Business School Accreditation in the Changing Global Marketplace: A Comparative Study of the Agencies and Their Competitive Strategies

ERIC Educational Resources Information Center

Zhao, Jun; Ferran, Carlos

2016-01-01

Purpose: This paper aims to examine current trends in business accreditation by describing and comparing the major international business accreditation agencies (Association to Advance Collegiate Schools of Business, European Quality Improvement System, Association of MBAs, Association of Collegiate Business Schools and Programs and International…

Identifying major hemorrhage with automated data: results of the Veterans Affairs study to improve anticoagulation (VARIA).

PubMed

Jasuja, Guneet K; Reisman, Joel I; Miller, Donald R; Berlowitz, Dan R; Hylek, Elaine M; Ash, Arlene S; Ozonoff, Al; Zhao, Shibei; Rose, Adam J

2013-01-01

Identifying major bleeding is fundamental to assessing the outcomes of anticoagulation therapy. This drives the need for a credible implementation in automated data for the International Society of Thrombosis and Haemostasis (ISTH) definition of major bleeding. We studied 102,395 patients who received 158,511 person-years of warfarin treatment from the Veterans Health Administration (VA) between 10/1/06-9/30/08. We constructed a list of ICD-9-CM codes of "candidate" bleeding events. Each candidate event was identified as a major hemorrhage if it fulfilled one of four criteria: 1) associated with death within 30days; 2) bleeding in a critical anatomic site; 3) associated with a transfusion; or 4) was coded as the event that precipitated or was responsible for the majority of an inpatient hospitalization. This definition classified 11,240 (15.8%) of 71, 338 candidate events as major hemorrhage. Typically, events more likely to be severe were retained at higher rates than those less likely to be severe. For example, Diverticula of Colon with Hemorrhage (562.12) and Hematuria (599.7) were retained 46% and 4% of the time, respectively. Major, intracranial, and fatal hemorrhage were identified at rates comparable to those found in randomized clinical trials however, higher than those reported in observational studies: 4.73, 1.29, and 0.41 per 100 patient years, respectively. We describe here a workable definition for identifying major hemorrhagic events from large automated datasets. This method of identifying major bleeding may have applications for quality measurement, quality improvement, and comparative effectiveness research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Trends in software reliability for digital flight control

NASA Technical Reports Server (NTRS)

Hecht, H.; Hecht, M.

1983-01-01

Software error data of major recent Digital Flight Control Systems Development Programs. The report summarizes the data, compare these data with similar data from previous surveys and identifies trends and disciplines to improve software reliability.

A Comparison of Case Study and Traditional Teaching Methods for Improvement of Oral Communication and Critical-Thinking Skills

ERIC Educational Resources Information Center

Noblitt, Lynnette; Vance, Diane E.; Smith, Michelle L. DePoy

2010-01-01

This study compares a traditional paper presentation approach and a case study method for the development and improvement of oral communication skills and critical-thinking skills in a class of junior forensic science majors. A rubric for rating performance in these skills was designed on the basis of the oral communication competencies developed…

Education in Rural Areas of China and South Africa: Comparative Perspectives on Policy and Educational Management. Comparative Perspectives: Education in China & South Africa.

ERIC Educational Resources Information Center

Gordon, Adele; Wang, Qiang

This report on the educational systems in China and South Africa compares the policies and processes of the two countries as they attempt to expand and improve rural education. Both countries experienced a major political upheaval, and even though there is a 50-year time lag between these events, political changes ushered in radical educational…

Quality Measures in Stroke

PubMed Central

Poisson, Sharon N.; Josephson, S. Andrew

2011-01-01

Stroke is a major public health burden, and accounts for many hospitalizations each year. Due to gaps in practice and recommended guidelines, there has been a recent push toward implementing quality measures to be used for improving patient care, comparing institutions, as well as for rewarding or penalizing physicians through pay-for-performance. This article reviews the major organizations involved in implementing quality metrics for stroke, and the 10 major metrics currently being tracked. We also discuss possible future metrics and the implications of public reporting and using metrics for pay-for-performance. PMID:23983840

2016 American College of Rheumatology (ACR) - European League Against Rheumatism (EULAR) Criteria for Minimal, Moderate and Major Clinical Response for Juvenile Dermatomyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative

PubMed Central

Rider, Lisa G.; Aggarwal, Rohit; Pistorio, Angela; Bayat, Nastaran; Erman, Brian; Feldman, Brian M.; Huber, Adam M.; Cimaz, Rolando; Cuttica, Rubén J.; de Oliveira, Sheila Knupp; Lindsley, Carol B.; Pilkington, Clarissa A.; Punaro, Marilyn; Ravelli, Angelo; Reed, Ann M.; Rouster-Stevens, Kelly; van Royen, Annet; Dressler, Frank; Magalhaes, Claudia Saad; Constantin, Tamás; Davidson, Joyce E.; Magnusson, Bo; Russo, Ricardo; Villa, Luca; Rinaldi, Mariangela; Rockette, Howard; Lachenbruch, Peter A.; Miller, Frederick W.; Vencovsky, Jiri; Ruperto, Nicolino

2017-01-01

Objective Develop response criteria for juvenile dermatomyositis (JDM). Methods We analyzed the performance of 312 definitions that used core set measures (CSM) from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Pediatric Rheumatology International Trials Organization (PRINTO) and were derived from natural history data and a conjoint-analysis survey. They were further validated in the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis trial. Experts considered 14 top-performing candidate criteria based on their performance characteristics and clinical face validity using nominal group technique at a consensus conference. Results Consensus was reached for a conjoint analysis–based continuous model with a Total Improvement Score of 0-100, using absolute percent change in CSM with thresholds for minimal (≥30 points), moderate (≥45), and major improvement (≥70). The same criteria were chosen for adult dermatomyositis/polymyositis with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal, 92-94% and 94-99% for moderate, and 91-98% and 85-85% for major improvement, respectively, in JDM patient cohorts using the IMACS and PRINTO CSM. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement (P=0.009–0.057) and in the Rituximab trial for significantly differentiating the physician rating of improvement (P<0.006). Conclusion The response criteria for JDM was a conjoint analysis–based model using a continuous improvement score based on absolute percent change in CSM, with thresholds for minimal, moderate, and major improvement. PMID:28382787

2016 American College of Rheumatology (ACR) - European League Against Rheumatism (EULAR) Criteria for Minimal, Moderate and Major Clinical Response for Juvenile Dermatomyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative

PubMed Central

Rider, Lisa G.; Aggarwal, Rohit; Pistorio, Angela; Bayat, Nastaran; Erman, Brian; Feldman, Brian M.; Huber, Adam M.; Cimaz, Rolando; Cuttica, Rubén J.; de Oliveira, Sheila Knupp; Lindsley, Carol B.; Pilkington, Clarissa A.; Punaro, Marilyn; Ravelli, Angelo; Reed, Ann M.; Rouster-Stevens, Kelly; van Royen, Annet; Dressler, Frank; Magalhaes, Claudia Saad; Constantin, Tamás; Davidson, Joyce E.; Magnusson, Bo; Russo, Ricardo; Villa, Luca; Rinaldi, Mariangela; Rockette, Howard; Lachenbruch, Peter A.; Miller, Frederick W.; Vencovsky, Jiri; Ruperto, Nicolino

2017-01-01

Objective Develop response criteria for juvenile dermatomyositis (JDM). Methods We analyzed the performance of 312 definitions that used core set measures (CSM) from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Pediatric Rheumatology International Trials Organization (PRINTO) and were derived from natural history data and a conjoint-analysis survey. They were further validated in the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis trial. Experts considered 14 top-performing candidate criteria based on their performance characteristics and clinical face validity using nominal group technique at a consensus conference. Results Consensus was reached for a conjoint analysis–based continuous model with a Total Improvement Score of 0-100, using absolute percent change in CSM with thresholds for minimal (≥30 points), moderate (≥45), and major improvement (≥70). The same criteria were chosen for adult dermatomyositis/polymyositis with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal, 92-94% and 94-99% for moderate, and 91-98% and 85-85% for major improvement, respectively, in JDM patient cohorts using the IMACS and PRINTO CSM. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement (P=0.009–0.057) and in the Rituximab trial for significantly differentiating the physician rating of improvement (P<0.006). Conclusion The response criteria for JDM was a conjoint analysis–based model using a continuous improvement score based on absolute percent change in CSM, with thresholds for minimal, moderate, and major improvement. PMID:28382778

Integrated pest management of "Golden Delicious" apples.

PubMed

Simončič, A; Stopar, M; Velikonja Bolta, Š; Bavčar, D; Leskovšek, R; Baša Česnik, H

2015-01-01

Monitoring of plant protection product (PPP) residues in "Golden Delicious" apples was performed in 2011-2013, where 216 active substances were analysed with three analytical methods. Integrated pest management (IPM) production and improved IPM production were compared. Results were in favour of improved IPM production. Some active compounds determined in IPM production (boscalid, pyraclostrobin, thiacloprid and thiametoxam) were not found in improved IPM production. Besides that, in 2011 and 2012, captan residues were lower in improved IPM production. Risk assessment was also performed. Chronic exposure of consumers was low in general, but showed no major differences for IPM and improved IPM production for active substances determined in both types of production. Analytical results were compared with the European Union report of 2010 where 1.3% of apple samples exceeded maximum residue levels (MRLs), while MRL exceedances were not observed in this survey.

Using Technology to Enhance the Effectiveness of General Chemistry Laboratory Courses

ERIC Educational Resources Information Center

Carvalho-Knighton, Kathleen M.; Keen-Rocha, Linda

2007-01-01

The effectiveness of two different laboratory techniques is compared to teach students majoring in science in a general chemistry laboratory. The results demonstrated that student laboratory activities with computer-interface systems could improve student understanding.

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

Nugraha, Andri Dian, E-mail: andridn104@gmail.com; Widiyantoro, Sri; Shiddiqi, Hasbi Ash

Indonesian archipelago region is located in active tectonic setting and high seismicity zone. During the last decade, Indonesian was experienced with destructive major earthquakes causing damage and victims. The information of precise earthquake location parameters are very important in partular for earthquake early warning to the society and for advance seismic studies. In this study, we attempted to improve hypocenter location compiled by BMKG for time periods of April, 2009 up to June, 2014 for about 22,000 earthquake events around Indonesian region. For the firts time, we applied teleseismic double-difference relocation algorithm (teletomoDD) to improve hypocenter region in Indonesia regionmore » combining regional and teleseismic stations. Hypocenter relocation was performed utilizing local, regional, and teleseismic P-wave arrival time data. Our relocation result show that travel-time RMS errors were greatly reduced compared to the BMKG catalog. Seismicity at shallower depth (less than 50 km) shows significantly improvement especially in depth, and refined shallow geological structures, e.g. trench and major strike slip faults. Clustered seismicity is also detected beneath volcanic region, and probably related volcano activities and also major faults nearby. In the Sunda arc region, seismicity at shallower depth centered at two major distributions parallel to the trench strike direction, i.e. around fore-arc and in mainland that related to major fault, e.g. the Sumatran fault, and volcanic fronts. Below Central Java region, relocated hypocenter result showed double seismic zone pattern. A seismic gap is detected around the Sunda-Banda transition zone where transition between oceanic subduction to continental crust collision of Australian plate occurs. In Eastern Indonesia region, shallow earthquakes are observed related to major strike slip faults, e.g. Sorong and Palu-Koro fault, volcanism, and shallow part of subduction and collision zones. We also compare our result in the Sunda Arc region with slab1.0 model and our relocated seismicity shows good agreement with the previous slab geometry. Horizontal position shift of relocated events are mostly perpendicular to the trench directions.« less

Effects of intensive short-term dynamic psychotherapy on social cognition in major depression.

PubMed

Ajilchi, Bita; Kisely, Steve; Nejati, Vahid; Frederickson, Jon

2018-05-23

Social cognition is commonly affected in psychiatric disorders and is a determinant of quality of life. However, there are few studies of treatment. To investigate the efficacy of intensive short-term dynamic psychotherapy on social cognition in major depression. This study used a parallel group randomized control design to compare pre-test and post-test social cognition scores between depressed participants receiving ISTDP and those allocated to a wait-list control group. Participants were adults (19-40 years of age) who were diagnosed with depression. We recruited 32 individuals, with 16 participants allocated to the ISTDP and control groups, respectively. Both groups were similar in terms of age, sex and educational level. Multivariate analysis of variance (MANOVA) demonstrated that the intervention was effective in terms of the total score of social cognition: the experimental group had a significant increase in the post-test compared to the control group. In addition, the experimental group showed a significant reduction in the negative subjective score compared to the control group as well as an improvement in response to positive neutral and negative states. Depressed patients receiving ISTDP show a significant improvement in social cognition post treatment compared to a wait-list control group.

Improving coeliac disease risk prediction by testing non-HLA variants additional to HLA variants.

PubMed

Romanos, Jihane; Rosén, Anna; Kumar, Vinod; Trynka, Gosia; Franke, Lude; Szperl, Agata; Gutierrez-Achury, Javier; van Diemen, Cleo C; Kanninga, Roan; Jankipersadsing, Soesma A; Steck, Andrea; Eisenbarth, Georges; van Heel, David A; Cukrowska, Bozena; Bruno, Valentina; Mazzilli, Maria Cristina; Núñez, Concepcion; Bilbao, Jose Ramon; Mearin, M Luisa; Barisani, Donatella; Rewers, Marian; Norris, Jill M; Ivarsson, Anneli; Boezen, H Marieke; Liu, Edwin; Wijmenga, Cisca

2014-03-01

The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case-control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD.

Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

PubMed

Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

Major Upgrades to the AIRS Version-6 Water Vapor Profile Methodology

NASA Technical Reports Server (NTRS)

Susskind, Joel; Blaisdell, John; Iredell, Lena

2015-01-01

This research is a continuation of part of what was shown at the last AIRS Science Team Meeting and the AIRS 2015 NetMeeting. AIRS Version 6 was finalized in late 2012 and is now operational. Version 6 contained many significant improvements in retrieval methodology compared to Version 5. Version 6 retrieval methodology used for the water vapor profile q(p) and ozone profile O3(p) retrievals is basically unchanged from Version 5, or even from Version 4. Subsequent research has made significant improvements in both water vapor and O3 profiles compared to Version 6.

Pharmacokinetics of Curcumin Diethyl Disuccinate, a Prodrug of Curcumin, in Wistar Rats.

PubMed

Bangphumi, Kunan; Kittiviriyakul, Chuleeporn; Towiwat, Pasarapa; Rojsitthisak, Pornchai; Khemawoot, Phisit

2016-12-01

Curcumin is the major bioactive component of turmeric, but has poor oral bioavailability that limits its clinical applications. To improve the in vitro solubility and alkaline stability, we developed a prodrug of curcumin by succinylation to obtain curcumin diethyl disuccinate, with the goal of improving the oral bioavailability of curcumin. The in vivo pharmacokinetic profile of curcumin diethyl disuccinate was compared with that of curcumin in male Wistar rats. Doses of curcumin 20 mg/kg intravenous or 40 mg/kg oral were used as standard regimens for comparison with the prodrug at equivalent doses in healthy adult rats. Blood, tissues, urine, and faeces were collected from time zero to 48 h after dosing to determine the prodrug level, curcumin level and a major metabolite by liquid chromatography-tandem spectrometry. The absolute oral bioavailability of curcumin diethyl disuccinate was not significantly improved compared with curcumin, with both compounds having oral bioavailability of curcumin less than 1 %. The major metabolic pathway of the prodrug was rapid hydrolysis to obtain curcumin, followed by glucuronidation. Interestingly, curcumin diethyl disuccinate gave superior tissue distribution with higher tissue to plasma ratio of curcumin and curcumin glucuronide in several organs after intravenous dosing at 1 and 4 h. The primary elimination route of curcumin glucuronide occurred via biliary and faecal excretion, with evidence of an entry into the enterohepatic circulation. Curcumin diethyl disuccinate did not significantly improve the oral bioavailability of curcumin due to first pass metabolism in the gastrointestinal tract. Further studies on reduction of first pass metabolism are required to optimise delivery of curcumin using a prodrug approach.

Comparison of univariate and multivariate models for prediction of major and minor elements from laser-induced breakdown spectra with and without masking

NASA Astrophysics Data System (ADS)

Dyar, M. Darby; Fassett, Caleb I.; Giguere, Stephen; Lepore, Kate; Byrne, Sarah; Boucher, Thomas; Carey, CJ; Mahadevan, Sridhar

2016-09-01

This study uses 1356 spectra from 452 geologically-diverse samples, the largest suite of LIBS rock spectra ever assembled, to compare the accuracy of elemental predictions in models that use only spectral regions thought to contain peaks arising from the element of interest versus those that use information in the entire spectrum. Results show that for the elements Si, Al, Ti, Fe, Mg, Ca, Na, K, Ni, Mn, Cr, Co, and Zn, univariate predictions based on single emission lines are by far the least accurate, no matter how carefully the region of channels/wavelengths is chosen and despite the prominence of the selected emission lines. An automated iterative algorithm was developed to sweep through all 5485 channels of data and select the single region that produces the optimal prediction accuracy for each element using univariate analysis. For the eight major elements, use of this technique results in a 35% improvement in prediction accuracy; for minors, the improvement is 13%. The best wavelength region choice for any given univariate analysis is likely to be an inherent property of the specific training set that cannot be generalized. In comparison, multivariate analysis using partial least-squares (PLS) almost universally outperforms univariate analysis. PLS using all the same wavelength regions from the univariate analysis produces results that improve in accuracy by 63% for major elements and 3% for minor element. This difference is likely a reflection of signal to noise ratios, which are far better for major elements than for minor elements, and likely limit their prediction accuracy by any technique. We also compare predictions using specific wavelength ranges for each element against those employing all channels. Masking out channels to focus on emission lines from a specific element that occurs decreases prediction accuracy for major elements but is useful for minor elements with low signals and proportionally much higher noise; use of PLS rather than univariate analysis is still recommended. Finally, we tested the generalizability of our results by analyzing a second data set from a different instrument. Overall prediction accuracies for the mixed data sets are higher than for either set alone for all major and minor elements except Ni, Cr, and Co, where results are roughly comparable.

SU-E-J-110: A Novel Level Set Active Contour Algorithm for Multimodality Joint Segmentation/Registration Using the Jensen-Rényi Divergence.

PubMed

Markel, D; Naqa, I El; Freeman, C; Vallières, M

2012-06-01

To present a novel joint segmentation/registration for multimodality image-guided and adaptive radiotherapy. A major challenge to this framework is the sensitivity of many segmentation or registration algorithms to noise. Presented is a level set active contour based on the Jensen-Renyi (JR) divergence to achieve improved noise robustness in a multi-modality imaging space. To present a novel joint segmentation/registration for multimodality image-guided and adaptive radiotherapy. A major challenge to this framework is the sensitivity of many segmentation or registration algorithms to noise. Presented is a level set active contour based on the Jensen-Renyi (JR) divergence to achieve improved noise robustness in a multi-modality imaging space. It was found that JR divergence when used for segmentation has an improved robustness to noise compared to using mutual information, or other entropy-based metrics. The MI metric failed at around 2/3 the noise power than the JR divergence. The JR divergence metric is useful for the task of joint segmentation/registration of multimodality images and shows improved results compared entropy based metric. The algorithm can be easily modified to incorporate non-intensity based images, which would allow applications into multi-modality and texture analysis. © 2012 American Association of Physicists in Medicine.

Linking Electricity for Peace: A Compelling Global Strategy.

ERIC Educational Resources Information Center

Meisen, Peter

1997-01-01

Comparative trend analysis shows striking improvements in all major societal indicators as electricity becomes available to developing nations. Discusses the linking of electrical grids between countries and across continents and the ramifications for standards of living, sustainable development, and world peace. (PVD)

Privileged Communication Embryonic Development Following Somatic Cell Nuclear Transfer Impeded by Persisting Histone Methylation

PubMed Central

Matoba, Shogo; Liu, Yuting; Lu, Falong; Iwabuchi, Kumiko A.; Shen, Li; Inoue, Azusa; Zhang, Yi

2014-01-01

SUMMARY Mammalian oocytes can reprogram somatic cells into a totipotent state enabling animal cloning through somatic cell nuclear transfer (SCNT). However, the majority of SCNT embryos fail to develop to term due to undefined reprogramming defects. Here we identify histone H3 lysine 9 trimethylation (H3K9me3) of donor cell genome as a major epigenetic barrier for efficient reprogramming by SCNT. Comparative transcriptome analysis identified reprogramming resistant regions (RRRs) that are expressed normally at 2-cell mouse embryos generated by IVF but not SCNT. RRRs are enriched for H3K9me3 in donor somatic cells, and its removal by ectopic expression of the H3K9me3 demethylase Kdm4d not only reactivates the majority of RRRs, but also greatly improves SCNT efficiency. Furthermore, use of donor somatic nuclei depleted of H3K9 methyltransferases markedly improves SCNT efficiency. Our study thus identifies H3K9me3 as a critical epigenetic barrier in SCNT-mediated reprogramming and provides a promising approach for improving mammalian cloning efficiency. PMID:25417163

Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment).

PubMed

Jayaram, Natalie; Spertus, John A; Kennedy, Kevin F; Vincent, Robert; Martin, Gerard R; Curtis, Jeptha P; Nykanen, David; Moore, Phillip M; Bergersen, Lisa

2017-11-21

Risk standardization for adverse events after congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR's (National Cardiovascular Data Registry) IMPACT Registry (Improving Pediatric and Adult Congenital Treatment). Between January 2011 and March 2014, 39 725 consecutive patients within IMPACT undergoing cardiac catheterization were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empirical data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event or death after cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%. The rate of major adverse event or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and 6 independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination, with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent, with a slope of 0.97 (standard error, 0.04; P value [for difference from 1] =0.53) and an intercept of 0.007 (standard error, 0.12; P value [for difference from 0] =0.95). The creation of a validated risk-standardization model for adverse outcomes after congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement. © 2017 American Heart Association, Inc.

Systematic literature review of health-related quality of life among aggressive non-Hodgkin lymphoma survivors.

PubMed

Lin, Vincent W; Blaylock, Barbara; Epstein, Josh; Purdum, Anna

2018-05-18

Studies have shown that a proportion of patients with aggressive non-Hodgkin lymphoma (NHL) treated with standard chemotherapy will have long-term life expectancy comparable to those in the age-adjusted general population. This systematic literature review summarizes current literature regarding health-related quality of life (HRQoL) of long-term (≥2 years) survivors of aggressive NHL. Electronic databases (without restriction on years) and abstracts from four major oncology and HRQoL conferences from 2014 to 2017 were searched. Studies were included if HRQoL or health utility was assessed at least 2 years after NHL diagnosis. Studies focusing on central nervous system lymphoma, or indolent NHL, were excluded. Results were categorized relative to baseline (improvement, deterioration or no change) and compared to the general population (better, comparable or worse). Fourteen studies met the inclusion criteria. Twelve studies included ≥1 HRQoL instrument, and two measured health utilities using EQ-5D. Half of the studies showed improvement (5/10) and half no change (5/10) in overall HRQoL. Compared to the general population, overall HRQoL was more comparable when assessed at ≥3 years from baseline (3/3 better or comparable) versus assessment at <3 years (2/3 better or comparable). Six studies reported on the physical HRQoL domain with improvement in 4/6 studies and no change in 2/6 studies. HRQoL of NHL survivors may improve from baseline and becomes more comparable to general population HRQoL with longer survival. Overall HRQoL improvement is driven mostly by improvements in the physical domain.

Delayed Ileal Pouch Anal Anastomosis Has a Lower 30-Day Adverse Event Rate: Analysis From the National Surgical Quality Improvement Program.

PubMed

Kochar, Bharati; Barnes, Edward L; Peery, Anne F; Cools, Katherine S; Galanko, Joseph; Koruda, Mark; Herfarth, Hans H

2018-04-25

Ulcerative colitis (UC) patients requiring colectomy often have a staged ileal pouch anal anastomosis (IPAA). There are no prospective data comparing timing of pouch creation. We aimed to compare 30-day adverse event rates for pouch creation at the time of colectomy (PTC) with delayed pouch creation (DPC). Using prospectively collected data from 2011-2015 through the National Surgical Quality Improvement Program, we conducted a cohort study including subjects aged ≥18 years with a postoperative diagnosis of UC. We assessed 30-day postoperative rates of unplanned readmissions, reoperations, and major and minor adverse events (AEs), comparing the stage of the surgery where the pouch creation took place. Using a modified Poisson regression model, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) adjusting for age, sex, race, body mass index, smoking status, diabetes, albumin, and comorbidities. Of 2390 IPAA procedures, 1571 were PTC and 819 were DPC. In the PTC group, 51% were on chronic immunosuppression preoperatively, compared with 15% in the DPC group (P < 0.01). After controlling for confounders, patients who had DPC were significantly less likely to have unplanned reoperations (RR, 0.42; 95% CI, 0.24-0.75), major AEs (RR, 0.72; 95% CI, 0.52-0.99), and minor AEs (RR, 0.48; 95% CI, 0.32-0.73) than PTC. Patients undergoing delayed pouch creation were at lower risk for unplanned reoperations and major and minor adverse events compared with patients undergoing pouch creation at the time of colectomy. 10.1093/ibd/izy082_video1izy082.video15776112442001.

Turkish University Students' Knowledge of Biotechnology and Attitudes toward Biotechnological Applications

ERIC Educational Resources Information Center

Öztürk-Akar, Ebru

2017-01-01

This study questions the presumed relation between formal schooling and scientific literacy about biotechnologies. Comparing science and nonscience majors' knowledge of and attitudes toward biotechnological applications, conclusions are drawn if their formal learnings improve pupils' understandings of and attitudes toward biotechnology…

Facial recognition of happiness among older adults with active and remitted major depression.

PubMed

Shiroma, Paulo R; Thuras, Paul; Johns, Brian; Lim, Kelvin O

2016-09-30

Biased emotion processing in depression might be a trait characteristic independent of mood improvement and a vulnerable factor to develop further depressive episodes. This phenomenon of among older adults with depression has not been adequately examined. In a 2-year cross-sectional study, 59 older patients with either active or remitted major depression, or never-depressed, completed a facial emotion recognition task (FERT) to probe perceptual bias of happiness. The results showed that depressed patients, compared with never depressed subjects, had a significant lower sensitivity to identify happiness particularly at moderate intensity of facial stimuli. Patients in remission from a previous major depressive episode but with none or minimal symptoms had similar sensitivity rate to identify happy facial expressions as compared to patients with an active depressive episode. Further studies would be necessary to confirm whether recognition of happy expression reflects a persistent perceptual bias of major depression in older adults. Published by Elsevier Ireland Ltd.

Examination of Daily Weather in the NCAR CCM

NASA Astrophysics Data System (ADS)

Cocke, S. D.

2006-05-01

The NCAR CCM is one of the most extensively studied climate models in the scientific community. However, most studies focus primarily on the long term mean behavior, typically monthly or longer time scales. In this study we examine the daily weather in the GCM by performing a series of daily or weekly 10 day forecasts for one year at moderate (T63) and high (T126) resolution. The model is initialized with operational "AVN" and ECMWF analyses, and model performance is compared to that of major operational centers, using conventional skill scores used by the major centers. Such a detailed look at the CCM at shorter time scales may lead to improvements in physical parameterizations, which may in turn lead to improved climate simulations. One finding from this study is that the CCM has a significant drying tendency in the lower troposphere compared to the operational analyses. Another is that the large scale predictability of the GCM is competitive with most of the operational models, particularly in the southern hemisphere.

Ripped from the Headlines: Using Current Events and Deliberative Democracy to Improve Student Performance in and Perceptions of Nonmajors Biology Courses†

PubMed Central

Tinsley, Heather N.

2016-01-01

Despite the importance of scientific literacy, many foundational science courses are plagued by low student engagement and performance. In an attempt to improve student outcomes, an introductory biology course for nonscience majors was redesigned to present the course content within the framework of current events and deliberative democratic exercises. During each instructional unit of the redesigned course, students were presented with a highly publicized policy question rooted in biological principles and currently facing lawmakers. Working in diverse groups, students sought out the information that was needed to reach an educated, rationalized decision. This approach models civic engagement and demonstrates the real-life importance of science to nonscience majors. The outcomes from two semesters in which the redesign were taught were compared with sections of the course taught using traditional pedagogies. When compared with other versions of the same course, presenting the course content within a deliberative democratic framework proved to be superior for increasing students’ knowledge gains and improving students’ perceptions of biology and its relevance to their everyday lives. These findings establish deliberative democracy as an effective pedagogical strategy for nonmajors biology. PMID:28101264

Functional Outcomes of Persons Undergoing Dysvascular Lower Extremity Amputations

PubMed Central

Sauter, Carley N.; Pezzin, Liliana E.; Dillingham, Timothy R.

2012-01-01

Objective To examine the effect of post-acute rehabilitation setting on functional outcomes among patients undergoing major lower extremity dysvascular amputations. Design A population-based, prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization following amputation and at six-month following the acute care discharge were analyzed using multivariate models and instrumental variable techniques. Results A total of 297 patients were analyzed based on post-acute care rehabilitation setting: acute inpatient rehabilitation (IRF), skilled nursing facility (SNF) or home. The majority (43.4%) received care in IRF, 32% in SNF, and 24.6% at home. On SF-36 subscales, significantly improved outcomes were observed for patients receiving post-acute care at an IRF relative to those cared for at a SNF in physical function (PF), role physical (RF) and physical component score (PCS). Patients receiving post-acute care in IRFs also experienced better RF and PCS outcomes compared to those discharged directly home. In addition, patients receiving post-acute care at an IRF were significantly more likely to score in the top quartile for general health in IRF compared to SNF or home, and less likely to score in the lowest quartile for PF, RF and PCS in IRF compared to SNF. Lower ADL impairment was observed in IRF compared to SNF. Conclusions Among this large and diverse cohort of patients undergoing major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services at an IRF yielded improved functional outcomes six months after amputation relative to care received at SNFs or home. PMID:23291599

Psychobiological Responses to Preferred and Prescribed Intensity Exercise in Major Depressive Disorder.

PubMed

Meyer, Jacob D; Ellingson, Laura D; Koltyn, Kelli F; Stegner, Aaron J; Kim, Jee-Seon; Cook, Dane B

2016-11-01

Exercise acutely improves mood in major depressive disorder (MDD). However, it is unknown whether benefits differ depending on whether exercise intensity is self-selected or prescribed. This study aimed to compare psychological and biological responses to preferred and prescribed steady-state exercise intensities to a patient-selected preferred intensity. Female adults (N = 24, age = 38.6 ± 14.0 yr) diagnosed with MDD completed four 30-min sessions of cycling exercise at three prescribed intensities (RPE of 11, 13, and 15) and one session with a self-selected intensity (preferred). Order was randomized and counterbalanced. Depressed mood (DM) was evaluated before, 10 min, and 30 min postexercise using the Profile of Mood States. Serum brain-derived neurotrophic factor (BDNF) was measured before and within 10 min postexercise. Changes in BDNF and DM for the preferred session were compared with the following prescribed sessions: 1) performed at the most similar intensity (matched on RPE; closest) and 2) with the greatest improvement in DM (greatest). Compared with the preferred session, improvement in DM was significantly larger after the greatest session (30 min postexercise: -11.8 ± 7.4 vs -3.4 ± 4.8), and the BDNF response was significantly greater after the closest session (5.4 ± 6.9 vs -1.4 ± 9.8 ng·mL). Permitting patients to select their own exercise intensity did not maximize improvements in mood. Further, preferred intensity exercise was also associated with a smaller BDNF response. Overall, the results suggest that exercise undertaken to improve mood should be prescribed on an individual basis in MDD and not necessarily based on the patient's preferred intensity. Clinicians, psychologists, and other practitioners should consider providing clear exercise intensity recommendations for symptom management in depression rather than allowing patients to self-select their intensity.

Implementing a lessons learned process at Sandia National Laboratories

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

Fosshage, Erik D.; Drewien, Celeste A.; Eras, Kenneth

2016-01-01

The Lessons Learned Process Improvement Team was tasked to gain an understanding of the existing lessons learned environment within the major programs at Sandia National Laboratories, identify opportunities for improvement in that environment as compared to desired attributes, propose alternative implementations to address existing inefficiencies, perform qualitative evaluations of alternative implementations, and recommend one or more near-term activities for prototyping and/or implementation. This report documents the work and findings of the team.

Aspirin Is Associated with Improved Survival in Severely Thrombocytopenic Cancer Patients with Acute Myocardial Infarction.

PubMed

Feher, Attila; Kampaktsis, Polydoros N; Parameswaran, Rekha; Stein, Eytan M; Steingart, Richard; Gupta, Dipti

2017-02-01

Patients with hematologic malignancies are at risk for severe thrombocytopenia (sTP). The risk and benefit of aspirin are not known in thrombocytopenic cancer patients experiencing acute myocardial infarction (AMI). Medical records of patients with hematologic malignancies diagnosed with AMI at Memorial Sloan Kettering Cancer Center during 2005-2014 were reviewed. sTP was defined as a platelet count <50,000 cells per µL within 7 days of AMI. Of 118 patients with hematologic malignancies who had AMI, 58 (49%) had sTP. Twenty-five patients (43%) with sTP received aspirin as a treatment for AMI. Compared with patients without sTP with AMI, patients with sTP with AMI were less likely to receive aspirin (83% vs. 43%; p  = .0001) and thienopyridine treatment (27% vs. 3%; p  = .0005). During median follow-up of 3.7 years after AMI, survival was lower in patients with sTP than in those with no sTP (23% vs. 50% at 1 year; log rank p  = .003). Patients with sTP who received aspirin for AMI had improved survival compared with those who did not (92% vs. 70% at 7 days, 72% vs. 33% at 30 days, and 32% vs. 13% at 1 year; log rank p  = .008). In multivariate regression models, aspirin use was associated with improved 30-day survival both in the overall patient cohort and in sTP patients. No fatal bleeding events occurred. Major bleeding was not associated with sTP or aspirin use. Treatment of AMI with aspirin in patients with hematologic malignancies and sTP is associated with improved survival without increase in major bleeding. The Oncologist 2017;22:213-221 Implications for Practice: In patients with hematologic malignancies and acute myocardial infarction with severe thrombocytopenia (platelet count < 50,000 cells/µL), guideline-recommended medical therapy is often withheld because of the fear of major bleeding. In this study, aspirin therapy was associated with improved survival without an increase in major bleeding in this high-risk patient cohort. © AlphaMed Press 2017.

A major haemorrhage protocol improves the delivery of blood component therapy and reduces waste in trauma massive transfusion.

PubMed

Khan, Sirat; Allard, Shubha; Weaver, Anne; Barber, Colin; Davenport, Ross; Brohi, Karim

2013-05-01

Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of blood components (packed red blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24h was gathered retrospectively. Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of blood component therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p<0.01) and CRYO:PRBC improved from 1:10 to 1:7 (p<0.05). We reported a significant reduction in the waste of platelets from 14% to 2% (p<0.01). Outcomes had improved: Median hospital length of stay was reduced from 54 days to 26 days (p<0.05). Implementation of a MHP results in improved delivery of blood components and a reduction in the waste of blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve blood product administration and patient outcomes in trauma haemorrhage. Level III diagnostic test study. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Undergraduate Statistics Education and the National Science Foundation

ERIC Educational Resources Information Center

Hall, Megan R.; Rowell, Ginger Holmes

2008-01-01

This paper describes 25 National Science Foundation supported projects that have innovations designed to improve education for students majoring or minoring in statistics. The characteristics of these projects and the common themes which emerge are compared with the American Statistical Association's (ASA) guidelines for developing statistics…

Precision control of soil N cycling via soil functional zone management

USDA-ARS?s Scientific Manuscript database

Managing the soil nitrogen (N) cycle is a major component of agricultural sustainability. Soil functional zone management (SFZM), a novel framework of agroecosystem management, may improve soil N management compared with conventional and no-tillage approaches by focusing on the timing and location (...

Which Dictionary? A Review of the Leading Learners' Dictionaries.

ERIC Educational Resources Information Center

Nesi, Hilary

Three major dictionaries designed for learners of English as a second language are reviewed, their elements and approaches compared and evaluated, their usefulness for different learners discussed, and recommendations for future dictionary improvement made. The dictionaries in question are the "Oxford Advanced Learner's Dictionary," the…

Preoperative Chemoprophylaxis is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism.

