact of donor type on graft survival and immunologic outcomes. Two hundred forty-one children (177 DDLT and 64 LDLT) were assessed. In multivariable analysis, LDLT was associated with a lower rate of acute cellular rejection (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.29-0.98; P = 0.04), a lower rate of chronic rejection (HR, 0.12; 95% CI, 0.03-0.56; P = 0.007), better graft survival on monotherapy immunosuppression at 3 years posttransplant (87.7% vs 46.7%; odds ratio, 7.41; 95% CI, 2.80-19.66; P < 0.001), and a lower rate of graft loss (HR, 0.29; 95% CI, 0.10-0.88; P = 0.03). Graft type was not an independent predictor of posttransplant mortality (LDLT HR, 0.57; 95% CI, 0.16-2.01; P = 0.38). Maternal graft LDLT was associated with a lower rate of acute cellular rejection (HR, 0.13; 95% CI, 0.03-0.64; P = 0.01) and posttransplant lymphoproliferative disorder (HR, 0.04; 95% CI, 0.004-0.44; P = 0.008) compared with paternal grafts. This study demonstrates the potential benefit of LDLT, particularly with maternal grafts, for pediatric liver transplant recipients on multiple clinical parameters over long-term follow-up.

Competitive Intelligence and Social Advantage.

ERIC Educational Resources Information Center

Davenport, Elisabeth; Cronin, Blaise

1994-01-01

Presents an overview of issues concerning civilian competitive intelligence (CI). Topics discussed include competitive advantage in academic and research environments; public domain information and libraries; covert and overt competitive intelligence; data diversity; use of the Internet; cooperative intelligence; and implications for library and…

Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic.

PubMed

Maqbool, Talha; Raju, Sneha; In, Eunji

2016-01-01

Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

Advantages and disadvantages in usage of bioinformatic programs in promoter region analysis

NASA Astrophysics Data System (ADS)

Pawełkowicz, Magdalena E.; Skarzyńska, Agnieszka; Posyniak, Kacper; ZiÄ bska, Karolina; PlÄ der, Wojciech; Przybecki, Zbigniew

2015-09-01

An important computational challenge is finding the regulatory elements across the promotor region. In this work we present the advantages and disadvantages from the application of different bioinformatics programs for localization of transcription factor binding sites in the upstream region of genes connected with sex determination in cucumber. We use PlantCARE, PlantPAN and SignalScan to find motifs in the promotor regions. The results have been compared and possible function of chosen motifs has been described.

A visual short-term memory advantage for objects of expertise

PubMed Central

Curby, Kim M.; Glazek, Kuba; Gauthier, Isabel

2014-01-01

Visual short-term memory (VSTM) is limited, especially for complex objects. Its capacity, however, is greater for faces than for other objects, an advantage that may stem from the holistic nature of face processing. If the holistic processing explains this advantage, then object expertise—which also relies on holistic processing—should endow experts with a VSTM advantage. We compared VSTM for cars among car experts to that among car novices. Car experts, but not car novices, demonstrated a VSTM advantage similar to that for faces; this advantage was orientation-specific and was correlated with an individual's level of car expertise. Control experiments ruled out accounts based solely on verbal- or long-term memory representations. These findings suggest that the processing advantages afforded by visual expertise result in domain-specific increases in VSTM capacity, perhaps by allowing experts to maximize the use of an inherently limited VSTM system. PMID:19170473

[Antihypertensive treatment for patients with hypertension and diabetes type II--current clinical research].

PubMed

Rajzer, Marek; Kawecka-Jaszcz, Kalina; Wojciechowska, Wiktoria

2003-01-01

The frequency of arterial hypertension occurrence in polish population amounts to 30-40%, among diabetics is significantly higher-70%. According to the WHO/ISH Guidelines all hypertensive patients with diabetes are included into the "high risk group" independent of hypertension stage. Pharmacological treatment of hypertension is this group of patients has a particular meaning. Among hypertensive patients the degree of blood pressure lowering is more effective for cardiovascular risk reduction than choice of drug. This fact is well documented in clinical trials comparing antihypertensive efficacy of old and new antihypertensive drugs (for example UKPDS, STOP 2, INSIGHT). From the other point of view renal protection and metabolic benefits, as well as reduction of target organ damage are more advantageous for angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists than for diuretics and beta-blockers. Despite fast progress in clinical research on new antihypertensive drugs (especially AT1 receptor inhibitors) ACE-I seem to still remain still the "first choice" for hypertensive diabetics. Adequate blood pressure control among diabetic hypertensives is of special importance and usually needs appropriate combined antihypertensive therapy. Our review presents detailed information about treatment advantages and disadvantages of drugs from different antihypertensive classes in light of current clinical trials and international guidelines.

Finale furioso: referee-biased injury times and their effects on home advantage in football.

PubMed

Riedl, Dennis; Strauss, Bernd; Heuer, Andreas; Rubner, Oliver

2015-01-01

The role of referees has become a central issue in the investigation of home advantage. The main aim of this study was a thorough examination of the referee bias concerning injury time in football, which is currently seen as an important example for the assertion that referees contribute to home advantage. First, we use archival data from the German Bundesliga (seasons 2000/2001-2010/2011) to confirm the existence of an asymmetry in the allocation of injury time. We show this asymmetry to be a bias by ruling out hitherto remaining alternative explanations (effect = 18 s, P < 0.001, R2(adj) = 0.05). Second, we identify a further referee bias, stating that referees systematically accord more injury time when one team leads in the game compared to a draw (effect = 21 s, P = 0.004, R2(adj) = 0.06). Third, the quantitative benefit of home or away teams in goals and points due to these biases is assessed. Overall, referee decisions on injury time indeed reveal biases, but they do not contribute to the home advantage, that is, there is no significant effect on goals scored by the teams. The qualitative findings (a new bias on injury time) as well as the quantitative findings (no overall effect) shed new light on the role of referees for home advantage.

Clinically relevant advances in on-chip affinity-based electrophoresis and electrochromatography.

PubMed

Hou, Chenlu; Herr, Amy E

2008-08-01

Clinical and point-of-care disease diagnostics promise to play an important role in personalized medicine, new approaches to global health, and health monitoring. Emerging instrument platforms based on lab-on-a-chip technology can confer performance advantages successfully exploited in electrophoresis and electrochromatography to affinity-based electrokinetic separations. This review surveys lab-on-a-chip diagnostic developments in affinity-based electrokinetic separations for quantitation of proteins, integration of preparatory functions needed for subsequent analysis of diverse biological samples, and initial forays into multiplexed analyses. The technologies detailed here underpin new clinical and point-of-care diagnostic strategies. The techniques and devices promise to advance translation of until now laboratory-based sample preparation and analytical assays to near-patient settings.

A Kantian argument against comparatively advantageous genetic modification.

PubMed

Jensen, David

2011-08-01

The genetic modification of children is becoming a more likely possibility given our rapid progress in medical technologies. I argue, from a broadly Kantian point of view, that at least one kind of such modification-modification by a parent for the sake of a child's comparative advantage-is not rationally justified. To argue this, I first characterize a necessary condition on reasons and rational justification: what is a reason for an agent to do an action in one set of circumstances must be a reason for any in those circumstances to do the action. I then show that comparatively advantageous genetic modification violates this principle since a child's "getting ahead" through genetic modification cannot be rationally justified unless other children also could receive the modification, thus rendering the advantage useless. Finally, I consider the major objection to this it seems to disallow all cases of a parent's helping a child get ahead, something that parents normally engage in with their children. I argue that typical practices of developing a comparative advantage in a child, as well as practices of societal competition in general, do not conflict because they involve circumstances that mitigate the universal character of reasons. Many ordinary cases of competitive advantage that we think of as unjust, in fact, can be explained by my argument.

The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation.

PubMed

Selzler, Anne-Marie; Rodgers, Wendy M; Berry, Tanya R; Stickland, Michael K

2016-11-01

Pulmonary rehabilitation (PR) improves functional exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD), although these outcomes are often not maintained following PR. Self-efficacy is a precursor to outcomes achievement, yet few studies have examined the importance of self-efficacy to outcome improvement during PR, or how it develops over time. Further, the contribution of exercise-specific self-efficacy to outcomes in PR is unknown. The aims of this study were to determine (a) whether baseline exercise self-efficacy predicts PR attendance and change in functional exercise capacity and health status over PR, and (b) if exercise self-efficacy changes with PR. Fifty-eight out of 64 patients with COPD completed PR and assessments of exercise self-efficacy (task, coping, scheduling), the 6-minute walk test (6MWT), and St. George's Respiratory Questionnaire (SGRQ) at the beginning and end of PR. Analyses were conducted to predict attendance, and change in 6MWT and SGRQ, while controlling for baseline demographic and clinical indicators. Change in 6MWT, SGRQ, and self-efficacy with PR was also examined. Clinically significant increases in the 6MWT and SGRQ were achieved with PR. Stronger task self-efficacy predicted better attendance, while stronger coping self-efficacy predicted greater 6MWT improvement. No variables predicted SGRQ change. Scheduling self-efficacy significantly improved with PR, whereas task and coping self-efficacy did not. Baseline exercise self-efficacy appears to be a determinant of rehabilitation attendance and functional exercise improvement with PR. Clinicians should evaluate and target exercise self-efficacy to maximize adherence and health outcome improvement with PR. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Clinical proteomics-driven precision medicine for targeted cancer therapy: current overview and future perspectives.

PubMed

Zhou, Li; Wang, Kui; Li, Qifu; Nice, Edouard C; Zhang, Haiyuan; Huang, Canhua

2016-01-01

Cancer is a common disease that is a leading cause of death worldwide. Currently, early detection and novel therapeutic strategies are urgently needed for more effective management of cancer. Importantly, protein profiling using clinical proteomic strategies, with spectacular sensitivity and precision, offer excellent promise for the identification of potential biomarkers that would direct the development of targeted therapeutic anticancer drugs for precision medicine. In particular, clinical sample sources, including tumor tissues and body fluids (blood, feces, urine and saliva), have been widely investigated using modern high-throughput mass spectrometry-based proteomic approaches combined with bioinformatic analysis, to pursue the possibilities of precision medicine for targeted cancer therapy. Discussed in this review are the current advantages and limitations of clinical proteomics, the available strategies of clinical proteomics for the management of precision medicine, as well as the challenges and future perspectives of clinical proteomics-driven precision medicine for targeted cancer therapy.

Polysemy Advantage with Abstract but Not Concrete Words

ERIC Educational Resources Information Center

Jager, Bernadet; Cleland, Alexandra A.

2016-01-01

It is a robust finding that ambiguous words are recognized faster than unambiguous words. More recent studies (e.g., Rodd et al. in "J Mem Lang" 46:245-266, 2002) now indicate that this "ambiguity advantage" may in reality be a "polysemy advantage": caused by related senses (polysemy) rather than unrelated meanings…

Symbol labelling improves advantageous decision-making on the Iowa Gambling Task in people with intellectual disabilities.

PubMed

Dymond, Simon; Bailey, Rebecca; Willner, Paul; Parry, Rhonwen

2010-01-01

Individuals with intellectual and developmental disabilities often have difficulties foregoing short-term loss for long-term gain. The Iowa Gambling Task (IGT) has been extensively adopted as a laboratory measure of this ability. In the present study, we undertook the first investigation with people with intellectual disabilities using a two-choice child version of the IGT, with measures of intellectual and executive functioning. Compared to a group of matched controls, people with intellectual disabilities performed advantageously and showed high levels of subjective awareness about the relative goodness and badness of the decks. A symbol labelling intervention, in which participants were taught to label the good and bad decks at regular intervals significantly improved advantageous decision-making to levels approximating that of controls. Factor analysis of executive functioning scores identified working memory and mental flexibility (response initiation and set shifting), with a near-significant inverse correlation between the extent to which the intervention was required and mental flexibility. These findings show, for the first time, that people with intellectual disabilities are capable of performing advantageously on the IGT and add to the growing clinical literature on decision-making. Copyright 2009 Elsevier Ltd. All rights reserved.

Androgens: basic biology and clinical implication.

PubMed

Orwoll, E S

2001-10-01

Although androgens have been considered essential modulators of bone biology in men, recent studies have indicated that estrogen may have an important, if not dominant, role. Nevertheless, there is strong evidence that androgens have independent skeletal actions. Nonaromatizable androgens influence a variety of aspects of bone cell biology and are capable of modulating bone remodeling and bone mass. It appears that androgens are particularly important in the control of periosteal bone formation, an effect that might underlie the gender difference in bone size. Alterations in androgen receptor function affect bone metabolism, and new information suggests that androgens modulate receptor homeostasis. The clinical implications of androgen effects, and how they interact with those of estrogens, are somewhat unclear. It is likely that overall bone homeostasis and gender differences depend on a combination of androgenic and estrogenic actions. Androgens may well provide advantages in the prevention and therapy of metabolic bone disorders in both men and women.

Nurses' evaluation of physicians' non-clinical performance in emergency departments: advantages, disadvantages and lessons learned.

PubMed

Alameddine, Mohamad; Mufarrij, Afif; Saliba, Miriam; Mourad, Yara; Jabbour, Rima; Hitti, Eveline

2015-02-27

Peer evaluation is increasingly used as a method to assess physicians' interpersonal and communication skills. We report on experience with soliciting registered nurses' feedback on physicians' non-clinical performance in the ED of a large academic medical center in Lebanon. We utilized a secondary analysis of a de-identified database of ED nurses' assessment of physicians' non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians' communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses' qualitative comments was carried out. A statistically significant increase in the averages of skills was observed between the first and second evaluations, followed by a significant decrease in the averages of the three skills between the second and third evaluations. Personalized feedback to ED physicians and communication training initially contributed to a significant positive impact on improving ED physicians' non-clinical skills as perceived by the ED nurses. Yet, gains achieved were lost upon reaching the third cycle of evaluation. However, the thematic analysis of the nurses' qualitative responses portrays a decrease in concerns across the various dimensions of non-clinical performance. Nurses' evaluation of the non-clinical performance of physicians has the potential of improving communication

Seventeen Years of Using Flowable Resin Restoratives--A Dental Practitioner's Personal Clinical Review.

PubMed

Firla, Markus Th

2015-04-01

Seen through the author's eyes on the basis of his practising dentistry for almost three decades, light-activated flowable resin restoratives (FRCs) or, in common clinical dental terminology, flowable composites have gradually gained major importance in restorative dentistry. Inputs to this ongoing trend are coming from continuous improvements in material properties and the favourable handling characteristics experienced with this particular group of restoratives. Intended to be used in direct adhesive filling procedures, the number and variety of recent generations of flowable composites for lining, restoration of all cavity classes (I-V), core build-ups and, more recently, 'bulk-fill-restorations', however, necessitates a profound clinical understanding of the selective use of flowable composites to ensure clinical success and guarantee long-term high quality results. Clinical relevance: Today's flowable composites allow for reliable restoration of all kinds of defects. However, both the handling characteristics and the material properties of FRCs must be fully understood before taking advantage of their potentially excellent clinical performance.

Energy Advantages for Green Schools

ERIC Educational Resources Information Center

Griffin, J. Tim

2012-01-01

Because of many advantages associated with central utility systems, school campuses, from large universities to elementary schools, have used district energy for decades. District energy facilities enable thermal and electric utilities to be generated with greater efficiency and higher system reliability, while requiring fewer maintenance and…

Did Babe Ruth Have a Comparative Advantage as a Pitcher?

ERIC Educational Resources Information Center

Scahill, Edward M.