PubMed

Selby, Luke V; Sovel, Mindy; Sjoberg, Daniel D; McSweeney, Margaret; Douglas, Damon; Jones, David R; Scardino, Peter T; Soff, Gerald A; Fabbri, Nicola; Sepkowitz, Kent; Strong, Vivian E; Sarkaria, Inderpal S

2016-02-01

We prospectively evaluated the safety and efficacy of adding preoperative chemoprophylaxis to our institution's operative venous thromboembolism (VTE) prophylaxis policy as part of a physician-led quality improvement initiative. Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive preoperative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared with rates of historical controls who had not received preoperative chemoprophylaxis. The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared with a cohort of 4,960 patients operated on between January 2012 and June 2013, who did not receive preoperative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received preoperative anticoagulation. When compared with the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre- vs post-intervention, 17% vs 14%; difference 3.5%, 95% CI 1.7% to 5%, p = 0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI -0.1% to 0.7%, p = 0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI 0.7% to 1.4%, p < 0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI 0.2% to 1%, p = 0.017) were significantly lower in the post-intervention group. In patients undergoing major cancer surgery, institution of a single dose of preoperative chemoprophylaxis, as part of a physician-led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Ziprasidone Augmentation of Escitalopram for Major Depressive Disorder: Efficacy Results From a Randomized, Double-Blind, Placebo-Controlled Study.

PubMed

Papakostas, George I; Fava, Maurizio; Baer, Lee; Swee, Michaela B; Jaeger, Adrienne; Bobo, William V; Shelton, Richard C

2015-12-01

The authors sought to test the efficacy of adjunctive ziprasidone in adults with nonpsychotic unipolar major depression experiencing persistent symptoms after 8 weeks of open-label treatment with escitalopram. This was an 8-week, randomized, double-blind, parallel-group, placebo-controlled trial conducted at three academic medical centers. Participants were 139 outpatients with persistent symptoms of major depression after an 8-week open-label trial of escitalopram (phase 1), randomly assigned in a 1:1 ratio to receive adjunctive ziprasidone (escitalopram plus ziprasidone, N=71) or adjunctive placebo (escitalopram plus placebo, N=68), with 8 weekly follow-up assessments. The primary outcome measure was clinical response, defined as a reduction of at least 50% in score on the 17-item Hamilton Depression Rating Scale (HAM-D). The Hamilton Anxiety Rating scale (HAM-A) and Visual Analog Scale for Pain were defined a priori as key secondary outcome measures. Rates of clinical response (35.2% compared with 20.5%) and mean improvement in HAM-D total scores (-6.4 [SD=6.4] compared with -3.3 [SD=6.2]) were significantly greater for the escitalopram plus ziprasidone group. Several secondary measures of antidepressant efficacy also favored adjunctive ziprasidone. The escitalopram plus ziprasidone group also showed significantly greater improvement on HAM-A score but not on Visual Analog Scale for Pain score. Ten (14%) patients in the escitalopram plus ziprasidone group discontinued treatment because of intolerance, compared with none in the escitalopram plus placebo group. Ziprasidone as an adjunct to escitalopram demonstrated antidepressant efficacy in adult patients with major depressive disorder experiencing persistent symptoms after 8 weeks of open-label treatment with escitalopram.

Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database.

PubMed

Elmi, Maryam; Azin, Arash; Elnahas, Ahmad; McCready, David R; Cil, Tulin D

2018-05-14

Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database. A retrospective cohort analysis was conducted using the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) 2007-2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity. Of the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity. This study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.

Vilazodone in the treatment of major depressive disorder: efficacy across symptoms and severity of depression.

PubMed

Khan, Arif; Sambunaris, Angelo; Edwards, John; Ruth, Adam; Robinson, Donald S

2014-03-01

Vilazodone is a potent selective serotonin reuptake inhibitor and serotonin 1A receptor partial agonist approved for the treatment of major depressive disorder in adults. To assess the efficacy of vilazodone across a range of symptoms and severities of depression, data from two phase III, 8-week, randomized, double-blind, placebo-controlled trials were pooled for analysis. Overall improvement in depressive symptoms measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-item Hamilton Depression Rating Scale was statistically significant (P<0.05) for vilazodone treatment compared with placebo as early as Week 1 and continued throughout double-blind treatment. Vilazodone treatment compared with placebo showed significant improvement on all 10 individual MADRS symptom items at end of treatment (P<0.01). Rates of response and remission were significantly greater in the vilazodone group relative to the placebo group, with numbers needed to treat ranging from eight to nine for response and 12-17 for remission. Between-group treatment differences in MADRS and the other outcome measures were similar among all depression subgroups, with no consistent pattern associated with depression severity. These findings support the efficacy of vilazodone across a broad range of depressive symptoms and severities for the treatment of major depressive disorder.

Facilities Performance Indicators Report, 2006-07

ERIC Educational Resources Information Center

Glazner, Steve, Ed.

2008-01-01

The "Facilities Performance Indicators Survey" ("FPI") supersedes and builds upon the two major surveys APPA conducted in the past: the Comparative Costs and Staffing (CCAS) survey and the Strategic Assessment Model (SAM). The "FPI" covers all the materials collected in CCAS and SAM, along with some select new data points and improved survey…

Predictors of Differential Response to Cognitive, Experiential, and Self-Directed Psychotherapeutic Procedures.

ERIC Educational Resources Information Center

Beutler, Larry E.; And Others

1991-01-01

Compared group cognitive therapy (CT); focused expressive psychotherapy; and supportive, self-directed therapy (S/SD) among 63 patients with major depressive disorder. Results suggest that patient characteristics can be used differentially to assign psychotherapy types. Externalizing patients and low defensive patients improved more in CT;…

Triple Jeopardy: Special Education for Palestinians in Israel

ERIC Educational Resources Information Center

Kasler, Jonathan; Jabareen, Yousef T.

2017-01-01

Research comparing special education for Jews and for Palestinian Arabs in Israel outlines major inequalities. This situation has remained largely unchanged for decades and there is little evidential reason to believe there will be improvement in the near future. Palestinian children requiring special education are adversely affected by a…

47 CFR 73.871 - Amendment of LPFM broadcast station applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... limitation during the pertinent filing window. (b) Amendments that would improve the comparative position of new and major change applications will not be accepted after the close of the pertinent filing window... the pertinent filing window. Subject to the provisions of this section, such amendments may be filed...

Optimizing Health Care for Adults with Spina Bifida

ERIC Educational Resources Information Center

Webb, Thomas S.

2010-01-01

Survival into adulthood for individuals with spina bifida has significantly improved over the last 40 years with the majority of patients now living as adults. Despite this growing population of adult patients who have increased medical needs compared to the general population, including spina bifida (SB)-specific care, age-related secondary…

The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder.

PubMed

Lin, Ching-Hua; Yang, Wei-Cheng

2017-07-01

We aimed to compare the degree of symptom relief to psychosocial functional (abbreviated as "functional") improvement and explore the relationships between symptom relief and functional improvement during acute electroconvulsive therapy for patients with major depressive disorder. Major depressive disorder inpatients (n=130) requiring electroconvulsive therapy were recruited. Electroconvulsive therapy was generally performed for a maximum of 12 treatments. Symptom severity, using the 17-item Hamilton Depression Rating Scale, and psychosocial functioning (abbreviated as "functioning"), using the Modified Work and Social Adjustment Scale, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale scores were converted to T-score units to compare the degrees of changes between depressive symptoms and functioning after electroconvulsive therapy. Structural equation modeling was used to test the relationships between 17-item Hamilton Depression Rating Scale and Modified Work and Social Adjustment Scale during acute electroconvulsive therapy. One hundred sixteen patients who completed at least the first 3 electroconvulsive therapy treatments entered the analysis. Reduction of 17-item Hamilton Depression Rating Scale T-scores was significantly greater than that of Modified Work and Social Adjustment Scale T-scores at assessments 2, 3, 4, and 5. The model analyzed by structural equation modeling satisfied all indices of goodness-of-fit (chi-square = 32.882, P =.107, TLI = 0.92, CFI = 0.984, RMSEA = 0.057). The 17-item Hamilton Depression Rating Scale change did not predict subsequent Modified Work and Social Adjustment Scale change. Functioning improved less than depressive symptoms during acute electroconvulsive therapy. Symptom reduction did not predict subsequent functional improvement. Depressive symptoms and functional impairment are distinct domains and should be assessed independently to accurately reflect the effectiveness of electroconvulsive therapy. © The Author 2017. Published by Oxford University Press on behalf of CINP.

Comparative analysis of maize (Zea mays) crop performance: natural variation, incremental improvements and economic impacts.

PubMed

Leibman, Mark; Shryock, Jereme J; Clements, Michael J; Hall, Michael A; Loida, Paul J; McClerren, Amanda L; McKiness, Zoe P; Phillips, Jonathan R; Rice, Elena A; Stark, Steven B

2014-09-01

Grain yield from maize hybrids continues to improve through advances in breeding and biotechnology. Despite genetic improvements to hybrid maize, grain yield from distinct maize hybrids is expected to vary across growing locations due to numerous environmental factors. In this study, we examine across-location variation in grain yield among maize hybrids in three case studies. The three case studies examine hybrid improvement through breeding, introduction of an insect protection trait or introduction of a transcription factor trait associated with increased yield. In all cases, grain yield from each hybrid population had a Gaussian distribution. Across-location distributions of grain yield from each hybrid partially overlapped. The hybrid with a higher mean grain yield typically outperformed its comparator at most, but not all, of the growing locations (a 'win rate'). These results suggest that a broad set of environmental factors similarly impacts grain yields from both conventional- and biotechnology-derived maize hybrids and that grain yields among two or more hybrids should be compared with consideration given to both mean yield performance and the frequency of locations at which each hybrid 'wins' against its comparators. From an economic standpoint, growers recognize the value of genetically improved maize hybrids that outperform comparators in the majority of locations. Grower adoption of improved maize hybrids drives increases in average U.S. maize grain yields and contributes significant value to the economy. © 2014 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

Resilience Training for Work-related Stress Among Health Care Workers: Results of a Randomized Clinical Trial Comparing In-person and Smartphone-delivered Interventions.

PubMed

Mistretta, Erin G; Davis, Mary C; Temkit, M'hamed; Lorenz, Christopher; Darby, Betty; Stonnington, Cynthia M

2018-01-24

The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution. Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention. Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome. Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.

Novel Goal-Directed Hemodynamic Optimization Therapy Based on Major Vasopressor during Corrective Cardiac Surgery in Patients with Severe Pulmonary Arterial Hypertension: A Pilot Study.

PubMed

Li, Shuwen; Ma, Qing; Yang, Yanwei; Lu, Jiakai; Zhang, Zhiquan; Jin, Mu; Cheng, Weiping

2016-12-22

Pulmonary arterial hypertension (PAH) is a common and fatal complication of congenital heart disease (CHD). PAH-CHD increases the risk for postoperative complications. Recent evidence suggests that perioperative goal-directed hemodynamic optimization therapy (GDHOT) significantly improves outcomes in surgery patients. Standard GDHOT is based on major solution volume, vasodilators and inotropic therapy, while novel GDHOT is based on major vasopressor and inotropic therapy. Therefore, we tested whether standard or novel GDHOT improves surgical outcomes in PAH-CHD patients. Forty PAH-CHD patients with a ventricular septal defect (VSD) and mean pulmonary arterial pressure (mPAP) >50 mmHg, who were scheduled for corrective surgery, were randomly assigned to 2 groups: SG (study group, n = 20) and CG (control group, n = 20). SG patients received perioperative hemodynamic therapy guided by novel GDHOT, while CG patients received standard GDHOT. Outcome data were recorded up to 28 days postoperatively. Ventilator time, length of ICU stay, and mortality were the primary endpoints. There were no significant differences in preoperative data, surgical procedure, and hospital mortality rates between the 2 groups. Time of mechanical ventilation and length of ICU stay were significantly shorter in SG patients compared to CG patients (P < .05, n = 20). Patients in SG showed a significantly increased systemic vascular resistance index and decreased cardiac index, but no change in pulmonary vascular resistance index at 12 and 24 hours after surgery compared to the controls (P < .05). Patients in SG had significantly decreased PAP, pulmonary arterial pressure/systemic arterial pressure (Pp/Ps), and RVSWI (right ventricular stroke work index) at 12 and 24 hours after surgery (P < .05, respectively). Patients in SG also showed significantly decreased central venous pressure at 4, 12, and 24 hours after surgery compared to those treated with standard protocol (P < .05). Our study provides clinical evidence that perioperative goal-directed hemodynamic optimization therapy based on major vasopressor is associated with reduced duration of postoperative respiratory support, and length of ICU stay in PAH-CHD patients undergoing elective surgery. These outcomes, then, may be linked to improved hemodynamics and preservation of right ventricular dynamic function.

Students Targeting Engineering and Physical Science (STEPS) at California State University Northridge (CSUN):Activities and Outcomes 2011-2016

NASA Astrophysics Data System (ADS)

Cadavid, A. C.; Pedone, V. A.; Horn, W.; Rich, H.

2016-12-01

The specific goal of STEPS at CSUN is to increase the number bachelor's degrees in STEM majors, particularly those in engineering, computer science, mathematics and the physical sciences. Prior to STEPS, only 33% of first-time freshmen in these majors graduated from CSUN within 6-7 years. We employ two main strategies: 1) fostering success in lower-division mathematics for freshmen and sophomores, 2) Summer Interdisciplinary Team Experience (SITE) for students transitioning to junior level courses. To improve success in mathematics, we have advanced initial placements in the foundational mathematics sequence by one or two semesters through improvements in the placement test (6-7% improvement) and have increased the first-time pass rate in foundational math courses through mandatory supplementary laboratories for at-risk students. Students who successfully complete the supplemental laboratories pass the lecture class at a higher rate than the total population of at-risk students (65% compared to 61%). Both approaches have been institutionalized. SITE targets students entering their junior years in a 3-week interdisciplinary team project that highlights problem solving and hands-on activities. Survey results of the 233 participants show that SITE: 1) maintained or increased desire to earn a STEM degree, 2) increased positive attitudes toward team-based problem solving, 3) increased understanding in how they will use their major in a career, and 4) increased interest in faculty-mentored research and industry internships. Our 5-year program is nearing completion and shows success in meeting our goal. We have measured a 9% point increase in the pass rate of Calculus I for post-STEPS cohorts compared to pre-STEPS cohorts. Failure to pass Calculus is a leading cause in non-completion of the majors targeted by STEPS. We have analyzed the graduation rates of two pre-STEPS cohorts that have had over 6 years to graduate. Both have a graduate rate of 28%. We expect that the 9% point increase in calculus passers will lead to a comparable increase in graduation rate, resulting in a 37% graduation rate for the post-STEPS cohorts.

A longitudinal population-based study exploring treatment utilization and suicidal ideation and behavior in major depressive disorder.

PubMed

Chartrand, Hayley; Robinson, Jennifer; Bolton, James M

2012-12-10

This study aimed to longitudinally examine the relationship between treatment utilization and suicidal behavior among people with major depressive disorder in a nationally representative sample. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Wave 1: N=43,093; Wave 2: N=34,653). Suicidal and non-suicidal individuals at Wave 1 were compared based on subsequent treatment utilization. Suicidal behavior at Wave 2 was compared between people with major depressive disorder who had sought treatment at Wave 1 versus those that had not. Individuals with past year major depressive disorder at Wave 1 who attempted suicide were more likely to be hospitalized at follow up compared to non-suicidal people with major depressive disorder [adjusted odds ratio (AOR)=4.46; 95% confidence interval [95% CI]: 2.54-7.85]; however, they were not more likely to seek other forms of treatment. Among those with past year major depressive disorder who sought treatment at baseline, visiting an emergency room (AOR=3.08; 95% CI: 1.61-5.89) and being hospitalized (AOR=2.41; 95% CI: 1.13-5.14), was associated with an increased likelihood of attempting suicide within 3 years even after adjusting for mental disorder comorbidity, depression severity, and previous suicidal behavior. Unable to draw conclusions about completed suicide or adequacy of treatment. Suicidal behavior does not lead individuals with major depressive disorder to seek treatment with professionals or use antidepressant medications; instead, they are more likely to use emergency services. These findings suggest that treatment efforts for people with major depressive disorder who are suicidal need improvement. Copyright © 2012 Elsevier B.V. All rights reserved.

Research requirements to improve safety of civil helicopters

NASA Technical Reports Server (NTRS)

Waters, K. T.

1977-01-01

Helicopter and fixed-wing accident data were reviewed and major accident causal factors were established. The impact of accidents on insurance rates was examined and the differences in fixed-wing and helicopter accident costs discussed. The state of the art in civil helicopter safety was compared to military helicopters. Goals were established based on incorporation of known technology and achievable improvements that require development, as well as administrative-type changes such as the impact of improved operational planning, training, and human factors effects. Specific R and D recommendations are provided with an estimation of the payoffs, timing, and development costs.

The cardiac regenerative potential of myoblasts remains limited despite improving their survival via antioxidant treatment.

PubMed

Beckman, Sarah A; Sekiya, Naosumi; Chen, William C W; Mlakar, Logan; Tobita, Kimimassa; Huard, Johnny

2014-01-01

Since myoblasts have been limited by poor cell survival after cellular myoplasty, the major goal of the current study was to determine whether improving myoblast survival with an antioxidant could improve cardiac function after the transplantation of the myoblasts into an acute myocardial infarction. We previously demonstrated that early myogenic progenitors such as muscle-derived stem cells (MDSCs) exhibited superior cell survival and improved cardiac repair after transplantation into infarcted hearts compared to myoblasts, which we partially attributed to MDSC's higher antioxidant levels. To determine if antioxidant treatment could increase myoblast survival, subsequently improving cardiac function after myoblast transplantation into infarcted hearts. Myoblasts were pre-treated with the antioxidant N-acetylcysteine (NAC) or the glutathione depleter, diethyl maleate (DEM), and injected into infarcted murine hearts. Regenerative potential was monitored by cell survival and cardiac function. At early time points, hearts injected with NAC-treated myoblasts exhibited increased donor cell survival, greater cell proliferation, and decreased cellular apoptosis, compared to untreated myoblasts. NAC-treated myoblasts significantly improved cardiac contractility, reduced fibrosis, and increased vascular density compared to DEM-treated myoblasts, but compared to untreated myoblasts, no difference was noted. While early survival of myoblasts transplanted into infarcted hearts was augmented by NAC pre-treatment, cardiac function remained unchanged compared to non-treated myoblasts. Despite improving cell survival with NAC treated myoblast transplantation in a MI heart, cardiac function remained similar to untreated myoblasts. These results suggest that the reduced cardiac regenerative potential of myoblasts, when compared to MDSCs, is not only attributable to cell survival but is probably also related to the secretion of paracrine factors by the MDSCs.

The cardiac regenerative potential of myoblasts remains limited despite improving their survival via antioxidant treatment

PubMed Central

Beckman, Sarah A.; Sekiya, Naosumi; Chen, William C.W.; Mlakar, Logan; Tobita, Kimimassa; Huard, Johnny

2017-01-01

Introduction Since myoblasts have been limited by poor cell survival after cellular myoplasty, the major goal of the current study was to determine whether improving myoblast survival with an antioxidant could improve cardiac function after the transplantation of the myoblasts into an acute myocardial infarction. Background We previously demonstrated that early myogenic progenitors such as muscle-derived stem cells (MDSCs) exhibited superior cell survival and improved cardiac repair after transplantation into infarcted hearts compared to myoblasts, which we partially attributed to MDSC’s higher antioxidant levels. Aim To determine if antioxidant treatment could increase myoblast survival, subsequently improving cardiac function after myoblast transplantation into infarcted hearts. Materials and Methods Myoblasts were pre-treated with the antioxidant N-acetylcysteine (NAC) or the glutathione depleter, diethyl maleate (DEM), and injected into infarcted murine hearts. Regenerative potential was monitored by cell survival and cardiac function. Results At early time points, hearts injected with NAC-treated myoblasts exhibited increased donor cell survival, greater cell proliferation, and decreased cellular apoptosis, compared to untreated myoblasts. NAC-treated myoblasts significantly improved cardiac contractility, reduced fibrosis, and increased vascular density compared to DEM-treated myoblasts, but compared to untreated myoblasts, no difference was noted. Discussion While early survival of myoblasts transplanted into infarcted hearts was augmented by NAC pre-treatment, cardiac function remained unchanged compared to non-treated myoblasts. Conclusion Despite improving cell survival with NAC treated myoblast transplantation in a MI heart, cardiac function remained similar to untreated myoblasts. These results suggest that the reduced cardiac regenerative potential of myoblasts, when compared to MDSCs, is not only attributable to cell survival but is probably also related to the secretion of paracrine factors by the MDSCs. PMID:28989945

Adjunctive aripiprazole therapy with escitalopram in patients with co-morbid major depressive disorder and alcohol dependence: Clinical and neuroimaging evidence

PubMed Central

Han, Doug Hyun; Kim, Sun Mi; Choi, Jung Eun; Min, Kyung Joon; Renshaw, Perry F.

2015-01-01

The effective treatment of depression has been reported to reduce the severity of alcohol use, potentially reflecting improvements in common brain reward circuits. We hypothesized that augmentation therapy of escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder, compared with treatment with escitalopram alone. Thirty-five subjects with major depressive disorder and alcohol dependence were recruited and randomly assigned into 17 aripiprazole + escitalopram and 18 escitalopram only groups. At baseline and following six weeks of treatment, symptoms of depression, craving for alcohol and brain activity were evaluated. During the six week treatment period, Beck Depression Inventory and clinical global index-severity (CGI-S) scores decreased in both the aripiprazole + escitalopram and escitalopram only groups. In addition, following the treatment period, the Korean alcohol urge questionnaire scores in the aripiprazole + escitalopram group were reduced from 23.3±8.4 to 14.3±4.9, compared with those of the escitalopram group of from 21.6±8.4 to 19.3±7.1 (F=13.1, p<0.01). The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group. The change of brain activity within the left anterior cingulate gyrus in all patients with co-morbid alcohol dependence and major depressive disorder was negatively correlated with the change in craving for alcohol. These findings suggest that the effects of aripiprazole on anterior cingulate cortex might mediate the successful treatment of alcohol dependence in patients with major depressive disorder. PMID:23325372

Year-2017 nuclear quadrupole moments

NASA Astrophysics Data System (ADS)

Pyykkö, Pekka

2018-05-01

A 'year-2017' set of nuclear quadrupole moments, Q, is presented. Compared to the previous, 'year-2008' set, a major revision of the value, or an improvement of the accuracy is reported for 21H, 37, 3918Ar, 39, 40, 4119K, 6730Zn, 48Cd, 49In, 50Sn (Mössbauer state), 51Sb, 87Fr and 90Th. Slight improvements or valuable reconfirmations exist for 4Be, 6C, 16S, 17Cl, 33As, 35Br, 53I, 54Xe, 56Ba, 57La and 72Hf.

Exercise therapy improves aerobic capacity of inpatients with major depressive disorder.

PubMed

Kerling, Arno; von Bohlen, Anne; Kück, Momme; Tegtbur, Uwe; Grams, Lena; Haufe, Sven; Gützlaff, Elke; Kahl, Kai G

2016-06-01

Unipolar depression is one of the most common diseases worldwide and is associated with a higher cardiovascular risk partly due to reduced aerobic capacity. Therefore, the aim of our study was to examine whether a structured aerobic training program can improve aerobic capacity in inpatients with MDD (major depressive disorder). Overall, 25 patients (13 women, 12 men) diagnosed with MDD were included in the study. Parameters of aerobic capacity, such as maximum performance, maximum oxygen consumption, and VAT (ventilatory anaerobic threshold), were assessed on a bicycle ergometer before and 6 weeks after a training period (three times per week for 45 min on two endurance machines). In addition, a constant load test was carried out at 50% of the maximum performance prior to and after the training period. The performance data were compared with 25 healthy controls matched for sex, age, and body mass index before and after the training period. Compared to controls, patients with MDD had significantly lower aerobic capacity. After training, there was a significant improvement in their performance data. A significant difference remained only for VAT between patients with MDD and healthy controls. With regard to the coincidence of MDD with cardiovascular and cardiometabolic disorders, a structured supervised exercise program carried out during hospitalization is a useful supplement for patients with MDD.

Incubation temperature and time of hatch impact broiler muscle growth and morphology.

PubMed

Clark, D L; Walter, K G; Velleman, S G

2017-09-01

The adult myogenic population of stem cells, called satellite cells, initially develop in late-term embryos. Satellite cells are the only myogenic cell that repair damaged myofibers and increase post-hatch growth. The objective of the current study was to determine if incubation temperatures and time of hatch impact growth and pectoralis major (p. major) muscle morphology. Eggs were incubated at a constant 37.8°C; however, from d 14 to 18, the eggs were subject to 39.5°C for 0, 3, or 12 h per day. Chicks were divided into early, mid, or late hatch groups based upon the time they emerged from the shell. Growth and feed efficiency were measured throughout the 63-day trial, while meat quality and muscle morphology were evaluated at the time of processing. The chicks incubated at an increased temperature for 12 h per d had reduced (P < 0.01) body weights throughout the trial compared to the 3 h treatment and control. The early hatch broilers were heavier (P < 0.01) at 63 d compared to mid and late hatch broilers. Chicks from the 12 h incubation treatment had an increased (P = 0.01) gain to feed ratio compared to the control. Broilers from the 12 h incubation treatment had lower (P < 0.01) p. major weights compared to the 0 and 3 h treatments. Early hatch broilers had heavier p. major weights (P < 0.01) compared to mid and late hatch groups. The 12 h incubation treatment also reduced the number of broilers with moderate to severe myopathic attributes compared to the control. Similarly, there were fewer late hatch birds with fibrotic and necrotic p. major muscles compared to the early hatch group. Together, these data demonstrate that altering incubation temperature is a feasible management strategy to improve muscle morphology without negatively impacting meat quality parameters. © 2017 Poultry Science Association Inc.

Improving the Teaching of Microsoft Excel: Traditional Book versus Online Platform

ERIC Educational Resources Information Center

Brooks, Stoney; Taylor, Joseph

2016-01-01

The authors explore the differences between traditional, book-based methods of teaching Excel and online, platform-supported methods by comparing teaching students in different locations, with and without online support. As Excel is a critical skill for business majors, the authors investigate which methods and locations provide the highest…

Web-Streamed Didactic Instruction on Substance Use Disorders Compares Favorably with Live-Lecture Format

ERIC Educational Resources Information Center

Maher, Karam-Hage; Brower, Kirk J.; Mullan, Patricia B.; Gay, Tamara; Gruppen, Larry D.

2013-01-01

Objective: Education about substance use disorders in medical schools and, subsequently, physicians' identification of and intervention in these diagnoses lag behind that of most other disabling disorders. To reduce barriers and improve access to education about this major public health concern, medical schools are increasingly adopting web-based…

EDRN Biomarker Reference Lab: Pacific Northwest National Laboratory — EDRN Public Portal

Cancer.gov

The purpose of this project is to develop antibody microarrays incorporating three major improvements compared to previous antibody microarray platforms, and to produce and disseminate these antibody microarray technologies for the Early Detection Research Network (EDRN) and the research community focusing on early detection, and risk assessment of cancer.

State Plans for Improving Statistical Services. Bulletin, 1961, No. 16. OE-20028

ERIC Educational Resources Information Center

Siebert, Ivan N., Comp.; Waddell, Jerry N., Comp.; Murphy, Louise R., Comp.

1961-01-01

The initiation of the educational records and reports study by the Office of Education in 1951 marked a turning point in the Federal State teamwork approach toward providing a basis for complete, accurate, and comparable educational information. In cooperation with State education agencies and professional groups, three major handbooks of standard…

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

Manyonda, Isaac T., E-mail: imanyond@sgul.ac.uk; Bratby, Mark; Horst, Jessica S.

Purpose: This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy. Methods: Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n = 81) or UAE (n = 82). Endpoints at 1 year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention. Results: UAE patients had shorter hospitalization (2 vs. 6 days, p < 0.001). By 1 year postintervention, significant and equal improvements in QoL scores had occurred in both groups (myomectomy n = 59; UAE nmore » = 61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2 years, among UAE patients (n = 57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n = 37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US. Conclusions: UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.« less

Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment.

PubMed

2017-01-01

Major depressive disorder and generalized anxiety disorder are among the most commonly diagnosed mental illnesses in Canada; both are associated with a high societal and economic burden. Treatment for major depressive disorder and generalized anxiety disorder consists of pharmacological and psychological interventions. Three commonly used psychological interventions are cognitive behavioural therapy (CBT), interpersonal therapy, and supportive therapy. The objectives of this report were to assess the effectiveness and safety of these types of therapy for the treatment of adults with major depressive disorder and/or generalized anxiety disorder, to assess the cost-effectiveness of structured psychotherapy (CBT or interpersonal therapy), to calculate the budget impact of publicly funding structured psychotherapy, and to gain a greater understanding of the experiences of people with major depressive disorder and/or generalized anxiety disorder. We performed a literature search on October 27, 2016, for systematic reviews that compared CBT, interpersonal therapy, or supportive therapy with usual care, waitlist control, or pharmacotherapy in adult outpatients with major depressive disorder and/or generalized anxiety disorder. We developed an individual-level state-transition probabilistic model for a cohort of adult outpatients aged 18 to 75 years with a primary diagnosis of major depressive disorder to determine the cost-effectiveness of individual or group CBT (as a representative form of structured psychotherapy) versus usual care. We also estimated the 5-year budget impact of publicly funding structured psychotherapy in Ontario. Finally, we interviewed people with major depressive disorder and/or generalized anxiety disorder to better understand the impact of their condition on their daily lives and their experience with different treatment options, including psychotherapy. Interpersonal therapy compared with usual care reduced posttreatment major depressive disorder scores (standardized mean difference [SMD]: 0.24, 95% confidence interval [CI]: -0.47 to -0.02) and reduced relapse/recurrence in patients with major depressive disorder (relative risk [RR]: 0.41, 95% CI: 0.27-0.63). Supportive therapy compared with usual care improved major depressive disorder scores (SMD: 0.58, 95% CI: 0.45-0.72) and increased posttreatment recovery (odds ratio [OR]: 2.71, 95% CI: 1.19-6.16) in patients with major depressive disorder. CBT compared with usual care increased response (OR: 1.58, 95% CI: 1.11-2.26) and recovery (OR: 3.42, 95% CI: 1.98-5.93) in patients with major depressive disorder and decreased relapse/recurrence (RR: 0.68, 95% CI: 0.65-0.87]). For patients with generalized anxiety disorder, CBT improved symptoms posttreatment (SMD: 0.80, 95% CI: 0.67-0.93), improved clinical response posttreatment (RR: 0.64, 95% CI: 0.55-0.74), and improved quality-of-life scores (SMD: 0.44, 95% CI: 0.06-0.82). There was a significant difference in posttreatment recovery (OR: 1.98, 95% CI: 1.11-3.54) and mean major depressive disorder symptom scores (weighted mean difference: -3.07, 95% CI: -4.69 to -1.45) for patients who received individual versus group CBT. Details about the providers of psychotherapy were rarely reported in the systematic reviews we examined.In the base case probabilistic cost-utility analysis, compared with usual care, both group and individual CBT were associated with increased survival: 0.11 quality-adjusted life-years (QALYs) (95% credible interval [CrI]: 0.03-0.22) and 0.12 QALYs (95% CrI: 0.03-0.25), respectively.Group CBT provided by nonphysicians was associated with the smallest increase in discounted costs: $401 (95% CrI: $1,177 to 1,665). Group CBT provided by physicians, individual CBT provided by nonphysicians, and individual CBT provided by physicians were associated with the incremental costs of $1,805 (95% CrI: 65-3,516), $3,168 (95% CrI: 889-5,624), and $5,311 (95% CrI: 2,539-8,938), respectively. The corresponding incremental cost-effectiveness ratio (ICER) was lowest for group CBT provided by nonphysicians ($3,715/QALY gained) and highest for individual CBT provided by physicians ($43,443/QALY gained). In the analysis that ranked best strategies, individual CBT versus group CBT provided by nonphysicians yielded an ICER of $192,618 per QALY. The probability of group CBT provided by nonphysicians being cost-effective versus usual care was greater than 95% for all willingness-to-pay thresholds over $20,000 per QALY and was around 88% for individual CBT provided by physicians at a threshold of $100,000 per QALY.We estimated that adding structured psychotherapy to usual care over the next 5 years would result in a net budget impact of $68 million to $529 million, depending on a range of factors. We also estimated that to provide structured psychotherapy to all adults with major depressive disorder (alone or combined with generalized anxiety disorder) in Ontario by 2021, an estimated 500 therapists would be needed to provide group therapy, and 2,934 therapists would be needed to provide individual therapy.People with major depressive disorder and/or generalized anxiety disorder with whom we spoke reported finding psychotherapy effective, but they also reported experiencing a large number of barriers that prevented them from finding effective psychotherapy in a timely manner. Participants reported wanting more freedom to choose the type of psychotherapy they received. Compared with usual care, treatment with CBT, interpersonal therapy, or supportive therapy significantly reduces depression symptoms posttreatment. CBT significantly reduces anxiety symptoms posttreatment in patients with generalized anxiety disorder.Compared with usual care, treatment with structured psychotherapy (CBT or interpersonal therapy) represents good value for money for adults with major depressive disorder and/or generalized anxiety disorder. The most affordable option is group structured psychotherapy provided by nonphysicians, with the selective use of individual structured psychotherapy provided by nonphysicians or physicians for those who would benefit most from it (i.e., patients who are not engaging well with or adhering to group therapy).

The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems.

PubMed

Howells, N R; Dunne, N; Reddy, S

2006-07-01

To report the casualty profile of the major incident at the Royal Berkshire Hospital, Reading, following the Ufton Nervet Train crash, November 2004. To make further proposals regarding major incident reporting and implementation of trauma-scoring systems. Retrospective analysis of emergency department and hospital notes. Calculation of index Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS) in all patients. Of 61 casualties, the majority (74%) were seen in the minors area of our emergency department with a mixture of blunt impact and penetrating glass injuries. One died and 16 were admitted. 10% had an ISS >16. All surviving patients had a TRISS predicted probability of survival >90%. We propose mandatory major incident reporting within 6 months of a major incident to aid development of a national database. As previously proposed, this will aid education and facilitate future major incident planning. We further propose the widespread use of trauma scoring systems to facilitate comparative analysis between major incidents, perhaps extrapolating this to develop a major incident score.

Maintained Improvement of Neurocognitive Function in Major Depressive Disorders 6 Months after ECT.

PubMed

Mohn, Christine; Rund, Bjørn Rishovd

2016-01-01

Both impaired and improved cognitive function after electroconvulsive therapy (ECT) in major depressive disorder (MDD) patients may occur. We have previously found improved cognitive function 6 weeks after ECT in this group. The aim of this study was to report 6-month follow-up results from the same prospective project monitoring cognitive effects of ECT. Thirty-one patients with MDD were assessed with the MATRICS Consensus Cognitive Battery (MCCB), the Everyday Memory Questionnaire (EMQ), and the Montgomery-Åsberg Depression Rating Scale prior to, 6 weeks, and 6 months after ECT. Compared to baseline, the speed of processing, attention/vigilance, and reasoning/problem solving test results were significantly improved. The depression score was significantly reduced. There were no changes in subjective memory complaint. There was no significant relationship between the EMQ and the MCCB subtests, but a significant correlation between current depression level and the EMQ. Six months after ECT the cognitive improvement reported at 6-week follow-up was maintained and extended. The corresponding decrease in depressive symptoms and stability in subjectively reported memory complaints suggest that the antidepressant effects of ECT do not occur at the expense of cognitive function.

Prospects for improving the salt tolerance of forest trees: A review

USGS Publications Warehouse

Allen, J.A.; Chambers, J.L.; Stine, M.

1994-01-01

Three major themes related to the improvement of salt tolerance in forest tree species are examined. First, evidence demonstrating that substantial intraspecific variation in salt tolerance exists in many species is presented. This evidence is important because it suggests that efforts to improve salt tolerance through conventional plant breeding techniques are justified. Second, the physiological and genetic mechanisms controlling salt tolerance are discussed briefly. Although salt tolerance involves the integration of numerous physiological processes, there is considerable evidence that differences in the ability to exclude Na+ and Cl- from leaves are the most important factors underlying intraspecific differences in tolerance. It is also becoming apparent that, although salt tolerance is a multigenic trait, major genes play an important role. Third, progress to date in improving salt tolerance of forest tree species is assessed. Compared with agricultural crops, relatively little progress has been made with either conventional or biotechnological methods, but field trials designed to test clones identified as salt tolerant in screening trials are underway now in several countries. We conclude that there is justification for cautious optimism about the prospects for improving salt tolerance in forest tree species.