1990-01-01

Advocates using baseball statistics to illustrate the advantages of specialization in production. Using Babe Ruth's record as an analogy, suggests a methodology for determining a player's comparative advantage as a teaching illustration. Includes the team's statistical profile in five tables to explain comparative advantage and profit maximizing.…

Back to Basics: A Bilingual Advantage in Infant Visual Habituation

ERIC Educational Resources Information Center

Singh, Leher; Fu, Charlene S. L.; Rahman, Aishah A.; Hameed, Waseem B.; Sanmugam, Shamini; Agarwal, Pratibha; Jiang, Binyan; Chong, Yap Seng; Meaney, Michael J.; Rifkin-Graboi, Anne

2015-01-01

Comparisons of cognitive processing in monolinguals and bilinguals have revealed a bilingual advantage in inhibitory control. Recent studies have demonstrated advantages associated with exposure to two languages in infancy. However, the domain specificity and scope of the infant bilingual advantage in infancy remains unclear. In the present study,…

Competitive Advantage and its Sources in an Evolving Market

NASA Astrophysics Data System (ADS)

Zaridis, Apostolos D.

2009-08-01

In a continuously altered and evolving Market, as is the food manufacturing market, the main and long-lasting objective of firm that is the maximization of its wealth and consequently the continuous remaining in profit regions, appears that it is possible to be achieved via the obtainment and maintenance of diachronically long-term competitive advantage, which it will render the firm unique or leader force in a inexorable competition that is continuously extended in a globalized market. Various definitions and different regards are developed in regard to the competitive advantage and the way with which a firm it is possible, acquiring it, to star in the market in which it is activated. As result of sustainable competitive advantage in a firm comes the above the average performance. Abundance of resources and competences that are proposed as sources of competitive advantage in the resource-based view literature exists, while they are added continuously new based on empiric studies. In any case, it appears to suffer hierarchy of sources of competitive advantage, with regard to sustainability of these.

Explaining Asian Americans' academic advantage over whites.

PubMed

Hsin, Amy; Xie, Yu

2014-06-10

The superior academic achievement of Asian Americans is a well-documented phenomenon that lacks a widely accepted explanation. Asian Americans' advantage in this respect has been attributed to three groups of factors: (i) socio-demographic characteristics, (ii) cognitive ability, and (iii) academic effort as measured by characteristics such as attentiveness and work ethic. We combine data from two nationally representative cohort longitudinal surveys to compare Asian-American and white students in their educational trajectories from kindergarten through high school. We find that the Asian-American educational advantage is attributable mainly to Asian students exerting greater academic effort and not to advantages in tested cognitive abilities or socio-demographics. We test explanations for the Asian-white gap in academic effort and find that the gap can be further attributed to (i) cultural differences in beliefs regarding the connection between effort and achievement and (ii) immigration status. Finally, we highlight the potential psychological and social costs associated with Asian-American achievement success.

Explaining Asian Americans’ academic advantage over whites

PubMed Central

Hsin, Amy; Xie, Yu

2014-01-01

The superior academic achievement of Asian Americans is a well-documented phenomenon that lacks a widely accepted explanation. Asian Americans’ advantage in this respect has been attributed to three groups of factors: (i) socio-demographic characteristics, (ii) cognitive ability, and (iii) academic effort as measured by characteristics such as attentiveness and work ethic. We combine data from two nationally representative cohort longitudinal surveys to compare Asian-American and white students in their educational trajectories from kindergarten through high school. We find that the Asian-American educational advantage is attributable mainly to Asian students exerting greater academic effort and not to advantages in tested cognitive abilities or socio-demographics. We test explanations for the Asian–white gap in academic effort and find that the gap can be further attributed to (i) cultural differences in beliefs regarding the connection between effort and achievement and (ii) immigration status. Finally, we highlight the potential psychological and social costs associated with Asian-American achievement success. PMID:24799702

THE 6-MINUTE WALK TEST AND OTHER CLINICAL ENDPOINTS IN DUCHENNE MUSCULAR DYSTROPHY: RELIABILITY, CONCURRENT VALIDITY, AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES FROM A MULTICENTER STUDY

PubMed Central

McDonald, Craig M; Henricson, Erik K; Abresch, R Ted; Florence, Julaine; Eagle, Michelle; Gappmaier, Eduard; Glanzman, Allan M; Spiegel, Robert; Barth, Jay; Elfring, Gary; Reha, Allen; Peltz, Stuart W

2013-01-01

Introduction: An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6-minute walk test (6MWT) and other endpoints. Methods: Screening and baseline evaluations included the 6-minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate–determined energy expenditure index, and other exploratory endpoints. Results: The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. Conclusions: The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression. Muscle Nerve 48: 357–368, 2013 PMID:23674289

TMS-EEG: From basic research to clinical applications

NASA Astrophysics Data System (ADS)

Hernandez-Pavon, Julio C.; Sarvas, Jukka; Ilmoniemi, Risto J.

2014-11-01

Transcranial magnetic stimulation (TMS) combined with electroencephalography (EEG) is a powerful technique for non-invasively studying cortical excitability and connectivity. The combination of TMS and EEG has widely been used to perform basic research and recently has gained importance in different clinical applications. In this paper, we will describe the physical and biological principles of TMS-EEG and different applications in basic research and clinical applications. We will present methods based on independent component analysis (ICA) for studying the TMS-evoked EEG responses. These methods have the capability to remove and suppress large artifacts, making it feasible, for instance, to study language areas with TMS-EEG. We will discuss the different applications and limitations of TMS and TMS-EEG in clinical applications. Potential applications of TMS are presented, for instance in neurosurgical planning, depression and other neurological disorders. Advantages and disadvantages of TMS-EEG and its variants such as repetitive TMS (rTMS) are discussed in comparison to other brain stimulation and neuroimaging techniques. Finally, challenges that researchers face when using this technique will be summarized.

Commit to Building on New England's "Employability" Advantage!

ERIC Educational Resources Information Center

Gittell, Ross

2017-01-01

Higher education has provided New England with an economic advantage, as the region without strong natural resource advantages has relied on its higher education institutions (HEIs) and brainpower. A higher education-based economic advantage has enabled the region to develop strong well-paying technology and knowledge-based industries tied to New…

The minimal clinically important difference of six-minute walk in Asian older adults.

PubMed

Kwok, Boon Chong; Pua, Yong Hao; Mamun, Kaysar; Wong, Wai Pong

2013-03-06

Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.

Direct Importance Estimation with Gaussian Mixture Models

NASA Astrophysics Data System (ADS)

Yamada, Makoto; Sugiyama, Masashi

The ratio of two probability densities is called the importance and its estimation has gathered a great deal of attention these days since the importance can be used for various data processing purposes. In this paper, we propose a new importance estimation method using Gaussian mixture models (GMMs). Our method is an extention of the Kullback-Leibler importance estimation procedure (KLIEP), an importance estimation method using linear or kernel models. An advantage of GMMs is that covariance matrices can also be learned through an expectation-maximization procedure, so the proposed method — which we call the Gaussian mixture KLIEP (GM-KLIEP) — is expected to work well when the true importance function has high correlation. Through experiments, we show the validity of the proposed approach.

The importance, impact and influence of group clinical supervision for graduate entry nursing students.

PubMed

Sheppard, Fiona; Stacey, Gemma; Aubeeluck, Aimee

2018-01-01

This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored. Copyright © 2017 Elsevier Ltd. All rights reserved.

Advantages and disadvantages of biodegradable platforms in drug eluting stents.

PubMed

Rodriguez-Granillo, Agustina; Rubilar, Bibiana; Rodriguez-Granillo, Gaston; Rodriguez, Alfredo E

2011-03-26

Coronary angioplasty with drug-eluting stent (DES) implantation is currently the most common stent procedure worldwide. Since the introduction of DES, coronary restenosis as well as the incidence of target vessel and target lesion revascularization have been significantly reduced. However, the incidence of very late stent thrombosis beyond the first year after stent deployment has more commonly been linked to DES than to bare-metal stent (BMS) implantation. Several factors have been associated with very late stent thrombosis after DES implantation, such as delayed healing, inflammation, stent mal-apposition and endothelial dysfunction. Some of these adverse events were associated with the presence of durable polymers, which were essential to allow the elution of the immunosuppressive drug in the first DES designs. The introduction of erodable polymers in DES technology has provided the potential to complete the degradation of the polymer simultaneously or immediately after the release of the immunosuppressive drug, after which a BMS remains in place. Several DES designs with biodegradable (BIO) polymers have been introduced in preclinical and clinical studies, including randomized trials. In this review, we analyze the clinical results from 6 observational and randomized studies with BIO polymers and discuss advantages and disadvantages of this new technology.

Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study

PubMed Central

Sinclair, Shane; McConnell, Shelagh; Raffin Bouchal, Shelley; Ager, Naree; Booker, Reanne; Enns, Bert; Fung, Tak

2015-01-01

Objectives The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers. Setting Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada. Participants: Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs. Results Data were analysed using the qualitative approach of latent content analysis. Addressing spiritual issues was understood by patients and healthcare providers, as a core, yet under addressed, component of comprehensive care. Both sets of participants felt that addressing basic spiritual issues was the responsibility of all members of the interdisciplinary team, while recognising the need for specialised and embedded support from a spiritual care professional. While healthcare providers felt that the impact of the illness and treatment had a negative effect on patients’ spiritual well-being, patients felt the opposite. Skills, challenges, key time points and clinical indicators associated with addressing spiritual issues were identified. Conclusions Despite a number of conceptual and clinical challenges associated with addressing spiritual issues patients and their healthcare providers emphasised the importance of an integrated approach whereby basic spiritual issues are addressed by members of the interdisciplinary team and by an embedded spiritual care professional, who in addition also provides specialised support. The identification of clinical issues associated with addressing spiritual needs provides healthcare providers with clinical guidance on how to better integrate this aspect of care into

An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications.

PubMed

Dweik, Raed A; Boggs, Peter B; Erzurum, Serpil C; Irvin, Charles G; Leigh, Margaret W; Lundberg, Jon O; Olin, Anna-Carin; Plummer, Alan L; Taylor, D Robin

2011-09-01

Measurement of fractional nitric oxide (NO) concentration in exhaled breath (Fe(NO)) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While Fe(NO) measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of Fe(NO) in clinical practice. To develop evidence-based guidelines for the interpretation of Fe(NO) measurements that incorporate evidence that has accumulated over the past decade. We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. The evidence related to the use of Fe(NO) measurements is reviewed and clinical practice recommendations are provided. In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV(1) reversibility or provocation tests are only indirectly associated with airway inflammation. Fe(NO) offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy.

IMPORTANCE OF CONTEXTUAL DATA IN PRODUCING HEALTH TECHNOLOGY ASSESSMENT RECOMMENDATIONS: A CASE STUDY.

PubMed

Poder, Thomas G; Bellemare, Christian A

2018-01-01

Contextual data and local expertise are important sources of data that cannot be ignored in hospital-based health technology assessment (HTA) processes. Despite a lack of or unconvincing evidence in the scientific literature, technology can be recommended in a given context. We illustrate this using a case study regarding biplane angiography for vascular neurointervention. A systematic literature review was conducted, along with an analysis of the context in our setting. The outcomes of interest were radiation doses, clinical complications, procedure times, purchase cost, impact on teaching program, the confidence of clinicians in the technology, quality of care, accessibility, and the volume of activity. A committee comprising managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation regarding biplane technology acquisition to replace a monoplane device. The systematic literature review yielded nine eligible articles for analysis. Despite a very low level of evidence in the literature, the biplane system appears to reduce ionizing radiation and medical complications, as well as shorten procedure time. Contextual data indicated that the biplane system could improve operator confidence, which could translate into reduced risk, particularly for complex procedures. In addition, the biplane system can support our institution in its advanced procedures teaching program. Given the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. Contextual data were of utmost importance in this recommendation. Moreover, this technology should be implemented alongside a responsibility to collect outcome data to optimize clinical protocol in the doses of ionizing delivered.

The importance of genotype-phenotype correlation in the clinical management of Marfan syndrome.

PubMed

Becerra-Muñoz, Víctor Manuel; Gómez-Doblas, Juan José; Porras-Martín, Carlos; Such-Martínez, Miguel; Crespo-Leiro, María Generosa; Barriales-Villa, Roberto; de Teresa-Galván, Eduardo; Jiménez-Navarro, Manuel; Cabrera-Bueno, Fernando

2018-01-22

Marfan syndrome (MFS) is a disorder of autosomal dominant inheritance, in which aortic root dilation is the main cause of morbidity and mortality. Fibrillin-1 (FBN-1) gene mutations are found in more than 90% of MFS cases. The aim of our study was to summarise variants in FBN-1 and establish the genotype-phenotype correlation, with particular interest in the onset of aortic events, in a broad population of patients with an initial clinical suspicion of MFS. This single centre prospective cohort study included all patients presenting variants in the FBN-1 gene who visited a Hereditary Aortopathy clinic between September 2010 and October 2016. The study included 90 patients with FBN-1 variants corresponding to 58 non-interrelated families. Of the 57 FBN-1 variants found, 25 (43.9%) had previously been described, 23 of which had been identified as associated with MFS, while the the remainder are described for the first time. For 84 patients (93.3%), it was possible to give a definite diagnosis of Marfan syndrome in accordance with Ghent criteria. 44 of them had missense mutations, 6 of whom had suffered an aortic event (with either prophylactic surgery for aneurysm or dissection), whereas 20 of the 35 patients with truncating mutations had suffered an event (13.6% vs. 57.1%, p < 0.001). These events tended to occur at earlier ages in patients with truncating compared to those with missense mutations, although not significantly (41.33 ± 3.77 vs. 37.5 ± 9.62 years, p = 0.162). Patients with MFS and truncating variants in FBN-1 presented a higher proportion of aortic events, compared to a more benign course in patients with missense mutations. Genetic findings could, therefore, have importance not only in the diagnosis, but also in risk stratification and clinical management of patients with suspected MFS.

Advantage of resonant power conversion in aerospace applications

NASA Technical Reports Server (NTRS)

Hansen, I. G.

1983-01-01

An ultrasonic, sinusoidal aerospace power distribution system is shown to have many advantages over other candidate power systems. These advantages include light weight, ease of fault clearing, versatility in handling many loads including motors, and the capability of production within the limits of present technology. References are cited that demonstrate the state of resonant converter technology and support these conclusions.

[Clinical microbiology laboratory and imported parasitic diseases].

PubMed

Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

2010-12-01

Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Evolving user needs and late-mover advantage

PubMed Central

Querbes, Adrien; Frenken, Koen

2016-01-01

We propose a generalized NK-model of late-mover advantage where late-mover firms leapfrog first-mover firms as user needs evolve over time. First movers face severe trade-offs between the provision of functionalities in which their products already excel and the additional functionalities requested by users later on. Late movers, by contrast, start searching when more functionalities are already known and typically come up with superior product designs. We also show that late-mover advantage is more probable for more complex technologies. Managerial implications follow. PMID:28596705

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

PubMed

Mattos, Jose L; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L; Soler, Zachary M

2018-05-02

Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID. © 2018 ARS-AAOA, LLC.

Potential advantages of using synchrotron X-ray based techniques in pediatric research.

PubMed

Pascolo, L; Esteve, F; Rizzardi, C; James, S; Menk, R H

2013-01-01

Synchrotron radiation (SR), which combines extremely high intensity, high collimation, tunability, and continuous energy spectrum, allows the development of advanced X-ray based techniques that are becoming a uniquely useful tool in life science research, along providing exciting opportunities in biomedical imaging and radiotherapy. This review summarize emerging techniques and their potential to greatly enhance the exploration of dynamical biological process occurring across various spatial and temporal regimes, from whole body physiology, down to the location of individual chemical species within single cells. In recent years pediatric research and clinic practice have started to profit from these new opportunities, particularly by extending the diagnostic and therapeutic capabilities of these X-ray based techniques. In diagnosis, technical advances in DEI and KES imaging modalities have been demonstrated as particularly valuable for children and women since SR allows dose minimization, with significant reductions compared to conventional approaches. However, the greatest expectations are in the field of SR based radiotherapy, increasingly studies are demonstrating SR radiotherapy provides improved chances of recovery; this is especially the case for pediatric patients. In addition, we report on the applicability of advanced X-ray microscopy techniques that offer exceptional spatial and quantitative resolution in elemental detection. These techniques, which are useful for in vitro studies, will be particularly advantageous where investigators seek deeper understanding of diseases where mismetabolism of metals, either physiological important (i.e. Cu, Zn) or outright toxic (i.e. Pb), underlies pathogenesis.