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

PubMed

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.

Ensemble Methods for Classification of Physical Activities from Wrist Accelerometry.

PubMed

Chowdhury, Alok Kumar; Tjondronegoro, Dian; Chandran, Vinod; Trost, Stewart G

2017-09-01

To investigate whether the use of ensemble learning algorithms improve physical activity recognition accuracy compared to the single classifier algorithms, and to compare the classification accuracy achieved by three conventional ensemble machine learning methods (bagging, boosting, random forest) and a custom ensemble model comprising four algorithms commonly used for activity recognition (binary decision tree, k nearest neighbor, support vector machine, and neural network). The study used three independent data sets that included wrist-worn accelerometer data. For each data set, a four-step classification framework consisting of data preprocessing, feature extraction, normalization and feature selection, and classifier training and testing was implemented. For the custom ensemble, decisions from the single classifiers were aggregated using three decision fusion methods: weighted majority vote, naïve Bayes combination, and behavior knowledge space combination. Classifiers were cross-validated using leave-one subject out cross-validation and compared on the basis of average F1 scores. In all three data sets, ensemble learning methods consistently outperformed the individual classifiers. Among the conventional ensemble methods, random forest models provided consistently high activity recognition; however, the custom ensemble model using weighted majority voting demonstrated the highest classification accuracy in two of the three data sets. Combining multiple individual classifiers using conventional or custom ensemble learning methods can improve activity recognition accuracy from wrist-worn accelerometer data.

Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder.

PubMed

Caldwell, Yoko Tsui; Steffen, Patrick R

2018-01-05

Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD. Copyright © 2018 Elsevier B.V. All rights reserved.

A patient with Cotard syndrome who showed an improvement in single photon emission computed tomography findings after successful treatment with antidepressants.

PubMed

Hashioka, Sadayuki; Monji, Akira; Sasaki, Masayuki; Yoshida, Ichiro; Baba, Kanji; Tashiro, Nobutada

2002-01-01

We report the case of a presenile woman with Cotard syndrome, in the context of major depression, who showed an improvement in bilateral frontal hypoperfusion in a SPECT study using 99mTc-HMPAO after undergoing successful treatment with antidepressant therapy. We also retrospectively evaluated her clinical course based on the clinical stages. The symptoms of Cotard syndrome have been reported to change dramatically according to the stages. This peculiarity made it difficult for us to rapidly diagnose Cotard syndrome in the context of major depression, and not dementia, and thereby adequately treat the patient in our case. Differences in the reduced blood flow regions and a time lag from psychiatric remission were observed before the improvement in the SPECT findings when comparing our case with a previously reported case of Cotard syndrome. These differences suggest that the mechanism of Cotard syndrome is still not well understood at the present time.

Effect of pH adjustment, homogenization and diafiltration on physicochemical, reconstitution, functional and rheological properties of medium protein milk protein concentrates (MPC70).

PubMed

Meena, Ganga Sahay; Singh, Ashish Kumar; Gupta, Vijay Kumar; Borad, Sanket; Arora, Sumit; Tomar, Sudhir Kumar

2018-04-01

Poor solubility is the major limiting factor in commercial applications of milk protein concentrates (MPC) powders. Retentate treatments such as pH adjustment using disodium phosphate (Na 2 HPO 4 ), also responsible for calcium chelation with homogenization and; its diafiltration with 150 mM NaCl solution were hypothesized to improve the functional properties of treated MPC70 powders. These treatments significantly improved the solubility, heat stability, water binding, dispersibility, bulk density, flowability, buffer index, foaming and emulsifying capacity of treated powders over control. Rheological behaviour of reconstituted MPC solutions was best explained by Herschel Bulkley model. Compared to rough, large globular structures with dents in control; majorly intact, separate, smaller particles of smooth surface, without any aggregation were observed in SEM micrograph of treated powders. Applied treatments are easy, cost-effective and capable to improve functional properties of treated powders that could replace control MPC70 powder in various food applications where protein functionality is of prime importance.

TMDIM: an improved algorithm for the structure prediction of transmembrane domains of bitopic dimers.

PubMed

Cao, Han; Ng, Marcus C K; Jusoh, Siti Azma; Tai, Hio Kuan; Siu, Shirley W I

2017-09-01

[Formula: see text]-Helical transmembrane proteins are the most important drug targets in rational drug development. However, solving the experimental structures of these proteins remains difficult, therefore computational methods to accurately and efficiently predict the structures are in great demand. We present an improved structure prediction method TMDIM based on Park et al. (Proteins 57:577-585, 2004) for predicting bitopic transmembrane protein dimers. Three major algorithmic improvements are introduction of the packing type classification, the multiple-condition decoy filtering, and the cluster-based candidate selection. In a test of predicting nine known bitopic dimers, approximately 78% of our predictions achieved a successful fit (RMSD <2.0 Å) and 78% of the cases are better predicted than the two other methods compared. Our method provides an alternative for modeling TM bitopic dimers of unknown structures for further computational studies. TMDIM is freely available on the web at https://cbbio.cis.umac.mo/TMDIM . Website is implemented in PHP, MySQL and Apache, with all major browsers supported.

TMDIM: an improved algorithm for the structure prediction of transmembrane domains of bitopic dimers

NASA Astrophysics Data System (ADS)

Cao, Han; Ng, Marcus C. K.; Jusoh, Siti Azma; Tai, Hio Kuan; Siu, Shirley W. I.

2017-09-01

α-Helical transmembrane proteins are the most important drug targets in rational drug development. However, solving the experimental structures of these proteins remains difficult, therefore computational methods to accurately and efficiently predict the structures are in great demand. We present an improved structure prediction method TMDIM based on Park et al. (Proteins 57:577-585, 2004) for predicting bitopic transmembrane protein dimers. Three major algorithmic improvements are introduction of the packing type classification, the multiple-condition decoy filtering, and the cluster-based candidate selection. In a test of predicting nine known bitopic dimers, approximately 78% of our predictions achieved a successful fit (RMSD <2.0 Å) and 78% of the cases are better predicted than the two other methods compared. Our method provides an alternative for modeling TM bitopic dimers of unknown structures for further computational studies. TMDIM is freely available on the web at https://cbbio.cis.umac.mo/TMDIM. Website is implemented in PHP, MySQL and Apache, with all major browsers supported.

Understanding Quality Issues in Your Surgical Department: Comparing the ACS NSQIP With Traditional Morbidity and Mortality Conferences in a Canadian Academic Hospital.

PubMed

Auspitz, Mark; Cleghorn, Michelle C; Tse, Alvina; Sockalingam, Sanjeev; Quereshy, Fayez A; Okrainec, Allan; Jackson, Timothy D

2015-01-01

Review of surgical complications in traditional morbidity and mortality (M&M) rounds remains an important mechanism to identify and discuss quality-of-care issues. This process relies on case selection by providers; therefore, complications identified for review may differ from those captured in comprehensive quality programs such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Additionally, although the ACS NSQIP captures robust data on complications in surgical wards, without strategies to disseminate this information to staff and improve practice, minimal change may result. The objective of this study was to compare complications identified by the ACS NSQIP with those captured in M&M conferences at a large Canadian academic hospital. Retrospective medical record reviews of all patients admitted to the general surgery unit from March 2012 to March 2013 were reviewed. Number and types of complications were recorded for cases that were both submitted and reviewed in M&M rounds and those cases that were submitted but not reviewed. These complications were compared with those extracted from our local ACS NSQIP database. A total of 1348 general surgical procedures were performed. The ACS NSQIP captured complications in 143 patients compared with 58 patients identified for review in M&M rounds. Both the methods identified similar proportions of major and minor complications (ACS NSQIP 52% major, 48% minor; M&M 58% major, 42% minor). More postoperative deaths were entered into the ACS NSQIP (12) than in M&M conferences (8 reviewed and 2 submitted). The ACS NSQIP identified higher proportions of surgical site infections and readmissions. However, M&M conferences captured additional complications in patients who did not undergo surgery and identified potential quality issues in patients who did not ultimately experience an adverse outcome. M&M rounds and the ACS NSQIP provide important and potentially complementary data on surgical quality. Incorporating the ACS NSQIP outcomes data into traditional M&M conferences may help to optimize quality improvement efforts. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A comparative study of traditional lecture methods and interactive lecture methods in introductory geology courses for non-science majors at the college level

NASA Astrophysics Data System (ADS)

Hundley, Stacey A.

In recent years there has been a national call for reform in undergraduate science education. The goal of this reform movement in science education is to develop ways to improve undergraduate student learning with an emphasis on developing more effective teaching practices. Introductory science courses at the college level are generally taught using a traditional lecture format. Recent studies have shown incorporating active learning strategies within the traditional lecture classroom has positive effects on student outcomes. This study focuses on incorporating interactive teaching methods into the traditional lecture classroom to enhance student learning for non-science majors enrolled in introductory geology courses at a private university. Students' experience and instructional preferences regarding introductory geology courses were identified from survey data analysis. The information gained from responses to the questionnaire was utilized to develop an interactive lecture introductory geology course for non-science majors. Student outcomes were examined in introductory geology courses based on two teaching methods: interactive lecture and traditional lecture. There were no significant statistical differences between the groups based on the student outcomes and teaching methods. Incorporating interactive lecture methods did not statistically improve student outcomes when compared to traditional lecture teaching methods. However, the responses to the survey revealed students have a preference for introductory geology courses taught with lecture and instructor-led discussions and students prefer to work independently or in small groups. The results of this study are useful to individuals who teach introductory geology courses and individuals who teach introductory science courses for non-science majors at the college level.

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

PubMed

Lai, Hou-Chuan; Chan, Shun-Ming; Lu, Chueng-He; Wong, Chih-Shung; Cherng, Chen-Hwan; Wu, Zhi-Fu

2017-02-01

Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Major Ion Content of Aerosols from Denali Base Camp during Summer 2013

NASA Astrophysics Data System (ADS)

Wake, C. P.; Burakowski, E. A.; Osterberg, E. C.

2014-12-01

Aerosol samples were collected on Teflon filters at a site up-glacier from Denali Base Camp (2380 m) in Denali National Park, Alaska during May and June of 2013 using an autonomous aerosol sampler powered by solar panels and batteries. The samples were analyzed for major ions via ion chromatography. Surface and fresh snow samples were also collected over the same time period and analyzed for major ions. Ion concentrations in the aerosol samples are completely dominated by NH4+ (mean concentration of 6.6 nmol/m3) and SO4= (mean concentration of 4.0 nmol/m3). Overall, the ion burden in aerosol samples from Denali Base Camp was much lower compared to aerosol samples collected from the Denali National Park and Trapper Creek IMPROVE sites over the same time period. In contrast to the aerosol chemistry, the snow chemistry is more balanced, with NH4+, Ca2+, and Na+ dominating the cation concentrations and NO3-, Cl-, and SO4= dominating the anion concentrations. The higher levels of Ca2+, Na+, and Cl- in the snow (relative to NH4+ and SO4=) compared to relative concentrations in the aerosol samples suggest that dry deposition of sea salt and dust are important contributors to the major ion signals preserved in the snow. This has important ramifications for improving our understanding of the reconstruction of North Pacific climate variability and change from glaciochemical records currently being developed from the 208 m ice cores recovered from the Mt. Hunter plateau (3900 m) during the summer of 2013.

Cost-effectiveness of escitalopram vs. citalopram in major depressive disorder.

PubMed

Fantino, Bruno; Moore, Nicholas; Verdoux, Hélène; Auray, Jean-Paul

2007-03-01

Clinical trials have shown better efficacy of escitalopram over citalopram, and review-based economic models the cost-effectiveness of escitalopram vs. citalopram (brand and generic). No head-to-head clinical trial has, however, evaluated the cost-effectiveness of both drugs so far. The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram (20 mg/day) or citalopram (40 mg/day) over 8 weeks in ambulatory care patients with major depressive disorder (baseline Montgomery-Asberg Depression Rating Scale score > or =30). Resources use was recorded using a standardized form recording use of healthcare services and days of sick leave for the 2-month prestudy period and for the 8-week study period. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (96 euro vs. 163 euro; P<0.05) from a healthcare perspective. Differences were mostly related to lower hospitalization costs for escitalopram compared with citalopram recipients, assuming a parity price between escitalopram and citalopram. Bootstrapped distributions of the cost-effectiveness ratios also showed better effectiveness and lower costs for escitalopram compared with citalopram. Escitalopram is significantly more effective than citalopram, and is associated with lower healthcare costs. This prospective economic analysis demonstrated that escitalopram is a cost-effective first-line treatment option for major depressive disorder.

Nursing students' mathematic calculation skills.

PubMed

Rainboth, Lynde; DeMasi, Chris

2006-12-01

This mixed method study used a pre-test/post-test design to evaluate the efficacy of a teaching strategy in improving beginning nursing student learning outcomes. During a 4-week student teaching period, a convenience sample of 54 sophomore level nursing students were required to complete calculation assignments, taught one calculation method, and mandated to attend medication calculation classes. These students completed pre- and post-math tests and a major medication mathematic exam. Scores from the intervention student group were compared to those achieved by the previous sophomore class. Results demonstrated a statistically significant improvement from pre- to post-test and the students who received the intervention had statistically significantly higher scores on the major medication calculation exam than did the students in the control group. The evaluation completed by the intervention group showed that the students were satisfied with the method and outcome.

Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars.

PubMed

Nirmal, Balakrishnan; Pai, Sathish B; Sripathi, Handattu; Rao, Raghavendra; Prabhu, Smitha; Kudur, Mohan H; Nayak, Sudhir U K

2013-01-01

Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

How rich is Australia's minerals endowment and is it adequate to sustain a major role in meeting international demand?

NASA Astrophysics Data System (ADS)

Lambert, I. B.

2012-04-01

Dr Ian Lambert, Geoscience Australia and Secretary General 34th International Geological Congress Australia has comparative advantages in production of mineral commodities compared to most other countries. These stem from its rich and diverse mineral endowment; availability of regional scale (pre-competitive) geoscience information to lower the risks of exploration; advances in exploration, mining and processing technologies; skilled work force; generally benign physical conditions; and low population density. Building on these strengths, Australia is a major producer and exporter of a wide range of mineral and energy commodities to global markets. Given that demand for most major commodities is likely to continue, and that there will be growing markets for some other commodities, Australia needs to have a strategic view of what is likely to be available for mining. Further, Australia (and the world) needs to be attuned to issues that need to be faced in meeting international demand for commodities in the long term. This presentation outlines how Australia's national minerals inventory is compiled. It discusses trends for Australia's identified mineral resources for major commodities, and how these compare with other major mining nations. It then considers some significant issues in relation to sustaining a strong mining sector - in the medium to long term this requires a strategic approach to achieve goals such as more effective/lower risk exploration particularly in greenfields regions; well-Informed decisions on mining proposals; ongoing significant improvements in efficiencies of energy, water and land use.

Cervical Cancer Screening Interventions for U.S. Latinas: A Systematic Review

ERIC Educational Resources Information Center

Corcoran, Jacqueline; Dattalo, Patrick; Crowley, Meghan

2012-01-01

The high cervical cancer mortality rate among Latinas compared with other ethnic groups in the United States is of major concern. Latina women are almost twice as likely to die from cervical cancer as non-Hispanic white women. To improve Latina cervical cancer screening rates, interventions have been developed and tested. This systematic review…

Comparison of Sugarcane and Energy Cane in Growth and Biomass Production

USDA-ARS?s Scientific Manuscript database

Sugarcane is one of major crops on sand soils in south Florida, but yields and profits are low compared to sugarcane grown on organic soils in the region. Energy cane may be an alternative crop on sand soils in the future to improve profits because of the growing interest of high biomass for energy....

Improving Reading and Literacy in Grades 1-5: A Resource Guide to Research-Based Programs.

ERIC Educational Resources Information Center

St. John, Edward P.; Loescher, Siri Ann; Bardzell, Jeffrey S.

Early reading and literacy have become the focus of policymakers, with a renewed emphasis on the early grades. This resource provides a guide to important and effective research-based reading programs. The guide's in-depth coverage analyzes and compares features, frameworks, tools, methods, and reform components for the following 17 major reading…

Feasibility of magnetic bearings for advanced gas turbine engines

NASA Technical Reports Server (NTRS)

Hibner, David; Rosado, Lewis

1992-01-01

The application of active magnetic bearings to advanced gas turbine engines will provide a product with major improvements compared to current oil lubricated bearing designs. A rethinking of the engine rotating and static structure design is necessary and will provide the designer with significantly more freedom to meet the demanding goals of improved performance, increased durability, higher reliability, and increased thrust to weight ratio via engine weight reduction. The product specific technology necessary for this high speed, high temperature, dynamically complex application has been defined. The resulting benefits from this approach to aircraft engine rotor support and the complementary engine changes and improvements have been assessed.

The comparative impact of the market penetration of energy-efficient measures: A sensitivity analysis of its impact on minority households

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

Bozinovich, L.V.; Poyer, D.A.; Anderson, J.L.

1993-12-01

A sensitivity study was made of the potential market penetration of residential energy efficiency as energy service ratio (ESR) improvements occurred in minority households, by age of house. The study followed a Minority Energy Assessment Model analysis of the National Energy Strategy projections of household energy consumption and prices, with majority, black, and Hispanic subgroup divisions. Electricity and total energy consumption and expenditure patterns were evaluated when the households` ESR improvement followed a logistic negative growth (i.e., market penetration) path. Earlier occurrence of ESR improvements meant greater discounted savings over the 22-year period.

Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults

PubMed Central

Blackwell, Simon E.; Browning, Michael; Mathews, Andrew; Pictet, Arnaud; Welch, James; Davies, Jim; Watson, Peter; Geddes, John R.

2015-01-01

Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work. PMID:25984421

2D Heterostructure coatings of hBN-MoS2 layers for corrosion resistance

NASA Astrophysics Data System (ADS)

Vandana, Sajith; Kochat, Vidya; Lee, Jonghoon; Varshney, Vikas; Yazdi, Sadegh; Shen, Jianfeng; Kosolwattana, Suppanat; Vinod, Soumya; Vajtai, Robert; Roy, Ajit K.; Sekhar Tiwary, Chandra; Ajayan, P. M.

2017-02-01

Heterostructures of atomically thin 2D materials could have improved physical, mechanical and chemical properties as compared to its individual components. Here we report, the effect of heterostructure coatings of hBN and MoS2 on the corrosion behavior as compared to coatings employing the individual 2D layer compositions. The poor corrosion resistance of MoS2 (widely used as wear resistant coating) can be improved by incorporating hBN sheets. Depending on the atomic stacking of the 2D sheets, we can further engineer the corrosion resistance properties of these coatings. A detailed spectroscopy and microscopy analysis has been used to characterize the different combinations of layered coatings. Detailed DFT based calculation reveals that the effect on the electrical properties due to atomic stacking is one of the major reasons for the improvement seen in corrosion resistance.

Effect of second cooling on the chemical components of essential oils from orange peel (Citrus sinensis).

PubMed

Chen, Yulong; Wu, Jijun; Xu, Yujuan; Fu, Manqing; Xiao, Gengsheng

2014-09-03

A second cooling was added to the oil collectors of an improved Clevenger-type apparatus (ICT) to investigate the thermal reaction of essential oils from orange peel compared to a traditional Clevenger-type apparatus (CT). The results demonstrated the yield rate of essential oil from ICT was significantly higher (p < 0.05) than that from CT. The major components of the essential oils consisted of monoterpenes, such as d-limonene, β-myrcene, β-pinene, γ-terpinene, α-pinene. Interestingly, ICT prevented the thermal reaction-the transformation of β-myrcene to β-thujene-and reduced the oxidation on α-pinene and β-pinene of the essential oil in comparison to CT. In addition, the yield rate of γ-terpinene can also be improved via ICT compared to CT. Thus, ICT is an effective improvement to traditional CT.

Efficacy of Desvenlafaxine Compared With Placebo in Major Depressive Disorder Patients by Age Group and Severity of Depression at Baseline.

PubMed

Mosca, Daniel; Zhang, Min; Prieto, Rita; Boucher, Matthieu

2017-04-01

This post hoc meta-analysis evaluated the efficacy and safety of desvenlafaxine 50 and 100 mg versus placebo across age groups and severity of depression at baseline in patients with major depressive disorder. Data from placebo and desvenlafaxine 50-mg and 100-mg dose arms were pooled from 9 short-term, placebo-controlled, major depressive disorder studies (N = 4279). Effects of age (18-40 years, >40 to <55 years, 55-<65 years, and ≥65 years) and baseline depression severity (mild, 17-item Hamilton Rating Scale for Depression total score [HAM-D17] ≤18; moderate, HAM-D17 >18 to <25; severe, HAM-D17 ≥25) on desvenlafaxine efficacy were assessed using analysis of covariance for continuous end points and logistic regression for categorical end points. Desvenlafaxine-treated (50 or 100 mg/d) patients had significantly (P < 0.05, 2-sided) greater improvement in most measures of depression and function compared with placebo for patients 18 to 40 years, older than 40 to younger than 55 years, and 55 to younger than 65 years, with no significant evidence of an effect of age. Desvenlafaxine significantly improved most measures of depression and function in moderately and severely depressed patients. There was a significant baseline severity by treatment interaction for HAM-D17 total score only (P = 0.027), with a larger treatment effect for the severely depressed group. Desvenlafaxine significantly improved depressive symptoms in patients younger than 65 years and in patients with moderate or severe baseline depression. Sample sizes were not adequate to assess desvenlafaxine efficacy in patients 65 years or older or with mild baseline depression.

Major Depressive Disorder in recovery and neuropsychological functioning: effects of selective serotonin reuptake inhibitor and dual inhibitor depression treatments on residual cognitive deficits in patients with Major Depressive Disorder in recovery.

PubMed

Herrera-Guzmán, Ixchel; Gudayol-Ferré, Esteve; Herrera-Abarca, Jorge E; Herrera-Guzmán, Daniel; Montelongo-Pedraza, Pedro; Padrós Blázquez, Ferran; Peró-Cebollero, Maribel; Guàrdia-Olmos, Joan

2010-06-01

Cognitive disturbances in Major Depressive Disorder (MDD) could persist beyond the symptomatic phase of the illness. However, the works addressing this topic did not usually account for the possible impact of medication on the cognitive functions of depressed patients. The present study aims to investigate whether MDD patients in remission treated with selective serotonin reuptake inhibitors (SSRI) or dual serotonergic-noradrenergic reuptake inhibitors (SNRI) show cognitive deficits, to study whether the same patients suffer neuropsychological disturbances when they are unmedicated and in recovery phase, and if the previous pharmacological treatment used to achieve the remission of MDD clinical symptoms had any effect in the profile of these patients' cognitive performance in the recovery phase. Thirty-six subjects with MDD treated with escitalopram and 37 depressed patients with duloxetine were compared both in remission phase and 24 weeks later, when they were unmedicated and in recovery phase. They were also compared, in both moments, to 37 healthy subjects. The control subjects showed a broader better cognitive performance than MDD patients in both measurement moments, but several cognitive functions improved over time. Also, the patients treated with SNRI performed better in memory tests than the SNRI-treated patients in remission phase, and in recovery phase. Our sample size is somewhat small, and we followed our patients only for 6months after treatment. Cognitive functions improve over time in patients with MDD beyond the remission phase, and the antidepressant treatment class used in acute depressive phase could influence his/her memory improvement. Copyright 2009 Elsevier B.V. All rights reserved.

Quality of life assessments in major depressive disorder: a review of the literature.

PubMed

Papakostas, George I; Petersen, Timothy; Mahal, Yasmin; Mischoulon, David; Nierenberg, Andrew A; Fava, Maurizio

2004-01-01

According to the DSM-IV classification, a diagnosis of Major Depressive Disorder (MDD) is possible only when there is evidence of significant inference with functioning. However, despite the high prevalence of MDD in the general population, it is uncommon for clinicians to assess overall functioning in a systematic way before making such diagnosis. An important correlate of functioning is quality of life, which is typically defined as "patients' own assessments of how they feel about what they have, how they are functioning, and their ability to derive pleasure from their life activities". In the present article, we review studies focusing on the relationship between depression and quality of life, particularly focusing on the impact of the treatment of depression on quality of life. Studies focusing on the quality of life in MDD are reviewed. Candidate studies published between 1970 and recently were initially identified by Pubmed and Ovid search cross-referencing the terms "quality of life," "psychosocial functioning" with "major depression" and "treatment." A number of studies report poorer quality of life in MDD patients compared to controls. Several studies also report an improvement in quality of life measures during various phases of treatment with antidepressants and/or psychotherapy. However, trials comparing the role of newer psychopharmacologic agents in the acute phase of treatment, and the role of newer psychotherapies in the continuation and maintenance phases of treatment in restoring psychosocial functioning and improving the quality of life in MDD are lacking. Exploring the impact of these modalities on psychosocial function and quality of life in MDD are necessary to help translate clinical response into restoration of psychosocial function and to thus further improve the standard of care.

Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program.

PubMed

Muluneh, Benyam; Schneider, Molly; Faso, Aimee; Amerine, Lindsey; Daniels, Rowell; Crisp, Brett; Valgus, John; Savage, Scott

2018-06-01

To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

A Network Meta-Analysis Comparing Effects of Various Antidepressant Classes on the Digit Symbol Substitution Test (DSST) as a Measure of Cognitive Dysfunction in Patients with Major Depressive Disorder.

PubMed

Baune, Bernhard T; Brignone, Mélanie; Larsen, Klaus Groes

2018-02-01

Major depressive disorder is a common condition that often includes cognitive dysfunction. A systematic literature review of studies and a network meta-analysis were carried out to assess the relative effect of antidepressants on cognitive dysfunction in major depressive disorder. MEDLINE, Embase, Cochrane, CDSR, and PsychINFO databases; clinical trial registries; and relevant conference abstracts were searched for randomized controlled trials assessing the effects of antidepressants/placebo on cognition. A network meta-analysis comparing antidepressants was conducted using a random effects model. The database search retrieved 11337 citations, of which 72 randomized controlled trials from 103 publications met the inclusion criteria. The review identified 86 cognitive tests assessing the effect of antidepressants on cognitive functioning. However, the Digit Symbol Substitution Test, which targets multiple domains of cognition and is recognized as being sensitive to change, was the only test that was used across 12 of the included randomized controlled trials and that allowed the construction of a stable network suitable for the network meta-analysis. The interventions assessed included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and other non-selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors. The network meta-analysis using the Digit Symbol Substitution Test showed that vortioxetine was the only antidepressant that improved cognitive dysfunction on the Digit Symbol Substitution Test vs placebo {standardized mean difference: 0.325 (95% CI = 0.120; 0.529, P=.009}. Compared with other antidepressants, vortioxetine was statistically more efficacious on the Digit Symbol Substitution Test vs escitalopram, nortriptyline, and the selective serotonin reuptake inhibitor and tricyclic antidepressant classes. This study highlighted the large variability in measures used to assess cognitive functioning. The findings on the Digit Symbol Substitution Test indicate differential effects of various antidepressants on improving cognitive function in patients with major depressive disorder. © The Author 2017. Published by Oxford University Press on behalf of CINP.

The Effect of Social Integration on Outcomes after Major Lower Extremity Amputation

PubMed Central

Hawkins, Alexander T.; Pallangyo, Anthony J.; Herman, Ayesiga M.; Schaumeier, Maria J.; Smith, Ann D.; Hevelone, Nathanael D.; Crandell, David M.; Nguyen, Louis

2016-01-01

Objective Major lower extremity amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. Methods From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form (Craig Handicap Assessment and Reporting Technique (CHART). Systemic social support was assessed by comparing a US and Tanzanian population. Walking function was measured using the 6MWT and quality of life (QoL) was measured using the EQ-5D. Results 102 major lower extremity amputees were recruited. 63 patients were enrolled in the US with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs. slow walk 23% vs. fast walk 10%; P=.01) and those with high social integration were more likely to be fast walkers (no walk 10% vs. slow walk 59% vs. fast walk 74%; P=.01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing quality of life scores in a multivariable analysis (β .002; SE .0008; P = .02). In comparing the US population with the Tanzanian cohort (39 subjects), there were no significant differences between functional or quality of life outcomes in the systemic social support analysis. Conclusions In the US population, increased social integration is associated with both improved function and quality of life outcomes among major lower extremity amputees. Systemic social support, as measured by comparing the US population with a Tanzanian population, was not associated with improved function or quality of life outcomes. In the US, steps should be taken to identify and aid amputees with poor social integration. PMID:26474508

Death Certification Errors and the Effect on Mortality Statistics.

PubMed

McGivern, Lauri; Shulman, Leanne; Carney, Jan K; Shapiro, Steven; Bundock, Elizabeth

Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non-Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics. We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates. Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death ( P < .001). Certificates for deaths occurring in hospitals were more likely to have major errors than certificates for deaths occurring at a private residence (59% vs 39%, P < .001). A total of 580 (93%) death certificates had a change in ICD-10 codes between the original and mock certificates, of which 348 (60%) had a change in the underlying cause-of-death code. Error rates on death certificates in Vermont are high and extend to ICD-10 coding, thereby affecting national mortality statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics.

Efficacy of desvenlafaxine 50 mg compared with placebo in patients with moderate or severe major depressive disorder: a pooled analysis of six randomized, double-blind, placebo-controlled studies.

PubMed

Papakostas, George I; Culpepper, Larry; Fayyad, Rana S; Musgnung, Jeff; Guico-Pabia, Christine J

2013-11-01

This study assessed the efficacy of desvenlafaxine 50 mg/day compared with placebo for treating moderate or severe major depressive disorder (MDD). Data were pooled from six double-blind, placebo-controlled, desvenlafaxine 50 mg/day fixed-dose studies in adults with MDD. The primary endpoint was improvement in 17-item Hamilton Rating Scale for Depression (HAM-D17) scores from baseline at week 8. HAM-D17 changes were evaluated in patients with moderate (18

Long-term follow-up of the United Kingdom Medical Research Council protocols for childhood acute Lymphoblastic leukaemia, 1980–2001

PubMed Central

Mitchell, Christopher; Richards, Sue; Harrison, Christine J; Eden, Tim

2009-01-01

Between 1980 and 2001, the United Kingdom Medical Research Council Childhood Leukemia Working Party has conducted 4 clinical trial in acute lymphoblastic leukemia, which have recruited a total of 6516 patients. UKALL VIII examined the role of daunorubicin in induction chemotherapy, and UKALL X examined the role of post-induction intensification. Both resulted in major improvement in the outcomes. UKALL XI examined the efficacy of different methods of CNS-directed therapy and the effects of an additional intensification. ALL97, which was initially based on the UKALL X D template (two intensification phases), examined the role of different steroids in induction and different thiopurines through continuing chemotherapy. A reappraisal of results from UKALL XI compared to other cooperative group results led to a redesign in 1999, which subsequently resulted in a major improvement in outcomes. Additionally, ALL97 and 97/99 demonstrated a significant advantage for the use of dexamethasone rather than prednisolone; although the use of 6-thioguanine resulted in fewer relapses, this advantage was offset by an increased incidence of deaths in remission. Over the era encompassed by these four trials there has been a major improvement in both event-free and overall survival for children in the UK with ALL. PMID:20010621

Do Biology Students Really Hate Math? Empirical Insights into Undergraduate Life Science Majors’ Emotions about Mathematics

PubMed Central

Wachsmuth, Lucas P.; Runyon, Christopher R.; Drake, John M.; Dolan, Erin L.

2017-01-01

Undergraduate life science majors are reputed to have negative emotions toward mathematics, yet little empirical evidence supports this. We sought to compare emotions of majors in the life sciences versus other natural sciences and math. We adapted the Attitudes toward the Subject of Chemistry Inventory to create an Attitudes toward the Subject of Mathematics Inventory (ASMI). We collected data from 359 science and math majors at two research universities and conducted a series of statistical tests that indicated that four AMSI items comprised a reasonable measure of students’ emotional satisfaction with math. We then compared life science and non–life science majors and found that major had a small to moderate relationship with students’ responses. Gender also had a small relationship with students’ responses, while students’ race, ethnicity, and year in school had no observable relationship. Using latent profile analysis, we identified three groups—students who were emotionally satisfied with math, emotionally dissatisfied with math, and neutral. These results and the emotional satisfaction with math scale should be useful for identifying differences in other undergraduate populations, determining the malleability of undergraduates’ emotional satisfaction with math, and testing effects of interventions aimed at improving life science majors’ attitudes toward math. PMID:28798211

Bayesian logistic regression approaches to predict incorrect DRG assignment.

PubMed

Suleiman, Mani; Demirhan, Haydar; Boyd, Leanne; Girosi, Federico; Aksakalli, Vural

2018-05-07

Episodes of care involving similar diagnoses and treatments and requiring similar levels of resource utilisation are grouped to the same Diagnosis-Related Group (DRG). In jurisdictions which implement DRG based payment systems, DRGs are a major determinant of funding for inpatient care. Hence, service providers often dedicate auditing staff to the task of checking that episodes have been coded to the correct DRG. The use of statistical models to estimate an episode's probability of DRG error can significantly improve the efficiency of clinical coding audits. This study implements Bayesian logistic regression models with weakly informative prior distributions to estimate the likelihood that episodes require a DRG revision, comparing these models with each other and to classical maximum likelihood estimates. All Bayesian approaches had more stable model parameters than maximum likelihood. The best performing Bayesian model improved overall classification per- formance by 6% compared to maximum likelihood, with a 34% gain compared to random classification, respectively. We found that the original DRG, coder and the day of coding all have a significant effect on the likelihood of DRG error. Use of Bayesian approaches has improved model parameter stability and classification accuracy. This method has already lead to improved audit efficiency in an operational capacity.

An improved wave rotor refrigerator using an outside gas flow for recycling the expansion work

NASA Astrophysics Data System (ADS)

Zhao, J.; Hu, D.

2017-03-01

To overcome the bottleneck of traditional gas wave refrigeration, an improved wave rotor refrigerator (WRR) cycle has been proposed, in which the expansion work was recycled during the process of refrigeration. Thermodynamic analysis of the two cycles shows that the refrigeration efficiency of the improved WRR cycle has been greatly increased compared with the traditional WRR. The performance of an improved WRR was investigated by adjusting the major operational parameters, such as the rotational speed of the wave rotor, port size, and inflow overpressure. The experimental results show that pressure loss can be reduced by nearly 40 % in this improved refrigeration system. Meanwhile, a two-dimensional numerical simulation was performed to understand the wave interactions that take place inside the rotor channels.

Does pedometer goal setting improve physical activity among Native elders? Results from a randomized pilot study.

PubMed

Sawchuk, Craig N; Russo, Joan E; Charles, Steve; Goldberg, Jack; Forquera, Ralph; Roy-Byrne, Peter; Buchwald, Dedra

2011-01-01

We examined if step-count goal setting resulted in increases in physical activity and walking compared to only monitoring step counts with pedometers among American Indian/Alaska Native elders. Outcomes included step counts, self-reported physical activity and well-being, and performance on the 6-minute walk test. Although no significant between-group differences were found, within-group analyses indicated that elders significantly improved on the majority of step count, physical activity, health-related quality of life, and 6-minute walk outcomes.

Precision breeding for RNAi suppression of a major 4-coumarate:coenzyme A ligase gene improves cell wall saccharification from field grown sugarcane.

PubMed

Jung, Je Hyeong; Kannan, Baskaran; Dermawan, Hugo; Moxley, Geoffrey W; Altpeter, Fredy

2016-11-01

Sugarcane (Saccharum spp. hybrids) is a major feedstock for commercial bioethanol production. The recent integration of conversion technologies that utilize lignocellulosic sugarcane residues as well as sucrose from stem internodes has elevated bioethanol yields. RNAi suppression of lignin biosynthetic enzymes is a successful strategy to improve the saccharification of lignocellulosic biomass. 4-coumarate:coenzyme A ligase (4CL) is a key enzyme in the biosynthesis of phenylpropanoid metabolites, such as lignin and flavonoids. Identifying a major 4CL involved in lignin biosynthesis among multiple isoforms with functional divergence is key to manipulate lignin biosynthesis. In this study, two full length 4CL genes (Sh4CL1 and Sh4CL2) were isolated and characterized in sugarcane. Phylogenetic, expression and RNA interference (RNAi) analysis confirmed that Sh4CL1 is a major lignin biosynthetic gene. An intragenic precision breeding strategy may facilitate the regulatory approval of the genetically improved events and was used for RNAi suppression of Sh4CL1. Both, the RNAi inducing cassette and the expression cassette for the mutated ALS selection marker consisted entirely of DNA sequences from sugarcane or the sexually compatible species Sorghum bicolor. Field grown sugarcane with intragenic RNAi suppression of Sh4CL1 resulted in reduction of the total lignin content by up to 16.5 % along with altered monolignol ratios without reduction in biomass yield. Mature, field grown, intragenic sugarcane events displayed 52-76 % improved saccharification efficiency of lignocellulosic biomass compared to wild type (WT) controls. This demonstrates for the first time that an intragenic approach can add significant value to lignocellulosic feedstocks for biofuel and biochemical production.

Comparison of China's Environmental Impact Assessment (EIA) law with the European Union (EU) EIA Directive.

PubMed

Chen, Qiaoling; Zhang, Yuanzhi; Ekroos, Ari

2007-09-01

In this paper, we first review the development of China's Environmental Impact Assessment (EIA) system in the past 30 years. Then we compare the framework and operational procedures of China's new EIA law with those of the EU EIA Directive. We also compare public participation, as well as sanctions and control in the two EIA systems. In addition, we identify where the processes in both EIA systems are similar or different from one another. By comparison, we noted that there are at least three obvious weaknesses in China's EIA system: (1) the application of new models for EIA legislation; (2) the improvement of EIA guidance and education; and (3) the enhancement of public participation in EIA process. Our study indicates that these three major shortcomings should be overcome and improved in China's EIA system, when compared with the EU EIA system.

A Comparison of Secondary Chemistry Courses and Chemistry Teacher Preparation Programs in Iowa and Saint Petersburg, Russia

NASA Astrophysics Data System (ADS)

Sanger, Michael J.; Brincks, Erik L.; Phelps, Amy J.; Pak, Maria S.; Lyovkin, Antony N.

2001-09-01

This paper, which is a result of the collaboration between the University of Northern Iowa (UNI) in Cedar Falls, Iowa, and Herzen State Pedagogical University of Russia in Saint Petersburg, compares the 7-12 chemistry courses in Iowa and Saint Petersburg and the chemistry teacher preparation programs at UNI and Herzen. Differences in the 7-12 chemistry courses include curriculum design (spiral versus layer cake), students' extracurricular activities, and access to technology in the classroom. Differences in the chemistry teacher preparation programs include the number of methods and chemistry content courses required, the number of chemistry teaching majors, the proportion of teaching majors enrolled in the different natural science programs, and the typical minors and endorsements received by these majors. Although we noted many differences in chemistry instruction between Iowa and Saint Petersburg, the secondary and college instructors still face many similar issues, which include overcoming student chemophobia, improving students' algorithmic and problem-solving skills, improving students' conceptual understanding at the particulate level, and dealing with shortages in qualified secondary science teachers.

Accuracy of the Surgeons' Clinical Prediction of Postoperative Major Complications Using a Visual Analog Scale.

PubMed

Woodfield, John C; Sagar, Peter M; Thekkinkattil, Dinesh K; Gogu, Praveen; Plank, Lindsay D; Burke, Dermot

2017-01-01

Although the risk factors that contribute to postoperative complications are well recognized, prediction in the context of a particular patient is more difficult. We were interested in using a visual analog scale (VAS) to capture surgeons' prediction of the risk of a major complication and to examine whether this could be improved. The study was performed in 3 stages. In phase I, the surgeon assessed the risk of a major complication on a 100-mm VAS immediately before and after surgery. A quality control questionnaire was designed to check if the VAS was being scored as a linear scale. In phase II, a VAS with 6 subscales for different areas of clinical risk was introduced. In phase III, predictions were completed following the presentation of detailed feedback on the accuracy of prediction of complications. In total, 1295 predictions were made by 58 surgeons in 859 patients. Eight surgeons did not use a linear scale (6 logarithmic, 2 used 4 categories of risk). Surgeons made a meaningful prediction of major complications (preoperative median score 40 mm for complications v. 22 mm for no complication, P < 0.001; postoperative 46 mm v. 21 mm, P < 0.001). In phase I, the discrimination of prediction for preoperative (0.778), postoperative (0.810), and POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) morbidity (0.750) prediction was similar. Although there was no improvement in prediction with a multidimensional VAS, there was a significant improvement in the discrimination of prediction after feedback (preoperative, 0.895; postoperative, 0.918). Awareness of different ways a VAS is scored is important when designing and interpreting studies. Clinical assessment of major complications by the surgeon was initially comparable to the prediction of the POSSUM morbidity score and improved significantly following the presentation of clinically relevant feedback. © The Author(s) 2016.

Silybum marianum pericarp yields enhanced silymarin products.

PubMed

AbouZid, Sameh F; Chen, Shao-Nong; McAlpine, James B; Friesen, J Brent; Pauli, Guido F

2016-07-01

An improved method for the purification of silymarin, the flavonolignan complex from the fruits of milk thistle, Silybum marianum, is reported. The method enables a more efficient extraction of silymarin from the pericarp after it has been separated mechanically from the rest of the fruits. Accelerated solvent extraction (ASE) was employed for each extraction procedure. Quantitation of the eight major silymarin components in the pericarp extract was compared to that of the whole fruit extract using two orthogonal analytical methods. The pericarp extract showed higher silymarin content (2.24-fold by HPLC and 2.12-fold by qHNMR) than whole fruit extract using acetone as an extraction solvent following defatting with hexane. Furthermore, the mg/g recovery of silymarin major components was not diminished by eliminating the hexane defatting step from the pericarp extraction procedure. The efficiencies of acetone, ethanol, and methanol as extraction solvents were compared. Methanol pericarp extract showed the highest content of the silymarin major components, 2.72-fold higher than an extract prepared from the whole fruits using acetone. Finally, all of the major silymarin components showed a higher w/w content in the pericarp extract than in a commercial extract. Copyright © 2016 Elsevier B.V. All rights reserved.

Increased Ghrelin Levels and Unchanged Adipocytokine Levels in Major Depressive Disorder.

PubMed

Tunçel, Özgür Korhan; Akbaş, Seher; Bilgici, Birşen

2016-10-01

One of the hypotheses of the pathophysiology of major depressive disorder (MDD) proposes that there is a relationship between adipocytokine and ghrelin levels and depression. Patients with major depression with a BMI ≤25 kg/m 2 between the ages of 11 and 18 years (n = 30) were compared with a healthy control group (n = 30). Both groups were evaluated across a pretreatment period (MD-PT) and an improved period (MD-I). We measured serum leptin, adiponectin, resistin, and ghrelin levels and other parameters related to metabolic syndrome, such as glucose, insulin, insulin resistance (homeostasis model assessment [HOMA]), triglycerides (TG), and total cholesterol (TCHOL). Leptin, adiponectin, and resistin levels did not differ across groups; however, ghrelin levels were increased in the MD-I group compared with the control and MD-PT groups (p < 0.05). HOMA levels were also higher in the MD-PT group than in the control group (p < 0.05). After treatment, there was no difference in this measurement. The relationship between adipocytokines and major depression may be dependent on ghrelin levels as a result of antidepressant treatment and subsequent obesity.

Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients.

PubMed

Benda, Nathalie M M; Seeger, Joost P H; Stevens, Guus G C F; Hijmans-Kersten, Bregina T P; van Dijk, Arie P J; Bellersen, Louise; Lamfers, Evert J P; Hopman, Maria T E; Thijssen, Dick H J

2015-01-01

Physical fitness is an important prognostic factor in heart failure (HF). To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT). We comprehensively compared effects of HIT versus continuous training (CT) in HF patients NYHA II-III on physical fitness, cardiovascular function and structure, and quality of life, and hypothesize that HIT leads to superior improvements compared to CT. Twenty HF patients (male:female 19:1, 64±8 yrs, ejection fraction 38±6%) were allocated to 12-weeks of HIT (10*1-minute at 90% maximal workload-alternated by 2.5 minutes at 30% maximal workload) or CT (30 minutes at 60-75% of maximal workload). Before and after intervention, we examined physical fitness (incremental cycling test), cardiac function and structure (echocardiography), vascular function and structure (ultrasound) and quality of life (SF-36, Minnesota living with HF questionnaire (MLHFQ)). Training improved maximal workload, peak oxygen uptake (VO2peak) related to the predicted VO2peak, oxygen uptake at the anaerobic threshold, and maximal oxygen pulse (all P<0.05), whilst no differences were present between HIT and CT (N.S.). We found no major changes in resting cardiovascular function and structure. SF-36 physical function score improved after training (P<0.05), whilst SF-36 total score and MLHFQ did not change after training (N.S.). Training induced significant improvements in parameters of physical fitness, although no evidence for superiority of HIT over CT was demonstrated. No major effect of training was found on cardiovascular structure and function or quality of life in HF patients NYHA II-III. Nederlands Trial Register NTR3671.

Variations in injury characteristics among paediatric patients following trauma: A retrospective descriptive analysis comparing pre-hospital and in-hospital deaths at Kamuzu Central Hospital, Lilongwe, Malawi.

PubMed

Purcell, Laura; Mabedi, Charles E; Gallaher, Jared; Mjuweni, Steven; McLean, Sean; Cairns, Bruce; Charles, Anthony

2017-06-01

Trauma is a major cause of paediatric mortality in sub-Saharan Africa. In absence of pre-hospital care, the injury mechanism and cause of death is difficult to characterise. Injury characteristics of pre-hospital deaths (PHD) versus in-hospital deaths (IHD) were compared. Using our trauma surveillance database, a retrospective, descriptive analysis of children (<18 years) presenting to Kamuzu Central Hospital in Lilongwe, Malawi from 2008 to 2013 was performed. Patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis. Of 30,462 paediatric trauma patients presenting between 2008 and 2013, 170 and 173 were PHD and IHD, respectively. In PHD and IHD patients mean age was 7.3±4.9 v 5.2±4.3 (p<0.001), respectively. IHD patients were more likely transported via ambulance than those PHD, 51.2% v 8.3% (p<0.001). The primary mechanisms of injury for PHD were road traffic injuries (RTI) (45.8%) and drowning (22.0%), with head injury (46.7%) being the predominant cause of death. Burns were the leading mechanism of injury (61.8%) and cause of death (61.9%) in IHD, with a mean total body surface area involvement of 24.7±16.0%. RTI remains Malawi's major driver of paediatric mortality. A majority of these deaths attributed to head injury occur prior to hospitalisation; therefore the mortality burden is underestimated if accounting for IHD alone. Death in burn patients is likely due to under-resuscitation or sepsis. Improving pre-hospital care and head injury and burn management can improve injury related paediatric mortality.

Increased situation awareness in major incidents-radio frequency identification (RFID) technique: a promising tool.

PubMed

Jokela, Jorma; Rådestad, Monica; Gryth, Dan; Nilsson, Helené; Rüter, Anders; Svensson, Leif; Harkke, Ville; Luoto, Markku; Castrén, Maaret

2012-02-01

In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.

Retrotransposons Are the Major Contributors to the Expansion of the Drosophila ananassae Muller F Element

PubMed Central

Shaffer, Christopher D.; Chen, Elizabeth J.; Quisenberry, Thomas J.; Ko, Kevin; Braverman, John M.; Giarla, Thomas C.; Mortimer, Nathan T.; Reed, Laura K.; Smith, Sheryl T.; Robic, Srebrenka; McCartha, Shannon R.; Perry, Danielle R.; Prescod, Lindsay M.; Sheppard, Zenyth A.; Saville, Ken J.; McClish, Allison; Morlock, Emily A.; Sochor, Victoria R.; Stanton, Brittney; Veysey-White, Isaac C.; Revie, Dennis; Jimenez, Luis A.; Palomino, Jennifer J.; Patao, Melissa D.; Patao, Shane M.; Himelblau, Edward T.; Campbell, Jaclyn D.; Hertz, Alexandra L.; McEvilly, Maddison F.; Wagner, Allison R.; Youngblom, James; Bedi, Baljit; Bettincourt, Jeffery; Duso, Erin; Her, Maiye; Hilton, William; House, Samantha; Karimi, Masud; Kumimoto, Kevin; Lee, Rebekah; Lopez, Darryl; Odisho, George; Prasad, Ricky; Robbins, Holly Lyn; Sandhu, Tanveer; Selfridge, Tracy; Tsukashima, Kara; Yosif, Hani; Kokan, Nighat P.; Britt, Latia; Zoellner, Alycia; Spana, Eric P.; Chlebina, Ben T.; Chong, Insun; Friedman, Harrison; Mammo, Danny A.; Ng, Chun L.; Nikam, Vinayak S.; Schwartz, Nicholas U.; Xu, Thomas Q.; Burg, Martin G.; Batten, Spencer M.; Corbeill, Lindsay M.; Enoch, Erica; Ensign, Jesse J.; Franks, Mary E.; Haiker, Breanna; Ingles, Judith A.; Kirkland, Lyndsay D.; Lorenz-Guertin, Joshua M.; Matthews, Jordan; Mittig, Cody M.; Monsma, Nicholaus; Olson, Katherine J.; Perez-Aragon, Guillermo; Ramic, Alen; Ramirez, Jordan R.; Scheiber, Christopher; Schneider, Patrick A.; Schultz, Devon E.; Simon, Matthew; Spencer, Eric; Wernette, Adam C.; Wykle, Maxine E.; Zavala-Arellano, Elizabeth; McDonald, Mitchell J.; Ostby, Kristine; Wendland, Peter; DiAngelo, Justin R.; Ceasrine, Alexis M.; Cox, Amanda H.; Docherty, James E.B.; Gingras, Robert M.; Grieb, Stephanie M.; Pavia, Michael J.; Personius, Casey L.; Polak, Grzegorz L.; Beach, Dale L.; Cerritos, Heaven L.; Horansky, Edward A.; Sharif, Karim A.; Moran, Ryan; Parrish, Susan; Bickford, Kirsten; Bland, Jennifer; Broussard, Juliana; Campbell, Kerry; Deibel, Katelynn E.; Forka, Richard; Lemke, Monika C.; Nelson, Marlee B.; O'Keeffe, Catherine; Ramey, S. Mariel; Schmidt, Luke; Villegas, Paola; Jones, Christopher J.; Christ, Stephanie L.; Mamari, Sami; Rinaldi, Adam S.; Stity, Ghazal; Hark, Amy T.; Scheuerman, Mark; Silver Key, S. Catherine; McRae, Briana D.; Haberman, Adam S.; Asinof, Sam; Carrington, Harriette; Drumm, Kelly; Embry, Terrance; McGuire, Richard; Miller-Foreman, Drew; Rosen, Stella; Safa, Nadia; Schultz, Darrin; Segal, Matt; Shevin, Yakov; Svoronos, Petros; Vuong, Tam; Skuse, Gary; Paetkau, Don W.; Bridgman, Rachael K.; Brown, Charlotte M.; Carroll, Alicia R.; Gifford, Francesca M.; Gillespie, Julie Beth; Herman, Susan E.; Holtcamp, Krystal L.; Host, Misha A.; Hussey, Gabrielle; Kramer, Danielle M.; Lawrence, Joan Q.; Martin, Madeline M.; Niemiec, Ellen N.; O'Reilly, Ashleigh P.; Pahl, Olivia A.; Quintana, Guadalupe; Rettie, Elizabeth A.S.; Richardson, Torie L.; Rodriguez, Arianne E.; Rodriguez, Mona O.; Schiraldi, Laura; Smith, Joanna J.; Sugrue, Kelsey F.; Suriano, Lindsey J.; Takach, Kaitlyn E.; Vasquez, Arielle M.; Velez, Ximena; Villafuerte, Elizabeth J.; Vives, Laura T.; Zellmer, Victoria R.; Hauke, Jeanette; Hauser, Charles R.; Barker, Karolyn; Cannon, Laurie; Parsamian, Perouza; Parsons, Samantha; Wichman, Zachariah; Bazinet, Christopher W.; Johnson, Diana E.; Bangura, Abubakarr; Black, Jordan A.; Chevee, Victoria; Einsteen, Sarah A.; Hilton, Sarah K.; Kollmer, Max; Nadendla, Rahul; Stamm, Joyce; Fafara-Thompson, Antoinette E.; Gygi, Amber M.; Ogawa, Emmy E.; Van Camp, Matt; Kocsisova, Zuzana; Leatherman, Judith L.; Modahl, Cassie M.; Rubin, Michael R.; Apiz-Saab, Susana S.; Arias-Mejias, Suzette M.; Carrion-Ortiz, Carlos F.; Claudio-Vazquez, Patricia N.; Espada-Green, Debbie M.; Feliciano-Camacho, Marium; Gonzalez-Bonilla, Karina M.; Taboas-Arroyo, Mariela; Vargas-Franco, Dorianmarie; Montañez-Gonzalez, Raquel; Perez-Otero, Joseph; Rivera-Burgos, Myrielis; Rivera-Rosario, Francisco J.; Eisler, Heather L.; Alexander, Jackie; Begley, Samatha K.; Gabbard, Deana; Allen, Robert J.; Aung, Wint Yan; Barshop, William D.; Boozalis, Amanda; Chu, Vanessa P.; Davis, Jeremy S.; Duggal, Ryan N.; Franklin, Robert; Gavinski, Katherine; Gebreyesus, Heran; Gong, Henry Z.; Greenstein, Rachel A.; Guo, Averill D.; Hanson, Casey; Homa, Kaitlin E.; Hsu, Simon C.; Huang, Yi; Huo, Lucy; Jacobs, Sarah; Jia, Sasha; Jung, Kyle L.; Wai-Chee Kong, Sarah; Kroll, Matthew R.; Lee, Brandon M.; Lee, Paul F.; Levine, Kevin M.; Li, Amy S.; Liu, Chengyu; Liu, Max Mian; Lousararian, Adam P.; Lowery, Peter B.; Mallya, Allyson P.; Marcus, Joseph E.; Ng, Patrick C.; Nguyen, Hien P.; Patel, Ruchik; Precht, Hashini; Rastogi, Suchita; Sarezky, Jonathan M.; Schefkind, Adam; Schultz, Michael B.; Shen, Delia; Skorupa, Tara; Spies, Nicholas C.; Stancu, Gabriel; Vivian Tsang, Hiu Man; Turski, Alice L.; Venkat, Rohit; Waldman, Leah E.; Wang, Kaidi; Wang, Tracy; Wei, Jeffrey W.; Wu, Dennis Y.; Xiong, David D.; Yu, Jack; Zhou, Karen; McNeil, Gerard P.; Fernandez, Robert W.; Menzies, Patrick Gomez; Gu, Tingting; Buhler, Jeremy; Mardis, Elaine R.; Elgin, Sarah C.R.

2017-01-01

The discordance between genome size and the complexity of eukaryotes can partly be attributed to differences in repeat density. The Muller F element (∼5.2 Mb) is the smallest chromosome in Drosophila melanogaster, but it is substantially larger (>18.7 Mb) in D. ananassae. To identify the major contributors to the expansion of the F element and to assess their impact, we improved the genome sequence and annotated the genes in a 1.4-Mb region of the D. ananassae F element, and a 1.7-Mb region from the D element for comparison. We find that transposons (particularly LTR and LINE retrotransposons) are major contributors to this expansion (78.6%), while Wolbachia sequences integrated into the D. ananassae genome are minor contributors (0.02%). Both D. melanogaster and D. ananassae F-element genes exhibit distinct characteristics compared to D-element genes (e.g., larger coding spans, larger introns, more coding exons, and lower codon bias), but these differences are exaggerated in D. ananassae. Compared to D. melanogaster, the codon bias observed in D. ananassae F-element genes can primarily be attributed to mutational biases instead of selection. The 5′ ends of F-element genes in both species are enriched in dimethylation of lysine 4 on histone 3 (H3K4me2), while the coding spans are enriched in H3K9me2. Despite differences in repeat density and gene characteristics, D. ananassae F-element genes show a similar range of expression levels compared to genes in euchromatic domains. This study improves our understanding of how transposons can affect genome size and how genes can function within highly repetitive domains. PMID:28667019

"Family Matters": A Systematic Review of the Evidence For Family Psychoeducation For Major Depressive Disorder.

PubMed

Brady, Pamela; Kangas, Maria; McGill, Katherine

2017-04-01

The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face-to-face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single-family studies, four multifamily studies, one single versus multifamily comparative study, and one peer-led, mixed-diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well-being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family-carer's well-being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed. © 2016 American Association for Marriage and Family Therapy.

Efficacy of Curcuma for Treatment of Osteoarthritis

PubMed Central

Perkins, Kimberly; Sahy, William; Beckett, Robert D.

2016-01-01

The objective of this review is to identify, summarize, and evaluate clinical trials to determine the efficacy of curcuma in the treatment of osteoarthritis. A literature search for interventional studies assessing efficacy of curcuma was performed, resulting in 8 clinical trials. Studies have investigated the effect of curcuma on pain, stiffness, and functionality in patients with knee osteoarthritis. Curcuma-containing products consistently demonstrated statistically significant improvement in osteoarthritis-related endpoints compared with placebo, with one exception. When compared with active control, curcuma-containing products were similar to nonsteroidal anti-inflammatory drugs, and potentially to glucosamine. While statistical significant differences in outcomes were reported in a majority of studies, the small magnitude of effect and presence of major study limitations hinder application of these results. Further rigorous studies are needed prior to recommending curcuma as an effective alternative therapy for knee osteoarthritis. PMID:26976085

Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces Pain for Posterosuperior Cuff Dysfunction.

PubMed

Shi, Lewis L; Cahill, Kirk E; Ek, Eugene T; Tompson, Jeffrey D; Higgins, Laurence D; Warner, Jon J P

2015-10-01

In patients with rotator cuff dysfunction, reverse shoulder arthroplasty can restore active forward flexion, but it does not provide a solution for the lack of active external rotation because of infraspinatus and the teres minor dysfunction. A modified L'Episcopo procedure can be performed in the same setting wherein the latissimus dorsi and teres major tendons are transferred to the lateral aspect of proximal humerus in an attempt to restore active external rotation. (1) Do latissimus dorsi and teres major tendon transfers with reverse shoulder arthroplasty improve external rotation function in patients with posterosuperior rotator cuff dysfunction? (2) Do patients experience less pain and have improved outcome scores after surgery? (3) What are the complications associated with reverse shoulder arthroplasty with latissimus dorsi and teres major transfer? Between 2007 and 2010, we treated all patients undergoing shoulder arthroplasty who had a profound external rotation lag sign and advanced fatty degeneration of the posterosuperior rotator cuff (infraspinatus plus teres minor) with this approach. A total of 21 patients (mean age 66 years; range, 58-82 years) were treated this way and followed for a minimum of 2 years (range, 26-81 months); none was lost to followup, and all have been seen in the last 5 years. We compared pre- and postoperative ranges of motion, pain, and functional status; scores were drawn from chart review. We also categorized major and minor complications. Active forward flexion improved from 56° ± 36° to 120° ± 38° (mean difference: 64° [95% confidence interval {CI}, 45°-83°], p < 0.001). Active external rotation with the arm adducted improved from 6° ± 16° to 38° ± 14° (mean difference: 30° [95% CI, 21°-39°], p < 0.001); active external rotation with the arm abducted improved from 19° ± 25° to 74° ± 22° (mean difference: 44° [95% CI, 22°-65°], p < 0.001). Pain visual analog score improved from 8.4 ± 2.3 to 1.7 ± 2.1 (mean difference: -6.9 [95% CI, -8.7 to -5.2], p < 0.001), and Single Assessment Numeric Evaluation score improved from 28% ± 21% to 80% ± 24% (mean difference: 46% [95% CI, 28%-64%], p < 0.001). There were six major complications, five of which were treated operatively. Overall, three patients' latissimus and teres major transfer failed based on persistent lack of external rotation. In patients with posterior and superior cuff deficiency, reverse shoulder arthroplasty combined with latissimus dorsi and teres major transfer through a single deltopectoral incision can reliably increase active forward flexion and external rotation. Patients experience pain relief and functional improvement but have a high rate of complications; therefore, we recommend the procedure be limited to patients indicated for reverse who have profound external rotation loss and a high grade of infraspinatus/teres minor fatty atrophy. Level IV, therapeutic study.

The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: results from a randomized controlled trial.

PubMed

Soczynska, Joanna K; Ravindran, Lakshmi N; Styra, Rima; McIntyre, Roger S; Cyriac, Anna; Manierka, Marena S; Kennedy, Sidney H

2014-12-15

Decrements in cognitive function are a common feature of Major Depressive Disorder (MDD), and whether distinct classes of antidepressants differentially affect memory in these individuals has not been sufficiently evaluated. In this study we sought to determine the effect of escitalopram and bupropion XL on memory and psychosocial function. Forty-one individuals (18-50 years) with MDD were enrolled in an 8-week, double-blind, double-dummy, randomized controlled comparative trial of bupropion XL and escitalopram. Thirty-six participants completed pre and post memory assessments. Verbal, non-verbal and working memory were evaluated with a comprehensive neuropsychological battery. Psychosocial function was assessed with the Sheehan Disability Scale and Endicott Work Productivity Scale. Escitalopram and bupropion XL significantly improved immediate as well as delayed verbal and nonverbal memory, global function (all p≤0.001), and work productivity (p=0.045), with no significant between-group differences. Improvement in immediate verbal memory exerted a direct influence on improvement in global function (p=0.006). Treatment with either escitalopram or bupropion XL was associated with improvement in memory and psychosocial function in adults with MDD. Copyright © 2014. Published by Elsevier Ireland Ltd.

A Tentative Study on the Task-Based Teaching of Writing to English Majors in Chinese Settings

ERIC Educational Resources Information Center

Zhaochun, Sun

2015-01-01

Under task-based learning (TBL) framework, language learners engage in purposeful, problem-oriented, and outcome-driven tasks that are comparable to traditional teaching methods which focus only on the correctness of grammar. In this study, the author employs Jane Willis' TBL framework and examines its effects on the improvement of EFL learners'…

A Study of an English Education Curriculum Developed for a County Penal Institution.

ERIC Educational Resources Information Center

Seubert, Hilary Frank

The major purpose of this study was to determine the extent of the progress of county prison students involved in a Curriculum for Improving Communications Skills (CICS) treatment as compared to another group of county inmates not pursuing this type of curriculum. The CICS program used in this research consisted of a series of twenty…

Applying the lessons of maternal mortality reduction to global emergency health

PubMed Central

Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

2015-01-01

Abstract Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions. PMID:26240463

Natural rubber latex allergy and asthma.

PubMed

Tarlo, S M

2001-01-01

Allergic responses to natural rubber latex (NRL) continue to be reported. In adults, the major exposure is in the occupational setting, especially in relation to NRL glove use by health care workers. Issues addressed over the past year include improving diagnostic methods for NRL allergy and characterization of NRL allergens relevant to various exposure groups and evaluating strategies for prevention and early detection of NRL allergy. Assessment of in vitro tests show good intertest correlation but lower sensitivity compared with skin test responses. NRL allergens have been further characterized as reported in the past year. Development of recombinant Hev b 3, a major NRL allergen relevant to children with spina bifida, enhances the likelihood for improved diagnostic reagents. Preliminary reports of primary preventive strategies suggest that avoidance of high-protein, powdered gloves in health care facilities can be cost-effective and is associated with a decline in sensitized workers.

Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression

PubMed Central

VITTENGL, J. R.; CLARK, L. A.; JARRETT, R. B.

2005-01-01

Background. Cognitive therapy reduces depressive symptoms of major depressive disorder, but little is known about concomitant reduction in social-interpersonal dysfunction. Method. We evaluated social-interpersonal functioning (self-reported social adjustment, interpersonal problems and dyadic adjustment) and depressive symptoms (two self-report and two clinician scales) in adult outpatients (n=156) with recurrent major depressive disorder at several points during a 20-session course of acute phase cognitive therapy. Consenting acute phase responders (n=84) entered a 2-year follow-up phase, which included an 8-month experimental trial comparing continuation phase cognitive therapy to assessment-only control. Results. Social-interpersonal functioning improved after acute phase cognitive therapy (dyadic adjustment d=0.47; interpersonal problems d=0.91; social adjustment d=1.19), but less so than depressive symptoms (d=1.55). Improvement in depressive symptoms and social-interpersonal functioning were moderately to highly correlated (r=0.39–0.72). Improvement in depressive symptoms was partly independent of social-interpersonal functioning (r=0.55–0.81), but improvement in social-interpersonal functioning independent of change in depressive symptoms was not significant (r=0.01–0.06). In acute phase responders, continuation phase therapy did not further enhance social-interpersonal functioning, but improvements in social-interpersonal functioning were maintained through the follow-up. Conclusions. Social-interpersonal functioning is improved after acute phase cognitive therapy and maintained in responders over 2 years. Improvement in social-interpersonal functioning is largely accounted for by decreases in depressive symptoms. PMID:15099419

Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment

PubMed Central

McMartin, Kristen; Gajic-Veljanoski, Olga; Wells, David; Higgins, Caroline; Walter, Melissa

2017-01-01

Background Major depressive disorder and generalized anxiety disorder are among the most commonly diagnosed mental illnesses in Canada; both are associated with a high societal and economic burden. Treatment for major depressive disorder and generalized anxiety disorder consists of pharmacological and psychological interventions. Three commonly used psychological interventions are cognitive behavioural therapy (CBT), interpersonal therapy, and supportive therapy. The objectives of this report were to assess the effectiveness and safety of these types of therapy for the treatment of adults with major depressive disorder and/or generalized anxiety disorder, to assess the cost-effectiveness of structured psychotherapy (CBT or interpersonal therapy), to calculate the budget impact of publicly funding structured psychotherapy, and to gain a greater understanding of the experiences of people with major depressive disorder and/or generalized anxiety disorder. Methods We performed a literature search on October 27, 2016, for systematic reviews that compared CBT, interpersonal therapy, or supportive therapy with usual care, waitlist control, or pharmacotherapy in adult outpatients with major depressive disorder and/or generalized anxiety disorder. We developed an individual-level state-transition probabilistic model for a cohort of adult outpatients aged 18 to 75 years with a primary diagnosis of major depressive disorder to determine the cost-effectiveness of individual or group CBT (as a representative form of structured psychotherapy) versus usual care. We also estimated the 5-year budget impact of publicly funding structured psychotherapy in Ontario. Finally, we interviewed people with major depressive disorder and/or generalized anxiety disorder to better understand the impact of their condition on their daily lives and their experience with different treatment options, including psychotherapy. Results Interpersonal therapy compared with usual care reduced posttreatment major depressive disorder scores (standardized mean difference [SMD]: 0.24, 95% confidence interval [CI]: −0.47 to −0.02) and reduced relapse/recurrence in patients with major depressive disorder (relative risk [RR]: 0.41, 95% CI: 0.27–0.63). Supportive therapy compared with usual care improved major depressive disorder scores (SMD: 0.58, 95% CI: 0.45–0.72) and increased posttreatment recovery (odds ratio [OR]: 2.71, 95% CI: 1.19–6.16) in patients with major depressive disorder. CBT compared with usual care increased response (OR: 1.58, 95% CI: 1.11–2.26) and recovery (OR: 3.42, 95% CI: 1.98–5.93) in patients with major depressive disorder and decreased relapse/recurrence (RR: 0.68, 95% CI: 0.65–0.87]). For patients with generalized anxiety disorder, CBT improved symptoms posttreatment (SMD: 0.80, 95% CI: 0.67–0.93), improved clinical response posttreatment (RR: 0.64, 95% CI: 0.55–0.74), and improved quality-of-life scores (SMD: 0.44, 95% CI: 0.06–0.82). There was a significant difference in posttreatment recovery (OR: 1.98, 95% CI: 1.11–3.54) and mean major depressive disorder symptom scores (weighted mean difference: −3.07, 95% CI: −4.69 to −1.45) for patients who received individual versus group CBT. Details about the providers of psychotherapy were rarely reported in the systematic reviews we examined. In the base case probabilistic cost–utility analysis, compared with usual care, both group and individual CBT were associated with increased survival: 0.11 quality-adjusted life-years (QALYs) (95% credible interval [CrI]: 0.03–0.22) and 0.12 QALYs (95% CrI: 0.03–0.25), respectively. Group CBT provided by nonphysicians was associated with the smallest increase in discounted costs: $401 (95% CrI: $1,177 to 1,665). Group CBT provided by physicians, individual CBT provided by nonphysicians, and individual CBT provided by physicians were associated with the incremental costs of $1,805 (95% CrI: 65–3,516), $3,168 (95% CrI: 889–5,624), and $5,311 (95% CrI: 2,539–8,938), respectively. The corresponding incremental cost-effectiveness ratio (ICER) was lowest for group CBT provided by nonphysicians ($3,715/QALY gained) and highest for individual CBT provided by physicians ($43,443/QALY gained). In the analysis that ranked best strategies, individual CBT versus group CBT provided by nonphysicians yielded an ICER of $192,618 per QALY. The probability of group CBT provided by nonphysicians being cost-effective versus usual care was greater than 95% for all willingness-to-pay thresholds over $20,000 per QALY and was around 88% for individual CBT provided by physicians at a threshold of $100,000 per QALY. We estimated that adding structured psychotherapy to usual care over the next 5 years would result in a net budget impact of $68 million to $529 million, depending on a range of factors. We also estimated that to provide structured psychotherapy to all adults with major depressive disorder (alone or combined with generalized anxiety disorder) in Ontario by 2021, an estimated 500 therapists would be needed to provide group therapy, and 2,934 therapists would be needed to provide individual therapy. People with major depressive disorder and/or generalized anxiety disorder with whom we spoke reported finding psychotherapy effective, but they also reported experiencing a large number of barriers that prevented them from finding effective psychotherapy in a timely manner. Participants reported wanting more freedom to choose the type of psychotherapy they received. Conclusions Compared with usual care, treatment with CBT, interpersonal therapy, or supportive therapy significantly reduces depression symptoms posttreatment. CBT significantly reduces anxiety symptoms posttreatment in patients with generalized anxiety disorder. Compared with usual care, treatment with structured psychotherapy (CBT or interpersonal therapy) represents good value for money for adults with major depressive disorder and/or generalized anxiety disorder. The most affordable option is group structured psychotherapy provided by nonphysicians, with the selective use of individual structured psychotherapy provided by nonphysicians or physicians for those who would benefit most from it (i.e., patients who are not engaging well with or adhering to group therapy). PMID:29213344

Assessment of failure to rescue after abdominal aortic aneurysm repair using the National Surgical Quality Improvement Program procedure-targeted data set.

PubMed

Dakour-Aridi, Hanaa; Paracha, Nawar Z; Locham, Satinderjit; Nejim, Besma; Malas, Mahmoud B

2018-05-18

Open aortic repair (OAR) is associated with higher risk of mortality compared with endovascular aneurysm repair (EVAR). The aim of this study was to compare failure to rescue (FTR) after major predischarge complications in patients undergoing OAR and EVAR. Patients who underwent OAR or EVAR in the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2015 were selected. Patients with ruptured aneurysm and those with type IV thoracoabdominal aneurysms were excluded. The primary outcome was FTR, defined as 30-day mortality in patients who developed at least one complication during their hospital stay. Univariable and multivariable statistics were used. A total of 9097 patients underwent abdominal aortic aneurysm repair. Of those, 3291 (36.2%) had at least one major predischarge complication, 82.5% after OAR (95% confidence interval [CI], 80.9%-84.1%) vs 21.3% after EVAR (95% CI, 20.4%-22.3%; P < .001). Increased FTR was seen after aneurysm rupture, cardiac arrest, septic shock, and acute kidney injury. On multivariable analysis, FTR was not significantly different between OAR and EVAR (adjusted odds ratio, 0.87; 95% CI, 0.61-1.24; P = .44). Propensity score matching and coarsened exact matching showed similar results. Although EVAR has fewer complications and lower in-hospital mortality than OAR, FTR after major predischarge complications does not depend on the type of surgical approach. When an in-hospital major complication occurs after EVAR, surgeons should be alert that FTR risk resulting in mortality is similar to that of OAR. Therefore, there is no safety net with EVAR. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Goal-Directed Fluid Therapy Guided by Cardiac Monitoring During High-Risk Abdominal Surgery in Adult Patients: Cost-Effectiveness Analysis of Esophageal Doppler and Arterial Pulse Pressure Waveform Analysis.