In Vitro Tumor Models: Advantages, Disadvantages, Variables, and Selecting the Right Platform.

PubMed

Katt, Moriah E; Placone, Amanda L; Wong, Andrew D; Xu, Zinnia S; Searson, Peter C

2016-01-01

In vitro tumor models have provided important tools for cancer research and serve as low-cost screening platforms for drug therapies; however, cancer recurrence remains largely unchecked due to metastasis, which is the cause of the majority of cancer-related deaths. The need for an improved understanding of the progression and treatment of cancer has pushed for increased accuracy and physiological relevance of in vitro tumor models. As a result, in vitro tumor models have concurrently increased in complexity and their output parameters further diversified, since these models have progressed beyond simple proliferation, invasion, and cytotoxicity screens and have begun recapitulating critical steps in the metastatic cascade, such as intravasation, extravasation, angiogenesis, matrix remodeling, and tumor cell dormancy. Advances in tumor cell biology, 3D cell culture, tissue engineering, biomaterials, microfabrication, and microfluidics have enabled rapid development of new in vitro tumor models that often incorporate multiple cell types, extracellular matrix materials, and spatial and temporal introduction of soluble factors. Other innovations include the incorporation of perfusable microvessels to simulate the tumor vasculature and model intravasation and extravasation. The drive toward precision medicine has increased interest in adapting in vitro tumor models for patient-specific therapies, clinical management, and assessment of metastatic potential. Here, we review the wide range of current in vitro tumor models and summarize their advantages, disadvantages, and suitability in modeling specific aspects of the metastatic cascade and drug treatment.

In Vitro Tumor Models: Advantages, Disadvantages, Variables, and Selecting the Right Platform

PubMed Central

Katt, Moriah E.; Placone, Amanda L.; Wong, Andrew D.; Xu, Zinnia S.; Searson, Peter C.

2016-01-01

In vitro tumor models have provided important tools for cancer research and serve as low-cost screening platforms for drug therapies; however, cancer recurrence remains largely unchecked due to metastasis, which is the cause of the majority of cancer-related deaths. The need for an improved understanding of the progression and treatment of cancer has pushed for increased accuracy and physiological relevance of in vitro tumor models. As a result, in vitro tumor models have concurrently increased in complexity and their output parameters further diversified, since these models have progressed beyond simple proliferation, invasion, and cytotoxicity screens and have begun recapitulating critical steps in the metastatic cascade, such as intravasation, extravasation, angiogenesis, matrix remodeling, and tumor cell dormancy. Advances in tumor cell biology, 3D cell culture, tissue engineering, biomaterials, microfabrication, and microfluidics have enabled rapid development of new in vitro tumor models that often incorporate multiple cell types, extracellular matrix materials, and spatial and temporal introduction of soluble factors. Other innovations include the incorporation of perfusable microvessels to simulate the tumor vasculature and model intravasation and extravasation. The drive toward precision medicine has increased interest in adapting in vitro tumor models for patient-specific therapies, clinical management, and assessment of metastatic potential. Here, we review the wide range of current in vitro tumor models and summarize their advantages, disadvantages, and suitability in modeling specific aspects of the metastatic cascade and drug treatment. PMID:26904541

Plant circadian clocks increase photosynthesis, growth, survival, and competitive advantage.

PubMed

Dodd, Antony N; Salathia, Neeraj; Hall, Anthony; Kévei, Eva; Tóth, Réka; Nagy, Ferenc; Hibberd, Julian M; Millar, Andrew J; Webb, Alex A R

2005-07-22

Circadian clocks are believed to confer an advantage to plants, but the nature of that advantage has been unknown. We show that a substantial photosynthetic advantage is conferred by correct matching of the circadian clock period with that of the external light-dark cycle. In wild type and in long- and short-circadian period mutants of Arabidopsis thaliana, plants with a clock period matched to the environment contain more chlorophyll, fix more carbon, grow faster, and survive better than plants with circadian periods differing from their environment. This explains why plants gain advantage from circadian control.

Important elements in farm animal-assisted interventions for persons with clinical depression: a qualitative interview study.

PubMed

Pedersen, Ingeborg; Ihlebæk, Camilla; Kirkevold, Marit

2012-01-01

The main aim of this study was to obtain participants' own experience of a farm animal-assisted intervention, and what they perceived as important elements in relation to their mental health. A qualitative study, inspired by a phenomenological-hermeneutical perspective was conducted. Eight persons with clinical depression who had completed a 12-week farm animal-assisted intervention at a dairy farm participated in thematic interviews between May and June 2009. The intervention was regarded as a positive experience for the participants. The analyses revealed that central elements in the intervention were the possibility to experience an ordinary work life, but also the importance of a distraction to their illness. Furthermore, the flexibility of the intervention made it possible to adjust the intervention to the participants' shifting reality and was thereby a key element in farm animal-assisted intervention. The flexibility and adapted work tasks were important elements that the participants associated with their experience of coping. A model showing the interaction between the different elements reported as important by the participants was constructed. This study shows that a farm animal-assisted intervention could be a supplement in mental health rehabilitation. All the elements in our model could possibly influence positively on mental health.

An Experiment in Comparative Advantage.

ERIC Educational Resources Information Center

Haupert, Michael J.

1996-01-01

Describes an undergraduate economics course experiment designed to teach the concepts of comparative advantage and opportunity costs. Students have a limited number of labor hours and can chose to produce either wheat or steel. As the project progresses, the students trade commodities in an attempt to maximize use of their labor hours. (MJP)

Computer-assisted technologies used in oral rehabilitation and the clinical documentation of alleged advantages - a systematic review.

PubMed

Jokstad, A

2017-04-01

The objective of this systematic review is to identify current computer-assisted technologies used for managing patients with a need to re-establish craniofacial appearance, subjective discomfort and stomatognathic function, and the extent of their clinical documentation. Electronic search strategies were used for locating clinical studies in MEDLINE through PubMed and in the Cochrane library, and in the grey literature through searches on Google Scholar. The searches for commercial digital products for use in oral rehabilitation resulted in identifying 225 products per November 2016, used for patient diagnostics, communication and therapy purposes, and for other computer-assisted applications in context with oral rehabilitation. About one-third of these products were described in about 350 papers reporting from clinical human studies. The great majority of digital products for use in oral rehabilitation has no clinical documentation at all, while the products from a distinct minority of manufacturers have frequently appeared in more or less scientific reports. Moore's law apply also to digital dentistry, which predicts that the capacity of microprocessors will continue to become faster and with lower cost per performance unit, and innovative software programs will harness these improvements in performance. The net effect is the noticeable short product life cycle of digital products developed for use in oral rehabilitation and often lack of supportive clinical documentation. Nonetheless, clinicians must request clinically meaningful information about new digital products to assess net benefits for the patients or the dental professionals and not accept only technological verbiage as a basis for product purchases. © 2017 John Wiley & Sons Ltd.

Cryptic Fitness Advantage: Diploids Invade Haploid Populations Despite Lacking Any Apparent Advantage as Measured by Standard Fitness Assays

PubMed Central

Gerstein, Aleeza C.; Otto, Sarah P.

2011-01-01

Ploidy varies tremendously within and between species, yet the factors that influence when or why ploidy variants are adaptive remains poorly understood. Our previous work found that diploid individuals repeatedly arose within ten replicate haploid populations of Saccharomyces cerevisiae, and in each case we witnessed diploid takeover within 1800 asexual generations of batch culture evolution in the lab. The character that allowed diploids to rise in frequency within haploid populations remains unknown. Here we present a number of experiments conducted with the goal to determine what this trait (or traits) might have been. Experiments were conducted both by sampling a small number of colonies from the stocks frozen every two weeks (93 generations) during the original experiment, as well through sampling a larger number of colonies at the two time points where polymorphism for ploidy was most prevalent. Surprisingly, none of our fitness component measures (lag phase, growth rate, biomass production) indicated an advantage to diploidy. Similarly, competition assays against a common competitor and direct competition between haploid and diploid colonies isolated from the same time point failed to indicate a diploid advantage. Furthermore, we uncovered a tremendous amount of trait variation among colonies of the same ploidy level. Only late-appearing diploids showed a competitive advantage over haploids, indicating that the fitness advantage that allowed eventual takeover was not diploidy per se but an attribute of a subset of diploid lineages. Nevertheless, the initial rise in diploids to intermediate frequency cannot be explained by any of the fitness measures used; we suggest that the resolution to this mystery is negative frequency-dependent selection, which is ignored in the standard fitness measures used. PMID:22174734

From politics to policy: a new payment approach in Medicare Advantage.

PubMed

Berenson, Robert A

2008-01-01

While the Medicare Advantage program's future remains contentious politically, the Medicare Payment Advisory Commission's (MedPAC's) recommended policy of financial neutrality at the local level between private plans and traditional Medicare ignores local market dynamics in important ways. An analysis correlating plan bids against traditional Medicare's local spending levels likely would provide an alternative method of setting benchmarks, by producing a blend of local and national rates. A result would be that the rural and lower-cost urban "floor counties" would have benchmarks below currently inflated levels but above what financial neutrality at the local level--MedPAC's approach--would produce.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era.

PubMed

Chen, Xing; Zhang, Xing

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era

PubMed Central

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty. PMID:28115932

An investigation of home advantage in the Summer Paralympic Games.

PubMed

Wilson, Darryl; Ramchandani, Girish

2017-01-01

There is a paucity of home advantage research set in the context of para-sport events. It is this gap in the knowledge that this paper addresses by investigating the prevalence and size of home advantage in the Summer Paralympic Games. Using a standardised measure of success, we compared the performances of nations when competing at home with their own performances away from home in the competition between 1960 and 2016. Both country-level and individual sport-level analyses were conducted for this time frame. A Wilcoxon signed rank test was used to determine whether there was a genuine difference in nations' performance under host and non-host conditions. Spearman's rank-order correlation was run to assess the relationship between nation quality and home advantage. Strong evidence of a home advantage effect in the Summer Paralympic Games was found at country level ( p  < 0.01). When examining individual sports, only athletics, table tennis, and wheelchair fencing returned a significant home advantage effect ( p  < 0.05). Possible explanations for these findings are discussed. The size of the home advantage effect was not significantly correlated with the quality or strength of the host nation ( p  > 0.10). While our results confirm that home advantage is prevalent in the Summer Paralympic Games at an overall country level and within specific sports, they do not explain fully why such an effect does exist. Future studies should investigate the causes of home advantage in the competition and also draw comparisons with the Summer Olympic Games to explore any differences between para-sport events and able-bodied events.

Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays.

PubMed

Baker, Laurence C; Bundorf, M Kate; Devlin, Aileen M; Kessler, Daniel P

2016-08-01

There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per admission, and its trend over time, in each of the three types of insurance for fixed baskets of hospital admissions across metropolitan areas. After accounting for differences in hospital networks, geographic areas, and case-mix between Medicare Advantage and FFS Medicare, we found that Medicare Advantage plans paid 5.6 percent less for hospital services than FFS Medicare did. Without taking into account the narrower networks of Medicare Advantage, the program paid 8.0 percent less than FFS Medicare. We also found that the rates paid by commercial plans were much higher than those of either Medicare Advantage or FFS Medicare, and growing. At least some of this difference comes from the much higher prices that commercial plans pay for profitable service lines. Project HOPE—The People-to-People Health Foundation, Inc.

India's growing participation in global clinical trials.

PubMed

Gupta, Yogendra K; Padhy, Biswa M

2011-06-01

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

Individual variability in clinical effect and tolerability of opioid analgesics - Importance of drug interactions and pharmacogenetics.

PubMed

Solhaug, Vigdis; Molden, Espen

2017-10-01

As pain is often a comorbid condition, many patients use opioid analgesics in combination with several other drugs. This implies a generally increased risk of drug interactions, which along with inherent pharmacogenetic variability and other factors may cause differences in therapeutic response of opioids. To provide an overview of interactions and pharmacogenetic variability of relevance for individual differences in effect and tolerability of opioid analgesics, which physicians and other healthcare professionals should be aware of in clinical practice. The article was based on unsystematic searches in PubMed to identify literature highlighting the clinical impact of drug interactions and pharmacogenetics as sources of variable response of opioid analgesics. Cytochrome P450 (CYP)-mediated metabolism is an important process for both clinically relevant interactions and pharmacogenetic variability of several opioids. Concomitant use of CYP inhibitors (e.g. paroxetine, fluoxetine and bupropion) or inducers (e.g. carbamazepine, phenobarbital and phenytoin) could counteract the clinical effect or trigger side effects of analgesics in the same manner as genetically determined differences in CYP2D6-mediated metabolism of many opioids. Moreover, combination treatment with drugs that inhibit or induce P-glycoprotein (ABCB1), a blood-brain barrier efflux transporter, may alter the amount ('dose') of opioids distributed to the brain. At the pharmacodynamic level, it is crucial to be aware of the potential risk of interaction causing serotonergic syndrome when combining opioids and serotonergic drugs, in particular antidepressants inhibiting serotonin reuptake (SSRIs and SNRIs). Regarding pharmacogenetics at the receptor level of pain treatment, the knowledge is currently scarce, but an allelic variant of the μ1 opioid receptor (OPRM1) gene has been associated with higher dosage requirement to achieve analgesia. Drug interactions and pharmacogenetic differences may lead to

An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications

PubMed Central

Dweik, Raed A.; Boggs, Peter B.; Erzurum, Serpil C.; Irvin, Charles G.; Leigh, Margaret W.; Lundberg, Jon O.; Olin, Anna-Carin; Plummer, Alan L.; Taylor, D. Robin

2011-01-01

Background: Measurement of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While FeNO measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of FeNO in clinical practice. Purpose: To develop evidence-based guidelines for the interpretation of FeNO measurements that incorporate evidence that has accumulated over the past decade. Methods: We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. Results: The evidence related to the use of FeNO measurements is reviewed and clinical practice recommendations are provided. Conclusions: In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV1 reversibility or provocation tests are only indirectly associated with airway inflammation. FeNO offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy. PMID:21885636

Canopy Flow Analysis Reveals the Advantage of Size in the Oldest Communities of Multicellular Eukaryotes

PubMed Central

Ghisalberti, Marco; Gold, David A.; Laflamme, Marc; Clapham, Matthew E.; Narbonne, Guy M.; Summons, Roger E.; Johnston, David T.; Jacobs, David K.

2015-01-01

Summary At Mistaken Point, Newfoundland, Canada, rangeomorph “fronds” dominate the earliest (579–565 million years ago) fossil communities of large (0.1 to 2 m height) multicellular benthic eukaryotes. They lived in low-flow environments, fueled by uptake [1–3] of dissolved reactants (osmotrophy). However, prokaryotes are effective osmotrophs, and the advantage of taller eukaryotic osmotrophs in this deepwater community context has not been addressed. We reconstructed flow-velocity profiles and vertical mixing using canopy flow models appropriate to the densities of the observed communities. Further modeling of processes at organismal surfaces documents increasing uptake with height in the community as a function of thinning of the diffusive boundary layer with increased velocity. The velocity profile, produced by canopy flow in the community, generates this advantage of upward growth. Alternative models of upward growth advantage based on redox/resource gradients fail, given the efficiency of vertical mixing. In benthic communities of osmotrophs of sufficient density, access to flow in low-flow settings provides an advantage to taller architecture, providing a selectional driver for communities of tall eukaryotes in contexts where phototropism cannot contribute to upward growth. These Ediacaran deep-sea fossils were preserved during the increasing oxygenation prior to the Cambrian radiation of animals and likely represent an important phase in the ecological and evolutionary transition to more complex eukaryotic forms. PMID:24462003

[Internet research methods: advantages and challenges].