PubMed

Legrand, Guillaume; Ruscio, Laura; Benhamou, Dan; Pelletier-Fleury, Nathalie

2015-07-01

Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA. Effectiveness data were defined from meta-analyses of randomized clinical trials. The clinical end points were avoidance of hospital mortality and avoidance of major complications. Hospital costs were estimated by the cost of corresponding diagnosis-related groups. Both goal-directed therapy strategies evaluated were more effective and less costly than CCA. Perioperative mortality and the rate of major complications were reduced by the use of ED and APPWA. Cost reduction was mainly due to the decrease in the rate of major complications. APPWA was dominant compared with ED in 71.6% and 27.6% and dominated in 23.8% and 20.8% of the cases when the end point considered was "major complications avoided" and "death avoided," respectively. Regarding cost per death avoided, APPWA was more likely to be cost-effective than ED in a wide range of willingness to pay. Cardiac output monitoring during high-risk abdominal surgery is cost-effective and is associated with a reduced rate of hospital mortality and major complications, whatever the device used. The two devices evaluated had negligible costs compared with the observed reduction in hospital costs. Our comparative studies suggest a larger effect with APPWA that needs to be confirmed by further studies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Key indicators of obstetric and neonatal care in the Republic of Sakha (Yakutia).

PubMed

Burtseva, Tatyana E; Odland, Jon Øyvind; Douglas, Natalya I; Grigoreva, Antonina N; Pavlova, Tatyana Y; Chichahov, Dgulustan A; Afanasieva, Lena N; Baisheva, Nurguyana S; Rad, Yana G; Tomsky, Mikhail I; Postoev, Vitaly A

2016-01-01

In the absence of a medical birth registry, the official statistics are the only sources of information about pregnancy outcomes in the Republic of Sakha (Yakutia) (RS). We analysed the official statistical data about birth rate, fertility, infant and maternal mortality in the RS in the period 2003-2014. Compared with all-Russian data, the RS had a higher birth rate, especially in rural districts. Maternal and infant mortality were also higher compared with all-Russian data, but had a decreasing trend. The majority of deaths occurred in the small level 1 units. We suggest that establishment of good predelivery transportation of pregnant women with high risk of complications from remote areas and centralization of risk deliveries with improved prenatal and neonatal care could improve the pregnancy outcome in Yakutia.

The 80-hour work week for residents: views from obstetric and gynecology program directors.

PubMed

Janoo, Jabin; Hashmi, Mahreen; Seybold, Dara J; Shapiro, Robert; Calhoun, Byron C; Bush, Stephen H

2014-01-01

In 2003, the Accreditation Council for Graduate Medical Education mandated an 80-hour work week restriction for residency programs. We examined program directors' views on how this mandate affects the education of Obstetrics and Gynecology residents. A 25 question survey was administered via Survey Monkey to Obstetrics and Gynecology program directors in the United States over three months in 2011. Fifty program directors (response rate of 28%) completed it with more men (62%) than women (38%) respondents. Overall, only 28% (14/50) responded that the program had improved, with significantly fewer men (5/14; 16.1%) than women (47.4% 9/19; p < 0.0169) directors reporting this. There was little perceived improvement in any of the six core ACGME performance objectives and in the CREOG scores, with the improvement ranging from 8% to 12%. In fact, while we observed the percentage of women directors reporting improvement in patient care and interpersonal and communication skills significantly higher compared with their male counterparts, the majority of women still reported either no improvement or a decline in these areas. Though our sample size was small, we found some significant difference between the views of male and female program directors. Both groups nonetheless responded with the majority with a decline or no change rather than a perceived improvement in any of the educational endeavors studied.

The 80-hour Work Week for Residents: Views from Obstetric and Gynecology Program Directors

PubMed Central

Janoo, Jabin; Hashmi, Mahreen; Seybold, Dara J.; Shapiro, Robert; Calhoun, Byron C.; Bush, Stephen H.

2015-01-01

In 2003, the Accreditation Council for Graduate Medical Education mandated an 80-hour work week restriction for residency programs. We examined program directors’ views on how this mandate affects the education of Obstetrics and Gynecology residents. A 25 question survey was administered via Survey Monkey to Obstetrics and Gynecology program directors in the United States over three months in 2011. Fifty program directors (response rate of 28%) completed it with more men (62%) than women (38%) respondents. Overall, only 28% (14/50) responded that the program had improved, with significantly fewer men (5/14; 16.1%) than women (47.4% 9/19; p<0.0169) directors reporting this. There was little perceived improvement in any of the six core ACGME performance objectives and in the CREOG scores, with the improvement ranging from 8% to 12%. In fact, while we observed the percentage of women directors reporting improvement in patient care and interpersonal and communication skills significantly higher compared with their male counterparts, the majority of women still reported either no improvement or a decline in these areas. Though our sample size was small, we found some significant difference between the views of male and female program directors. Both groups nonetheless responded with the majority with a decline or no change rather than a perceived improvement in any of the educational endeavors studied. PMID:25643470

Combined therapy with desferrioxamine and deferiprone in beta thalassemia major patients with transfusional iron overload.

PubMed

Daar, S; Pathare, A V

2006-05-01

Iron overload is the main cause of morbidity and mortality especially from heart failure in patients with beta thalassemia major (TM). Successful iron chelation is therefore essential for the optimal management of TM. Although desferrioxamine (DFX) has been the major iron-chelating treatment of transfusional iron overload, compliance is a major hindrance in achieving optimal therapeutic results. The availability of oral iron chelation with deferiprone (L(1)) since 1987 is useful but showed poor efficacy when used alone as compared to DFX. We therefore decided to compare DFX alone with a prospective combined therapy with DFX and L(1) in beta thalassemia major patients with iron overload. We studied 91 patients with beta thalassemia major (mean age+/-SD, 15.02+/-5.8; range 2-30 years) attending the day care unit for regular transfusional support. They received packed red cells every 3-4 weeks to maintain pretransfusion hemoglobin concentration above 9 g/dl. They had been receiving DFX at a daily dose of 40 mg kg(-1) day(-1) by subcutaneous infusion for 8-10 h on 4-5 nights each week for the past several years. However, due to various reasons, they had developed considerable transfusional iron overload. These patients were allocated to prospectively receive additional therapy with oral iron chelator L(1) at 75 mg kg(-1) day(-1) body weight in three divided doses with food after informed consent and continued to receive treatment with DFX as per the above dosage. Of the 91 patients, six developed severe gastrointestinal (GI) upset, two agranulocytosis, two arthropathy, one persistently raised liver enzymes, two died owing to sepsis, and two received allogeneic bone marrow transplantation. Amongst the remaining 76 patients, 21 were found noncompliant (not taking DFX regularly, but taking L(1) regularly). Thus, in the 55 evaluable patients {6-48 months on combination therapy; mean [(+/-SD)22+/-12 months]}, the mean serum ferritin (+/-SD) fell dramatically from 3,088 (+/-1,299) ng/ml (DFX alone) to 2,051 (+/-935) ng/ml (DFX and L(1); p<0.001). It is interesting to note that there was also a significant improvement in the myocardial function as assessed by the ejection fraction (p<0.004) and fractional shortening (p<0.05) in those patients (n=42) who could be studied after being on combination therapy for a minimum of 1 year. The study emphasizes that beta thalassemia major patients with transfusional iron overload can be successfully treated with a combination of DFX and L(1). Our results also demonstrate a significant statistical improvement after as little as 6 months of combination therapy. Furthermore, these improvements lead to a progressive fall in the mean serum ferritin. Lastly, the study also demonstrates significant improvement in the echocardiographic parameters of myocardial performance in these patients receiving combination therapy.

Turkish university students' knowledge of biotechnology and attitudes toward biotechnological applications.

PubMed

Öztürk-Akar, Ebru

2017-03-04

This study questions the presumed relation between formal schooling and scientific literacy about biotechnologies. Comparing science and nonscience majors' knowledge of and attitudes toward biotechnological applications, conclusions are drawn if their formal learnings improve pupils' understandings of and attitudes toward biotechnology applications. Sample of the study consists of 403 undergraduate and graduate students, 198 nonscience, and 205 science majors. The Biotechnology Knowledge Questionnaire and the Biotechnology Attitude Questionnaire were administered. Descriptive statistics (mean and percentages), t test, and correlations were used to examine the participants' knowledge of biotechnology and attitudes toward biotechnological applications and differences as regards their majors. Although the science majors had higher knowledge and attitude scores than the nonscience majors, it is not possible to say that they have sufficient knowledge of biotechnologies. Besides, the participants' attitudes toward biotechnological applications were not considerably related to their knowledge of biotechnology. © 2016 by The International Union of Biochemistry and Molecular Biology, 45(2):115-125, 2017. © 2016 The International Union of Biochemistry and Molecular Biology.

Respect the technique: Status-based respect increases minority group social cohesion with majority groups, while also increasing minority collective action tendencies.

PubMed

Glasford, Demis E; Johnston, Brian

2018-01-01

The present work explores the implications of respect for social change. Social change can be achieved via improved attitudes between minority and majority groups (i.e., social cohesion) or via action taken by minority groups (i.e., collective action). Recent work suggests that the social cohesion route to social change, in particular an emphasis on commonality, may be incompatible with the collective action route to social change. We suggest that social-cohesion strategies rooted in status-based respect may allow for social cohesion and collective action. We experimentally investigated the relative effects of a majority group communicating status-based respect and commonality, as compared to a control, on minority group members' social cohesion with the majority group and willingness to engage in collective action. Status-based respect increased positive attitudes toward a majority group, relative to commonality and control, but was also associated with increased collective action tendencies. Implications for social change are discussed.

Combined citalopram and methylphenidate improved treatment response compared to either drug alone in geriatric depression: a randomized double-blind, placebo-controlled trial

PubMed Central

Lavretsky, Helen; Reinlieb, Michelle; Cyr, Natalie St.; Siddarth, Prabha; Ercoli, Linda M.; Senturk, Damla

2015-01-01

Objective We evaluated the potential of methylphenidate to improve antidepressant response to citalopram in elderly depressed patients with respect to clinical and cognitive outcomes. Methods We conducted a 16-week randomized double-blind placebo-controlled trial for geriatric depression in 143 older outpatients diagnosed with major depression comparing treatment response in three groups: 1) methylphenidate and placebo (N=48); 2) citalopram and placebo (N=48); 3) methylphenidate and citalopram (N=47). Primary outcome was defined as the change in depression severity. Remission was defined as Hamilton Depression Rating Scale (HDRS-24) score of 6 or below. Secondary outcomes included measures of anxiety, apathy, quality of life, and cognition. Results Citalopram daily doses ranged between 20–60 mg (mean 32 mg); methylphenidate daily doses ranged between 5–40 mg (mean 16 mg). All groups showed significant improvement in the severity of depression. However, the improvement in depression severity and the clinical global impression was more prominent in the methylphenidate and citalopram group compared to methylphenidate and placebo and citalopram and placebo (P<0.05). Additionally, the rate of improvement in the methylphenidate and citalopram group was significantly faster than that in the citalopram and placebo in the first 4 weeks of the trial. The groups did not differ on cognitive improvement or the number of side-effects. Conclusions Combined treatment with citalopram and methylphenidate demonstrated an enhanced clinical response profile in the mood and wellbeing, and the rate of response compared to either drug. All treatments led to an improvement in cognitive functioning, without additional benefit from the use of methylphenidate. PMID:25677354

Consumer opinions with ancillary hospital services: improving service delivery in Turkish hospitals.

PubMed

Tengilimoglu, D; Kisa, A; Dziegielewski, S F

1999-10-01

This article reports the results of 2,045 consumer interviews conducted after discharge from seven major public and private hospitals in the country of Turkey. The direct measurement of consumer-satisfaction and utilization of this information to improve service delivery is a relatively new phenomena for this country. Based on postdischarge consumer interviews information on satisfaction of several ancillary hospital service variables was identified and inclusion for achieving overall consumer satisfaction is emphasized. Two critical areas were examined: ancillary staff and consumer relations and overall impressions of the comfort of the facility. Relationships and percentages within and among these variables are reported. Overall, the majority of the complaints noted by consumers were not related to direct treatment rather they focused on interactions with the hospital's staff and other services provided by the facility (e.g., comfort, cleanliness, parking, etc.). When comparing the different hospitals across these variables significant differences were noted at the .05 level between the seven different hospitals examined. Findings and recommendations from this study are presented to assist in providing a basis for the development of improved consumer satisfaction.

United States benefits of improved worldwide wheat crop information from a LANDSAT system

NASA Technical Reports Server (NTRS)

Heiss, K. P.; Sand, F.; Seidel, A.; Warner, D.; Sheflin, N.; Bhattacharyya, R.; Andrews, J.

1975-01-01

The value of worldwide information improvements on wheat crops, promised by LANDSAT, is measured in the context of world wheat markets. These benefits are based on current LANDSAT technical goals and assume that information is made available to all (United States and other countries) at the same time. A detailed empirical sample demonstration of the effect of improved information is given; the history of wheat commodity prices for 1971-72 is reconstructed and the price changes from improved vs. historical information are compared. The improved crop forecasting from a LANDSAT system assumed include wheat crop estimates of 90 percent accuracy for each major wheat producing region. Accurate, objective worldwide wheat crop information using space systems may have a very stabilizing influence on world commodity markets, in part making possible the establishment of long-term, stable trade relationships.

Analysis of RFQ vacuum system for HINS tests at MDB

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

Piekarz, Henryk; /Fermilab

The arrangement of RFQ vacuum system is briefly described. The projections of the vacuum level using standard out-gassing rates for the RFQ major components are compared with measurements. The permeation of water through the Viton O-rings of the LCW manifold inside the RFQ vacuum vessel is analyzed and compared with RGA data. A model where the out-gassing water from the vanes inner surfaces affects seriously RFQ operation is devised and compared with RFQ performance. The rate of a hydrogen gas spill from the LEBT into the RFQ vacuum space is also projected. Suggestions to correct and improve RFQ operation aremore » presented.« less

Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with Major Depressive Disorder: Systematic review and meta-analysis.

PubMed

Wagner, Stefanie; Engel, Alice; Engelmann, Jan; Herzog, David; Dreimüller, Nadine; Müller, Marianne B; Tadić, André; Lieb, Klaus

2017-11-01

Early improvement of depressive symptoms during the first two weeks of antidepressant treatment has been discussed to be a resilience signal predicting a later positive treatment outcome in patients with Major Depressive Disorder (MDD). However, the predictive value of early improvement varies between studies, and the use of different antidepressants may explain heterogeneous results. The objective of this review was to assess the predictive value of early improvement on later response and remission and to identify antidepressants with the highest chance of early improvement. We included 17 randomized controlled trials investigating early improvement in 14,779 adult patients with MDD comparing monotherapy with an antidepressant against placebo or another antidepressant drug. 62% (range: 35-85%) of patients treated with an antidepressant and 47% (range: 21-69%) with placebo were early improver, defined as a >20%/25% symptom reduction after two weeks of treatment. Early improvement predicted response and remission after 5-12 weeks of treatment with high sensitivity (85%; 95%-CI: 84.3 to 85.7) and low to moderate specificity (54%; 95%-CI: 53.1 to 54.9). Early improver had a 8.37 fold (6.97-10.05) higher likelihood to become responder and a 6.38 fold (5.07-8.02) higher likelihood to be remitter at endpoint than non-improver. The highest early improver rates were achieved in patients treated with mirtazapine or a tricyclic antidepressant. This finding of a high predictive value of early improvement on treatment outcome may be important for treatment decisions in the early course of antidepressant treatment. Further studies should test the efficacy of such early treatment decisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Investigating students' perceptions of graduate learning outcomes in mathematics

NASA Astrophysics Data System (ADS)

King, Deborah; Varsavsky, Cristina; Belward, Shaun; Matthews, Kelly

2017-11-01

The purpose of this study is to explore the perceptions mathematics students have of the knowledge and skills they develop throughout their programme of study. It addresses current concerns about the employability of mathematics graduates by contributing much needed insight into how degree programmes are developing broader learning outcomes for students majoring in mathematics. Specifically, the study asked students who were close to completing a mathematics major (n = 144) to indicate the extent to which opportunities to develop mathematical knowledge along with more transferable skills (communication to experts and non-experts, writing, working in teams and thinking ethically) were included and assessed in their major. Their perceptions were compared to the importance they assign to each of these outcomes, their own assessment of improvement during the programme and their confidence in applying these outcomes. Overall, the findings reveal a pattern of high levels of students' agreement that these outcomes are important, but evidence a startling gap when compared to students' perceptions of the extent to which many of these - communication, writing, teamwork and ethical thinking - are actually included and assessed in the curriculum, and their confidence in using such learning.

The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

PubMed Central

Ben-Nafa, Walid; Munro, Wendy

2018-01-01

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma. PMID:29561260

The oral health of refugees and asylum seekers: a scoping review.

PubMed

Keboa, Mark Tambe; Hiles, Natalie; Macdonald, Mary Ellen

2016-10-07

Improving the oral health of refugees and asylum seekers is a global priority, yet little is known about the overall burden of oral diseases and their causes for this population. To synthesize available evidence on the oral health of, and access to oral health care by this population. Using a scoping review methodology, we retrieved 3321 records from eight databases and grey literature; 44 publications met the following inclusion criteria: empirical research focused on refugees and/or asylum seekers' oral health, published between 1990 and 2014 in English, French, Italian, Portuguese, or Spanish. Analysis included descriptive and thematic analysis, as well as critical appraisal using the Critical Appraisal Skills Programme (CASP) criteria for quantitative and qualitative studies. The majority of publications (86 %) were from industrialized countries, while the majority of refugees are resettled in developing countries. The most common study designs were quantitative (75 %). Overall, the majority of studies (76 %) were of good quality. Studies mainly explored oral health status, knowledge and practices; a minority (9 %) included interventions. The refugee populations in the studies showed higher burden of oral diseases and limited access to oral health care compared to even the least privileged populations in the host countries. Minimal strategies to improve oral health have been implemented; however, some have impressive outcomes. Oral health disparities for this population remain a major concern. More research is needed on refugees in developing countries, refugees residing in refugee camps, and interventions to bridge oral health disparities. This review has utility for policymakers, practitioners, researchers, and other stakeholders working to improve the oral health of this population.

Relationship between major depressive disorder and associated painful physical symptoms: analysis of data from two pooled placebo-controlled, randomized studies of duloxetine.

PubMed

Robinson, Michael J; Sheehan, David; Gaynor, Paula J; Marangell, Lauren B; Tanaka, Yoko; Lipsius, Sarah; Ohara, Fumihiro; Namiki, Chihiro

2013-11-01

The aim of this study was to evaluate the relationship between painful physical symptoms (PPS) and outcomes in major depressive disorder (MDD). Post-hoc analysis of two identically designed 8-week trials compared the efficacy of 60 mg/day duloxetine (N=523) with that of placebo (N=532) in treating PPS associated with MDD. The Montgomery-Åsberg Depression Rating Scale (MADRS) total score, the Brief Pain Inventory (BPI) average pain score, and the Sheehan Disability Scale global functional impairment score assessed depression symptoms, pain, and functioning, respectively. Remission was defined as a MADRS score of 10 or less, and the BPI response subgroup was defined as a 50% or greater reduction from baseline. Path analyses assessed relationships among variables. Duloxetine-treated patients who had a 50% or greater reduction in BPI score at endpoint had higher rates of remission. Path analysis indicated that 16% of likelihood of remission in depression symptoms was because of the direct effect of treatment, 41% because of pain reduction, and 43% because of functional improvement. Path analysis also indicated that 51% of improvement in functioning was attributed to pain improvement and 43% to mood improvement. Results demonstrate that improvement in pain and mood contributes to functional improvement, and pain reduction and functional improvement increase the likelihood of remission of depressive symptoms with duloxetine treatment in patients with both MDD and PPS at baseline.

Sulfonation of Tyrosine as a Method To Improve Biodistribution of Peptide-Based Radiotracers: Novel 18F-Labeled Cyclic RGD Analogues.

PubMed

Haskali, Mohammad B; Denoyer, Delphine; Noonan, Wayne; Culinane, Carleen; Rangger, Christine; Pouliot, Normand; Haubner, Roland; Roselt, Peter D; Hicks, Rodney J; Hutton, Craig A

2017-04-03

Control of the biodistribution of radiolabeled peptides has proven to be a major challenge in their application as imaging agents for positron emission tomography (PET). Modification of peptide hydrophilicity in order to increase renal clearance has been a common endeavor to improve overall biodistribution. Herein, we examine the effect of site-specific sulfonation of tyrosine moieties in cyclic(RGDyK) peptides as a means to enhance their hydrophilicity and improve their biodistribution. The novel sulfonated cyclic(RGDyK) peptides were conjugated directly to 4-nitrophenyl 2-[ 18 F]fluoropropionate, and the biodistribution of the radiolabeled peptides was compared with that of their nonsulfonated, clinically relevant counterparts, [ 18 F]GalactoRGD and [ 18 F]FPPRGD2. Site-specific sulfonation of the tyrosine residues was shown to increase hydrophilicity and improve biodistribution of the RGD peptides, despite contributing just 79 Da toward the MW, compared with 189 Da for both the "Galacto" and mini-PEG moieties, suggesting this may be a broadly applicable approach to enhancing biodistribution of radiolabeled peptides.

Development of Matrix Microstructures in UHTC Composites

NASA Technical Reports Server (NTRS)

Johnson, Sylvia; Stackpoole, Margaret; Gusman, Michael

2012-01-01

One of the major issues hindering the use of ultra high temperature ceramics for aerospace applications is low fracture toughness. There is considerable interest in developing fiber-reinforced composites to improve fracture toughness. Considerable knowledge has been gained in controlling and improving the microstructure of monolithic UHTCs, and this paper addresses the question of transferring that knowledge to composites. Some model composites have been made and the microstructures of the matrix developed has been explored and compared to the microstructure of monolithic materials in the hafnium diboride/silicon carbide family. Both 2D and 3D weaves have been impregnated and processed.

Chest Wall Trauma.

PubMed

Majercik, Sarah; Pieracci, Fredric M

2017-05-01

Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management. Copyright © 2017 Elsevier Inc. All rights reserved.

Low-gravity homogenization and solidification of aluminum antimonide. [Apollo-Soyuz test project

NASA Technical Reports Server (NTRS)

Ang, C.-Y.; Lacy, L. L.

1976-01-01

The III-V semiconducting compound AlSb shows promise as a highly efficient solar cell material, but it has not been commercially exploited because of difficulties in compound synthesis. Liquid state homogenization and solidification of AlSb were carried out in the Apollo-Soyuz Test Project Experiment MA-044 in the hope that compositional homogeneity would be improved by negating the large density difference between the two constituents. Post-flight analysis and comparative characterization of the space-processed and ground-processed samples indicate that there are major homogeneity improvements in the low-gravity solidified material.

Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

PubMed

Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

2017-01-01

Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of an industry in transition.

PubMed

Baliga, B R; Johnson, B

1986-12-01

The health care industry is undergoing major structural changes. The significance of these changes for individual competitors moving toward the 1990s is not yet clear. This article assesses the implications of the current changes by applying Porter's industry structure and generic strategy frameworks to the health care industry. Present trends are compared to this analysis to highlight areas where individual hospitals might improve their competitive positioning.

Do Biology Students Really Hate Math? Empirical Insights into Undergraduate Life Science Majors' Emotions about Mathematics.

PubMed

Wachsmuth, Lucas P; Runyon, Christopher R; Drake, John M; Dolan, Erin L

2017-01-01

Undergraduate life science majors are reputed to have negative emotions toward mathematics, yet little empirical evidence supports this. We sought to compare emotions of majors in the life sciences versus other natural sciences and math. We adapted the Attitudes toward the Subject of Chemistry Inventory to create an Attitudes toward the Subject of Mathematics Inventory (ASMI). We collected data from 359 science and math majors at two research universities and conducted a series of statistical tests that indicated that four AMSI items comprised a reasonable measure of students' emotional satisfaction with math. We then compared life science and non-life science majors and found that major had a small to moderate relationship with students' responses. Gender also had a small relationship with students' responses, while students' race, ethnicity, and year in school had no observable relationship. Using latent profile analysis, we identified three groups-students who were emotionally satisfied with math, emotionally dissatisfied with math, and neutral. These results and the emotional satisfaction with math scale should be useful for identifying differences in other undergraduate populations, determining the malleability of undergraduates' emotional satisfaction with math, and testing effects of interventions aimed at improving life science majors' attitudes toward math. © 2017 L.P. Wachsmuth et al. CBE—Life Sciences Education © 2017 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Safety and efficacy of early intervention with pimecrolimus cream 1% combined with corticosteroids for major flares in infants and children with atopic dermatitis.

PubMed

Siegfried, Elaine; Korman, Neil; Molina, Carmen; Kianifard, Farid; Abrams, Ken

2006-01-01

To assess early intervention with pimecrolimus combined with corticosteroid (CS) for major flares in patients with severe atopic dermatitis (AD). In this 6-month, double-blind, multicenter, randomized, vehicle-controlled, parallel-group in 35 US centers, 275 children aged 3 months to 11 years with mild to severe AD applied the study medication twice daily at first signs/symptoms of AD. For major flares not controlled with study medication, a mid-potency CS cream replaced the evening study drug for up to 3 weeks. The percentage of subjects with no major flares was the main outcome measure. Pimecrolimus reduced the major flare incidence and prolonged flare-free intervals. Significantly more pimecrolimus subjects (52%) had no major flares compared with vehicle subjects (34%; p = 0.007). Pimecrolimus significantly delayed the first flare (median, 53 days vs 13 days; p<0.001), and increased the time between flares (median, 31 days vs 15 days). Additionally, there was earlier pruritus improvement (median, day 3 vs day 6; p = 0.034) in the pimecrolimus group, as well as a reduced need for CS by 37% (p = 0.020) [corrected] Adverse events (AEs) incidence and type were comparable between groups. Combination therapy with pimecrolimus used at half the recommended dose did not shorten the mean flare duration or alter the AE profile. Early treatment of signs/symptoms of AD with pimecrolimus cream 1% provided an effective steroid-sparing option that reduced the incidence of major flares.

Improving depression and enhancing resilience in family dementia caregivers: a pilot randomized placebo-controlled trial of escitalopram.

PubMed

Lavretsky, Helen; Siddarth, Prabha; Irwin, Michael R

2010-02-01

This study examined the potential of an antidepressant drug, escitalopram, to improve depression, resilience to stress, and quality of life in family dementia caregivers in a randomized placebo-controlled double-blinded trial. Forty family caregivers (43-91 years of age, 25 children and 15 spouses; 26 women) who were taking care of their relatives with Alzheimer disease were randomized to receive either escitalopram 10 mg/day or placebo for 12 weeks. Severity of depression, resilience, burden, distress, quality of life, and severity of care-recipient's cognitive and behavioral disturbances were assessed at baseline and over the course of the study. The Hamilton Depression Rating Scale scores at baseline ranged between 10 and 28. The groups were stratified by the diagnosis of major and minor depression. Most outcomes favored escitalopram over placebo. The severity of depression improved, and the remission rate was greater with the drug compared with placebo. Measures of anxiety, resilience, burden, and distress improved on escitalopram compared with placebo. Among caregivers, this small randomized controlled trial found that escitalopram use resulted in improvement in depression, resilience, burden and distress, and quality of life. Our results need to be confirmed in a larger sample.

Use of a Y-tube conduit after facial nerve injury reduces collateral axonal branching at the lesion site but neither reduces polyinnervation of motor endplates nor improves functional recovery.

PubMed

Hizay, Arzu; Ozsoy, Umut; Demirel, Bahadir Murat; Ozsoy, Ozlem; Angelova, Srebrina K; Ankerne, Janina; Sarikcioglu, Sureyya Bilmen; Dunlop, Sarah A; Angelov, Doychin N; Sarikcioglu, Levent

2012-06-01

Despite increased understanding of peripheral nerve regeneration, functional recovery after surgical repair remains disappointing. A major contributing factor is the extensive collateral branching at the lesion site, which leads to inaccurate axonal navigation and aberrant reinnervation of targets. To determine whether the Y tube reconstruction improved axonal regrowth and whether this was associated with improved function. We used a Y-tube conduit with the aim of improving navigation of regenerating axons after facial nerve transection in rats. Retrograde labeling from the zygomatic and buccal branches showed a halving in the number of double-labeled facial motor neurons (15% vs 8%; P < .05) after Y tube reconstruction compared with facial-facial anastomosis coaptation. However, in both surgical groups, the proportion of polyinnervated motor endplates was similar (≈ 30%; P > .05), and video-based motion analysis of whisking revealed similarly poor function. Although Y-tube reconstruction decreases axonal branching at the lesion site and improves axonal navigation compared with facial-facial anastomosis coaptation, it fails to promote monoinnervation of motor endplates and confers no functional benefit.

Improved Methodology for Surface and Atmospheric Soundings, Error Estimates, and Quality Control Procedures: the AIRS Science Team Version-6 Retrieval Algorithm

NASA Technical Reports Server (NTRS)

Susskind, Joel; Blaisdell, John; Iredell, Lena

2014-01-01

The AIRS Science Team Version-6 AIRS/AMSU retrieval algorithm is now operational at the Goddard DISC. AIRS Version-6 level-2 products are generated near real-time at the Goddard DISC and all level-2 and level-3 products are available starting from September 2002. This paper describes some of the significant improvements in retrieval methodology contained in the Version-6 retrieval algorithm compared to that previously used in Version-5. In particular, the AIRS Science Team made major improvements with regard to the algorithms used to 1) derive surface skin temperature and surface spectral emissivity; 2) generate the initial state used to start the cloud clearing and retrieval procedures; and 3) derive error estimates and use them for Quality Control. Significant improvements have also been made in the generation of cloud parameters. In addition to the basic AIRS/AMSU mode, Version-6 also operates in an AIRS Only (AO) mode which produces results almost as good as those of the full AIRS/AMSU mode. This paper also demonstrates the improvements of some AIRS Version-6 and Version-6 AO products compared to those obtained using Version-5.

Improving TWSTFT short-term stability by network time transfer.

PubMed

Tseng, Wen-Hung; Lin, Shinn-Yan; Feng, Kai-Ming; Fujieda, M; Maeno, H

2010-01-01

Two-way satellite time and frequency transfer (TWSTFT) is one of the major techniques to compare the atomic time scales between timing laboratories. As more and more TWSTFT measurements have been performed, the large number of point-to-point 2-way time transfer links has grown to be a complex network. For future improvement of the TWSTFT performance, it is important to reduce measurement noise of the TWSTFT results. One method is using TWSTFT network time transfer. The Asia-Pacific network is an exceptional case of simultaneous TWSTFT measurements. Some indirect links through relay stations show better shortterm stabilities than the direct link because the measurement noise may be neutralized in a simultaneous measurement network. In this paper, the authors propose a feasible method to improve the short-term stability by combining the direct and indirect links in the network. Through the comparisons of time deviation (TDEV), the results of network time transfer exhibit clear improved short-term stabilities. For the links used to compare 2 hydrogen masers, the average gain of TDEV at averaging times of 1 h is 22%. As TWSTFT short-term stability can be improved by network time transfer, the network may allow a larger number of simultaneously transmitting stations.

Improving Outcome for Mental Disorders by Enhancing Memory for Treatment

PubMed Central

Harvey, Allison G.; Lee, Jason; Smith, Rita L.; Gumport, Nicole B.; Hollon, Steven D.; Rabe-Hesketh, Sophia; Hein, Kerrie; Dolsen, Michael R.; Hamen, Kristen; Kanady, Jennifer C.; Thompson, Monique A.; Abrons, Deidre

2017-01-01

Summary Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (CTMS; n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for ‘response’ and ‘remission’ were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome. PMID:27089159

Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

PubMed Central

Dundar, Yusuf; Cannon, Richard B.; Monroe, Marcus M.; Buchmann, Luke Oliver; Hunt, Jason Patrick

2016-01-01

Objective Report routes of skull base invasion for head and neck nonmelanoma skin cancers (NMSCs) and their survival outcomes. Design Retrospective. Participants Ninety patients with NMSC with skull base invasion between 2004 and 2014. Major Outcome Measures Demographic, tumor characteristics, and treatments associated with different types of skull base invasion and disease-specific survival (DSS) and overall survival (OS). Results Perineural invasion (PNI) to the skull base occurred in 69% of patients, whereas 38% had direct skull base invasion. Age, histology, orbital invasion, active immunosuppression, cranial nerve (CN) involved, and type of skull base invasion were significantly associated with DSS and OS (p < 0.05). Patients with basal cell carcinoma (BCC) had significantly improved DSS and OS compared with other histologies (p < 0.05). Patients with CN V PNI had significantly improved DSS and OS compared with CN VII PNI (p < 0.05). Patients with zone II PNI had significantly improved DSS and OS compared with those with direct invasion or zone III PNI (p < 0.05). Nonsurgical therapy was rarely used and is associated with a reduction in DSS and OS (p < 0.05). Conclusion Patterns and survival outcomes for NMSC skull base invasion are reported. Zone II PNI, BCC, and CN V PNI are associated with improved survival outcomes. PMID:28321381

Efficacy of Curcuma for Treatment of Osteoarthritis.

PubMed

Perkins, Kimberly; Sahy, William; Beckett, Robert D

2017-01-01

The objective of this review is to identify, summarize, and evaluate clinical trials to determine the efficacy of curcuma in the treatment of osteoarthritis. A literature search for interventional studies assessing efficacy of curcuma was performed, resulting in 8 clinical trials. Studies have investigated the effect of curcuma on pain, stiffness, and functionality in patients with knee osteoarthritis. Curcuma-containing products consistently demonstrated statistically significant improvement in osteoarthritis-related endpoints compared with placebo, with one exception. When compared with active control, curcuma-containing products were similar to nonsteroidal anti-inflammatory drugs, and potentially to glucosamine. While statistical significant differences in outcomes were reported in a majority of studies, the small magnitude of effect and presence of major study limitations hinder application of these results. Further rigorous studies are needed prior to recommending curcuma as an effective alternative therapy for knee osteoarthritis. © The Author(s) 2016.

Major depressive and anxiety disorders in visually impaired older adults.

PubMed

van der Aa, Hilde P A; Comijs, Hannie C; Penninx, Brenda W J H; van Rens, Ger H M B; van Nispen, Ruth M A

2015-01-20

We assessed the prevalence of subthreshold depression and anxiety, and major depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and general anxiety disorder) in visually impaired older adults and compared these estimates with those of normally sighted peers. Cross-sectional data were analyzed based on telephone interviews with visually impaired older adults aged ≥ 60 years (n = 615) with a visual acuity of ≥ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face interviews with community-dwelling normally sighted peers (n = 1232). To determine prevalence rates, the normally sighted population was weighted on sex and age to fit the visually impaired population. Logistic regression analyses were used to compare the populations and to correct for confounders. The prevalence of major depressive disorder (5.4%) and anxiety disorders (7.5%), as well as the prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%), were significantly higher in visually impaired older adults compared to their normally sighted peers (P < 0.05). Agoraphobia and social phobia were the most prevalent anxiety disorders in visually impaired older adults. This study shows that depression and anxiety are major public health problems in visually impaired older adults. Research on psychotherapeutic and psychopharmacologic interventions to improve depression and anxiety in this population is warranted. (http://www.trialregister.nl number, NTR3296.). Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.

Effect of home testing of international normalized ratio on clinical events.

PubMed

Matchar, David B; Jacobson, Alan; Dolor, Rowena; Edson, Robert; Uyeda, Lauren; Phibbs, Ciaran S; Vertrees, Julia E; Shih, Mei-Chiung; Holodniy, Mark; Lavori, Philip

2010-10-21

Warfarin anticoagulation reduces thromboembolic complications in patients with atrial fibrillation or mechanical heart valves, but effective management is complex, and the international normalized ratio (INR) is often outside the target range. As compared with venous plasma testing, point-of-care INR measuring devices allow greater testing frequency and patient involvement and may improve clinical outcomes. We randomly assigned 2922 patients who were taking warfarin because of mechanical heart valves or atrial fibrillation and who were competent in the use of point-of-care INR devices to either weekly self-testing at home or monthly high-quality testing in a clinic. The primary end point was the time to a first major event (stroke, major bleeding episode, or death). The patients were followed for 2.0 to 4.75 years, for a total of 8730 patient-years of follow-up. The time to the first primary event was not significantly longer in the self-testing group than in the clinic-testing group (hazard ratio, 0.88; 95% confidence interval, 0.75 to 1.04; P=0.14). The two groups had similar rates of clinical outcomes except that the self-testing group reported more minor bleeding episodes. Over the entire follow-up period, the self-testing group had a small but significant improvement in the percentage of time during which the INR was within the target range (absolute difference between groups, 3.8 percentage points; P<0.001). At 2 years of follow-up, the self-testing group also had a small but significant improvement in patient satisfaction with anticoagulation therapy (P=0.002) and quality of life (P<0.001). As compared with monthly high-quality clinic testing, weekly self-testing did not delay the time to a first stroke, major bleeding episode, or death to the extent suggested by prior studies. These results do not support the superiority of self-testing over clinic testing in reducing the risk of stroke, major bleeding episode, and death among patients taking warfarin therapy. (Funded by the Department of Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT00032591.).