PubMed

Liu, Yi; Tien, Yueh-Hsuan

2009-12-01

Compared to traditional research methods, using the Internet to conduct research offers a number of advantages to the researcher, which include increased access to sensitive issues and vulnerable / hidden populations; decreased data entry time requirements; and enhanced data accuracy. However, Internet research also presents certain challenges to the researcher. In this article, the advantages and challenges of Internet research methods are discussed in four principle issue areas: (a) recruitment, (b) data quality, (c) practicality, and (d) ethics. Nursing researchers can overcome problems related to sampling bias and data truthfulness using creative methods; resolve technical problems through collaboration with other disciplines; and protect participant's privacy, confidentiality and data security by maintaining a high level of vigilance. Once such issues have been satisfactorily addressed, the Internet should open a new window for Taiwan nursing research.

The Advantages and Disadvantages of Seeking Commonality in Military Equipment

DTIC Science & Technology

2011-01-01

rand 2011 www.rand.org The Advantages and Disadvantages of Seeking Commonality in Military Equipment I ncreasingly, the Army and the Department...advantages and disadvantages of commonality and developed a decision aid to help Army policymakers manage these tradeoffs. The study drew upon...TITLE AND SUBTITLE The Advantages and Disadvantages of Seeking Commonality in Military Equipment 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic

PubMed Central

Maqbool, Talha; Raju, Sneha; In, Eunji

2016-01-01

Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21”×32” patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache.

PubMed

Silva, Ariovaldo Alberto da; Brandão, Karina Viana; Faleiros, Bruno Engler; Tavares, Rafael Mattos; Lara, Rodrigo Pinto; Januzzi, Eduardo; Carvalho, Anísio Bueno de; Carvalho, Eliane Maria Duarte de; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betania Mara Franco; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

2014-02-01

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

Advantages of later motherhood.

PubMed

Myrskylä, M; Barclay, K; Goisis, A

2017-01-01

In high-income countries childbearing has been increasingly postponed since the 1970s and it is crucial to understand the consequences of this demographic shift. The literature has tended to characterize later motherhood as a significant health threat for children and parents. We contribute to this debate by reviewing recent evidence suggesting that an older maternal age can also have positive effects. Literature linking the age at parenthood with the sociodemographic characteristics of the parents, with macrolevel interactions, and with subjective well-being. Comprehensive review of the existing literature. Recent studies show that there can also be advantages associated with later motherhood. First, whilst in past older mothers had low levels of education and large families, currently older mothers tend to have higher education and smaller families than their younger peers. Consequently, children born to older mothers in the past tended to have worse outcomes than children born to younger mothers, whilst the opposite is true in recent cohorts. Second, postponement of childbearing means that the child is born at a later date and in a later birth cohort, and may benefit from secular changes in the macroenvironment. Evidence shows that when the positive trends in the macroenvironment are strong they overweigh the negative effects of reproductive ageing. Third, existing studies show that happiness increases around and after childbirth among older mothers, whereas for younger mothers the effect does not exist or is short-lived. There are important sociodemographic pathways associated with postponement of childbearing which might compensate or even more than compensate for the biological disadvantages associated with reproductive ageing.

The second leg home advantage: evidence from European football cup competitions.

PubMed

Page, Lionel; Page, Katie

2007-12-01

The home advantage is a widely acknowledged sporting phenomenon, especially in association football. Here, we examine the second leg home advantage, an effect that is discussed in the public domain but which has received very little scientific attention. The second leg home advantage effect occurs when on average teams are more likely to win a two-stage knock-out competition when they play at home in the second leg. That is, both teams have a home advantage but this advantage is significantly greater for the team that plays at home second. Examining data from three different European Cup football competitions spanning 51 years, we show that the second leg home advantage is a real phenomenon. The second leg home team has more than a 50% probability to qualify for the next round in the competition even after controlling for extra time and team ability as possible alternative explanations. The second leg home advantage appears, however, to have decreased significantly over the past decade. Possible reasons for its existence and subsequent decline are presented.

[Inverse innovation models in the nurse clinic of a Urology Department].

PubMed

Gamarra, Manuela; López, Maria C; Luján, Marcos; Mora, Jose Ramón

2015-01-01

In the urology clinics there is an important volume of limited-complexity pathology that consumes an important part of resources. Delegating some tasks of this type to Nurses may imply a competitive advantage in economic terms without decrease in the quality of the care given to patients and their level of satisfaction. This is an example of the concept of inverse innovation. In this work we try to make public our experience in the management by nursing staff of features of the urology consultation traditionally reserved to physicians, as well as the design of the related processes. We developed the most frequent processes competence of the nursing staff in the unit: 1) Care of ambulatory urological surgery pathology; 2) Urologic ultrasound; 3) Traditional urologic nurse consultation. During 2013 the nursing staff performed 423 ambulatory urologic surgery pathology clinic visits, 931 urologic ultrasounds and 1019 varied actions corresponding to traditional urological nurse work.We developed stabilization formularies and flow diagrams of the aforementioned processes. We performed a quantification of the amount of money saved in comparison with the costs generated if a nurse or a physician was employed. Such saving was 2,78 and 4,00 Euros in the ambulatory urological surgery pathology and urologic ultrasound, respectively. Total savings in both processes was 4900 Euros. Implication of urological nursing staff in certain care tasks traditionally reserved to the physician is possible without increase in quality defects, obtaining an advantage in terms of economic cost and flexibility in staff organization thanks to the expansion of the competence array.

Thoracoscopic versus robotic approaches: advantages and disadvantages.

PubMed

Wei, Benjamin; D'Amico, Thomas A

2014-05-01

The overall advantages of thoracoscopy over thoracotomy in terms of patient recovery have been fairly well established. The use of robotics, however, is a newer and less proven modality in the realm of thoracic surgery. Robotics offers distinct advantages and disadvantages in comparison with video-assisted thoracoscopic surgery. Robotic technology is now used for a variety of complex cardiac, urologic, and gynecologic procedures including mitral valve repair and microsurgical treatment of male infertility. This article addresses the potential benefits and limitations of using the robotic platform for the performance of a variety of thoracic operations. Copyright © 2014 Elsevier Inc. All rights reserved.

Information Technology: Tomorrow's Advantage Today.

ERIC Educational Resources Information Center

Haag, Stephen; Keen, Peter

This textbook is designed for a one-semester introductory course in which the goal is to give students a foundation in the basics of information technology (IT). It focuses on how the technology works, issues relating to its use and development, how it can lend personal and business advantages, and how it is creating a globally networked society.…

Achieving a sustainable service advantage.

PubMed

Coyne, K P

1993-01-01

Many managers believe that superior service should play little or no role in competitive strategy; they maintain that service innovations are inherently copiable. However, the author states that this view is too narrow. For a company to achieve a lasting service advantage, it must base a new service on a capability gap that competitors cannot or will not copy.

Voices to reckon with: perceptions of voice identity in clinical and non-clinical voice hearers

PubMed Central

Badcock, Johanna C.; Chhabra, Saruchi

2013-01-01

The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. Identity perception in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human (i.e., real, external) voice perception, and shapes the emotional (distress) and behavioral (help-seeking) response to the experience. Yet, the phenomenological assessment of voice identity is often limited, for example to the gender of the voice, and has failed to take advantage of recent models and evidence on human voice perception. In this paper we aim to synthesize the literature on identity in real and hallucinated voices and begin by providing a comprehensive overview of the features used to judge voice identity in healthy individuals and in people with schizophrenia. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. Next we provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. Our studies used diverse methods, assessing recognition and binding of words and voices in memory as well as multidimensional scaling of voice dissimilarity judgments. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. In contrast, these voice processing abilities appear to be generally intact in non-clinical hallucinators. The review highlights some important avenues for future research and treatment of AVH associated with a need for care, and suggests some novel insights into other symptoms of psychosis. PMID:23565088

Advantages and disadvantages of pinless external fixation.

PubMed

Thomas, S R; Giele, H; Simpson, A H

2000-12-01

The AO pinless external fixator (PEF) uses trocar tipped clamps to grip the outer tibial cortex rather than pins to transfix it. Its main advantage is to avoid further contamination of the medullary canal in open tibial fractures where a nail may subsequently be used. We tested the anatomical safety of this device and its effect on plastic surgical procedures compared with a standard unilateral external fixator (UEF).The PEF and UEF were placed on two amputated limbs which were then dissected. Structures at risk were traced on ten cadaver limbs. We found that important anatomical structures were endangered by the PEF and that safe zones could not always be defined. The UEF avoided these structures. Plastic surgical approaches were made more difficult by the PEF which imposed limitations on local flap design and endangered the arterial perforators which supply them. We conclude that safety is compromised by the PEF because margins for error are small. It poses additional problems in soft tissue reconstruction and highlights the need for co-operation between plastic surgical and orthopaedic teams in choice of fixation device.

CHAPTER 7: Glycoprotein Enrichment Analytical Techniques: Advantages and Disadvantages

PubMed Central

Zhu, Rui; Zacharias, Lauren; Wooding, Kerry M.; Peng, Wenjing; Mechref, Yehia

2017-01-01

Protein glycosylation is one of the most important posttranslational modifications. Numerous biological functions are related to protein glycosylation. However, analytical challenges remain in the glycoprotein analysis. To overcome the challenges associated with glycoprotein analysis, many analytical techniques were developed in recent years. Enrichment methods were used to improve the sensitivity of detection while HPLC and mass spectrometry methods were developed to facilitate the separation of glycopeptides/proteins and enhance detection, respectively. Fragmentation techniques applied in modern mass spectrometers allow the structural interpretation of glycopeptides/proteins while automated software tools started replacing manual processing to improve the reliability and throughout of the analysis. In this chapter, the current methodologies of glycoprotein analysis were discussed. Multiple analytical techniques are compared, and advantages and disadvantages of each technique are highlighted. PMID:28109440

Clinical applications of MS-based protein quantification.

PubMed

Sabbagh, Bassel; Mindt, Sonani; Neumaier, Michael; Findeisen, Peter

2016-04-01

Mass spectrometry-based assays are increasingly important in clinical laboratory medicine and nowadays are already commonly used in several areas of routine diagnostics. These include therapeutic drug monitoring, toxicology, endocrinology, pediatrics, and microbiology. Accordingly, some of the most common analyses are therapeutic drug monitoring of immunosuppressants, vitamin D, steroids, newborn screening, and bacterial identification. However, MS-based quantification of peptides and proteins for routine diagnostic use is rather rare up to now despite excellent analytical specificity and good sensitivity. Here, we want to give an overview over current fit-for-purpose assays for MS-based protein quantification. Advantages as well as challenges of this approach will be discussed with focus on feasibility for routine diagnostic use. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The Real Transformation: Building and Maintaining Long-Term Competitive Advantage

DTIC Science & Technology

2003-01-01

TERM COMPETITIVE ADVANTAGE LTC EDWARD C. CARDON, USA A TRANFORMATION PAPER FOR THE CHAIRMAN OF THE JOINT CHIEFS OF STAFF SEMINAR...SUBTITLE The Real Transformation: Building and Maintaining Long-Term Competitive Advantage 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...long-term military competitive advantage in comparison to the rest of the world.4 This approach suggests a model that places competition as the

The Advantages of the MGL-140 for the Marine Corps

DTIC Science & Technology

2006-02-07

comparison of the specifications of the M203 and MGL-140 portrays the fundamental benefits of modern weapon systems technology, the true advantages of the...The Advantages of the MGL-140 for the Marine Corps Subject Area Warfighting EWS 2006 Contemporary Issues Paper The... Advantages of the MGL-140 for the Marine Corps Submitted by Captain OF Adeyemi to Majors AL Shaw & WC Stophel, CG 3 7 February 2006

The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders.

PubMed

Farrar, John T; Pritchett, Yili L; Robinson, Michael; Prakash, Apurva; Chappell, Amy

2010-02-01

Data on 1,700 patients pooled from 5 randomized, placebo-controlled duloxetine studies (3 in diabetic peripheral neuropathic pain and 2 in fibromyalgia) were analyzed to determine clinically important differences (CIDs) in the 0 to 10 Numeric Rating Scale-Pain Intensity (NRS-PI) for patient-reported "worst" and "least" pain intensity while validating the previously published level for "average" pain. The correspondence between the baseline-to-endpoint raw and percentage change in the NRS-PI for the worst, least, and average pain were compared to patients' perceived improvements at endpoint as measured by the 7-point Patient Global Impression of Improvement (PGI-I) scales. Stratification by baseline pain separated the raw but not the percent change scores. The PGI-I category of "much better" or above was our a priori definition of a CID. Cutoff points for the NRS-PI change scores were determined using a receiver operator curve analysis. A consistent relationship between the worst and average NRS-PI percent change and the PGI-I was demonstrated regardless of the study, pain type, age, sex, or treatment group with a reduction of approximately 34%. The least pain item CID was slightly higher at 41%. Raw change CID cutoff points were approximately -2, -2.5 and -3 for least, average, and worst pain respectively. We determined an anchor-based value for the change in the worst, least, and average pain intensity items of the Brief Pain Inventory that best represents a clinically important difference. Our findings support a standard definition of a clinically important difference in clinical trials of chronic-pain therapies. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

Home advantage and player nationality in international club football.

PubMed

Poulter, Damian R

2009-06-01

The home advantage effect was investigated at a team and player level in Union of European Football Associations (UEFA) Champions League football using in-depth performance and disciplinary variables. Performance analysis revealed that the home team scored more goals, had more shots on and off target, had a greater share of possession, and won more corners than the away team. There was an opposite trend for disciplinary variables, with the home team committing less fouls than the away team, and receiving less yellow and red cards. There were home advantage effects at player level for goals, total shots, shots on target, assists, and yellow cards, as found in the team analysis. In addition, foreign players demonstrated a home advantage effect for goals scored, whereas domestic players scored an equivalent number of goals at home and away venues. Results are discussed in relation to the home advantage literature and wider implications for the sport.

[Importance of the 11β-hydroxysteroid dehydrogenase enzyme in clinical disorders].

PubMed

Feldman, Karolina; Likó, István; Nagy, Zsolt; Szappanos, Agnes; Grolmusz, Vince Kornél; Tóth, Miklós; Rácz, Károly; Patócs, Attila

2013-02-24

Glucocorticoids play an important role in the regulation of carbohydrate and amino acid metabolism, they modulate the function of the immune system, and contribute to stress response. Increased and decreased production of glucocorticoids causes specific diseases. In addition to systemic hypo- or hypercortisolism, alteration of local synthesis and metabolism of cortisol may result in tissue-specific hypo- or hypercortisolism. One of the key enzymes participating in the local synthesis and metabolism of cortisol is the 11β-hydroxysteroid dehydrogenase enzyme. Two isoforms, type 1 and type 2 enzymes are located in the endoplasmic reticulum and catalyze the interconversion of hormonally active cortisol and inactive cortisone. The type 1 enzyme mainly works as an activator, and it is responsible for the generation of cortisol from cortisone in liver, adipose tissue, brain and bone. The gene encoding this enzyme is located on chromosome 1. The authors review the physiological and pathophysiological processes related to the function of the type 1 11β-hydroxysteroid dehydrogenase enzyme. They summarize the potential significance of polymorphic variants of the enzyme in clinical diseases as well as knowledge related to inhibitors of enzyme activity. Although further studies are still needed, inhibition of the enzyme activity may prove to be an effective tool for the treatment of several diseases such as obesity, osteoporosis and type 2 diabetes.