Impact of single-point GPS integrated water vapor estimates on short-range WRF model forecasts over southern India

NASA Astrophysics Data System (ADS)

Kumar, Prashant; Gopalan, Kaushik; Shukla, Bipasha Paul; Shyam, Abhineet

2017-11-01

Specifying physically consistent and accurate initial conditions is one of the major challenges of numerical weather prediction (NWP) models. In this study, ground-based global positioning system (GPS) integrated water vapor (IWV) measurements available from the International Global Navigation Satellite Systems (GNSS) Service (IGS) station in Bangalore, India, are used to assess the impact of GPS data on NWP model forecasts over southern India. Two experiments are performed with and without assimilation of GPS-retrieved IWV observations during the Indian winter monsoon period (November-December, 2012) using a four-dimensional variational (4D-Var) data assimilation method. Assimilation of GPS data improved the model IWV analysis as well as the subsequent forecasts. There is a positive impact of ˜10 % over Bangalore and nearby regions. The Weather Research and Forecasting (WRF) model-predicted 24-h surface temperature forecasts have also improved when compared with observations. Small but significant improvements were found in the rainfall forecasts compared to control experiments.

Saxagliptin for the treatment of type 2 diabetes mellitus: assessing cardiovascular data

PubMed Central

2012-01-01

Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular (CV) disease; however, conclusive evidence that glycemic control leads to improved cardiovascular outcomes is lacking. Saxagliptin is a potent, selective dipeptidyl peptidase-4 inhibitor approved as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. Saxagliptin was evaluated in a series of phase III trials as monotherapy; add-on therapy to metformin, a sulfonylurea, or a thiazolidinedione; and as initial therapy in combination with metformin. Saxagliptin consistently improved glycemic control (as reflected by significant decreases in glycated hemoglobin, fasting plasma glucose, and postprandial glucose compared with controls) and was generally well tolerated. In these analyses, saxagliptin had clinically neutral effects on body weight, blood pressure, lipid levels, and other markers of CV risk compared with controls. A retrospective meta-analysis of 8 phase II and phase III trials found no evidence that saxagliptin increases CV risk in patients with T2DM (Cox proportional hazard ratio, 0.43; 95% CI, 0.23-0.80 for major adverse cardiovascular events retrospectively adjudicated). Instead, it raised the hypothesis that saxagliptin may reduce the risk of major adverse CV events. A long-term CV outcome trial, Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-THrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) is currently ongoing to determine whether saxagliptin reduces CV risk in T2DM. PMID:22248301

Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

PubMed

Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

2006-01-01

We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

The addition of a tension night splint to a structured home rehabilitation programme in patients with chronic plantar fasciitis does not lead to significant additional benefits in either pain, function or flexibility: a single-blinded randomised controlled trial

PubMed Central

2017-01-01

Objective To identify any improvements in pain or function in patients with chronic plantar fasciitis following the use of a tension night splint (TNS). Methods Single-blinded randomised controlled trial, with participants split evenly between intervention group (TNS + home exercise programme/HEP) and control group (HEP only). Follow-up at 3 months, with interim data at 6 weeks. Results 40 patients recruited. Mean age 52.1 years, 33% male, mean body mass index 30.8 kg/m2, mean duration of symptoms of 25 months. Improvement in self-reported ‘average pain' in the intervention group from 6.8/10 at baseline to 5.6/10 at 6 weeks, and 5.3/10 at 3 months (both clinically and statistically significant at both time points), compared with control group of 7.1/10 at baseline to 6.2/10 at 6 weeks and 5.6/10 at 3 months (significant only at 3 months). Improvements in self-reported ‘worst pain', ‘pain walking' and ‘pain first thing in the morning' in both groups at all time periods. Improvements were seen in revised Foot Function Index at all time points in both groups, but limited changes seen in flexibility and no significant changes in anxiety or depression Hospital Anxiety and Depression Scale domains or sleep quality in either group. However, no differences were seen between the outcomes seen in the two groups for the majority of the measures studied. Conclusions Improvements in pain and some functional measures seen in both groups, with few, if any, differences seen in outcomes between the intervention group compared with the control group. However, ongoing pain symptoms were reported in both groups, suggesting that ‘help' rather than ‘cure' was obtained for the majority. There is a possibility of earlier benefit seen in the intervention group compared with the control group, but data are unclear and further work may be needed. Trial registration number ClinicalTrials.gov: NCT02546115; results. PMID:29259809

Citalopram, methylphenidate, or their combination in geriatric depression: a randomized, double-blind, placebo-controlled trial.

PubMed

Lavretsky, Helen; Reinlieb, Michelle; St Cyr, Natalie; Siddarth, Prabha; Ercoli, Linda M; Senturk, Damla

2015-06-01

The authors evaluated the potential of methylphenidate to improve antidepressant response to citalopram, as assessed by clinical and cognitive outcomes, in elderly depressed patients. The authors conducted a 16-week randomized double-blind placebo-controlled trial for geriatric depression in 143 older outpatients diagnosed with major depression comparing treatment response in three treatment groups: methylphenidate plus placebo (N=48), citalopram plus placebo (N=48), and citalopram plus methylphenidate (N=47). The primary outcome measure was change in depression severity. Remission was defined as a score of 6 or less on the Hamilton Depression Rating Scale. Secondary outcomes included measures of anxiety, apathy, quality of life, and cognition. Daily doses ranged from 20 mg to 60 mg for citalopram (mean=32 mg) and from 5 mg to 40 mg for methylphenidate (mean=16 mg). All groups showed significant improvement in depression severity and in cognitive performance. However, the improvement in depression severity and the Clinical Global Impressions improvement score was more prominent in the citalopram plus methylphenidate group compared with the other two groups. Additionally, the rate of improvement in the citalopram plus methylphenidate group was significantly higher than that in the citalopram plus placebo group in the first 4 weeks of the trial. The groups did not differ in cognitive improvement or number of side effects. Combined treatment with citalopram and methylphenidate demonstrated an enhanced clinical response profile in mood and well-being, as well as a higher rate of remission, compared with either drug alone. All treatments led to an improvement in cognitive functioning, although augmentation with methylphenidate did not offer additional benefits.

The comparative effectiveness and cost-effectiveness of vitreoretinal interventions.

PubMed

Brown, Melissa M; Brown, Gary C; Brown, Heidi C; Irwin, Blair; Brown, Kathryn S

2008-05-01

The comparative effectiveness of medical interventions has recently been emphasized in the literature, typically for interventions in a similar class. Value-based medicine, the practice of medicine based on the value (improvement in quality of life and/or length of life) conferred by medical interventions, allows a measure of comparative effectiveness of interventions across all of health care, no matter how disparate. This report discusses recent comparative effectiveness studies in the vitreoretinal literature. Vitreoretinal interventions have good to excellent comparative effectiveness compared with commonly utilized interventions across health care, such as treatment for osteoporosis and hyperlipidemia. They also tend to be cost-effective when an upper limit of $100 000/quality-adjusted life-year is utilized. Value can be measured using either or both of two outcomes - the quality-adjusted life-year gain and/or the percentage improvement in value - both of which allow for an evaluation of comparative effectiveness, which can be compared on the same scale for every intervention. This value can also be integrated with costs using the outcome of dollars expended per quality-adjusted life-year ($/quality-adjusted life-year, or the cost-utility ratio), which allows a comparison of cost-effectiveness across all interventions. The majority of vitreoretinal interventions confer considerable value and are cost-effective.

Creatine supplementation and swim performance: a brief review.

PubMed

Hopwood, Melissa J; Graham, Kenneth; Rooney, Kieron B

2006-03-01

Nutritional supplements are popular among athletes participating in a wide variety of sports. Creatine is one of the most commonly used dietary supplements, as it has been shown to be beneficial in improving performance during repeated bouts of high-intensity anaerobic activity. This review examines the specific effects of creatine supplementation on swimming performance, and considers the effects of creatine supplementation on various measures of power development in this population. Research performed on the effect of creatine supplementation on swimming performance indicates that whilst creatine supplementation is ineffective in improving performance during a single sprint swim, dietary creatine supplementation may benefit repeated interval swim set performance. Considering the relationship between sprint swimming performance and measurements of power, the effect of creatine supplementation on power development in swimmers has also been examined. When measured on a swim bench ergometer, power development does show some improvement following a creatine supplementation regime. How this improvement in power output transfers to performance in the pool is uncertain. Although some evidence exists to suggest a gender effect on the performance improvements seen in swimmers following creatine supplementation, the majority of research indicates that male and female swimmers respond equally to supplementation. A major limitation to previous research is the lack of consideration given to the possible stroke dependant effect of creatine supplementation on swimming performance. The majority of the research conducted to date has involved examination of the freestyle swimming stroke only. The potential for performance improvements in the breaststroke and butterfly swimming strokes is discussed, with regards to the biomechanical differences and differences in efficiency between these strokes and freestyle. Key PointsCreatine supplementation does not improve single sprint swimming performance.Creatine supplementation does improve repeated interval swim set performance.Creatine supplementation does improve power development in swimmers when measured on a swim bench ergometer.As a result of the high energy demands of the butterfly and breaststroke competitive swimming styles, potentially, the benefits associated with creatine supplementation and swimming performance could be greater when swimming butterfly or breaststroke, compared to the commonly examined freestyle swimming stroke.

The effects of desvenlafaxine on neurocognitive and work functioning in employed outpatients with major depressive disorder.

PubMed

Lam, Raymond W; Iverson, Grant L; Evans, Vanessa C; Yatham, Lakshmi N; Stewart, Kurtis; Tam, Edwin M; Axler, Auby; Woo, Cindy

2016-10-01

Major depressive disorder (MDD) is associated with staggering personal and economic costs, a major proportion of which stem from impaired psychosocial and occupational functioning. Few studies have examined the impact of depression-related cognitive dysfunction on work functioning. We examined the association between neurocognitive and work functioning in employed patients with MDD. Employed adult outpatients (n=36) with MDD of at least moderate severity (≥23 on the Montgomery Asberg Depression Rating Scale, MADRS) and subjective cognitive complaints completed neurocognitive tests (CNS Vital Signs computerized battery) and validated self-reports of their work functioning (LEAPS, HPQ) before and after 8 weeks of open-label treatment with flexibly-dosed desvenlafaxine 50-100mg/day. Relationships between neurocognitive tests and functional measures were examined using bivariate correlational and multiple regression analyses, as appropriate. An ANCOVA model examined whether significant change in neurocognitive performance, defined as improvement of ≥1SD in the Neurocognition Index (NCI) from baseline to post-treatment, was associated with improved outcomes. Patients showed significant improvements in depressive symptom, neurocognitive, and work functioning measures following treatment with desvenlafaxine (e.g., MADRS response=77% and MADRS remission=49%). There were no significant correlations between changes in NCI or cognitive domain subscales and changes in MADRS, LEAPS, or HPQ scores. However, patients demonstrating significant improvement in NCI scores (n=11, 29%) had significantly greater improvement in clinical and work functioning outcomes compared to those without NCI improvement. The limitations of this study include small sample size, lack of a placebo control group, and lack of a healthy comparison group. Our sample also had more years of education and higher premorbid intelligence than the general population. There were no significant correlations between changes in neurocognitive and work functioning measures in this study. However, meaningful improvement in neurocognitive functioning with desvenlafaxine was associated with greater improvement in both mood and occupational outcomes. This suggests that addressing cognitive dysfunction may improve clinical and occupational outcomes in employed patients with MDD. However, the relationship between neurocognitive and work functioning in MDD is complex and requires further study. Copyright © 2016 Elsevier B.V. All rights reserved.

Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH: re-evaluation of four controlled clinical studies.

PubMed

Oelke, Matthias; Berges, Richard; Schläfke, Sandra; Burkart, Martin

2014-10-01

To determine the effects of the herbal fixed-dose combination PRO 160/120 (extracts from saw palmetto fruits and stinging nettle roots) on nocturnal voiding frequency, as measured by question 7 of the IPSS questionnaire, in patients with moderate-to-severe LUTS/BPH after 24 weeks of treatment compared to placebo, to the α-blocker tamsulosin, or to the 5α-reductase inhibitor finasteride. The study is about post hoc evaluation of four published randomized, double-blind clinical trials on PRO 160/120, two compared with placebo, one with finasteride and one with tamsulosin. In addition, a pooled data analysis of the two placebo-controlled trials was conducted. We analyzed data from a total of 922 patients with a mean age of 66 years and a mean baseline nocturnal voiding frequency of 2.1. In the pooled analysis of placebo-controlled trials, nocturnal voids improved by 0.8 (29 %) with PRO 160/120 compared to 0.6 (18 %) with placebo (p = 0.015, Wilcoxon test, one-tailed). The 69 % responder rate to PRO 160/120 was significantly superior to the placebo response (52 %; p = 0.003, χ (2)-test, two-tailed). The majority of responders improved by 1 void/night. Absolute improvements and response rates were consistently higher with PRO 160/120 than with placebo over a range of baseline nocturnal voiding frequencies. There were no differences between PRO 160/120 and finasteride or tamsulosin regarding absolute improvement of nocturnal voids or responds rates. PRO 160/120 significantly improved nocturnal voiding frequency compared to placebo and similar to tamsulosin or finasteride.

Persea americana (avocado): bringing ancient flowers to fruit in the genomics era.

PubMed

Chanderbali, André S; Albert, Victor A; Ashworth, Vanessa E T M; Clegg, Michael T; Litz, Richard E; Soltis, Douglas E; Soltis, Pamela S

2008-04-01

The avocado (Persea americana) is a major crop commodity worldwide. Moreover, avocado, a paleopolyploid, is an evolutionary "outpost" among flowering plants, representing a basal lineage (the magnoliid clade) near the origin of the flowering plants themselves. Following centuries of selective breeding, avocado germplasm has been characterized at the level of microsatellite and RFLP markers. Nonetheless, little is known beyond these general diversity estimates, and much work remains to be done to develop avocado as a major subtropical-zone crop. Among the goals of avocado improvement are to develop varieties with fruit that will "store" better on the tree, show uniform ripening and have better post-harvest storage. Avocado transcriptome sequencing, genome mapping and partial genomic sequencing will represent a major step toward the goal of sequencing the entire avocado genome, which is expected to aid in improving avocado varieties and production, as well as understanding the evolution of flowers from non-flowering seed plants (gymnosperms). Additionally, continued evolutionary and other comparative studies of flower and fruit development in different avocado strains can be accomplished at the gene expression level, including in comparison with avocado relatives, and these should provide important insights into the genetic regulation of fruit development in basal angiosperms.

Changes in quality of life over 1 year in patients with head and neck cancer.

PubMed

Ronis, David L; Duffy, Sonia A; Fowler, Karen E; Khan, Mumtaz J; Terrell, Jeffrey E

2008-03-01

To characterize and compare quality of life (QOL) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year. Prospective cohort study. Three otolaryngology clinics. Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer. Health-related QOL was assessed using the 36-item Short-Form Health Survey and a head and neck cancer-specific QOL scale. Over 1 year, QOL decreased for physical functioning measures and eating but improved for mental health QOL. Depression and smoking were major predictors of poor QOL at baseline. Major predictors of change in QOL from baseline to 1 year were treatment factors, especially feeding tube placement (9 scales), chemotherapy (3 scales), and radiation therapy (3 scales). Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year. Health-related physical QOL tended to decline over 1 year and mental health QOL improved. The major predictors of change in QOL were treatment factors, smoking, and depressive symptoms. Physicians should alert patients to the relative effects on QOL one may experience with different treatments.

Body temperature and major neurological improvement in tPA-treated stroke patients.

PubMed

Kvistad, C E; Thomassen, L; Waje-Andreassen, U; Logallo, N; Naess, H

2014-05-01

Major neurological improvement (MNI) at 24 hours represents a marker of early recanalization in ischaemic stroke. Although low body temperature is considered neuroprotective in cerebral ischaemia, some studies have suggested that higher body temperature may promote clot lysis in the acute phase of ischaemic stroke. We hypothesized that higher body temperature was associated with MNI in severe stroke patients treated with tPA, suggesting a beneficial effect of higher body temperature on clot lysis and recanalization. Patients with ischaemic stroke or transient ischaemic attack (TIA) treated with tPA between February 2006 and August 2012 were prospectively included and retrospectively analysed. Body temperature was measured upon admission. MNI was defined by a ≥8 point improvement in NIHSS score at 24 hours as compared to NIHSS score on admission. No significant improvement (no-MNI) was defined by either an increase in NIHSS score or a decrease of ≤2 points at 24 hours in patients with an admission NIHSS score of ≥8. Of the 2351 patients admitted with ischaemic stroke or TIA, 347 patients (14.8%) were treated with tPA. A total of 32 patients (9.2%) had MNI and 56 patients (16.1%) had no-MNI. Patients with MNI had higher body temperatures compared with patients with no-MNI (36.7°C vs 36.3°C, P = 0.004). Higher body temperature was independently associated with MNI when adjusted for confounders (OR 5.16, P = 0.003). Higher body temperature was independently associated with MNI in severe ischaemic stroke patients treated with tPA. This may suggest a beneficial effect of higher body temperature on clot lysis and recanalization. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The relationship between symptom relief and functional improvement during acute fluoxetine treatment for patients with major depressive disorder.

PubMed

Lin, Ching-Hua; Chou, Li-Shiu; Chen, Ming-Chao; Chen, Cheng-Chung

2015-08-15

The purpose of this study was to compare the rate of symptom relief to functional improvement and examine the relationships between symptom relief and functional improvement during the acute phase of treatment. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Symptom severity, using the 17-item Hamilton Depression Rating Scale (HAMD-17), and functioning, using the Modified Work and Social Adjustment Scale (MWSAS), were measured regularly. The outcome measures were the HAMD-17 score and MWSAS score at weeks 1, 2, 3, 4, and 6. We compared the effect size and the reduction rate of HAMD-17 to those of MWSAS at week 1, 2, 3, 4, and 6. Structural equation modeling was used to examine relationships among the study variables. Of the 131 participants, 126 had at least one post-baseline assessment at week 1 and were included in the analysis. The HAMD-17 had a larger effect size and reduction rate than the MWSAS at weeks 1, 2, 3, 4, and 6. Parsimonious model satisfied all indices of goodness-of-fit (Chi-Square/df=1.479, TLI=0.978, CFI=0.986, RMSEA=0.062) and had all paths with significant path coefficients. MWSAS at week 0 predicted HAMD-17 at week 1. This was an open-labeled study with small sample size. Depressive symptoms improved more quickly than functioning during the acute phase of treatment. Depressive symptoms and functional impairment are distinct domains, and should be assessed independently. Copyright © 2015 Elsevier B.V. All rights reserved.

Advanced porous electrodes with flow channels for vanadium redox flow battery

NASA Astrophysics Data System (ADS)

Bhattarai, Arjun; Wai, Nyunt; Schweiss, Ruediger; Whitehead, Adam; Lim, Tuti M.; Hng, Huey Hoon

2017-02-01

Improving the overall energy efficiency by reducing pumping power and improving flow distribution of electrolyte, is a major challenge for developers of flow batteries. The use of suitable channels can improve flow distribution through the electrodes and reduce flow resistance, hence reducing the energy consumption of the pumps. Although several studies of vanadium redox flow battery have proposed the use of bipolar plates with flow channels, similar to fuel cell designs, this paper presents the use of flow channels in the porous electrode as an alternative approach. Four types of electrodes with channels: rectangular open channel, interdigitated open cut channel, interdigitated circular poked channel and cross poked circular channels, are studied and compared with a conventional electrode without channels. Our study shows that interdigitated open channels can improve the overall energy efficiency up to 2.7% due to improvement in flow distribution and pump power reduction while interdigitated poked channel can improve up to 2.5% due to improvement in flow distribution.

The Enduring Health Challenges of Afghan Immigrants and Refugees in Iran: A Systematic Review

PubMed Central

Hosseini Divkolaye, Nasim Sadat; Burkle, Frederick M.

2017-01-01

Introduction Iran is the third country in the world with the highest number of registered refugees with the majority coming from Afghanistan. They suffer major health and social risks yet their health status has never been comprehensively determined. Methods This systematic review of the literature highlights major disparities among documented immigrants in health access, communicable and non-communicable diseases and the increasingly desperate plight of undocumented immigrants. Results Comparing with Iranian population, the findings suggest the higher prevalence of most diseases among Afghan immigrants and refugees. This highlights the importance of increasing the migrants' access to health services from both public health as well as human rights perspectives. Discussion Although the Iranian government has taken new initiatives to overcome this challenge, certain issues have still remained unaddressed. Potential solutions to improve this process are discussed. PMID:28856065

[Difference analysis among majors in medical parasitology exam papers by test item bank proposition].

PubMed

Jia, Lin-Zhi; Ya-Jun, Ma; Cao, Yi; Qian, Fen; Li, Xiang-Yu

2012-04-30

The quality index among "Medical Parasitology" exam papers and measured data for students in three majors from the university in 2010 were compared and analyzed. The exam papers were formed from the test item bank. The alpha reliability coefficients of the three exam papers were above 0.70. The knowledge structure and capacity structure of the exam papers were basically balanced. But the alpha reliability coefficients of the second major was the lowest, mainly due to quality of test items in the exam paper and the failure of revising the index of test item bank in time. This observation demonstrated that revising the test items and their index in the item bank according to the measured data can improve the quality of test item bank proposition and reduce the difference among exam papers.

Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder.

PubMed

Herrera-Guzmán, Ixchel; Herrera-Abarca, Jorge E; Gudayol-Ferré, Esteve; Herrera-Guzmán, Daniel; Gómez-Carbajal, Lizbeth; Peña-Olvira, Miriam; Villuendas-González, Erwin; Joan, Guàrdia-Olmos

2010-05-30

Several reports suggest that antidepressants may improve cognitive functioning in patients with major depressive disorder (MDD). The present work aims to study the effects of selective serotonin reuptake inhibitors (SSRIs) and serotonergic-noradrenergic reuptake inhibitors (SNRIs) treatments on the performance of working memory, attention and executive functions in patients with MDD. A total of 73 subjects meeting the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) criteria for MDD, and 37 control subjects were assessed with the Hamilton Depression Rating Scale and a neuropsychological battery. The subjects were medicated with escitalopram (n=36) or duloxetine (n=37) for 24 weeks. At the end of the trial, the subjects were assessed again with the same tests. The depressed subjects showed alterations in attention and cognitive functions when compared to the control group. The administration of both treatments improved working memory, as well as attention and all the executive functions, but the cognitive functions of depressed patients do not improve enough to reach the levels of performance of the control subjects. Our results suggest that both SSRI and SNRI treatments presented the same efficacy in improving attention and the remaining executive functions. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Effect of Major Royal Jelly Proteins on Spatial Memory in Aged Rats: Metabolomics Analysis in Urine.

PubMed

Chen, Di; Liu, Fang; Wan, Jian-Bo; Lai, Chao-Qiang; Shen, Li-Rong

2017-04-19

Royal jelly (RJ) produced by worker honeybees is the sole food for the queen bee throughout her life as well as the larvae of worker bees for the first 3 days after hatching. Supplementation of RJ in the diet has been shown to increase spatial memory in rodents. However, the key constituents in RJ responsible for improvement of cognitive function are unknown. Our objective was to determine if the major royal jelly proteins (MRJPs) extracted from RJ can improve the spatial memory of aged rats. The spatial memory assay using the Morris water maze test was administered once to rats after a 14-week feeding. Metabolomics analysis based on quadrupole time-of-flight mass spectrometry was conducted to examine the differences in compounds from urine. Aged male rats fed MRJPs showed improved spatial memory up to 48.5% when compared to the control male aged rats fed distilled water. The metabolite pattern of the MRJPs-fed aged rats was regressed to that of the young rats. Compounds altered by MRJPs were mapped to nicotinate and nicotinamide metabolism, cysteine taurine metabolism, and energy metabolism pathways. In summary, MRJPs may improve spatial memory and possess the potential for prevention of cognitive impairment via the cysteine and taurine metabolism and energy metabolism pathways in aged rats.

Oral chelators deferasirox and deferiprone for transfusional iron overload in thalassemia major: new data, new questions

PubMed Central

Neufeld, Ellis J.

2006-01-01

For nearly 30 years, patients with transfusional iron overload have depended on nightly deferoxamine infusions for iron chelation. Despite dramatic gains in life expectancy in the deferoxamine era for patients with transfusion-dependent anemias, the leading cause of death for young adults with thalassemia major and related disorders has been cardiac disease from myocardial iron deposition. Strategies to reduce cardiac disease by improving chelation regimens have been of the highest priority. These strategies have included development of novel oral iron chelators to improve compliance, improved assessment of cardiac iron status, and careful epidemiologic assessment of European outcomes with deferiprone, an oral alternative chelator available for about a decade. Each of these strategies is now bearing fruit. The novel oral chelator deferasirox was recently approved by the Food and Drug Administration (FDA); a randomized clinical trial demonstrates that deferasirox at 20 to 30 mg/kg/d can maintain or improve hepatic iron in thalassemia as well as deferoxamine. A randomized trial based on cardiac T2* magnetic resonance imaging (MRI) suggests that deferiprone can unload myocardial iron faster than deferoxamine. Retrospective epidemiologic data suggest dramatic reductions in cardiac events and mortality in Italian subjects exposed to deferiprone compared with deferoxamine. These developments herald a new era for iron chelation, but many unanswered questions remain. PMID:16627763

Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters.

PubMed

Asgary, Ramin; Sckell, Blanca; Alcabes, Analena; Naderi, Ramesh; Adongo, Philip; Ogedegbe, Gbenga

2015-01-01

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants' average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.

Low-Visibility Visual Simulation with Real Fog

NASA Technical Reports Server (NTRS)

Chase, Wendell D.

1982-01-01

An environmental fog simulation (EFS) attachment was developed to aid in the study of natural low-visibility visual cues and subsequently used to examine the realism effect upon the aircraft simulator visual scene. A review of the basic fog equations indicated that the two major factors must be accounted for in the simulation of low visibility-one due to atmospheric attenuation and one due to veiling luminance. These factors are compared systematically by: comparing actual measurements lo those computed from the Fog equations, and comparing runway-visual-range-related visual-scene contrast values with the calculated values. These values are also compared with the simulated equivalent equations and with contrast measurements obtained from a current electronic fog synthesizer to help identify areas in which improvements are needed. These differences in technique, the measured values, the Features of both systems, a pilot opinion survey of the EFS fog, and improvements (by combining features of both systems) that are expected to significantly increase the potential as well as flexibility for producing a very high-fidelity, low-visibility visual simulation are discussed.

Low-visibility visual simulation with real fog

NASA Technical Reports Server (NTRS)

Chase, W. D.

1981-01-01

An environmental fog simulation (EFS) attachment was developed to aid in the study of natural low-visibility visual cues and subsequently used to examine the realism effect upon the aircraft simulator visual scene. A review of the basic fog equations indicated that two major factors must be accounted for in the simulation of low visibility - one due to atmospheric attenuation and one due to veiling luminance. These factors are compared systematically by (1) comparing actual measurements to those computed from the fog equations, and (2) comparing runway-visual-range-related visual-scene contrast values with the calculated values. These values are also compared with the simulated equivalent equations and with contrast measurements obtained from a current electronic fog synthesizer to help identify areas in which improvements are needed. These differences in technique, the measured values, the features of both systems, a pilot opinion survey of the EFS fog, and improvements (by combining features of both systems) that are expected to significantly increase the potential as well as flexibility for producing a very high-fidelity low-visibility visual simulation are discussed.

Comparing the Effects of Bupropion and Escitalopram on Excessive Internet Game Play in Patients with Major Depressive Disorder.

PubMed

Nam, Beomwoo; Bae, Sujin; Kim, Sun Mi; Hong, Ji Seon; Han, Doug Hyun

2017-11-30

Several studies have suggested the efficacy of bupropion and escitalopram on reducing the excessive internet game play. We hypothesized that both bupropion and escitalopram would be effective on reducing the severity of depressive symptoms and internet gaming disorder (IGD) symptoms in patients with both major depressive disorder and IGD. However, the changes in brain connectivity between the default mode network (DMN) and the salience network were different between bupropion and escitalopram due to their different pharmacodynamics. This study was designed as a 12-week double blind prospective trial. Thirty patients were recruited for this research (15 bupropion group+15 escitalopram group). To assess the differential functional connectivity (FC) between the hubs of the DMN and the salience network, we selected 12 regions from the automated anatomical labeling in PickAtals software. After drug treatment, the depressive symptoms and IGD symptoms in both groups were improved. Impulsivity and attentional symptoms in the bupropion group were significantly decreased, compared to the escitalopram group. After treatment, FC within only the DMN in escitalopram decreased while FC between DMN and salience network in bupropion group decreased. Bupropion was associated with significantly decreased FC within the salience network and between the salience network and the DMN, compared to escitalopram. Bupropion showed greater effects than escitalopram on reducing impulsivity and attentional symptoms. Decreased brain connectivity between the salience network and the DMN appears to be associated with improved excessive IGD symptoms and impulsivity in MDD patients with IGD.

Efficacy and safety of add on low-dose mirtazapine in depression.

PubMed

Matreja, Prithpal S; Badyal, Dinesh K; Deswal, Randhir S; Sharma, Arvind

2012-03-01

Although antidepressant medications are effective, they have a delayed onset of effect. Mirtazapine, an atypical antidepressant is an important option for add-on therapy in major depression. There is insufficient data on mirtazapine in Indian population; hence this study was designed to study the add-on effect of low-dose mirtazapine with selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD) in Indian population. In an open, randomized study, 60 patients were divided into two groups. In Group A (n=30) patients received conventional SSRIs for 6 weeks. In Group B (n=30) patients received conventional SSRIs with low-dose mirtazapine for 6 weeks. Patients were evaluated at baseline and then at 1, 2, 3, 4, 5, and 6 weeks. There was significant improvement in Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg depression rating scale (MADRS) scores (P<0.05) in both groups. Mirtazapine in low dose as add on therapy showed improvement in scores, had earlier onset of action, and more number of responders and remitters as compared to conventional treatment (P<0.05). No serious adverse event was reported in either of the groups. Low-dose mirtazapine as add-on therapy has shown better efficacy, earlier onset of action and more number of responders and remitters as compared to conventional treatment in MDD in Indian patients.

Health Benefits of Urban Allotment Gardening: Improved Physical and Psychological Well-Being and Social Integration.

PubMed

Soga, Masashi; Cox, Daniel T C; Yamaura, Yuichi; Gaston, Kevin J; Kurisu, Kiyo; Hanaki, Keisuke

2017-01-12

With an ever-increasing urban population, promoting public health and well-being in towns and cities is a major challenge. Previous research has suggested that participating in allotment gardening delivers a wide range of health benefits. However, evidence from quantitative analyses is still scarce. Here, we quantify the effects, if any, of participating in allotment gardening on physical, psychological and social health. A questionnaire survey of 332 people was performed in Tokyo, Japan. We compared five self-reported health outcomes between allotment gardeners and non-gardener controls: perceived general health, subjective health complaints, body mass index (BMI), mental health and social cohesion. Accounting for socio-demographic and lifestyle variables, regression models revealed that allotment gardeners, compared to non-gardeners, reported better perceived general health, subjective health complaints, mental health and social cohesion. BMI did not differ between gardeners and non-gardeners. Neither frequency nor duration of gardening significantly influenced reported health outcomes. Our results highlight that regular gardening on allotment sites is associated with improved physical, psychological and social health. With the recent escalation in the prevalence of chronic diseases, and associated healthcare costs, this study has a major implication for policy, as it suggests that urban allotments have great potential for preventative healthcare.

The beneficial effects of combined grape pomace and omija fruit extracts on hyperglycemia, adiposity and hepatic steatosis in db/db mice: a comparison with major index compounds.

PubMed

Cho, Su-Jung; Park, Hae-Jin; Jung, Un Ju; Kim, Hye-Jin; Moon, Byoung Seok; Choi, Myung-Sook

2014-09-30

This study investigated the effects of combined grape pomace and omija fruit extracts (GO) on diabetes-related metabolic changes in type 2 diabetic db/db mice. The effects of GO were compared with those of a resveratrol and schizandrin mixture (RS), which is a mixture of major components of GO. Mice were fed a normal diet with RS (0.005% resveratrol and 0.02% schizandrin in diet, w/w) or GO (0.3% grape pomace ethanol extract and 0.05% omija fruit ethanol extract in diet, w/w) for seven weeks. RS and GO not only lowered the levels of blood and plasma glucose, HbA1c, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) with a simultaneous decrease in hepatic gluconeogenic enzymes activities and adiposity, but also improved preservation of the pancreatic β-cells. Plasma leptin and resistin levels were lower while the plasma adiponectin level was higher in the RS and GO groups than in the control group. Especially, GO increased hepatic glucokinase activity and gene expression and improved hepatic steatosis by elevating fatty acid oxidation compared to RS. These findings suggest that GO ameliorates hyperglycemia, adiposity and hepatic steatosis in type 2 diabetic mice.

Health Benefits of Urban Allotment Gardening: Improved Physical and Psychological Well-Being and Social Integration

PubMed Central

Soga, Masashi; Cox, Daniel T. C.; Yamaura, Yuichi; Gaston, Kevin J.; Kurisu, Kiyo; Hanaki, Keisuke

2017-01-01

With an ever-increasing urban population, promoting public health and well-being in towns and cities is a major challenge. Previous research has suggested that participating in allotment gardening delivers a wide range of health benefits. However, evidence from quantitative analyses is still scarce. Here, we quantify the effects, if any, of participating in allotment gardening on physical, psychological and social health. A questionnaire survey of 332 people was performed in Tokyo, Japan. We compared five self-reported health outcomes between allotment gardeners and non-gardener controls: perceived general health, subjective health complaints, body mass index (BMI), mental health and social cohesion. Accounting for socio-demographic and lifestyle variables, regression models revealed that allotment gardeners, compared to non-gardeners, reported better perceived general health, subjective health complaints, mental health and social cohesion. BMI did not differ between gardeners and non-gardeners. Neither frequency nor duration of gardening significantly influenced reported health outcomes. Our results highlight that regular gardening on allotment sites is associated with improved physical, psychological and social health. With the recent escalation in the prevalence of chronic diseases, and associated healthcare costs, this study has a major implication for policy, as it suggests that urban allotments have great potential for preventative healthcare. PMID:28085098

Recent Developments in Active Tumor Targeted Multifunctional Nanoparticles for Combination Chemotherapy in Cancer Treatment and Imaging

PubMed Central

Glasgow, Micah D. K.; Chougule, Mahavir B.

2016-01-01

Nanotechnology and combination therapy are two major fields that show great promise in the treatment of cancer. The delivery of drugs via nanoparticles helps to improve drug’s therapeutic effectiveness while reducing adverse side effects associated with high dosage by improving their pharmacokinetics. Taking advantage of molecular markers over-expressing on tumor tissues compared to normal cells, an “active” molecular marker targeted approach would be beneficial for cancer therapy. These actively targeted nanoparticles would increase drug concentration at the tumor site, improving efficacy while further reducing chemo-resistance. The multidisciplinary approach may help to improve the overall efficacy in cancer therapy. This review article summarizes recent developments of targeted multifunctional nanoparticles in the delivery of various drugs for a combinational chemotherapy approach to cancer treatment and imaging. PMID:26554150

VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data

DTIC Science & Technology

2014-11-01

VA HEALTH CARE Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...00-2014 4. TITLE AND SUBTITLE VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data Why GAO Did This Study In 2013, VA estimated that about 1.5 million

Serum Galectin-3 and Poor Outcomes Among Patients With Acute Ischemic Stroke.