Advantage of four-electrode over two-electrode defibrillators

NASA Astrophysics Data System (ADS)

Bragard, J.; Šimić, A.; Laroze, D.; Elorza, J.

2015-12-01

Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock.

Regulation of Small Mitochondrial DNA Replicative Advantage by Ribonucleotide Reductase in Saccharomyces cerevisiae

PubMed Central

Bradshaw, Elliot; Yoshida, Minoru; Ling, Feng

2017-01-01

Small mitochondrial genomes can behave as selfish elements by displacing wild-type genomes regardless of their detriment to the host organism. In the budding yeast Saccharomyces cerevisiae, small hypersuppressive mtDNA transiently coexist with wild-type in a state of heteroplasmy, wherein the replicative advantage of the small mtDNA outcompetes wild-type and produces offspring without respiratory capacity in >95% of colonies. The cytosolic enzyme ribonucleotide reductase (RNR) catalyzes the rate-limiting step in dNTP synthesis and its inhibition has been correlated with increased petite colony formation, reflecting loss of respiratory function. Here, we used heteroplasmic diploids containing wild-type (rho+) and suppressive (rho−) or hypersuppressive (HS rho−) mitochondrial genomes to explore the effects of RNR activity on mtDNA heteroplasmy in offspring. We found that the proportion of rho+ offspring was significantly increased by RNR overexpression or deletion of its inhibitor, SML1, while reducing RNR activity via SML1 overexpression produced the opposite effects. In addition, using Ex Taq and KOD Dash polymerases, we observed a replicative advantage for small over large template DNA in vitro, but only at low dNTP concentrations. These results suggest that dNTP insufficiency contributes to the replicative advantage of small mtDNA over wild-type and cytosolic dNTP synthesis by RNR is an important regulator of heteroplasmy involving small mtDNA molecules in yeast. PMID:28717049

Undermatched? School-Based Linguistic Status, College Going, and the Immigrant Advantage

ERIC Educational Resources Information Center

Callahan, Rebecca M.; Humphries, Melissa H.

2016-01-01

Considerable research investigates the immigrant advantage--the academic benefit first- and second-generation students experience relative to native-born peers. However, little work examines how school-based linguistic status may influence this advantage. Contradictory patterns exist: Research identifies both an immigrant advantage and a language…

The Growing Importance of CNVs: New Insights for Detection and Clinical Interpretation

PubMed Central

Valsesia, Armand; Macé, Aurélien; Jacquemont, Sébastien; Beckmann, Jacques S.; Kutalik, Zoltán

2013-01-01

Differences between genomes can be due to single nucleotide variants, translocations, inversions, and copy number variants (CNVs, gain or loss of DNA). The latter can range from sub-microscopic events to complete chromosomal aneuploidies. Small CNVs are often benign but those larger than 500 kb are strongly associated with morbid consequences such as developmental disorders and cancer. Detecting CNVs within and between populations is essential to better understand the plasticity of our genome and to elucidate its possible contribution to disease. Hence there is a need for better-tailored and more robust tools for the detection and genome-wide analyses of CNVs. While a link between a given CNV and a disease may have often been established, the relative CNV contribution to disease progression and impact on drug response is not necessarily understood. In this review we discuss the progress, challenges, and limitations that occur at different stages of CNV analysis from the detection (using DNA microarrays and next-generation sequencing) and identification of recurrent CNVs to the association with phenotypes. We emphasize the importance of germline CNVs and propose strategies to aid clinicians to better interpret structural variations and assess their clinical implications. PMID:23750167

Restoration of US Aid to Fiji: The Advantages of Obscurity

DTIC Science & Technology

1991-12-20

RESTORATION OF US AID TO FIJI: THE ADVANTAGES OF OBSCURITY Elizabeth McKune NWC Class of 󈨠 December 20, 1991 Report Documentation Page Form...COVERED 20-12-1991 to 20-12-1991 4. TITLE AND SUBTITLE Restoration of US Aid to Fiji: The Advantages of Obscurity 5a. CONTRACT NUMBER 5b...unimportance were advantageous . PHASE ONE Background In the context of the South Pacific, however, Fiji was prominent, frequently cited as a model

Optimal Control Design Advantages Utilizing Two-Degree-of-Freedom Controllers

DTIC Science & Technology

1993-12-01

AFrTIGAE/ENYIV3D-27 AD--A273 839 D"TIC OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS THESIS Michael J. Stephens...AFIT/GAE/ENY/93D-27 OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS THESIS Presented to the Faculty of the Graduate...measurement noises compared to the I- DOF model. xvii OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS I. Introduction L1

Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities

PubMed Central

Athanasiou, Thanos

2016-01-01

Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers—particularly middle managers—also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions. PMID:26647411

Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

PubMed

Smith, Kirsten V; Thew, Graham R

2017-09-01

The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Seeking the competitive advantage: it's more than cost reduction.

PubMed

South, S F

1999-01-01

Most organizations focus considerable time and energy on reducing operating costs as a way to attain marketplace advantage. This strategy was not inappropriate in the past. To be competitive in the future, however, focus must be placed on other issues, not just cost reduction. The near future will be dominated by service industries, knowledge management, and virtual partnerships, with production optimization and flexibility, innovation, and strong partnerships defining those organizations that attain competitive advantage. Competitive advantage will reside in clarifying the vision and strategic plan, reviewing and redesigning work processes to optimize resources and value-added work, and creating change-ready environments and empowered workforces.

Copy number variation plays an important role in clinical epilepsy

PubMed Central

Olson, Heather; Shen, Yiping; Avallone, Jennifer; Sheidley, Beth R.; Pinsky, Rebecca; Bergin, Ann M.; Berry, Gerard T.; Duffy, Frank H.; Eksioglu, Yaman; Harris, David J.; Hisama, Fuki M.; Ho, Eugenia; Irons, Mira; Jacobsen, Christina M.; James, Philip; Kothare, Sanjeev; Khwaja, Omar; Lipton, Jonathan; Loddenkemper, Tobias; Markowitz, Jennifer; Maski, Kiran; Megerian, J. Thomas; Neilan, Edward; Raffalli, Peter C.; Robbins, Michael; Roberts, Amy; Roe, Eugene; Rollins, Caitlin; Sahin, Mustafa; Sarco, Dean; Schonwald, Alison; Smith, Sharon E.; Soul, Janet; Stoler, Joan M.; Takeoka, Masanori; Tan, Wen-Han; Torres, Alcy R.; Tsai, Peter; Urion, David K.; Weissman, Laura; Wolff, Robert; Wu, Bai-Lin; Miller, David T.; Poduri, Annapurna

2015-01-01

Objective To evaluate the role of copy number abnormalities detectable by chromosomal microarray (CMA) testing in patients with epilepsy at a tertiary care center. Methods We identified patients with ICD-9 codes for epilepsy or seizures and clinical CMA testing performed between October 2006 and February 2011 at Boston Children’s Hospital. We reviewed medical records and included patients meeting criteria for epilepsy. We phenotypically characterized patients with epilepsy-associated abnormalities on CMA. Results Of 973 patients who had CMA and ICD-9 codes for epilepsy or seizures, 805 patients satisfied criteria for epilepsy. We observed 437 copy number variants (CNVs) in 323 patients (1–4 per patient), including 185 (42%) deletions and 252 (58%) duplications. Forty (9%) were confirmed de novo, 186 (43%) were inherited, and parental data were unavailable for 211 (48%). Excluding full chromosome trisomies, CNV size ranged from 18 kb to 142 Mb, and 34% were over 500 kb. In at least 40 cases (5%), the epilepsy phenotype was explained by a CNV, including 29 patients with epilepsy-associated syndromes and 11 with likely disease-associated CNVs involving epilepsy genes or “hotspots.” We observed numerous recurrent CNVs including 10 involving loss or gain of Xp22.31, a region described in patients with and without epilepsy. Interpretation Copy number abnormalities play an important role in patients with epilepsy. Given that the diagnostic yield of CMA for epilepsy patients is similar to the yield in autism spectrum disorders and in prenatal diagnosis, for which published guidelines recommend testing with CMA, we recommend the implementation of CMA in the evaluation of unexplained epilepsy. PMID:24811917

Reasoning about Other People's Beliefs: Bilinguals Have an Advantage

ERIC Educational Resources Information Center

Rubio-Fernandez, Paula; Glucksberg, Sam

2012-01-01

Bilingualism can have widespread cognitive effects. In this article we investigate whether bilingualism might have an effect on adults' abilities to reason about other people's beliefs. In particular, we tested whether bilingual adults might have an advantage over monolingual adults in false-belief reasoning analogous to the advantage that has…

COMP-1 promotes competitive advantage of nematode sperm.

PubMed

Hansen, Jody M; Chavez, Daniela R; Stanfield, Gillian M

2015-03-19

Competition among sperm to fertilize oocytes is a ubiquitous feature of sexual reproduction as well as a profoundly important aspect of sexual selection. However, little is known about the cellular mechanisms sperm use to gain competitive advantage or how these mechanisms are regulated genetically. In this study, we utilize a forward genetic screen in Caenorhabditis elegans to identify a gene, comp-1, whose function is specifically required in competitive contexts. We show that comp-1 functions in sperm to modulate their migration through and localization within the reproductive tract, thereby promoting their access to oocytes. Contrary to previously described models, comp-1 mutant sperm show no defects in size or velocity, thereby defining a novel pathway for preferential usage. Our results indicate not only that sperm functional traits can influence the outcome of sperm competition, but also that these traits can be modulated in a context-dependent manner depending on the presence of competing sperm.

A Longitudinal Study of Memory Advantages in Bilinguals

PubMed Central

Ljungberg, Jessica K.; Hansson, Patrik; Andrés, Pilar; Josefsson, Maria; Nilsson, Lars-Göran

2013-01-01

Typically, studies of cognitive advantages in bilinguals have been conducted previously by using executive and inhibitory tasks (e.g. Simon task) and applying cross-sectional designs. This study longitudinally investigated bilingual advantages on episodic memory recall, verbal letter and categorical fluency during the trajectory of life. Monolingual and bilingual participants (n = 178) between 35–70 years at baseline were drawn from the Betula Prospective Cohort Study of aging, memory, and health. Results showed that bilinguals outperformed monolinguals at the first testing session and across time both in episodic memory recall and in letter fluency. No interaction with age was found indicating that the rate of change across ages was similar for bilinguals and monolinguals. As predicted and in line with studies applying cross-sectional designs, no advantages associated with bilingualism were found in the categorical fluency task. The results are discussed in the light of successful aging. PMID:24023803

The intelligent clinical laboratory as a tool to increase cancer care management productivity.

PubMed

Mohammadzadeh, Niloofar; Safdari, Reza

2014-01-01

Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.

Clinically important respiratory effects of dust exposure and smoking in British coal miners

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

Marine, W.M.; Gurr, D.; Jacobsen, M.

A unique data set of 3380 British coal miners has been reanalyzed with major focus on nonpneumoconiotic respiratory conditions. The aim was to assess the independent contribution of smoking and exposure to respirable dust to clinically significant measures of respiratory dysfunction. Exposure to coal-mine dust was monitored over a 10-yr period. Medical surveys provided estimates of prior dust exposure and recorded respiratory symptoms. Each man's FEV1 was compared with the level predicted for his age and height by an internally derived prediction equation for FEV1. Four respiratory indices were considered at the end of the 10-yr period: FEV1 less thanmore » 80%, chronic bronchitis, chronic bronchitis with FEV1 less than 80%, and FEV1 less than 65%. Results were uniformly incorporated into logistic regression equations for each condition. The equations include coefficients for age, dust, and when indicated, an interaction term for age and dust. Dust-related increases in prevalence of each of the 4 conditions were statistically significant and were similar for smokers and nonsmokers at the mean age (47 yr). There was no evidence that smoking potentiates the effect of exposure to dust. Estimates of prevalences at the mean age of all 4 measures of respiratory dysfunction were greater in smokers. At intermediate and high dust exposure the prevalence of the 4 conditions in nonsmokers approached the prevalence in smokers at hypothetically zero dust exposure. Both smoking and dust exposure can cause clinically important respiratory dysfunction and their separate contributions to obstructive airway disease in coal miners appear to be additive.« less

A female advantage in the serial production of non-representational learned gestures.

PubMed

Chipman, Karen; Hampson, Elizabeth

2006-01-01

Clinical research has demonstrated a sex difference in the neuroanatomical organization of the limb praxis system. To test for a corresponding sex difference in the functioning of this system, we compared healthy men and women on a gesture production task modeled after those used in apraxia research. In two separate studies, participants were taught to perform nine non-representational gestures in response to computer-generated color cues. After extensive practice with the gestures, the color cues were placed on a timer and presented in randomized sequences at progressively faster speeds. A detailed videotape analysis revealed that women in both studies committed significantly fewer 'praxic' errors than men (i.e., errors that resembled those seen in limb apraxia). This was true during both the untimed practice trials and the speeded trials of the task, despite equivalent numbers of errors between the sexes in the 'non-praxic' (i.e., executory) error categories. Women in both studies also performed the task at significantly faster speeds than men. This finding was not accounted for by a female advantage in extraneous elements of the task, i.e., speed of color processing, associative retrieval, or motor execution. Together, the two studies provide convergent support for a female advantage in the efficiency of forelimb gesture production. They are consistent with emerging evidence of a sex difference in the anatomical organization of the praxis system.

Achieving Competitive Advantage in Human Resource Management in General School District of Riyadh in Saudi Arabia

ERIC Educational Resources Information Center

Al dakeel, Taghreed M.; Almannie, Mohamed A.

2015-01-01

The general school district of Riyadh is one of largest in the country of (45) school districts in Saudi Arabia. The school districts play an important roles in the development of education, therefore the objective of the study is to examine the roles of the management in the school districts to see if it is achieving competitive advantage. After…

[Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery].

PubMed

Zheng, Minhua; Ma, Junjun

2017-06-25

Since the emergence of minimally invasive technology twenty years ago, as a surgical concept and surgical technique for colorectal cancer surgery, its obvious advantages have been recognized. Laparoscopic technology, as one of the most important technology platform, has got a lot of evidence-based support for the oncological safety and effectiveness in colorectal cancer surgery Laparoscopic technique has advantages in terms of identification of anatomic plane and autonomic nerve, protection of pelvic structure, and fine dissection of vessels. But because of the limitation of laparoscopic technology there are still some deficiencies and shortcomings, including lack of touch and lack of stereo vision problems, in addition to the low rectal cancer, especially male, obese, narrow pelvis, larger tumors, it is difficult to get better view and manipulating triangle in laparoscopy. However, the emergence of a series of new minimally invasive technology platform is to make up for the defects and deficiencies. The robotic surgical system possesses advantages, such as stereo vision, higher magnification, manipulator wrist with high freedom degree, filtering of tremor and higher stability, but still has disadvantages, such as lack of haptic feedback, longer operation time, high operation cost and expensive price. 3D system of laparoscopic surgery has similar visual experience and feelings as robotic surgery in the 3D view, the same operating skills as 2D laparoscopy and a short learning curve. The price of 3D laparoscopy is also moderate, which makes the 3D laparoscopy more popular in China. Transanal total mesorectal excision (taTME) by changing the traditional laparoscopic pelvic surgery approach, may have certain advantages for male cases with narrow pelvic and patients with large tumor, and it is in accordance with the technical concept of natural orifice, with less minimally invasive and better cosmetics, which can be regarded as a supplemental technique of the

[Process and key points of clinical literature evaluation of post-marketing traditional Chinese medicine].