PubMed

Wang, Aili; Zhong, Chongke; Zhu, Zhengbao; Xu, Tian; Peng, Yanbo; Xu, Tan; Peng, Hao; Chen, Chung-Shiuan; Wang, Jinchao; Ju, Zhong; Li, Qunwei; Geng, Deqin; Sun, Yingxian; Zhang, Jianhui; Yuan, Xiaodong; Chen, Jing; Zhang, Yonghong; He, Jiang

2018-01-01

Elevated galectin-3 has been associated with atherosclerosis and poor outcomes in patients with heart failure. However, it remains unclear whether galectin-3 has any effect on the poor outcomes of ischemic stroke. The aim of the present study was to examine the association between galectin-3 with poor outcomes among patients with acute ischemic stroke. Serum galectin-3 was measured in 3082 patients with acute ischemic stroke. The primary outcome was a combination of death or major disability (modified Rankin Scale score, ≥3) at 3 months after stroke. Compared with the lowest quartile of galectin-3, multivariate adjusted odds ratios (95% confidence intervals) for the highest quartile of galectin-3 were 1.55 (1.15-2.09) for composite outcome, 2.10 (0.89-4.95) for death, and 1.43 (1.05-1.93) for major disability. The addition of galectin-3 to the conventional risk factors significantly improved prediction of the combined outcome of death or major disability in patients with ischemic stroke (net reclassification index, 18.9%; P <0.001; integrated discrimination improvement, 0.4%; P =0.001). Higher levels of serum galectin-3 were independently associated with increased risk of death or major disability after stroke onset, suggesting that galectin-3 may have prognostic value in poor outcomes of ischemic stroke. © 2017 American Heart Association, Inc.

The DSM-III personality disorders section: a commentary.

PubMed

Frances, A

1980-09-01

The author reviews the DSM-III section on personality disorders, discusses several of its more controversial diagnoses, and suggests some possible alternatives. He attributes the continued low reliability of personality diagnoses, compared with the other major sections of DSM-III, to two inherent obstacles: the lack of clear boundaries demarcating the personality disorders from normality and from one another, and the confounding influence of state and role factors. Nonetheless, the DSM-III multiaxial system highlights the importance of personality diagnosis and, together with the provision of clearly specified diagnostic criteria, achieves a considerably improved reliability compared with previous nomenclatures.

Head Pose Estimation on Eyeglasses Using Line Detection and Classification Approach

NASA Astrophysics Data System (ADS)

Setthawong, Pisal; Vannija, Vajirasak

This paper proposes a unique approach for head pose estimation of subjects with eyeglasses by using a combination of line detection and classification approaches. Head pose estimation is considered as an important non-verbal form of communication and could also be used in the area of Human-Computer Interface. A major improvement of the proposed approach is that it allows estimation of head poses at a high yaw/pitch angle when compared with existing geometric approaches, does not require expensive data preparation and training, and is generally fast when compared with other approaches.

An overview of HyFIE Technical Research Project: cross-testing in main European hypersonic wind tunnels on EXPERT body

NASA Astrophysics Data System (ADS)

Brazier, Jean-Philippe; Martinez Schramm, Jan; Paris, Sébastien; Gawehn, Thomas; Reimann, Bodo

2016-09-01

HyFIE project aimed at improving the measurement techniques in hypersonic wind tunnels and comparing the experimental data provided by four major European facilities: DLR HEG and H2K, ONERA F4 and VKI Longshot. A common geometry of EXPERT body was chosen and four different models were used. A large amount of experimental data was collected and compared with the results of numerical simulations. Collapsing all the measured values showed a good agreement between the different facilities, as well as between experimental and computed data.

Decision support in psychiatry – a comparison between the diagnostic outcomes using a computerized decision support system versus manual diagnosis

PubMed Central

Bergman, Lars G; Fors, Uno GH

2008-01-01

Background Correct diagnosis in psychiatry may be improved by novel diagnostic procedures. Computerized Decision Support Systems (CDSS) are suggested to be able to improve diagnostic procedures, but some studies indicate possible problems. Therefore, it could be important to investigate CDSS systems with regard to their feasibility to improve diagnostic procedures as well as to save time. Methods This study was undertaken to compare the traditional 'paper and pencil' diagnostic method SCID1 with the computer-aided diagnostic system CB-SCID1 to ascertain processing time and accuracy of diagnoses suggested. 63 clinicians volunteered to participate in the study and to solve two paper-based cases using either a CDSS or manually. Results No major difference between paper and pencil and computer-supported diagnosis was found. Where a difference was found it was in favour of paper and pencil. For example, a significantly shorter time was found for paper and pencil for the difficult case, as compared to computer support. A significantly higher number of correct diagnoses were found in the diffilt case for the diagnosis 'Depression' using the paper and pencil method. Although a majority of the clinicians found the computer method supportive and easy to use, it took a longer time and yielded fewer correct diagnoses than with paper and pencil. Conclusion This study could not detect any major difference in diagnostic outcome between traditional paper and pencil methods and computer support for psychiatric diagnosis. Where there were significant differences, traditional paper and pencil methods were better than the tested CDSS and thus we conclude that CDSS for diagnostic procedures may interfere with diagnosis accuracy. A limitation was that most clinicians had not previously used the CDSS system under study. The results of this study, however, confirm that CDSS development for diagnostic purposes in psychiatry has much to deal with before it can be used for routine clinical purposes. PMID:18261222

Acute and long-term treatment of late-life major depressive disorder: duloxetine versus placebo.

PubMed

Robinson, Michael; Oakes, Tina Myers; Raskin, Joel; Liu, Peng; Shoemaker, Scarlett; Nelson, J Craig

2014-01-01

To compare the efficacy of duloxetine with placebo on depression in elderly patients with major depressive disorder. Multicenter, 24-week (12-week short-term and 12-week continuation), randomized, placebo-controlled, double-blind trial. United States, France, Mexico, Puerto Rico. Age 65 years or more with major depressive disorder diagnosis (one or more previous episode); Mini-Mental State Examination score ≥20; Montgomery-Asberg Depression Rating Scale total score ≥20. Duloxetine 60 or 120 mg/day or placebo; placebo rescue possible. Primary-Maier subscale of the 17-item Hamilton Depression Rating Scale (HAMD-17) at week 12. Secondary-Geriatric Depression Scale, HAMD-17 total score, cognitive measures, Brief Pain Inventory (BPI), Numeric Rating Scales (NRS) for pain, Clinical Global Impression-Severity scale, Patient Global Impression of Improvement in acute phase and acute plus continuation phase of treatment. Compared with placebo, duloxetine did not show significantly greater improvement from baseline on Maier subscale at 12 weeks, but did show significantly greater improvement at weeks 4, 8, 16, and 20. Similar patterns for Geriatric Depression Scale and Clinical Global Impression-Severity scale emerged, with significance also seen at week 24. There was a significant treatment effect for all BPI items and 4 of 6 NRS pain measures in the acute phase, most BPI items and half of the NRS measures in the continuation phase. More duloxetine-treated patients completed the study (63% versus 55%). A significantly higher percentage of duloxetine-treated patients versus placebo discontinued due to adverse event (15.3% versus 5.8%). Although the antidepressant efficacy of duloxetine was not confirmed by the primary outcome, several secondary measures at multiple time points suggested efficacy. Duloxetine had significant and meaningful beneficial effects on pain. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Media literacy as a violence-prevention strategy: a pilot evaluation.

PubMed

Webb, Theresa; Martin, Kathryn; Afifi, Abdelmonem A; Kraus, Jess

2010-09-01

Youth violence is a major unresolved public health problem in the United States and media exposure to violence is a synergistic source of this national problem. One media literacy curriculum designed specifically to address this issue is Beyond Blame: Challenging Violence in the Media. The purpose of this pilot study was to examine the curriculum's feasibility as a full-scale intervention. Intervention and control groups were similar with respect to knowledge of the Beyond Blame curriculum at baseline. Intervention students scored much higher on the posttest compared with the control students. The majority (90.2%) of the intervention students reported a significant increase in pre- to posttest score compared with only 18.8% of the control students (p < .0001). The magnitude of the score increase for intervention students was much greater than those in the control group. Several intervention students (N = 49; 19.9%) improved their score by 12 or more points compared with the control students who showed only a 1- to 7-point score increase (N = 3; 18.8%; p < .0001). The pre-and posttest scores were similar for males and females. Three of the six intervention classrooms scored higher on both the pretest and posttest compared with the other three classrooms.

The intention of North-Western Ethiopian dairy farmers to control mastitis

PubMed Central

Koop, Gerrit; Lam, Theo J. G. M.; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers’ subjective norms. PMID:28787018

The intention of North-Western Ethiopian dairy farmers to control mastitis.

PubMed

Mekonnen, Sefinew Alemu; Koop, Gerrit; Lam, Theo J G M; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers' subjective norms.

The contribution of dream masochism to the sex ratio difference in major depression.

PubMed

Cartwright, R D; Wood, E

1993-02-01

Twenty-five women and twenty-one men undergoing divorce had three laboratory nights of sleep on two occasions 1 year apart. On the third night, dream reports were elicited from subjects for each period of rapid eye movement (REM) sleep. Three groups differing on dream "masochism" were compared on personality, sex role, and social adjustment. Women "masochistic" dreamers had significantly higher scores on a scale of negative aspects of traditional feminine sex role identity than men or women without such dreams. They also showed less improvement at followup and had more need for emotional support. Dream masochism may be a continuing cognitive characteristic that contributes to the vulnerability of women to major depression.

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis.

PubMed

Koeppen, Daniel; Piepenbrock, Claudia; Kroppenstedt, Stefan; Čabraja, Mario

2017-01-01

Decompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery. This is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom's criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1-7° and ≥8°) and final lordosis (4 Omega-groups: 0-7°, 8-14°, 15-21°, ≥22°). 219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom's criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome. Decompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms "balance" and "physiologic lordosis" remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful.

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

PubMed Central

Koeppen, Daniel; Piepenbrock, Claudia; Kroppenstedt, Stefan; Čabraja, Mario

2017-01-01

Purpose Decompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery. Methods This is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom’s criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1–7° and ≥8°) and final lordosis (4 Omega-groups: 0–7°, 8–14°, 15–21°, ≥22°). Results 219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom’s criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome. Conclusions Decompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms “balance” and “physiologic lordosis” remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful. PMID:28430792

[Mental disorders due to brain lesions in the DSM-5 in the light of the previous versions].

PubMed

Derouesné, Christian

2013-12-01

The DSM-5 introduces major modifications in the category of mental disorders due to brain lesions compared to the previous DSM versions, which are reviewed in this paper. The description of the category Major neurocognitive disorder, as a substitute for dementia, seems to fit better for patients and families, and more adapted to many neurodegenerative cognitive disorders for which memory impairment is not predominant. Similarly, the introduction of the category of Mild neurocognitive disorder appears to be an improvement although some difficulty still remains for distinguishing mild cognitive disorder from normal aging. The addition of new etiological categories such as fronto-temporal NCD or NCD with Lewy bodies should also to be considered as a significant improvement. Despite these advances, to circumscribe the mental disorders due to brain lesions to cognitive deficits and biological mechanisms remains highly questionable, and does not provide an adequate care for the patients and families if not complemented by a psychological and environmental approach.

Landowner and practitioner perspectives on private land conservation programs

USGS Publications Warehouse

Lute, Michelle L.; Gillespie, Caitlyn R.; Fontaine, Joseph J.; Martin, Dustin R.

2018-01-01

Efforts to reverse declines in native grasslands benefit from agricultural policies that encourage private land conservation. The U.S. Department of Agriculture’s Conservation Reserve Program (CRP) improved conservation across landscapes but enrollment has declined. We used sequential exploratory mixed methods to compare landowner and conservation practitioners’ perceptions, evaluate perceived benefits, and identify potential improvements to CRP. Focus groups of practitioners informed a quantitative survey of landowners who had properties >160 total acres in Nebraska. Results suggest potential misalignment in perceptions between practitioners and landowners. Practitioners were concerned that conservation, especially of wildlife, was secondary to profit. But the majority of landowners valued CRP-related ecosystem services, including native pollinators. Practitioners posited that younger landowners were primarily profit motivated, but CRP enrollment did not differ by demographics. Practitioners and landowners identified rule complexity as a major challenge and practitioner–landowner relationships as critical to success. Findings suggest that practitioners may underestimate non-economic motivations and illuminate opportunities to encourage private land conservation.

Child Health Partnerships: a review of program characteristics, outcomes and their relationship.

PubMed

Jayaratne, Kapila; Kelaher, Margaret; Dunt, David

2010-06-17

Novel approaches are increasingly employed to address the social determinants of health of children world-wide. Such approaches have included complex social programs involving multiple stakeholders from different sectors jointly working together (hereafter Child Health Partnerships). Previous reviews have questioned whether these programs have led to significant improvements in child health and related outcomes. We aim to provide definitive answers to this question as well as identifying the characteristics of successful partnerships. A comprehensive literature search identified 11 major Child Health Partnerships in four comparable developed countries. A critical review is focused on various aspects of these including their target groups, program mechanics and outcomes. There was evidence of success in several major areas from the formation of effective joint operations of partners in different partnership models to improvement in both child wellbeing and parenting. There is emerging evidence that Child Health Partnerships are cost-effective. Population characteristics and local contexts need to be taken into account in the introduction and implementation of these programs.

A Modified Actor-Power-Accountability Framework (MAPAF) for analyzing decentralized forest governance: case study from Ethiopia.

PubMed

Mohammed, Abrar Juhar; Inoue, Makoto

2014-06-15

This paper posits a Modified Actor-Power-Accountability Framework (MAPAF) that makes three major improvements on the Actor-Power-Accountability Framework (APAF) developed by Agrawal and Ribot (1999). These improvements emphasize the nature of decentralized property rights, linking the outputs of decentralization with its outcomes and the inclusion of contextual factors. Applying MAPAF to analyze outputs and outcomes from two major decentralized forest policies in Ethiopia, i.e., delegation and devolution, has demonstrated the following strengths of the framework. First, by incorporating vital bundles of property rights into APAF, MAPAF creates a common ground for exploring and comparing the extent of democratization achieved by different decentralizing reforms. Second, the inclusion of social and environmental outcomes in MAPAF makes it possible to link the output of decentralization with local level outcomes. Finally, the addition of contextual factors enhances MAPAF's explanatory power by providing room for investigating exogenous factors other than democratization that contribute to the outcomes of decentralization reforms. Copyright © 2014 Elsevier Ltd. All rights reserved.

Computational approaches for the classification of seed storage proteins.

PubMed

Radhika, V; Rao, V Sree Hari

2015-07-01

Seed storage proteins comprise a major part of the protein content of the seed and have an important role on the quality of the seed. These storage proteins are important because they determine the total protein content and have an effect on the nutritional quality and functional properties for food processing. Transgenic plants are being used to develop improved lines for incorporation into plant breeding programs and the nutrient composition of seeds is a major target of molecular breeding programs. Hence, classification of these proteins is crucial for the development of superior varieties with improved nutritional quality. In this study we have applied machine learning algorithms for classification of seed storage proteins. We have presented an algorithm based on nearest neighbor approach for classification of seed storage proteins and compared its performance with decision tree J48, multilayer perceptron neural (MLP) network and support vector machine (SVM) libSVM. The model based on our algorithm has been able to give higher classification accuracy in comparison to the other methods.

The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementation.

PubMed

Busch, Alisa B; Huskamp, Haiden A; Normand, Sharon-Lise T; Young, Alexander S; Goldman, Howard; Frank, Richard G

2006-06-01

Since the 1990s, parity laws have been implemented to reduce inequities in mental health coverage compared with that for general medical conditions. It is unclear if parity under managed care is associated with improvements in mental health treatment quality. Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation. The objective of this study was to examine the association between parity implementation and changes in MDD treatment quality in the Federal Employees' Health Benefits (FEHB) Program. We conducted retrospective analyses of insurance claims data. Logistic regression models estimated quality changes for MDD-diagnosed enrollees from pre- to postparity. Subjects included MDD-diagnosed FEHB insured enrollees, aged 18-64, across multiple states and 6 FEHB plans before (1999-2000) and after (2001-2002) parity implementation. Measures included receipt of any antidepressant or psychotherapy within a given calendar year of diagnosis; receipt of appropriate psychotherapy frequency/intensity and duration; and pharmacotherapy duration during acute-phase treatment episodes. Postparity, several plans improved significantly in the likelihood of receiving antidepressant medication. In the acute-phase episodes, the greatest improvement was seen in the likelihood of follow up >or=4 months. Few or no other changes were observed in the acute-phase treatment intensity or duration quality measures. Parity under managed care was associated with modest improvements. The observed improvements were consistent with secular trends in MDD treatment. Whereas mental health parity is an important policy goal, these results highlight its limitations: improving the financing of care may not be sufficient to improve quality.

Mineral Resource of the Month: Talc

USGS Publications Warehouse

Virta, Robert L.; Van Gosen, Bradley S.

2014-01-01

When people think of talc, they often think of talcum and baby powder. However, these uses of talc are minor compared to its use in industrial manufacturing. The leading use of talc in the United States is in the production of ceramics, where it is a source of magnesium oxide, serves as a flux to reduce firing temperatures, and improves thermal shock characteristics of the final product. Worldwide, the major use of talc is as a paper constituent, where it fills the interstices between cellulose paper fibers, reduces paper transparency, improves ink receptivity, and absorbs undesirable tree sap residues that can generate blemishes in the paper.

Methods for Generating Hydrogel Particles for Protein Delivery

PubMed Central

Liu, Allen L.; García, Andrés J.

2016-01-01

Proteins represent a major class of therapeutic molecules with vast potential for the treatment of acute and chronic diseases and regenerative medicine applications. Hydrogels have long been investigated for their potential in carrying and delivering proteins. As compared to bulk hydrogels, hydrogel microparticles (microgels) hold promise in improving aspects of delivery owing to their less traumatic route of entry into the body and improved versatility. This review discusses common methods of fabricating microgels, including emulsion polymerization, microfluidic techniques, and lithographic techniques. Microgels synthesized from both natural and synthetic polymers are discussed, as are a series of microgels fashioned from environment-responsive materials. PMID:27160672

An interactive modeling lesson increases students' understanding of ploidy during meiosis.

PubMed

Wright, L Kate; Newman, Dina L

2011-01-01

Chromosome structure is confusing to students at all levels, and chromosome behavior during meiosis is a notoriously difficult topic. Undergraduate biology majors are exposed to the process of meiosis numerous times during their presecondary and postsecondary education, yet understanding of key concepts, such as the point at which haploidy is established, does not improve substantially with repeated exposure. Based on student's drawings, 96% of intermediate-level biology majors have unclear or incorrect ideas about meiosis. Students have difficulty diagramming the process of meiosis starting with three unreplicated pairs of chromosomes, and even when they can produce an accurate diagram, they are unclear how to assign the terms "haploid" and "diploid." We designed an interactive lesson based on constructivist theory to address these issues in a large lecture class. Pretest and posttest scores showed a significant improvement in students' understanding of ploidy compared to a parallel class taught in the traditional way (e.g. using the textbook diagrams). In interviews afterward, those students whose scores improved on exams specifically pointed to the features of the in-class modeling that were deliberately incorporated for that purpose. Copyright © 2011 Wiley Periodicals, Inc.

Evidence of a major gene from Bayesian segregation analyses of liability to osteochondral diseases in pigs.

PubMed

Kadarmideen, Haja N; Janss, Luc L G

2005-11-01

Bayesian segregation analyses were used to investigate the mode of inheritance of osteochondral lesions (osteochondrosis, OC) in pigs. Data consisted of 1163 animals with OC and their pedigrees included 2891 animals. Mixed-inheritance threshold models (MITM) and several variants of MITM, in conjunction with Markov chain Monte Carlo methods, were developed for the analysis of these (categorical) data. Results showed major genes with significant and substantially higher variances (range 1.384-37.81), compared to the polygenic variance (sigmau2). Consequently, heritabilities for a mixed inheritance (range 0.65-0.90) were much higher than the heritabilities from the polygenes. Disease allele frequencies range was 0.38-0.88. Additional analyses estimating the transmission probabilities of the major gene showed clear evidence for Mendelian segregation of a major gene affecting osteochondrosis. The variants, MITM with informative prior on sigmau2, showed significant improvement in marginal distributions and accuracy of parameters. MITM with a "reduced polygenic model" for parameterization of polygenic effects avoided convergence problems and poor mixing encountered in an "individual polygenic model." In all cases, "shrinkage estimators" for fixed effects avoided unidentifiability for these parameters. The mixed-inheritance linear model (MILM) was also applied to all OC lesions and compared with the MITM. This is the first study to report evidence of major genes for osteochondral lesions in pigs; these results may also form a basis for underpinning the genetic inheritance of this disease in other animals as well as in humans.

A comparison of observed teaching practices with teacher perceptions of their teaching during and following major funding

NASA Astrophysics Data System (ADS)

Kimble, Larry Lee

The purposes of this study were: (1) to determine how the teaching practices of eight exemplary Iowa teachers changed over time (1994--1999); (2) to investigate discrepancies between the perceptions of teaching compared with actual performance of these behaviors exhibited in videotapes of their teaching; and (3) to determine how STS/Constructivist teaching behaviors changed after major NSF funding. Data were collected at multiple times over a five year period. Quantitative data included use of the ESTEEM for evaluating three consecutive days of "best" teaching on the part of the eight teachers. The TPI and CLES were used for measuring perceptions of the teachers. Interviews concerning classrooms and teaching practices were conducted. Assessment and teaching methods were also reviewed. Major findings include: (1) Teaching practices indicate that all eight teachers achieved expert status in all four areas measured by the ESTEEM. These include (1) facilitating the learning process from a constructivist perspective; (2) content-specific pedagogy related to student understanding; (3) adjustments in strategies based on interactions with the students; and (4) teacher knowledge of subject matter. Constructivist practices improved significantly at each data sampling over the studied period (significant at the .05 level). (2) Teacher perceptions of their constructivist teaching practices as measured by the TPI and CLES were very high. This was especially true for the CLES where five areas of constructivist teaching were evaluated, namely: (1) personal relevance; (2) scientific uncertainty; (3) critical voice; (4) shared control, and (5) student negotiations. The perceptions continued to improve over the studied period (significant at the .05 level). (3) Similarities between teacher observed practices and their perceptions of their teaching were noted. In many cases, the actual practices were observed to be better. (4) The teachers improved regarding wait-time between teacher questions and student responses. (5) The teachers asked fewer questions, but developed classes with more student-student interaction. (6) Assessment strategies used by the eight teachers continued to improve and were often an integral part of instruction. (7) The eight teachers continued to grow and improve with respect to constructivist strategies two years after major NSF funding.

Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine.

PubMed

Serrano-Blanco, A; Gabarron, E; Garcia-Bayo, I; Soler-Vila, M; Caramés, E; Peñarrubia-Maria, M T; Pinto-Meza, A; Haro, J M

2006-04-01

Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice. A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter. Of the 103 patients, 38.8% (n = 40) were diagnosed with major depressive disorder, 14.6% (n = 15) with dysthymic disorder, and 46.6% (n = 48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder, p < 0.05; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder, p < 0.05). The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups. Exclusion criteria, participating physicians may not represent GPs. In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified.

Epistemologies and scientific reasoning skills among undergraduate science students

NASA Astrophysics Data System (ADS)

Mollohan, Katherine N.

Non-cognitive factors such as students' attitudes and beliefs toward a subject and their proficiency in scientific reasoning are important aspects of learning within science disciplines. Both factors have been studied in relation to science education in various discplines. This dissertation presents three studies that investigate student epistemologies and scientific reasoning in the domain of biology education. The first study investigated students' epistemic viewpoints in two introductory biology courses, one for science majors and one for non-science majors. This quantitative investigation revealed that the majors exhibited a negative shift in their attitudes and beliefs about biology and learning biology during a semester of introductory instruction. However, the non-science majors did not exhibit a similar shift. If fact, the non-science majors improved in their attitudes and beliefs during a semester of instruction, though not significantly so. The second study expands epistemological research to a population that has often been left out of this work, that is, intermediate-level biology majors. Quantitative and qualitative data was collected to reveal that junior and senior ranked students for the most part were able to characterize their views about biology and learning biology, and were able to associate factors with their epistemic improvement. Finally, the third study expands epistemology research further to determine if scientific reasoning and student attitudes and beliefs about learning science (specifically biology) are related. After a description of how various science and engineering majors compare in their scientific reasoning skills, this study indicated that among intermediate level biology majors there is no relationship between scientific reasoning skills and epistemologies, nor is there a relationship with other educational factors, including the number of courses taken during an undergraduate career, cumulative GPA, and standardized test scores (ACT). Taken together, the results of these studies can inform science education, particularly discipline-based education research in biology.

Barriers and Facilitators to Effective Feedback: A Qualitative Analysis of Data From Multispecialty Resident Focus Groups.

PubMed

Reddy, Shalini T; Zegarek, Matthew H; Fromme, H Barrett; Ryan, Michael S; Schumann, Sarah-Anne; Harris, Ilene B

2015-06-01

Despite the importance of feedback, the literature suggests that there is inadequate feedback in graduate medical education. We explored barriers and facilitators that residents in anesthesiology, emergency medicine, obstetrics and gynecology, and surgery experience with giving and receiving feedback during their clinical training. Residents from 3 geographically diverse teaching institutions were recruited to participate in focus groups in 2012. Open-ended questions prompted residents to describe their experiences with giving and receiving feedback, and discuss facilitators and barriers. Data were transcribed and analyzed using the constant comparative method associated with a grounded theory approach. A total of 19 residents participated in 1 of 3 focus groups. Five major themes related to feedback were identified: teacher factors, learner factors, feedback process, feedback content, and educational context. Unapproachable attendings, time pressures due to clinical work, and discomfort with giving negative feedback were cited as major barriers in the feedback process. Learner engagement in the process was a major facilitator in the feedback process. Residents provided insights for improving the feedback process based on their dual roles as teachers and learners. Time pressures in the learning environment may be mitigated by efforts to improve the quality of teacher-learner relationships. Forms for collecting written feedback should be augmented by faculty development to ensure meaningful use. Efforts to improve residents' comfort with giving feedback and encouraging learners to engage in the feedback process may foster an environment conducive to increasing feedback.

Significantly improved neurocognitive function in major depressive disorders 6 weeks after ECT.

PubMed

Mohn, Christine; Rund, Bjørn Rishovd

2016-09-15

Cognitive side effects may occur after electroconvulsive treatment (ECT) in depressive disorder patients. Previous studies have been limited by small numbers of cognitive functions assessed. The present study reports the first results from a prospective project monitoring cognitive effects of ECT using a comprehensive neuropsychological test battery and subjective report of everyday cognitive function. Thirty-one patients with major depressive disorder were assessed with the MATRICS Consensus Cognitive Battery (MCCB). Subjective cognitive complaints were described with the Everyday Memory Questionnaire (EMQ). Severity of depression symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). These assessments were performed prior to and 6 weeks after non-standardized ECT. Compared to baseline, the mean depression severity level was nearly halved and there were significant improvements in mean levels of Speed of Processing, Attention/Vigilance, and Visual Learning 6 weeks after ECT. The other cognitive domains were not altered from baseline. There was no significant change in subjective cognitive complaints. At baseline, there were several significant correlations between the MADRS and MCCB scores. There was no strong association between the EMQ and MCCB scores at either assessment point, but the post-ECT EMQ score was significantly correlated with depression severity. Major limitations were low N and lack of uniform ECT procedure. There was significant improvement in Speed of Processing, Attention/Vigilance, and Visual Learning 6 weeks after ECT. Cognitive tests scores were related to severity of depression, but not to subjective memory complaints. Copyright © 2016 Elsevier B.V. All rights reserved.

The Effects of Group Play Therapy on Self-Concept Among 7 to 11 Year-Old Children Suffering From Thalassemia Major.

PubMed

Tomaj, Ome Kolsoum; Estebsari, Fatemeh; Taghavi, Taraneh; Borim Nejad, Leili; Dastoorpoor, Maryam; Ghasemi, Afsaneh

2016-04-01

Children suffering from thalassemia have higher levels of depression and lower levels of self-concept. The aim of this study was to determine if group play therapy could significantly increase self-concept among children with thalassemia major ages 7 to 11 years old in teaching hospitals of Golestan province, Iran, in 2012. In this randomized, controlled clinical trial, 60 children with thalassemia major were randomly assigned to intervention (30 children) and control (30 children) groups. The intervention included eight 45 to 60 minute sessions during four weeks, during which the intervention group received group play therapy. The control group received no interventions. Self-concept was measured three times using the Piers-Harris children's self-concept scale: before, immediately after, and a month after the intervention. For the intervention group, results showed that the mean self-concept score was significantly higher at the second point in time compared to the baseline (P < 0.001), going from 60.539 to 69.908. Likewise, comparing the first and third time points, the mean score significantly increased and reached 70.611 (P < 0.001). Furthermore, changes in the mean score from the second to the third time point, though non-significant (P = 0.509), followed the trend, going from 69.908 to 70.611. For the control group, comparing the first, second, and third time points did not result in any significant change in the mean score (P > 0.05). The results showed that group play therapy improves self-concept in children suffering from thalassemia major.

Parameterization of DFTB3/3OB for Sulfur and Phosphorus for Chemical and Biological Applications

PubMed Central

2015-01-01

We report the parametrization of the approximate density functional tight binding method, DFTB3, for sulfur and phosphorus. The parametrization is done in a framework consistent with our previous 3OB set established for O, N, C, and H, thus the resulting parameters can be used to describe a broad set of organic and biologically relevant molecules. The 3d orbitals are included in the parametrization, and the electronic parameters are chosen to minimize errors in the atomization energies. The parameters are tested using a fairly diverse set of molecules of biological relevance, focusing on the geometries, reaction energies, proton affinities, and hydrogen bonding interactions of these molecules; vibrational frequencies are also examined, although less systematically. The results of DFTB3/3OB are compared to those from DFT (B3LYP and PBE), ab initio (MP2, G3B3), and several popular semiempirical methods (PM6 and PDDG), as well as predictions of DFTB3 with the older parametrization (the MIO set). In general, DFTB3/3OB is a major improvement over the previous parametrization (DFTB3/MIO), and for the majority cases tested here, it also outperforms PM6 and PDDG, especially for structural properties, vibrational frequencies, hydrogen bonding interactions, and proton affinities. For reaction energies, DFTB3/3OB exhibits major improvement over DFTB3/MIO, due mainly to significant reduction of errors in atomization energies; compared to PM6 and PDDG, DFTB3/3OB also generally performs better, although the magnitude of improvement is more modest. Compared to high-level calculations, DFTB3/3OB is most successful at predicting geometries; larger errors are found in the energies, although the results can be greatly improved by computing single point energies at a high level with DFTB3 geometries. There are several remaining issues with the DFTB3/3OB approach, most notably its difficulty in describing phosphate hydrolysis reactions involving a change in the coordination number of the phosphorus, for which a specific parametrization (3OB/OPhyd) is developed as a temporary solution; this suggests that the current DFTB3 methodology has limited transferability for complex phosphorus chemistry at the level of accuracy required for detailed mechanistic investigations. Therefore, fundamental improvements in the DFTB3 methodology are needed for a reliable method that describes phosphorus chemistry without ad hoc parameters. Nevertheless, DFTB3/3OB is expected to be a competitive QM method in QM/MM calculations for studying phosphorus/sulfur chemistry in condensed phase systems, especially as a low-level method that drives the sampling in a dual-level QM/MM framework. PMID:24803865

Ethnicity, education attainment, media exposure, and prenatal care in Vietnam.

PubMed

Trinh, Ha Ngoc; Korinek, Kim

2017-02-01

Prenatal care coverage in Vietnam has been improving, but ethnic minority women still lag behind in receiving adequate level and type of care. This paper examines ethnic disparities in prenatal care utilization by comparing two groups of ethnic minority and majority women. We examine the roots of ethnic disparity in prenatal care utilization, focusing on how education and media exposure change health behaviours and lessen disparities. We rely on the 2002 Vietnam Demographic and Health Survey to draw our sample, predictors and the three dimensions of prenatal care, including timing of onset, frequency of visits, and type of provider. Results from multinomial-, and binary-logistic regression provide evidence that ethnic minority women are less likely to obtain frequent prenatal care and seek care from professional providers than their majority counterparts. However, we find that ethnic minority women are more likely to obtain early care compared to ethnic majority women. Results for predicted probabilities suggest that education and media exposure positively influenced prenatal care behaviours with higher level of education and media exposure associating with accelerated probability of meeting prenatal care requirements. Our results imply the needs for expansion of media access and schools as well as positive health messages being broadcasted in culturally competent ways.

Efficacy of twice-daily vs once-daily sessions of repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: a retrospective study

PubMed Central

Modirrousta, Mandana; Meek, Benjamin P; Wikstrom, Sara L

2018-01-01

Purpose There is no clinical consensus on the optimal protocol for the treatment of major depressive disorder (MDD) using repetitive transcranial magnetic stimulation (rTMS). Accelerated protocols using more than a single session of treatment per day have been suggested as a means to reduce the overall length of time required for rTMS therapy. The objective of this study is to compare the treatment outcomes of patients with MDD who received two sessions of rTMS per day vs those who received one session per day, keeping the overall number of delivered pulses constant. Patients and methods In a retrospective study, we compared treatment outcomes of 36 patients with MDD who received 30 sessions of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Patients received 3,000 pulses per session (5 s trains, 25 s intertrain interval) at 110% of resting motor threshold using a figure-eight coil. Patients received either two rTMS sessions per day (n=17) or one session per day (n=19). Depression symptoms were assessed by a psychiatrist using the Hamilton Rating Scale for Depression at baseline and after every 10 sessions of rTMS. Results The majority of patients in both groups responded to treatment, and there was a trend toward greater response rate in the twice-daily (TD) group (82.4%) compared to the once-daily (OD) group (52.6%). TD stimulation was tolerable for patients and produced no adverse side effects. Patients in the TD group experienced an improvement in symptoms faster than the OD group due to the accelerated therapy period. Conclusion Administration of two rTMS treatment sessions per day is tolerable for patients and does not seem to be inferior in efficacy to a OD protocol. TD administration has the benefit of producing symptom improvement over a shorter time span and requires fewer visits to the clinic. PMID:29398915

rTMS of the dorsomedial prefrontal cortex for major depression: safety, tolerability, effectiveness, and outcome predictors for 10 Hz versus intermittent theta-burst stimulation.

PubMed

Bakker, Nathan; Shahab, Saba; Giacobbe, Peter; Blumberger, Daniel M; Daskalakis, Zafiris J; Kennedy, Sidney H; Downar, Jonathan

2015-01-01

Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS). To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series. A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014. Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure. Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Quality of life research in neuro-oncology: a quantitative comparison.

PubMed

Klein, Elizabeth; Altshuler, David; Hallock, Abhirami; Szerlip, Nicholas

2014-01-01

Our understanding of the biology of neuro-oncologic disease has improved vastly over time, however overall patient survival remains relatively poor. Our goal as clinicians, therefore, should be to ensure that the quality of life (QOL) in that survival time is optimized. Here we review neuro-oncology QOL abstracts presented at major oncology conferences and the published literature to make a quantitative comparison to other common cancer subtypes. First, all abstracts presented at major oncology meetings from 2008 to 2012 were reviewed and filtered to find those related to QOL in CNS, breast, lung, and prostate cancer. Next, a Medline search was performed to identify all QOL papers published from 2003 to 2012 for the same cancer subtypes. The results were compared as absolute values and percentages. The average percentage of CNS QOL-related abstracts presented at ASCO and ASTRO over the last 5 years was 4.9 %, compared to 6.4 % for breast, 4.4 % for lung, and 6.1 % for prostate. There is a significant difference in total percentage of QOL abstracts over the time period when comparing CNS to breast and prostate, but not lung (p < 0.05). The Medline search revealed an average of 25.2 publications per year for CNS cancer, compared to 146.2 for breast, 39.3 for lung, and 64.2 for prostate. When looking at trends over time, publications in CNS cancer have not been as prolific and have not increased as rapidly as publications in breast and lung cancer, indicating that QOL is underrepresented in neuro-oncology research. We need to improve this by standardizing QOL measures and including them in every outcome study.

Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

PubMed

Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

2012-05-01

Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy.