PubMed

Liu, Huan; Xie, Yanming

2011-10-01

The clinical literature evaluation of the post-marketing traditional Chinese medicine is a comprehensive evaluation by the comprehensive gain, analysis of the drug, literature of drug efficacy, safety, economy, based on the literature evidence and is part of the evaluation of evidence-based medicine. The literature evaluation in the post-marketing Chinese medicine clinical evaluation is in the foundation and the key position. Through the literature evaluation, it can fully grasp the information, grasp listed drug variety of traditional Chinese medicines second development orientation, make clear further clinical indications, perfect the medicines, etc. This paper discusses the main steps and emphasis of the clinical literature evaluation. Emphasizing security literature evaluation should attach importance to the security of a comprehensive collection drug information. Safety assessment should notice traditional Chinese medicine validity evaluation in improving syndrome, improveing the living quality of patients with special advantage. The economics literature evaluation should pay attention to reliability, sensitivity and practicability of the conclusion.

Advantages of genome sequencing by long-read sequencer using SMRT technology in medical area.

PubMed

Nakano, Kazuma; Shiroma, Akino; Shimoji, Makiko; Tamotsu, Hinako; Ashimine, Noriko; Ohki, Shun; Shinzato, Misuzu; Minami, Maiko; Nakanishi, Tetsuhiro; Teruya, Kuniko; Satou, Kazuhito; Hirano, Takashi

2017-07-01

PacBio RS II is the first commercialized third-generation DNA sequencer able to sequence a single molecule DNA in real-time without amplification. PacBio RS II's sequencing technology is novel and unique, enabling the direct observation of DNA synthesis by DNA polymerase. PacBio RS II confers four major advantages compared to other sequencing technologies: long read lengths, high consensus accuracy, a low degree of bias, and simultaneous capability of epigenetic characterization. These advantages surmount the obstacle of sequencing genomic regions such as high/low G+C, tandem repeat, and interspersed repeat regions. Moreover, PacBio RS II is ideal for whole genome sequencing, targeted sequencing, complex population analysis, RNA sequencing, and epigenetics characterization. With PacBio RS II, we have sequenced and analyzed the genomes of many species, from viruses to humans. Herein, we summarize and review some of our key genome sequencing projects, including full-length viral sequencing, complete bacterial genome and almost-complete plant genome assemblies, and long amplicon sequencing of a disease-associated gene region. We believe that PacBio RS II is not only an effective tool for use in the basic biological sciences but also in the medical/clinical setting.

The half-truth of first-mover advantage.

PubMed

Suarez, Fernando; Lanzolla, Gianvito

2005-04-01

Many executives take for granted that the first company in a new product category gets an unbeatable head start and reaps long-lasting benefits. But that doesn't always happen. The authors of this article discovered that much depends on the pace at which the category's technology is changing and the speed at which the market is evolving. By analyzing these two factors, companies can improve their odds of succeeding as first movers with the resources they possess. Gradual evolution in both the technology and the market provides a first mover with the best conditions for creating a dominant position that is long lasting (Hoover in the vacuum cleaner industry is a good example). In such calm waters, a company can defend its advantages even without exceptional skills or extensive financial resources. When the market is changing rapidly and the product isn't, a first entrant with extensive resources can obtain a long-lasting advantage (as Sony did with its Walkman personal stereo); a company with only limited resources probably must settle for a short-term benefit. When the market is static but the product is changing constantly, first-mover advantages of either kind--durable or short-lived--are unlikely. Only companies with very deep pockets can survive (think of Sony and the digital cameras it pioneered). Rapid churn in both the technology and the market creates the worst conditions. But if companies have an acute sense of when to exit-as Netscape demonstrated when it agreed to be acquired by AOL-a worthwhile short-term gain is possible. Before venturing into a newly forming market, you need to analyze the environment, assess your resources, then determine which type offirst-mover advantage is most achievable. Once you've gone into the water, you have no choice but to swim.

Sources of Safety Data and Statistical Strategies for Design and Analysis: Clinical Trials.

PubMed

Zink, Richard C; Marchenko, Olga; Sanchez-Kam, Matilde; Ma, Haijun; Jiang, Qi

2018-03-01

There has been an increased emphasis on the proactive and comprehensive evaluation of safety endpoints to ensure patient well-being throughout the medical product life cycle. In fact, depending on the severity of the underlying disease, it is important to plan for a comprehensive safety evaluation at the start of any development program. Statisticians should be intimately involved in this process and contribute their expertise to study design, safety data collection, analysis, reporting (including data visualization), and interpretation. In this manuscript, we review the challenges associated with the analysis of safety endpoints and describe the safety data that are available to influence the design and analysis of premarket clinical trials. We share our recommendations for the statistical and graphical methodologies necessary to appropriately analyze, report, and interpret safety outcomes, and we discuss the advantages and disadvantages of safety data obtained from clinical trials compared to other sources. Clinical trials are an important source of safety data that contribute to the totality of safety information available to generate evidence for regulators, sponsors, payers, physicians, and patients. This work is a result of the efforts of the American Statistical Association Biopharmaceutical Section Safety Working Group.

Advantages and Disadvantages of Health Care Accreditation Mod­els

PubMed Central

Tabrizi, Jafar S.; Gharibi, Farid; Wilson, Andrew J.

2011-01-01

Background: This systematic review seeks to define the general advantages and disadvan­tages of accreditation programs to assist in choosing the most appropriate approach. Method: Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Results: Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve­ment, patient and staff safety, improving health services integration, public’s confi­dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Conclusion: Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can­ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita­tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec­tives and needs. PMID:24688896

Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations.

PubMed

Li, Mimi M; Hamady, Mohamad S; Bicknell, Colin D; Riga, Celia V

2018-06-01

Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures. Occupational radiation exposure is an emerging concern with the use of increasingly complex endovascular interventions. The robotic systems offer an added benefit of radiation reduction, as the operator is seated away from the radiation source during manipulation of the catheter. Pre-clinical studies have demonstrated reduction in force and frequency of vessel wall contact, resulting in reduced tissue trauma, as well as improved procedural times. Both safety and feasibility have been demonstrated in early clinical reports, with the first robot-assisted fenestrated endovascular aortic repair in 2013. Following from this, the Magellan system has been used to successfully undertake a variety of complex aortic procedures, including fenestrated/branched endovascular aortic repair, embolization, and angioplasty.

Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements.

PubMed

Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta

2016-01-01

Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

Advantages and mechanisms of polarity and cell shape determination in Caulobacter crescentus.

PubMed

Lawler, Melanie L; Brun, Yves V

2007-12-01

The tremendous diversity of bacterial cell shapes and the targeting of proteins and macromolecular complexes to specific subcellular sites strongly suggest that cellular organization provides important advantages to bacteria in their environment. Key advances have been made in the understanding of the mechanism and function of polarity and cell shape by studying the aquatic bacterium Caulobacter crescentus, whose cell cycle progression involves the ordered synthesis of different polar structures, and culminates in the biosynthesis of a thin polar cell envelope extension called the stalk. Recent results indicate that the important function of polar development is to maximize cell attachment to surfaces and to improve nutrient uptake by nonmotile and attached cells. Major progress has been made in understanding the regulatory network that coordinates polar development and morphogenesis and the role of polar localization of regulatory proteins.

Fourier Transform Infrared Spectroscopy: Part II. Advantages of FT-IR.

ERIC Educational Resources Information Center

Perkins, W. D.

1987-01-01

This is Part II in a series on Fourier transform infrared spectroscopy (FT-IR). Described are various advantages of FT-IR spectroscopy including energy advantages, wavenumber accuracy, constant resolution, polarization effects, and stepping at grating changes. (RH)

[Continuing importance of the clinical approach. Observations on a regional collaboration between general practitioners, internists and cardiologists].

PubMed

Jaussi, A

1994-11-12

The advent of high-tech diagnostic methods raises concerns nowadays about the value of the clinical approach and bedside diagnosis. This at least is the impression given by modern scientific literature, which rarely even mentions this part of examination of the patient. In order to define the actual role played by auscultation in the management of cardiological patients by the primary care physician, the records of 250 patients consecutively referred to a cardiologist are analyzed. The practitioner's initial clinical diagnosis is compared to the final cardiological diagnosis. Per referred patient, 1.76 specialized consultations were needed. In 64% of the cases only one such consultation took place. Initial diagnosis was correct in 80% of all cases, partly correct in 11% and incorrect in 9% of the cases. Out of the 64 cases of valvular diseases, 33 were initially correctly recognized by the physician. The cardiological investigation was also invasive in 6.5% of all cases, 4.5% of the patients eventually undergoing invasive or surgical treatment. Thus the great majority of the patients (93.5%) were managed by the primary physician with "first-line" cardiologist's support, which was often only occasional (only one specialized consultation in about two thirds of all cases). This highly independent and presumably cost-effective patient management by the primary care physician implies a high level of clinical skill. It stresses the outstanding importance of continuing teaching of the clinical approach and particularly of cardiac auscultation, which is still the best screening method for valvular heart disease.

Demonstration of quantum advantage in machine learning

NASA Astrophysics Data System (ADS)

Ristè, Diego; da Silva, Marcus P.; Ryan, Colm A.; Cross, Andrew W.; Córcoles, Antonio D.; Smolin, John A.; Gambetta, Jay M.; Chow, Jerry M.; Johnson, Blake R.

2017-04-01

The main promise of quantum computing is to efficiently solve certain problems that are prohibitively expensive for a classical computer. Most problems with a proven quantum advantage involve the repeated use of a black box, or oracle, whose structure encodes the solution. One measure of the algorithmic performance is the query complexity, i.e., the scaling of the number of oracle calls needed to find the solution with a given probability. Few-qubit demonstrations of quantum algorithms, such as Deutsch-Jozsa and Grover, have been implemented across diverse physical systems such as nuclear magnetic resonance, trapped ions, optical systems, and superconducting circuits. However, at the small scale, these problems can already be solved classically with a few oracle queries, limiting the obtained advantage. Here we solve an oracle-based problem, known as learning parity with noise, on a five-qubit superconducting processor. Executing classical and quantum algorithms using the same oracle, we observe a large gap in query count in favor of quantum processing. We find that this gap grows by orders of magnitude as a function of the error rates and the problem size. This result demonstrates that, while complex fault-tolerant architectures will be required for universal quantum computing, a significant quantum advantage already emerges in existing noisy systems.

Composite outcomes in randomized clinical trials: arguments for and against.

PubMed

Ross, Sue

2007-02-01

Composite outcomes that combine a number of individual outcomes (such as types of morbidity) are frequently used as primary outcomes in obstetrical trials. The main argument for their use is to ensure that trials can answer important clinical questions in a timely fashion, without needing huge sample sizes. Arguments against their use are that composite outcomes may be difficult to use and interpret, leading to errors in sample size estimation, possible contradictory trial results, and difficulty in interpreting findings. Such problems may reduce the credibility of the research, and may impact on the implementation of findings. Composite outcomes are an attractive solution to help to overcome the problem of limited available resources for clinical trials. However, future studies should carefully consider both the advantages and disadvantages before using composite outcomes. Rigorous development and reporting of composite outcomes is essential if the research is to be useful.

Traditional and innovative experimental and clinical trial designs and their advantages and pitfalls.

PubMed

Weimer, Katja; Enck, Paul

2014-01-01

Many study designs and design variants have been developed in the past to either overcome or enhance drug-placebo differences in clinical trials or to identify and characterize placebo responders in experimental studies. They share many commonalities as well as differences that are discussed here: the role of deception and ethical restrictions, habituation effects and the control of the natural course of disease, assay sensitivity testing and effective blinding, acceptability and motivation of patients and volunteers, and the development of individualized medicine. These are fostered by two opposite strategies: utilizing the beneficial aspects of the placebo response-and avoiding its negative counterpart, the nocebo effect-in medical routine for the benefit of patients, and minimizing-by controlling-the negative aspects of the placebo effect during drug development.

Clinical medical librarian: the last unicorn?

PubMed

Demas, J M; Ludwig, L T

1991-01-01

In the information age of the 1990s, the clinical medical librarian (CML) concept, like many other personalized library services, is often criticized as being too labor-intensive and expensive; others praise its advantages. To determine the attitudes of medical school library directors and clinical department heads toward implementation and feasibility of a CML program, forty randomly selected medical schools were surveyed. A double-blind procedure was used to sample department heads in internal medicine, pediatrics, and surgery, as well as health sciences library directors identified by the Association of Academic Health Sciences Library Directors (AAHSLD) annual statistics. The survey instrument was designed to measure responses to the following attitudinal variables: acceptance and nonacceptance of a CML program; importance to patient care, education, and research; influence on information-seeking patterns of health care professionals; ethical issues; CML extension services; and costs. Seventy-nine usable questionnaires out of a total of 120 (66%) were obtained from clinical medical personnel, and 30 usable questionnaires out of a total of 40 (75%) were obtained from medical school library directors. Survey results indicated significant differences between clinical medical personnel and library personnel regarding attitudes toward CML influence on information-seeking patterns, ethics, alternative CML services, and costs. Survey results also indicated a continuing strong support for CML programs in the medical school setting; however, differences of opinion existed toward defining the role of the CML and determining responsibility for funding.

Is There a Cosmetic Advantage to Single-Incision Laparoscopic Surgical Techniques Over Standard Laparoscopic Surgery? A Systematic Review and Meta-analysis.

PubMed

Evans, Luke; Manley, Kate

2016-06-01

Single-incision laparoscopic surgery represents an evolution of minimally invasive techniques, but has been a controversial development. A cosmetic advantage is stated by many authors, but has not been found to be universally present or even of considerable importance by patients. This systematic review and meta-analysis demonstrates that there is a cosmetic advantage of the technique regardless of the operation type. The treatment effect in terms of cosmetic improvement is of the order of 0.63.

Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages?

PubMed

Lee, Benjamin E; Korst, Robert J; Kletsman, Elaine; Rutledge, John R

2014-02-01

To determine if there are advantages to transitioning to robotics by a surgeon who is already proficient in performing video-assisted thoracic surgical (VATS) lobectomy. A single surgeon proficient in VATS lobectomy initiated a robotic lobectomy program, and a retrospective review was conducted of his patients undergoing minimally invasive lobectomy (robotics or VATS) for lung cancer between 2011 and 2012. Data collected included patient/tumor characteristics, morbidity, mortality, operative times, and length of hospital stay. Over a 24-month period, a total of 69 patients underwent minimally invasive lobectomy (35 robotic, 34 VATS). Patients in each group were similar in age and clinical stage. Robotic upper lobectomy operative times were longer than VATS (172 vs 134 minutes; P = .001), with no significant difference in lower lobectomies noted (140 vs 123 minutes; P = .1). Median length of stay was 3 days in both groups, and the median number of lymph nodes harvested was 18 (robotic) versus 16 (VATS; P = .42). Morbidity and mortality for robotic versus VATS were 11% versus 18% (P = .46) and 0% versus 3% (P = .49), respectively. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes. The learning curve for robotic upper lobectomies seems to be more significant than that for lower lobectomies. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Dual mobility cups provide biomechanical advantages in situations at risk for dislocation: a finite element analysis.

PubMed

Terrier, Alexandre; Latypova, Adeliya; Guillemin, Maika; Parvex, Valérie; Guyen, Olivier

2017-03-01

Constrained devices, standard implants with large heads, and dual mobility systems have become popular options to manage instability after total hip arthroplasty (THA). Clinical results with these options have shown variable success rates and significant higher rates of aseptic loosening and mechanical failures with constrained implants. Literature suggests potential advantages of dual mobility, however little is known about its biomechanics. We present a comparative biomechanical study of a standard implant, a constrained implant, and a dual mobility system. A finite element analysis was developed to assess and compare these acetabular options with regard to the range of motion (ROM) to impingement, the angle of dislocation, the resistive torque, the volume of polyethylene (PE) with a stress above 80% of the elastic limit, and the interfacial cup/bone stress. Dual mobility implants provided the greatest ROM to impingement and allowed delaying subluxation and dislocation when compared to standard and constrained implants. Dual mobility also demonstrated the lowest resistive torque at subluxation while the constrained implant provided the greatest one. The lowest critical PE volume was observed with the dual mobility implant, and the highest stress at the interfaces was observed with the constrained implant. This study highlights the biomechanical advantages of dual mobility systems over constrained and standard implants, and is supported by the clinical results reported. Therefore, the use of dual mobility systems in situations at risk for instability should be advocated and constrained implants should be restricted to salvage situations.

Using generalizability theory to develop clinical assessment protocols.

PubMed

Preuss, Richard A

2013-04-01

Clinical assessment protocols must produce data that are reliable, with a clinically attainable minimal detectable change (MDC). In a reliability study, generalizability theory has 2 advantages over classical test theory. These advantages provide information that allows assessment protocols to be adjusted to match individual patient profiles. First, generalizability theory allows the user to simultaneously consider multiple sources of measurement error variance (facets). Second, it allows the user to generalize the findings of the main study across the different study facets and to recalculate the reliability and MDC based on different combinations of facet conditions. In doing so, clinical assessment protocols can be chosen based on minimizing the number of measures that must be taken to achieve a realistic MDC, using repeated measures to minimize the MDC, or simply based on the combination that best allows the clinician to monitor an individual patient's progress over a specified period of time.

Advantages of thin silicon solar cells for use in space

NASA Technical Reports Server (NTRS)

Denman, O. S.

1978-01-01

A system definition study on the Solar Power Satellite System showed that a thin, 50 micrometers, silicon solar cell has significant advantages. The advantages include a significantly lower performance degradation in a radiation environment and high power-to-mass ratios. The advantages of such cells for an employment in space is further investigated. Basic questions concerning the operation of solar cells are considered along with aspects of radiation induced performance degradation. The question arose in this connection how thin a silicon solar cell had to be to achieve resistance to radiation degradation and still have good initial performance. It was found that single-crystal silicon solar cells could be as thin as 50 micrometers and still develop high conversion efficiencies. It is concluded that the use of 50 micrometer silicon solar cells in space-based photovoltaic power systems would be advantageous.

Myospherulosis following sinus surgery: pathological curiosity or important clinical entity?

PubMed

Sindwani, Raj; Cohen, Jacob T; Pilch, Ben Z; Metson, Ralph B

2003-07-01

Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery. Case-control study at an academic medical center. Thirty-two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period. Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P =.023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P =.009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 +/- 2.1 vs. 4.5 +/- 7.1 y, respectively [P =.086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis. Patients who develop myospherulosis from lipid-based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.

How much better are females? The occurrence of female advantage, its proximal causes and its variation within and among gynodioecious species

PubMed Central

Dufay, Mathilde; Billard, Emmanuelle

2012-01-01

Background Gynodioecy is a reproductive system of interest for evolutionary biologists, as it poses the question of how females can be maintained while competing with hermaphrodites that possess both male and female functions. One necessary condition for the maintenance of this polymorphism is the occurrence of a female advantage, i.e. a better seed production or quality by females compared with hermaphrodites. Theoretically, its magnitude can be low when sterility mutations are cytoplasmic, while a 2-fold advantage is needed in the case of nuclear sterility. Such a difference is often thought to be due to reduced inbreeding depression in obligatory outcrossed females. Finally, variation in sex ratio and female advantage occur among populations of some gynodioecious species, though the prevalence of such variation is unknown. Scope By reviewing and analysing the data published on 48 gynodioecious species, we examined three important issues about female advantage. (1) Are reduced selfing and inbreeding depression likely to be the major cause of female advantage? (2) What is the magnitude of female advantage and does it fit theoretical predictions? (3) Does the occurrence or the magnitude of female advantage vary among populations within species and why? Conclusions It was found that a female advantage occurred in 40 species, with a magnitude comprised between 1 and 2 in the majority of cases. In many species, reduced selfing may not be a necessary cause of this advantage. Finally, female advantage varied among populations in some species, but both positive and negative correlations were found with female frequency. The role of reduced selfing in females for the evolution of gynodioecy, as well as the various processes that affect sex ratios and female advantage in populations are discussed. PMID:21459860

Advantages and limitations of the Five Domains model for assessing welfare impacts associated with vertebrate pest control.

PubMed

Beausoleil, N J; Mellor, D J

2015-01-01

Many pest control activities have the potential to impact negatively on the welfare of animals, and animal welfare is an important consideration in the development, implementation and evaluation of ethically defensible vertebrate pest control. Thus, reliable and accurate methods for assessing welfare impacts are required. The Five Domains model provides a systematic method for identifying potential or actual welfare impacts associated with an event or situation in four physical or functional domains (nutrition, environment, health or functional status, behaviour) and one mental domain (overall mental or affective state). Here we evaluate the advantages and limitations of the Five Domains model for this purpose and illustrate them using specific examples from a recent assessment of the welfare impacts of poisons used to lethally control possums in New Zealand. The model has a number of advantages which include the following: the systematic identification of a wide range of impacts associated with a variety of control tools; the production of relative rankings of tools in terms of their welfare impacts; the easy incorporation of new information into assessments; and the highlighting of additional information needed. For example, a recent analysis of sodium fluoroacetate (1080) poisoning in possums revealed the need for more information on the period from the onset of clinical signs to the point at which consciousness is lost, as well as on the level of consciousness during or after the occurrence of muscle spasms and seizures. The model is also valuable because it clearly separates physical or functional and affective impacts, encourages more comprehensive consideration of negative affective experiences than has occurred in the past, and allows development and evaluation of targeted mitigation strategies. Caution must be used in interpreting and applying the outputs of the model, most importantly because relative rankings or grades are fundamentally qualitative in

Clinical validation of robot simulation of toothbrushing--comparative plaque removal efficacy.

PubMed

Lang, Tomas; Staufer, Sebastian; Jennes, Barbara; Gaengler, Peter

2014-07-04

Clinical validation of laboratory toothbrushing tests has important advantages. It was, therefore, the aim to demonstrate correlation of tooth cleaning efficiency of a new robot brushing simulation technique with clinical plaque removal. Clinical programme: 27 subjects received dental cleaning prior to 3-day-plaque-regrowth-interval. Plaque was stained, photographically documented and scored using planimetrical index. Subjects brushed teeth 33-47 with three techniques (horizontal, rotating, vertical), each for 20s buccally and for 20s orally in 3 consecutive intervals. The force was calibrated, the brushing technique was video supported. Two different brushes were randomly assigned to the subject. Robot programme: Clinical brushing programmes were transfered to a 6-axis-robot. Artificial teeth 33-47 were covered with plaque-simulating substrate. All brushing techniques were repeated 7 times, results were scored according to clinical planimetry. All data underwent statistical analysis by t-test, U-test and multivariate analysis. The individual clinical cleaning patterns are well reproduced by the robot programmes. Differences in plaque removal are statistically significant for the two brushes, reproduced in clinical and robot data. Multivariate analysis confirms the higher cleaning efficiency for anterior teeth and for the buccal sites. The robot tooth brushing simulation programme showed good correlation with clinically standardized tooth brushing.This new robot brushing simulation programme can be used for rapid, reproducible laboratory testing of tooth cleaning.

[THE CONDITION AND TENDENCIES OF DEVELOPMENT OF CLINICAL AND SANITARY MICROBIOLOGY IN THE RUSSIAN FEDERATION AND PROBLEM OF IMPORT SUBSTITUTION].

PubMed

Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A

2015-08-01

The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production

[Discussion of the Application of Micro-lecture in the Clinical Training 
of Thoracic Surgery].

PubMed

Li, Xiaofei; Lei, Jie

2018-04-20

Today, with the rapid development of network information technology, the micro-lecture plays a role in the teaching activities is becoming more and more important. The short and efficient teaching content of micro-lecture can be downloaded rapidly, expediently, and repeatedly, which improve the learning efficiency and independent learning capability. The clinical training of thoracic surgery elementarily remains at the scrabble stage. We require continuous reform and introduce new modes of teaching, which compatible with the development of society and the study habits of novice, to enhance the effectiveness of clinical training. In this paper, the concept, characteristic and advantage of micro-lecture was discussed, and the feasibility of application of micro-lecture in thoracic surgery teaching was also discussed. Our aim was to promote the application of micro-lecture in the clinical training of thoracic surgery reasonable and extensive.
.

What specifications for a centre or network of excellence in clinical research?

PubMed

Diebolt, Vincent; Lang, Marie; Thoby, Frédérique

2016-02-01

The Giens 2015 Workshop Round Table entitled "What specifications for a centre or network of excellence in clinical research?" took a viewpoint distinct from earlier work and studies on changes in clinical research activities in France. The purpose of the present work was to identify, starting from concrete examples, the main strengths and advantages of clinical research activity in France related, in part, to the background environment and also to the specific characteristics of the investigation centres considered to be among the most high-performance units in activity. The criteria retained were grouped into a set of specifications that could be used to establish a "label of excellence" upon which the different teams and clinical research centres could model themselves. It was thus considered that belonging to a centre or structured network with at least a national configuration, when this is possible for the medial topic in question, constitutes a real advantage. Four benchmarks were identified: the scientific and clinical expertise of the head investigator, as well as the qualification and operational capacity of the centre's team; definition and measurement of performance using clearly displayed indicators and evaluation procedures; the quality of the overall trial "process" and of each of its component steps; communication, because know-how and promotion go hand in hand, with the main objective of informing the professional and general public about the value of the research centre meeting the above-mentioned criteria, about its networks of competencies, and more generally, about the important assets of the background of clinical research in France. This sector of research is funded by the public authorities via calls for public grants, financial aids for structures supporting clinical research in the University Hospital Centres and other healthcare institutions allowing for a professionalization of the research occupations, and the national public health

Lineup composition, suspect position, and the sequential lineup advantage.

PubMed

Carlson, Curt A; Gronlund, Scott D; Clark, Steven E

2008-06-01

N. M. Steblay, J. Dysart, S. Fulero, and R. C. L. Lindsay (2001) argued that sequential lineups reduce the likelihood of mistaken eyewitness identification. Experiment 1 replicated the design of R. C. L. Lindsay and G. L. Wells (1985), the first study to show the sequential lineup advantage. However, the innocent suspect was chosen at a lower rate in the simultaneous lineup, and no sequential lineup advantage was found. This led the authors to hypothesize that protection from a sequential lineup might emerge only when an innocent suspect stands out from the other lineup members. In Experiment 2, participants viewed a simultaneous or sequential lineup with either the guilty suspect or 1 of 3 innocent suspects. Lineup fairness was varied to influence the degree to which a suspect stood out. A sequential lineup advantage was found only for the unfair lineups. Additional analyses of suspect position in the sequential lineups showed an increase in the diagnosticity of suspect identifications as the suspect was placed later in the sequential lineup. These results suggest that the sequential lineup advantage is dependent on lineup composition and suspect position. (c) 2008 APA, all rights reserved

Building Information Model: advantages, tools and adoption efficiency

NASA Astrophysics Data System (ADS)

Abakumov, R. G.; Naumov, A. E.

2018-03-01

The paper expands definition and essence of Building Information Modeling. It describes content and effects from application of Information Modeling at different stages of a real property item. Analysis of long-term and short-term advantages is given. The authors included an analytical review of Revit software package in comparison with Autodesk with respect to: features, advantages and disadvantages, cost and pay cutoff. A prognostic calculation is given for efficiency of adoption of the Building Information Modeling technology, with examples of its successful adoption in Russia and worldwide.

Implementing Clinical Research Using Factorial Designs: A Primer.

PubMed

Baker, Timothy B; Smith, Stevens S; Bolt, Daniel M; Loh, Wei-Yin; Mermelstein, Robin; Fiore, Michael C; Piper, Megan E; Collins, Linda M

2017-07-01

Factorial experiments have rarely been used in the development or evaluation of clinical interventions. However, factorial designs offer advantages over randomized controlled trial designs, the latter being much more frequently used in such research. Factorial designs are highly efficient (permitting evaluation of multiple intervention components with good statistical power) and present the opportunity to detect interactions amongst intervention components. Such advantages have led methodologists to advocate for the greater use of factorial designs in research on clinical interventions (Collins, Dziak, & Li, 2009). However, researchers considering the use of such designs in clinical research face a series of choices that have consequential implications for the interpretability and value of the experimental results. These choices include: whether to use a factorial design, selection of the number and type of factors to include, how to address the compatibility of the different factors included, whether and how to avoid confounds between the type and number of interventions a participant receives, and how to interpret interactions. The use of factorial designs in clinical intervention research poses choices that differ from those typically considered in randomized clinical trial designs. However, the great information yield of the former encourages clinical researchers' increased and careful execution of such designs. Copyright © 2017. Published by Elsevier Ltd.

The Advantage of Same-Sex Programs.

ERIC Educational Resources Information Center

Wollam, Jean

1990-01-01

Considered are advantages of summer science programs limited to young high school women. Same sex courses are seen to eliminate unconscious gender bias in instruction and counter tendencies for female students to be less involved in science, mathematics, and computer activities. Four specific programs are briefly described. (DB)

Minimum clinically important differences in chronic pain vary considerable by baseline pain and methodological factors: systematic review of empirical studies.

PubMed

Frahm Olsen, Mette; Bjerre, Eik; Hansen, Maria Damkjær; Tendal, Britta; Hilden, Jørgen; Hróbjartsson, Asbjørn

2018-05-21

The minimum clinically important difference (MCID) is used to interpret the relevance of treatment effects, e.g., when developing clinical guidelines, evaluating trial results or planning sample sizes. There is currently no agreement on an appropriate MCID in chronic pain and little is known about which contextual factors cause variation. This is a systematic review. We searched PubMed, EMBASE, and Cochrane Library. Eligible studies determined MCID for chronic pain based on a one-dimensional pain scale, a patient-reported transition scale of perceived improvement, and either a mean change analysis (mean difference in pain among minimally improved patients) or a threshold analysis (pain reduction associated with best sensitivity and specificity for identifying minimally improved patients). Main results were descriptively summarized due to considerable heterogeneity, which were quantified using meta-analyses and explored using subgroup analyses and metaregression. We included 66 studies (31.254 patients). Median absolute MCID was 23 mm on a 0-100 mm scale (interquartile range [IQR] 12-39) and median relative MCID was 34% (IQR 22-45) among studies using the mean change approach. In both cases, heterogeneity was very high: absolute MCID I 2  = 99% and relative MCID I 2  = 96%. High variation was also seen among studies using the threshold approach: median absolute MCID was 20 mm (IQR 15-30) and relative MCID was 32% (IQR 15-41). Absolute MCID was strongly associated with baseline pain, explaining approximately two-thirds of the variation, and to a lesser degree with the operational definition of minimum pain relief and clinical condition. A total of 15 clinical and methodological factors were assessed as possible causes for variation in MCID. MCID for chronic pain relief vary considerably. Baseline pain is strongly associated with absolute, but not relative, measures. To a much lesser degree, MCID is also influenced by the operational definition of relevant pain

Customerizing the clinical laboratory. Repositioning for enhanced service and a competitive advantage.

PubMed

Schuler, R S

1989-01-01

The call for excellence has never been louder, especially in the health-care industry. This call typically means increased service, i.e., faster, more accurate and, of course, friendlier service--all easier said than done, but qualities that make enhanced customer service so powerful. The excellent companies are learning that because it is so difficult to customerize, few competitors do so. Therefore, by devoting the time and effort necessary for customerization, they can move ahead of their competitors. But surpassing competitors by excellent service can be done inside of companies as well as outside. All units and departments have customers. The key to customerization inside is finding out what your customers want and behaving accordingly. The results go beyond enhanced customer satisfaction. They also include enhanced energy levels, reduced turnover, increased pride, and greater creativity for the newly customerized department. All it takes is an understanding of and dedication to customerization. Repositioning the existing department is critical to the success of any attempt to customerize. This article thoroughly describes customerization and the entire process of repositioning the clinical laboratory. One will not occur without the other.

77 FR 24984 - Importer of Controlled Substances; Notice of Application; Clinical Supplies Management, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-26

... Application; Clinical Supplies Management, Inc. Pursuant to 21 U.S.C. 958(i), the Attorney General shall... on November 13, 2011, Clinical Supplies Management, Inc., 342 42nd Street South, Fargo, North Dakota... distributing to customers which are qualified clinical sites conducting clinical trials under the auspices of...

77 FR 38084 - Importer of Controlled Substances; Notice of Registration; Clinical Supplies Management, Inc.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... Registration; Clinical Supplies Management, Inc. By Notice dated April 17, 2012, and published in the Federal Register on April 26, 2012, 77 FR 24984, Clinical Supplies Management, Inc., 342 42nd Street South, Fargo..., labeling, and distributing to customers which are qualified clinical sites conducting clinical trials under...

ABC gene expression profiles have clinical importance and possibly form a new hallmark of cancer.

PubMed

Dvorak, Pavel; Pesta, Martin; Soucek, Pavel

2017-05-01

Adenosine triphosphate-binding cassette proteins constitute a large family of active transporters through extracellular and intracellular membranes. Increased drug efflux based on adenosine triphosphate-binding cassette protein activity is related to the development of cancer cell chemoresistance. Several articles have focused on adenosine triphosphate-binding cassette gene expression profiles (signatures), based on the expression of all 49 human adenosine triphosphate-binding cassette genes, in individual tumor types and reported connections to established clinicopathological features. The aim of this study was to test our theory about the existence of adenosine triphosphate-binding cassette gene expression profiles common to multiple types of tumors, which may modify tumor progression and provide clinically relevant information. Such general adenosine triphosphate-binding cassette profiles could constitute a new attribute of carcinogenesis. Our combined cohort consisted of tissues from 151 cancer patients-breast, colorectal, and pancreatic carcinomas. Standard protocols for RNA isolation and quantitative real-time polymerase chain reaction were followed. Gene expression data from individual tumor types as well as a merged tumor dataset were analyzed by bioinformatics tools. Several general adenosine triphosphate-binding cassette profiles, with differences in gene functions, were established and shown to have significant relations to clinicopathological features such as tumor size, histological grade, or clinical stage. Genes ABCC7, A3, A8, A12, and C8 prevailed among the most upregulated or downregulated ones. In conclusion, the results supported our theory about general adenosine triphosphate-binding cassette gene expression profiles and their importance for cancer on clinical as well as research levels. The presence of ABCC7 (official symbol CFTR) among the genes with key roles in the profiles supports the emerging evidence about its crucial role in various

Principles and advantages of robotics in urologic surgery.

PubMed

Renda, Antonio; Vallancien, Guy

2003-04-01

Although the available minimally invasive surgical techniques (ie, laparoscopy) have clear advantages, these procedures continue to cause problems for patients. Surgical tools are limited by set axes of movement, restricting the degree of freedom available to the surgeon. In addition, depth perception is lost with the use of two-dimensional viewing systems. As surgeons view a "virtual" target on a television screen, they are hampered by decreased sensory input and a concurrent loss of dexterity. The development of robotic assistance systems in recent years could be the key to overcoming these difficulties. Using robotic systems, surgeons can experience a more natural and ergonomic surgical "feel." Surgical assistance, dexterity and precision enhancement, systems networking, and image-guided therapy are among the benefits offered by surgical robots. In return, the surgeon gains a shorter learning curve, reduced fatigue, and the opportunity to perform complex procedures that would be difficult using conventional laparoscopy. With the development of image-guided technology, robotic systems will become useful tools for surgical training and simulation. Remote surgery is not a routine procedure, but several teams are working on this and experiencing good results. However, economic concerns are the major drawbacks of these systems; before remote surgery becomes routinely feasible, the clinical benefits must be balanced with high investment and running costs.

Know the risk, take the win: how executive functions and probability processing influence advantageous decision making under risk conditions.

PubMed

Brand, Matthias; Schiebener, Johannes; Pertl, Marie-Theres; Delazer, Margarete

2014-01-01

Recent models on decision making under risk conditions have suggested that numerical abilities are important ingredients of advantageous decision-making performance, but empirical evidence is still limited. The results of our first study show that logical reasoning and basic mental calculation capacities predict ratio processing and that ratio processing predicts decision making under risk. In the second study, logical reasoning together with executive functions predicted probability processing (numeracy and probability knowledge), and probability processing predicted decision making under risk. These findings suggest that increasing an individual's understanding of ratios and probabilities should lead to more advantageous decisions under risk conditions.

Multiplex sequence analysis demonstrates the competitive growth advantage of the A-to-G mutants of clarithromycin-resistant Helicobacter pylori.

PubMed

Wang, G; Rahman, M S; Humayun, M Z; Taylor, D E

1999-03-01

Clarithromycin resistance in Helicobacter pylori is due to point mutation within the 23S rRNA. We examined the growth rates of different types of site-directed mutants and demonstrated quantitatively the competitive growth advantage of A-to-G mutants over other types of mutants by a multiplex sequencing assay. The results provide a rational explanation of why A-to-G mutants are predominantly observed among clarithromycin-resistant clinical isolates.

Childhood eczema: disease of the advantaged?

PubMed Central

Williams, H. C.; Strachan, D. P.; Hay, R. J.

1994-01-01

OBJECTIVE--To determine whether the increased prevalence of childhood eczema in advantaged socioeconomic groups is due to increased parental reporting. DESIGN--Comparison of parental reports of eczema with visible eczema recorded by medical officers during a detailed physical examination. SETTING--National birth cohort study. SUBJECTS--8279 children from England, Wales, and Scotland born during 3-9 March 1958 and followed up at the ages of 7, 11, and 16. MAIN OUTCOME MEASURES--Prevalence of eczema according to parental report compared with medical officer's examination at the ages of 7, 11, and 16. RESULTS--Prevalence of both reported and examined eczema increased with rising social class at the ages of 7, 11, and 16 years. The point prevalence of examined eczema at age 7 was 4.8%, 3.6%, 3.6%, 2.4%, 2.2%, and 2.4% in social classes I, II, III non-manual, III manual, IV, and V respectively (chi 2 value for linear trend 12.6, P < 0.001). This trend persisted after adjustment for potential confounders such as region and family size and was not present for examined psoriasis or acne. CONCLUSIONS--Eczema is more prevalent among British schoolchildren in social classes I and II than those in lower classes. Exposures associated with social class are probably at least as important as genetic factors in the expression of childhood eczema. PMID:8173454

Robustness of the Sequential Lineup Advantage

ERIC Educational Resources Information Center

Gronlund, Scott D.; Carlson, Curt A.; Dailey, Sarah B.; Goodsell, Charles A.

2009-01-01

A growing movement in the United States and around the world involves promoting the advantages of conducting an eyewitness lineup in a sequential manner. We conducted a large study (N = 2,529) that included 24 comparisons of sequential versus simultaneous lineups. A liberal statistical criterion revealed only 2 significant sequential lineup…

A new cognitive evaluation battery for Down syndrome and its relevance for clinical trials

PubMed Central

de Sola, Susana; de la Torre, Rafael; Sánchez-Benavides, Gonzalo; Benejam, Bessy; Cuenca-Royo, Aida; del Hoyo, Laura; Rodríguez, Joan; Catuara-Solarz, Silvina; Sanchez-Gutierrez, Judit; Dueñas-Espin, Ivan; Hernandez, Gimena; Peña-Casanova, Jordi; Langohr, Klaus; Videla, Sebastia; Blehaut, Henry; Farre, Magi; Dierssen, Mara; Cuenca-Royo, Aida

2015-01-01

The recent prospect of pharmaceutical interventions for cognitive impairment of Down syndrome (DS) has boosted a number of clinical trials in this population. However, running the trials has raised some methodological challenges and questioned the prevailing methodology used to evaluate cognitive functioning of DS individuals. This is usually achieved by comparing DS individuals to matched healthy controls of the same mental age. We propose a new tool, the TESDAD Battery that uses comparison with age-matched typically developed adults. This is an advantageous method for probing the clinical efficacy of DS therapies, allowing the interpretation and prediction of functional outcomes in clinical trials. In our DS population the TESDAD battery permitted a quantitative assessment of cognitive defects, which indicated language dysfunction and deficits in executive function, as the most important contributors to other cognitive and adaptive behavior outcomes as predictors of functional change in DS. Concretely, auditory comprehension and functional academics showed the highest potential as end-point measures of therapeutic intervention for clinical trials: the former as a cognitive key target for therapeutic intervention, and the latter as a primary functional outcome measure of clinical efficacy. Our results also emphasize the need to explore the modulating effects of IQ, gender and age on cognitive enhancing treatments. Noticeably, women performed significantly better than men of the same age and IQ in most cognitive tests, with the most consistent differences occurring in memory and executive functioning and negative trends rarely emerged on quality of life linked to the effect of age after adjusting for IQ and gender. In sum, the TESDAD battery is a useful neurocognitive tool for probing the clinical efficacy of experimental therapies in interventional studies in the DS population suggesting that age-matched controls are advantageous for determining normalization of

Competitive Advantage, Uncertainty, and Weapons Procurement: Striking Balance for the Future

DTIC Science & Technology

2009-05-02

position of the Department of the Army, Department of Defense, or the U.S. Government. COMPETITIVE ADVANTAGE , UNCERTAINTY, AND WEAPONS PROCUREMENT: STRIKING...Competitive Advantage , Uncertainty, and Weapons Procurement: Striking Balance for the Future 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...the right balance of investments all leading to a sustained competitive advantage . This paper presents an analysis of how effective this overhaul has

Transnasal endoscopy: Technical considerations, advantages and limitations.

PubMed

Atar, Mustafa; Kadayifci, Abdurrahman

2014-02-16

Transnasal endoscopy (TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way, TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope. Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.

Transnasal endoscopy: Technical considerations, advantages and limitations

PubMed Central

Atar, Mustafa; Kadayifci, Abdurrahman

2014-01-01

Transnasal endoscopy (TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way, TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope. Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes. PMID:24567791

The clinical importance of the metabolite equol-a clue to the effectiveness of soy and its isoflavones.

PubMed

Setchell, Kenneth D R; Brown, Nadine M; Lydeking-Olsen, Eva

2002-12-01

Equol [7-hydroxy-3-(4'-hydroxyphenyl)-chroman] is a nonsteroidal estrogen of the isoflavone class. It is exclusively a product of intestinal bacterial metabolism of dietary isoflavones and it possesses estrogenic activity, having affinity for both estrogen receptors, ERalpha and ERbeta. Equol is superior to all other isoflavones in its antioxidant activity. It is the end product of the biotransformation of the phytoestrogen daidzein, one of the two main isoflavones found in abundance in soybeans and most soy foods. Once formed, it is relatively stable; however, equol is not produced in all healthy adults in response to dietary challenge with soy or daidzein. Several recent dietary intervention studies examining the health effects of soy isoflavones allude to the potential importance of equol by establishing that maximal clinical responses to soy protein diets are observed in people who are good "equol-producers." It is now apparent that there are two distinct subpopulations of people and that "bacterio-typing" individuals for their ability to make equol may hold the clue to the effectiveness of soy protein diets in the treatment or prevention of hormone-dependent conditions. In reviewing the history of equol, its biological properties, factors influencing its formation and clinical data, we propose a new paradigm. The clinical effectiveness of soy protein in cardiovascular, bone and menopausal health may be a function of the ability to biotransform soy isoflavones to the more potent estrogenic isoflavone, equol. The failure to distinguish those subjects who are "equol-producers" from "nonequol producers" in previous clinical studies could plausibly explain the variance in reported data on the health benefits of soy.

Fix my child: The importance of including siblings in clinical assessments.

PubMed

Farnfield, Steve

2017-07-01

This study examined concordance in the attachment strategies of school-aged siblings with reference to environmental risk in terms of poverty and maltreatment. It also investigated the effect of child maltreatment and maternal mental illness on children's psychosocial functioning in terms of the Dynamic-Maturational Model of Attachment and Adaptation (DMM) including unresolved trauma and the DMM Depressed modifier. The attachment strategies of 30 sibling pairs, aged 5-14 years, were assessed using the School-age Assessment of Attachment (SAA). Unlike most previous studies, this study included siblings from large families of two to six children. The main finding was that as environmental risk increases, the diversity of sibling attachment strategies decreases with greater recourse to the DMM Type A3-6 and A/C strategies. Unlike previous studies, the highest level of concordance was found in sibling pairs with the opposite gender. Boys whose mothers had a history of mental illness were significantly more likely than girls to be assessed with the DMM-depression modifier. As danger increases, children in the same family experience more of the same childhood. Further research should focus on single case, intra-familial studies to build a systemic model of the shared environment. Research should also evaluate the effects of environmental risk compared with size of the sibling group on children's attachment strategies. The clinical implications point to the importance of assessing all children in the family using a model built around functional formulation rather than diagnosing the symptoms of a particular child.

Comparison of Clinical Advantage between Topiroxostat and Febuxostat in Hemodialysis Patients.

PubMed

Mitsuboshi, Satoru; Yamada, Hitoshi; Nagai, Kazuhiko; Okajima, Hideo

2017-01-01

To determine the response of hemodialysis (HD) patients to topiroxostat after a switch from febuxostat, we evaluated the efficacy, tolerability, and serum concentration of topiroxostat in HD patients after the switch. In this 16-month prospective observational study, we assessed the serum uric acid (UA) levels, other laboratory data, and serum topiroxostat concentrations of 10 HD patients who had been receiving febuxostat at a dose of 10 mg/d for over 1 year. No statistical difference was observed between the tolerability index at baseline and 16 months after the switch to topiroxostat. Serum UA after the switch in all patients (attained serum UA levels of ≤6 mg/dL) was 5.6±1.7 mg/dL (60%) at baseline, 4.9±0.5 mg/dL (100%) at 6 months and 5.7±0.4 mg/dL (50%) at 16 months (p=0.25), respectively. In patients with baseline serum UA levels >6 mg/dL, serum UA was significantly reduced at 6 and 16 months compared with baseline. Minimum serum concentrations of serum topiroxostat were lower than the limit of quantification (<25 ng/mL). Our results indicate that a switch from febuxostat 10 mg/d to topiroxostat 40 mg/d might reduce serum UA levels, with no change in other clinical laboratory data over the long term. These effects were more frequent in patients with high serum UA levels. Furthermore, topiroxostat therapy was more cost effective than febuxostat therapy. Thus, topiroxostat therapy could be a better treatment option for HD patients who develop high serum UA levels after febuxostat 10 mg/d administration.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2018-01-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2017-05-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2016 Elsevier Inc. All rights reserved.

The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization.

PubMed

Baicker, Katherine; Chernew, Michael E; Robbins, Jacob A

2013-12-01

More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial - offsetting more than 10% of increased payments to Medicare Advantage plans. Copyright © 2013 Elsevier B.V. All rights reserved.

The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

PubMed Central

Baicker, Katherine; Chernew, Michael; Robbins, Jacob

2013-01-01

More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans. PMID:24308880

Practices of Weight Regulation Among Elite Athletes in Combat Sports: A Matter of Mental Advantage?