PubMed

Noel, Camille E; Parikh, Parag J; Spencer, Christopher R; Green, Olga L; Hu, Yanle; Mutic, Sasa; Olsen, Jeffrey R

2015-01-01

Onboard magnetic resonance imaging (OB-MRI) for daily localization and adaptive radiotherapy has been under development by several groups. However, no clinical studies have evaluated whether OB-MRI improves visualization of the target and organs at risk (OARs) compared to standard onboard computed tomography (OB-CT). This study compared visualization of patient anatomy on images acquired on the MRI-(60)Co ViewRay system to those acquired with OB-CT. Fourteen patients enrolled on a protocol approved by the Institutional Review Board (IRB) and undergoing image-guided radiotherapy for cancer in the thorax (n = 2), pelvis (n = 6), abdomen (n = 3) or head and neck (n = 3) were imaged with OB-MRI and OB-CT. For each of the 14 patients, the OB-MRI and OB-CT datasets were displayed side-by-side and independently reviewed by three radiation oncologists. Each physician was asked to evaluate which dataset offered better visualization of the target and OARs. A quantitative contouring study was performed on two abdominal patients to assess if OB-MRI could offer improved inter-observer segmentation agreement for adaptive planning. In total 221 OARs and 10 targets were compared for visualization on OB-MRI and OB-CT by each of the three physicians. The majority of physicians (two or more) evaluated visualization on MRI as better for 71% of structures, worse for 10% of structures, and equivalent for 14% of structures. 5% of structures were not visible on either. Physicians agreed unanimously for 74% and in majority for > 99% of structures. Targets were better visualized on MRI in 4/10 cases, and never on OB-CT. Low-field MR provides better anatomic visualization of many radiotherapy targets and most OARs as compared to OB-CT. Further studies with OB-MRI should be pursued.

The ROC program: accelerated restoration of competency in a jail setting.

PubMed

Rice, Kevin; Jennings, Jerry L

2014-01-01

In 29 months of operation, the restoration of competency (ROC) program provided treatment services to 192 incompetent to stand trial patients in a jail setting. The ROC restored competency for 55% of the patients in an average of 57 days compared to the state hospital average of 180 days. The average cost of treatment/restoration per admission was $15,568 compared to the state hospital average of $81,000. The ROC model accelerates needed treatment for mentally ill defendants, cuts demand for costly state hospital forensic beds, and assists jails in better managing inmates with severe psychiatric disorders--yielding major cost savings and improved care. In addition to preventing readmissions and negative behavioral episodes, the ROC improved the broader forensic system by eliminating the state hospital waiting list, accelerating access to psychiatric services, promoting local access for lawyers and family, and gaining stakeholder satisfaction.

Reevaluating the Mass-Radius Relation for Low-mass, Main-sequence Stars

NASA Astrophysics Data System (ADS)

Feiden, Gregory A.; Chaboyer, Brian

2012-09-01

We examine the agreement between the observed and theoretical low-mass (<0.8 M ⊙) stellar main-sequence mass-radius relationship by comparing detached eclipsing binary (DEB) data with a new, large grid of stellar evolution models. The new grid allows for a realistic variation in the age and metallicity of the DEB population, characteristic of the local galactic neighborhood. Overall, our models do a reasonable job of reproducing the observational data. A large majority of the models match the observed stellar radii to within 4%, with a mean absolute error of 2.3%. These results represent a factor of two improvement compared to previous examinations of the low-mass mass-radius relationship. The improved agreement between models and observations brings the radius deviations within the limits imposed by potential starspot-related uncertainties for 92% of the stars in our DEB sample.

Electrolytes for solid oxide fuel cells

NASA Astrophysics Data System (ADS)

Fergus, Jeffrey W.

The high operating temperature of solid oxide fuel cells (SOFCs), as compared to polymer electrolyte membrane fuel cells (PEMFCs), improves tolerance to impurities in the fuel, but also creates challenges in the development of suitable materials for the various fuel cell components. In response to these challenges, intermediate temperature solid oxide fuel cells (IT-SOFCs) are being developed to reduce high-temperature material requirements, which will extend useful lifetime, improve durability and reduce cost, while maintaining good fuel flexibility. A major challenge in reducing the operating temperature of SOFCs is the development of solid electrolyte materials with sufficient conductivity to maintain acceptably low ohmic losses during operation. In this paper, solid electrolytes being developed for solid oxide fuel cells, including zirconia-, ceria- and lanthanum gallate-based materials, are reviewed and compared. The focus is on the conductivity, but other issues, such as compatibility with electrode materials, are also discussed.

Cardiac Imaging System

NASA Technical Reports Server (NTRS)

1990-01-01

Although not available to all patients with narrowed arteries, balloon angioplasty has expanded dramatically since its introduction with an estimated further growth to 562,000 procedures in the U.S. alone by 1992. Growth has fueled demand for higher quality imaging systems that allow the cardiologist to be more accurate and increase the chances of a successful procedure. A major advance is the Digital Cardiac Imaging (DCI) System designed by Philips Medical Systems International, Best, The Netherlands and marketed in the U.S. by Philips Medical Systems North America Company. The key benefit is significantly improved real-time imaging and the ability to employ image enhancement techniques to bring out added details. Using a cordless control unit, the cardiologist can manipulate images to make immediate assessment, compare live x-ray and roadmap images by placing them side-by-side on monitor screens, or compare pre-procedure and post procedure conditions. The Philips DCI improves the cardiologist's precision by expanding the information available to him.

Best antihypertensive strategies to improve blood pressure control in Latin America: position of the Latin American Society of Hypertension.

PubMed

Coca, Antonio; López-Jaramillo, Patricio; Thomopoulos, Costas; Zanchetti, Alberto

2018-02-01

: Evidence from randomized trials has shown that effective treatment with blood pressure (BP)-lowering medications reduces the risk of cardiovascular morbidity and mortality in patients with hypertension. Therefore, hypertension control and prevention of subsequent morbidity and mortality should be achievable for all patients worldwide. However, many people in Latin America remain undiagnosed, untreated or have inadequately controlled BP, even where this is access to health systems. Barriers to hypertension control in low-income countries include difficulties in transportation to health services; inappropriate opening hours; difficulties in making clinic appointments; inaccessible healthcare facilities, lack of insurance and high treatment costs. After a review of the best recent available evidence on the efficacy and tolerability of antihypertensive drugs and strategies, the Latin American Society of Hypertension experts conclude that all major classes of BP-lowering drugs be available to hypertensive patients, because all have been shown to reduce major cardiovascular outcomes compared with placebo, and have shown to be associated with a comparable risk of major cardiovascular events and mortality when compared between classes. Within each class, no evidence whatsoever is available to show that one compound is more effective than another in outcome prevention. Therefore, the selection of individual drugs may be based mainly on the capacity of Latin American governments to obtain the lowest prices of the different molecules manufactured by companies with high production quality standards.

Speed of Improvement in Symptoms of Depression With Desvenlafaxine 50 mg and 100 mg Compared With Placebo in Patients With Major Depressive Disorder.

PubMed

Katzman, Martin A; Nierenberg, Andrew A; Wajsbrot, Dalia B; Meier, Ellen; Prieto, Rita; Pappadopulos, Elizabeth; Mackell, Joan; Boucher, Matthieu

2017-10-01

This post hoc analysis examined the time point at which clinically significant improvement in major depressive disorder (MDD) symptoms occurs with desvenlafaxine versus placebo. Data were pooled from 9 short-term, double-blind, placebo-controlled studies in adults with MDD randomly assigned to desvenlafaxine 50 mg/d, 100 mg/d, or placebo. A mixed-effects model for repeated-measures analysis of change from baseline score was used to determine the time point at which desvenlafaxine treatment groups separated from placebo on the 17-item Hamilton Rating Scale for Depression and psychosocial outcomes. The association between early improvement and week 8 outcomes was examined using logistic regression analyses. Time to remission for patients with early improvement versus without early improvement was assessed using Kaplan-Meier techniques. Comparisons between groups were performed with log-rank tests. In the intent-to-treat population (N = 4279 patients: desvenlafaxine 50 mg/d, n = 1714; desvenlafaxine 100 mg/d, n = 870; placebo, n = 1695), a statistically significant improvement on the 17-item Hamilton Rating Scale for Depression was observed with desvenlafaxine 50 mg/d at week 1 (P = 0.0129) and with desvenlafaxine 100 mg/d at week 2 (P = 0.0002) versus placebo. Early improvement was a significant predictor of later remission. Treatment assignment, baseline depression scale scores, and race were significantly associated with probability of early improvement. On several measures of depressive symptoms and function, desvenlafaxine 50 mg/d and 100 mg/d separated from placebo as early as week 1 and no later than week 4 in patients with MDD. These findings suggest that clinicians may be able to use depression rating scale scores early in treatment as a guide to inform treatment optimization.

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates?

PubMed

Ball, Chad G; Dente, Christopher J; Shaz, Beth; Wyrzykowski, Amy D; Nicholas, Jeffrey M; Kirkpatrick, Andrew W; Feliciano, David V

2013-10-01

Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma. Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007-2009) with patients injured before the creation of an institutional MTP (2005-2007). Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.

Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System.

PubMed

Massarweh, Nader N; Kougias, Panagiotis; Wilson, Mark A

2016-12-01

The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system. To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years. A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014. Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time. Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P < .001 for all). Although there were no clinically meaningful differences in rates of complications and major complications across hospital risk-adjusted mortality quintiles (any complications: lowest quintile, 20 945 of 147 721 [14.2%] vs highest quintile, 18 938 of 135 557 [14%]; major complications: lowest quintile, 14 044 of 147 721 [9.5%] vs highest quintile, 12 881 of 135 557 [9.5%]), FTR rates (any complications: lowest quintile, 2249 of 20 945 [10.7%] vs highest quintile, 2769 of 18 938 [14.6%]; major complications: lowest quintile, 2161 of 14 044 [15.4%] vs highest quintile, 2663 of 12 881 [20.7%]) were significantly higher with increasing quintile (P < .001). However, across hospital quintiles, there were significant decreases in morbidity (20.6%-29.9% decrease; trend test, P < .001 for all) and FTR (29.2%-50.6% decrease; trend test, P < .001 for all) during the study period. After hierarchical modeling, the odds of postoperative mortality, FTR, and FTR after a major complication were approximately 40% to 50% lower in the most recent study year compared with 15 years ago (P < .001 for all). For the past 15 years, morbidity, mortality, and FTR have improved within the VA health system. Other integrated health systems providing a high volume of surgical care for their enrollees may benefit by critically evaluating the system-level approaches of the VA health system to surgical quality improvement.

Improving depression and enhancing resilience in family dementia caregivers: a pilot randomized placebo-controlled trial of escitalopram

PubMed Central

Lavretsky, H.; Siddarth, P.; Irwin, M. R.

2009-01-01

Background This study examined the potential of an antidepressant drug, escitalopram, to improve depression, resilience to stress, and quality of life in family dementia caregivers in a randomized placebo-controlled double-blind trial. Methods Forty family caregivers (43–91 years of age, 25 children and 15 spouses; 26 women) who were taking care of their relatives with Alzheimer’s disease were randomized to receive either escitalopram 10 mg/day or placebo for 12 weeks. Severity of depression, resilience, burden, distress, quality of life, and severity of care-recipient’s cognitive and behavioral disturbances were assessed at baseline and over the course of the study. The Hamilton Depression Rating Scale (HDRS) scores at baseline ranged between 10–28. The groups were stratified by the diagnosis of major and minor depression. Results Most outcomes favored escitalopram over placebo. The severity of depression improved and the remission rate was greater with the drug compared to placebo. Measures of anxiety, resilience, burden and distress improved on escitalopram compared to placebo. Discussion Among caregivers, this small randomized controlled trial found that escitalopram use resulted in improvement in depression, resilience, burden and distress, and quality of life. Our results need to be confirmed in a larger sample. PMID:20104071

The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction.

PubMed

Wahidi, Momen M; Unroe, Mark A; Adlakha, Natasha; Beyea, Mathew; Shofer, Scott L

2011-09-01

Laser has been the main ablative modality in the airways, but a growing experience with endobronchial electrocautery suggests a comparable efficacy and safety profile. To evaluate the efficacy and safety of electrocautery as the primary heat therapy for malignant and benign airway obstruction. A retrospective review of all patients undergoing endobronchial electrocautery, alone or in combination with other airway tools, at Duke University Medical Center between April 2004 and November 2009. Data on efficacy (luminal patency, symptomatic, radiographic, or physiologic improvement) and safety (complication rate) were collected. Ninety-four patients underwent 117 procedures with endobronchial electrocautery for endobronchial malignant and nonmalignant disease. Endoscopic improvement was seen in 94% of cases. Seventy-one percent of patients reported symptomatic improvement. Radiographic studies demonstrated luminal improvement in 78% of patients on chest computed tomography, improved aeration on chest computed tomography and chest x-ray in 63% and 43% of patients, respectively. The rate of major complications was 0.8%, whereas minor complications occurred in 6.8% of cases. There was no perioperative mortality. Endobronchial electrocautery is effective and safe when used as an ablative modality in malignant and benign airway obstruction and has a comparable profile to laser with the advantage of lower cost.

The Role of Teacher's Corrective Feedback in Improving Iranian EFL Learners' Writing Accuracy over Time: Is Learner's Mother Tongue Relevant?

ERIC Educational Resources Information Center

Rahimi, Mohammad

2009-01-01

The purpose of the present study was to investigate the impact of feedback on writing accuracy over time and examine the relevance of the students' mother tongue to the feedback effect. To this end, the study compared two groups of Iranian English majors (N = 56) over a period of four months: one with indirect grammar feedback and the other with…

[Assessment of actual benefits of new drugs by the Transparency Committee].

PubMed

Le Jeunne, C

2008-01-01

When a drug has been granted a marketing authorization, if the pharmaceutical company wants it to be covered by the National Health Insurance, the company has to submit a file with all the studies concerning the drug, especially drug-drug comparative studies, to be assessed by the Transparency Committee. Drugs are assessed on two criteria: actual or expected benefit (AB) and improvement in actual benefit (IAB). Actual benefit mainly takes into account the severity of the disease concerned, the level of efficacy relative to known side effects (risk-benefit ratio), and the place the drug is intended to take in the therapeutic strategy. At the end of the assessment, AB is considered as important, moderate, poor or insufficient (to justify inclusion of the drug on the list of products to be reimbursed). After actual benefit is determined, improvement of actual benefit is assessed, comparing the estimated benefit of this drug with one of drugs with the same indication that is already reimbursed, to assess whether this drug will improve the patient's disease. This can be assessed by direct comparison (two drugs compared in the same clinical trial) or by indirect comparison (separate studies with the same design). There are four levels of added value, from I (major improvement) to IV (minor improvement). Level V represents no improvement. This second assessment is always relative to another drug. It never provides an absolute score. However, IAB is very important for pharmaceutical companies, because it is a fundamental criterion to determine the price of the drug, which is discussed with the Economic Committee of Health Products in a final phase. Actual benefit and improvement in actual benefit are allocated for each indication of a drug.

The effects of vortioxetine on cognitive performance in working patients with major depressive disorder: A short-term, randomized, double-blind, exploratory study.

PubMed

Baune, Bernhard T; Sluth, Lasse B; Olsen, Christina K

2018-03-15

Major Depressive Disorder (MDD) is a complex disease characterized by emotional, physical and cognitive symptoms. We explored the efficacy of vortioxetine versus placebo on outcomes of cognition, functioning and mood symptoms in working patients with depression, using paroxetine as an active reference. Gainfully employed patients (18-65 years, N = 152) with MDD were randomized 1:1:1 to 8 weeks' double-blind, parallel treatment either with vortioxetine (10mg/day) or paroxetine (20mg/day), or with placebo. The primary efficacy measure was the Digit Symbol Substitution Test (DSST), analyzed using a mixed model for repeated measurements, and the key secondary efficacy measure was the University of San Diego Performance-based Skills Assessment - Brief (UPSA-B), analyzed using analysis of covariance (last observation carried forward). At week 8, DSST and UPSA-B performance had improved relative to baseline in all treatment groups, with no statistically significant differences between treatment groups. While improvements in mood were comparable for vortioxetine and paroxetine, numerical improvements in cognitive performance (DSST) were larger with vortioxetine. Vortioxetine significantly improved overall cognitive performance and clinician-rated functioning relative to placebo. The majority of adverse events were mild or moderate, with nausea being the most common adverse event for vortioxetine. Small sample sizes implied limited statistical power. This explorative study showed no significant differences versus placebo in DSST or UPSA-B performance at week 8. However, secondary results support vortioxetine as an effective and well-tolerated antidepressant, supporting an added benefit for cognition and functioning, which could have particular therapeutic relevance for the working patient population. Copyright © 2017 H Lundbeck A/S. Published by Elsevier B.V. All rights reserved.

An innovative approach to achieve re-centering and ductility of cement mortar beams through randomly distributed pseudo-elastic shape memory alloy fibers

NASA Astrophysics Data System (ADS)

Shajil, N.; Srinivasan, S. M.; Santhanam, M.

2012-04-01

Fibers can play a major role in post cracking behavior of concrete members, because of their ability to bridge cracks and distribute the stress across the crack. Addition of steel fibers in mortar and concrete can improve toughness of the structural member and impart significant energy dissipation through slow pull out. However, steel fibers undergo plastic deformation at low strain levels, and cannot regain their shape upon unloading. This is a major disadvantage in strong cyclic loading conditions, such as those caused by earthquakes, where self-centering ability of the fibers is a desired characteristic in addition to ductility of the reinforced cement concrete. Fibers made from an alternative material such as shape memory alloy (SMA) could offer a scope for re-centering, thus improving performance especially after a severe loading has occurred. In this study, the load-deformation characteristics of SMA fiber reinforced cement mortar beams under cyclic loading conditions were investigated to assess the re-centering performance. This study involved experiments on prismatic members, and related analysis for the assessment and prediction of re-centering. The performances of NiTi fiber reinforced mortars are compared with mortars with same volume fraction of steel fibers. Since re-entrant corners and beam columns joints are prone to failure during a strong ground motion, a study was conducted to determine the behavior of these reinforced with NiTi fiber. Comparison is made with the results of steel fiber reinforced cases. NiTi fibers showed significantly improved re-centering and energy dissipation characteristics compared to the steel fibers.

The safe environment for every kid model: impact on pediatric primary care professionals.

PubMed

Dubowitz, Howard; Lane, Wendy G; Semiatin, Joshua N; Magder, Laurence S; Venepally, Mamata; Jans, Merel

2011-04-01

To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM). In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression). The SEEK model included the parent screening questionnaire and the participation of a social worker. SEEK's impact was evaluated in 3 ways: (1) the health professional questionnaire (HPQ), which assessed HPs' attitudes and practice regarding the targeted problems; (2) observations of HPs conducting checkups; and (3) review of children's medical records. The 102 HPs averaged 45 years of age; 68% were female, and 74% were in suburban practices. Comparing baseline scores with 6-, 18-, and 36-month follow-up data, the HPQ revealed significant (P < .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort level and perceived competence (both at 6, 18, and 36 months). SEEK HPs screened for targeted problems more often than did controls based on observations 24 months after the initial training and the medical records (P < .001). The SEEK model led to significant and sustained improvement in several areas. This is a crucial first step in helping HPs address major psychosocial problems that confront many families. SEEK offers a modest yet promising enhancement of primary care.

Comparing effects of citalopram with fluoxetine on sleep quality in patients with major depressive disorder.

PubMed

Shahsavand-Ananloo, E; Berenji, F; Sadeghniiat, K; Alimadadi, A; Zahiroddin, A R; Tabatabaee, M; Abbasi-Asl, M; Ghaeli, P

2013-05-01

Sleep disturbance is a common complaint in major depressive disorder (MDD) including impairment of both subjective and objective parameters. All antidepressants affect sleep architecture and quality. This trial was designed to compare the effects of short-term use of citalopram with fluoxetine on sleep quality (SQ) of patients with MDD based on Diagnostic and Statistical Manual for Mental Disorders - Text Revision 4th edition (DSM-IV-TR) criteria. Patients who met the study criteria entered this open-label study. Sleep quality and depression severity were evaluated by using Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory-II (BDI-II), respectively. Patients could not have received any antidepressant for at least one month prior entering the study. Subjects were assigned to receive either fluoxetine or citalopram for 8 weeks. The relationships between SQ and severity of depression were also studied at weeks 4 and 8. Data was analyzed by using SPSS 11.5 version. Nineteen patients received fluoxetine 20-40 mg/day and 21 received citalopram 20-40 mg/day. After 4 and 8 weeks treatment with both fluoxetine and citalopram, significant improvements in SQ were noted in both groups. However, no significant difference between the two groups was observed. Additionally, a significant and positive correlation between improvements in SQ and depression was noted after 8 weeks treatment with citalopram but not with fluoxetine. This study noted that both citalopram and fluoxetine improved SQ in outpatients with MDD after 8 weeks without any significant difference between the 2 groups.

Accurate quantitative CF-LIBS analysis of both major and minor elements in alloys via iterative correction of plasma temperature and spectral intensity

NASA Astrophysics Data System (ADS)

Shuxia, ZHAO; Lei, ZHANG; Jiajia, HOU; Yang, ZHAO; Wangbao, YIN; Weiguang, MA; Lei, DONG; Liantuan, XIAO; Suotang, JIA

2018-03-01

The chemical composition of alloys directly determines their mechanical behaviors and application fields. Accurate and rapid analysis of both major and minor elements in alloys plays a key role in metallurgy quality control and material classification processes. A quantitative calibration-free laser-induced breakdown spectroscopy (CF-LIBS) analysis method, which carries out combined correction of plasma temperature and spectral intensity by using a second-order iterative algorithm and two boundary standard samples, is proposed to realize accurate composition measurements. Experimental results show that, compared to conventional CF-LIBS analysis, the relative errors for major elements Cu and Zn and minor element Pb in the copper-lead alloys has been reduced from 12%, 26% and 32% to 1.8%, 2.7% and 13.4%, respectively. The measurement accuracy for all elements has been improved substantially.

The environmental audit. I. Concepts

NASA Astrophysics Data System (ADS)

Schaeffer, David J.; Kerster, Harold W.; Perry, James A.; Cox, David K.

1985-05-01

Extensive criticism of water quality monitoring programs has developed as costs are compared with the benefits produced by monitoring efforts. Collecting water quality data while developing understanding of the functional character of the environment will improve water quality monitoring data utility in environmental management. The “environmental audit” characterizes the attributes of the natural environment (that is, attribute type, intensity, and variability), providing a theoretical as well as practical foundation for data interpretation. In the view proposed here, traditional monitoring means the very narrow activity of collecting samples and perhaps analyzing them and storing the analyses. In the environmental audit, these activities are a mechanism to systematically improve environmental monitoring and assessment by improving the design and implementation of environmental programs. Major reasons why existing programs fail to meet the needs of legislators, regulators, and conservationists are identified.

Study of the cross-market effects of Brexit based on the improved symbolic transfer entropy GARCH model—An empirical analysis of stock–bond correlations

PubMed Central

Chen, Xiurong; Zhao, Rubo

2017-01-01

In this paper, we study the cross-market effects of Brexit on the stock and bond markets of nine major countries in the world. By incorporating information theory, we introduce the time-varying impact weights based on symbolic transfer entropy to improve the traditional GARCH model. The empirical results show that under the influence of Brexit, flight-to-quality not only commonly occurs between the stocks and bonds of each country but also simultaneously occurs among different countries. We also find that the accuracy of the time-varying symbolic transfer entropy GARCH model proposed in this paper has been improved compared to the traditional GARCH model, which indicates that it has a certain practical application value. PMID:28817712

Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention.

PubMed

Arnetz, J E; Hasson, H

2007-07-01

Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. The study was a prospective, non-randomized, controlled intervention. Nursing staff in two municipal elderly care organizations in western Sweden. In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

Improving dietary intake to prevent anemia in adolescent girls through community kitchens in a periurban population of Lima, Peru.

PubMed

Creed-Kanashiro, H M; Uribe, T G; Bartolini, R M; Fukumoto, M N; López, T T; Zavaleta, N M; Bentley, M E

2000-02-01

Peru has high rates of iron deficiency anemia. The prevalence is 35% in nonpregnant women of fertile age and 24.7% in adolescent girls in slums of periurban Lima. The major cause of anemia is low intake of dietary iron. A community-based, randomized behavioral and dietary intervention trial was conducted to improve dietary iron intake and iron bioavailability of adolescent girls living in periurban areas of Lima, Peru. Results show that there was a change in knowledge about anemia and improved dietary iron intake in the 71 girls who completed the study compared with the 66 girls in the control group. Although the 9-mo. intervention was not sufficient to improve hemoglobin levels significantly, there appeared to be a protective effect in maintaining the iron status of girls in comparison with the control group.

Structural abnormality of the corticospinal tract in major depressive disorder

PubMed Central

2014-01-01

Background Scientists are beginning to document abnormalities in white matter connectivity in major depressive disorder (MDD). Recent developments in diffusion-weighted image analyses, including tractography clustering methods, may yield improved characterization of these white matter abnormalities in MDD. In this study, we acquired diffusion-weighted imaging data from MDD participants and matched healthy controls. We analyzed these data using two tractography clustering methods: automated fiber quantification (AFQ) and the maximum density path (MDP) procedure. We used AFQ to compare fractional anisotropy (FA; an index of water diffusion) in these two groups across major white matter tracts. Subsequently, we used the MDP procedure to compare FA differences in fiber paths related to the abnormalities in major fiber tracts that were identified using AFQ. Results FA was higher in the bilateral corticospinal tracts (CSTs) in MDD (p’s < 0.002). Secondary analyses using the MDP procedure detected primarily increases in FA in the CST-related fiber paths of the bilateral posterior limbs of the internal capsule, right superior corona radiata, and the left external capsule. Conclusions This is the first study to implicate the CST and several related fiber pathways in MDD. These findings suggest important new hypotheses regarding the role of CST abnormalities in MDD, including in relation to explicating CST-related abnormalities to depressive symptoms and RDoC domains and constructs. PMID:25295159

Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis.

PubMed

van Walsem, Anneloes; Pandhi, Shaloo; Nixon, Richard M; Guyot, Patricia; Karabis, Andreas; Moore, R Andrew

2015-03-19

There is argument over the benefits and risks of drugs for treating chronic musculoskeletal pain. This study compared the efficacy, safety, and tolerability of diclofenac, ibuprofen, naproxen, celecoxib, and etoricoxib for patients with pain caused by osteoarthritis (OA) or rheumatoid arthritis (RA). A systematic literature review used Medline and EMBASE to identify randomised controlled trials. Efficacy outcomes assessed included: pain relief measured by visual analogue scale (VAS); Western Ontario McMaster Universities Arthritis Index (WOMAC) VAS or WOMAC Likert scale; physical functioning measured by WOMAC VAS or Likert scale; and patient global assessment (PGA) of disease severity measured on VAS or 5-point Likert scale. Safety outcomes included: Antiplatelet Trialists' Collaboration (APTC), major cardiovascular (CV) and major upper gastrointestinal (GI) events, and withdrawals. Data for each outcome were synthesized by a Bayesian network meta-analysis (NMA). For efficacy assessments, labelled doses for OA treatment were used for the base case while labelled doses for RA treatment were also included in the sensitivity analysis. Pooled data across dose ranges were used for safety. Efficacy, safety, and tolerability data were found for 146,524 patients in 176 studies included in the NMA. Diclofenac (150 mg/day) was likely to be more effective in alleviating pain than celecoxib (200 mg/day), naproxen (1000 mg/day), and ibuprofen (2400 mg/day), and similar to etoricoxib (60 mg/day); a lower dose of diclofenac (100 mg/day) was comparable to all other treatments in alleviating pain. Improved physical function with diclofenac (100 and 150 mg/day) was mostly comparable to all other treatments. PGA with diclofenac (100 and 150 mg/day) was likely to be more effective or comparable to all other treatments. All active treatments were similar for APTC and major CV events. Major upper GI events with diclofenac were lower compared to naproxen and ibuprofen, comparable to celecoxib, and higher than etoricoxib. Risk of withdrawal with diclofenac was lower compared to ibuprofen, similar to celecoxib and naproxen, and higher than etoricoxib. The benefit-risk profile of diclofenac was comparable to other treatments used for pain relief in OA and RA; benefits and risks vary in individuals and need consideration when making treatment decisions.

Statistical study on the variations of OH and O2 rotational temperatures observed by SATI at King Sejong Station (62.22S, 58.78W), Antarctica

NASA Astrophysics Data System (ADS)

Kim, J.; Kim, J. H.; Jee, G.; Lee, C.; Kim, Y.

2017-12-01

Spectral Airglow Temperature Imager (SATI) installed at King Sejong Station (62.22S, 58.78W), Antarctica, has been continuously measured the airglow emissions from OH (6-2) Meinel and O2 (0-1) atmospheric bands since 2002, in order to investigate the dynamics of the polar MLT region. The measurements allow us to derive the rotational temperature at peak emission heights known as about 87 km and 94 km for OH and O2 airglows, respectively. In this study, we briefly introduce improved analysis technique that modified original analysis code. The major change compared to original program is the improvement of the function to find the exact center position in the observed image. In addition to brief introduction of the improved technique, we also present the results statistically investigating the periodic variations on the temperatures of two layers during the period of 2002 through 2011 and compare our results with those from the temperatures measured by satellite.

A Biogeotechnical engineering approach to Combat Desertification

NASA Astrophysics Data System (ADS)

Chang, I.; Im, J.; Cho, G. C.; Lee, S. J.

2016-12-01

The acceleration of global warming is not only inducing rising sea levels and abnormal climate problems, but also geotechnical hazards such as desertification. Recently, 30% of Earth's dry land has been affected by desertification, and approximately 850 million people are suffering due to famine, poverty, and hygiene problems induced by desertification. Global warming and unsustainable land development are known to be major triggers promoting desertification. Numerous global agencies and companies are thus contributing to anti-desertification movements. However, tree planting alone is not an ideal solution given that it takes approximately 2 3 years for stabilization. It is thus imperative to develop innovative technology that can promote vegetation growth and improve soil erosion resistance. In this study, a unique soil treatment and anti-desertification method is developed using microbial biopolymers. Biopolymers can effectively strengthen soil and improve durability. In particular, anionic-hydrophilic biopolymers delay water evaporation, thereby retaining a higher soil moisture condition compared to non-treated soil. Results of this study show that microbial biopolymer treatment is highly effective in improving both vegetation growth (3 times faster) and soil erosion resistance (less than 2%), compared to untreated earth surfaces.

The effectiveness of courses developed to recruit and retain minority students in the geology major at California State University, Sacramento

NASA Astrophysics Data System (ADS)

Hammersley, L. C.

2014-12-01

The lack of diversity in the geosciences has long been recognized as a problem. While improvements have been made, the proportion of Bachelor's degrees in the earth sciences awarded to Hispanic students in 2012 was only 5.6%, a huge disparity with the 17% of the U.S. population that is Hispanic. At California State University, Sacramento, 19% of the student population is Hispanic but, of the 61 students that earned an undergraduate degree in geology between 2005 and 2010, only four were Hispanic. In response to the lack of diversity in the geology major, we developed a new Geology of Mexico course with the goal of recruiting Hispanic students to the major. We present a quantitative evaluation of the effectiveness of this course in attracting Hispanic students, encouraging them to take more geology courses, and recruiting them to the major. Data was collected in the Geology of Mexico course and in the equivalent Physical Geology course. During the period evaluated, 93% of enrollment in Geology of Mexico was Hispanic compared with 18.5% in Physical Geology. We found that Hispanic students in Physical Geology earned lower grades than did nonminority students, while Hispanic students in Geology of Mexico earned grades comparable with nonminority students in Physical Geology. Overall, Geology of Mexico students also showed more positive attitude changes to the geosciences and were more likely to take another geology course. The recruitment rate into the major for Hispanic students in Geology of Mexico was comparable to the recruitment rate for nonminority students in Physical Geology. Since 2008, the proportion of Hispanic geology majors has risen from 4.5% to 14.1% and, notably, the proportion of underrepresented minorities has increased from 4.5% to 22.2%, reflecting a significant overall increase in diversity of the major. In order to increase retention of minority students, we developed a field course for new majors who were not yet ready for upper division courses. This field trip allows students to get to know the faculty and to create bonds with fellow new majors, thus creating a stronger bond to the department and developing a cohort effect earlier in the students' educational path.

A systematic review of the efficacy of ergogenic aids for improving running performance.

PubMed

Schubert, Matthew M; Astorino, Todd A

2013-06-01

Running is a common form of activity worldwide, and participants range from "weekend warriors" to Olympians. Unfortunately, few studies have examined efficacy of various ergogenic aids in runners because the majority of the literature consists of cycling-based protocols, which do not relate to running performance. The majority of running studies conducted markedly vary in regards to specific distance completed, subject fitness level, and effectiveness of the ergogenic aid examined. The aim of this article was to systematically examine the literature concerning utility of several ergogenic aids on middle-distance running (400-5,000 m) and long-distance running (10,000 meters marathon = 42.2 km) performance. In addition, this article highlights the dearth of running-specific studies in the literature and addresses recommendations for future research to optimize running performance through nutritional intervention. Results revealed 23 studies examining effects of various ergogenic aids on running performance, with a mean Physiotherapy Evidence Database score equal to 7.85 ± 0.70. Of these studies, 71% (n = 15) demonstrated improved running performance with ergogenic aid ingestion when compared with a placebo trial. The most effective ergogenic aids for distances from 400 m to 40 km included sodium bicarbonate (4 studies; 1.5 ± 1.1% improvement), sodium citrate (6 studies; 0.3 ± 1.7% improvement), caffeine (CAFF) (7 studies; 1.1 ± 0.4% improvement), and carbohydrate (CHO) (6 studies; 4.1 ± 4.4% improvement). Therefore, runners may benefit from ingestion of sodium bicarbonate to enhance middle distance performance and caffeine and carbohydrate to enhance performance at multiple distances.

A new therapeutic effect of simvastatin revealed by functional improvement in muscular dystrophy.

PubMed

Whitehead, Nicholas P; Kim, Min Jeong; Bible, Kenneth L; Adams, Marvin E; Froehner, Stanley C

2015-10-13

Duchenne muscular dystrophy (DMD) is a lethal, degenerative muscle disease with no effective treatment. DMD muscle pathogenesis is characterized by chronic inflammation, oxidative stress, and fibrosis. Statins, cholesterol-lowering drugs, inhibit these deleterious processes in ischemic diseases affecting skeletal muscle, and therefore have potential to improve DMD. However, statins have not been considered for DMD, or other muscular dystrophies, principally because skeletal-muscle-related symptoms are rare, but widely publicized, side effects of these drugs. Here we show positive effects of statins in dystrophic skeletal muscle. Simvastatin dramatically reduced damage and enhanced muscle function in dystrophic (mdx) mice. Long-term simvastatin treatment vastly improved overall muscle health in mdx mice, reducing plasma creatine kinase activity, an established measure of muscle damage, to near-normal levels. This reduction was accompanied by reduced inflammation, more oxidative muscle fibers, and improved strength of the weak diaphragm muscle. Shorter-term treatment protected against muscle fatigue and increased mdx hindlimb muscle force by 40%, a value comparable to current dystrophin gene-based therapies. Increased force correlated with reduced NADPH Oxidase 2 protein expression, the major source of oxidative stress in dystrophic muscle. Finally, in old mdx mice with severe muscle degeneration, simvastatin enhanced diaphragm force and halved fibrosis, a major cause of functional decline in DMD. These improvements were accompanied by autophagy activation, a recent therapeutic target for DMD, and less oxidative stress. Together, our findings highlight that simvastatin substantially improves the overall health and function of dystrophic skeletal muscles and may provide an unexpected, novel therapy for DMD and related neuromuscular diseases.

A new therapeutic effect of simvastatin revealed by functional improvement in muscular dystrophy

PubMed Central

Whitehead, Nicholas P.; Kim, Min Jeong; Bible, Kenneth L.; Adams, Marvin E.; Froehner, Stanley C.

2015-01-01

Duchenne muscular dystrophy (DMD) is a lethal, degenerative muscle disease with no effective treatment. DMD muscle pathogenesis is characterized by chronic inflammation, oxidative stress, and fibrosis. Statins, cholesterol-lowering drugs, inhibit these deleterious processes in ischemic diseases affecting skeletal muscle, and therefore have potential to improve DMD. However, statins have not been considered for DMD, or other muscular dystrophies, principally because skeletal-muscle-related symptoms are rare, but widely publicized, side effects of these drugs. Here we show positive effects of statins in dystrophic skeletal muscle. Simvastatin dramatically reduced damage and enhanced muscle function in dystrophic (mdx) mice. Long-term simvastatin treatment vastly improved overall muscle health in mdx mice, reducing plasma creatine kinase activity, an established measure of muscle damage, to near-normal levels. This reduction was accompanied by reduced inflammation, more oxidative muscle fibers, and improved strength of the weak diaphragm muscle. Shorter-term treatment protected against muscle fatigue and increased mdx hindlimb muscle force by 40%, a value comparable to current dystrophin gene-based therapies. Increased force correlated with reduced NADPH Oxidase 2 protein expression, the major source of oxidative stress in dystrophic muscle. Finally, in old mdx mice with severe muscle degeneration, simvastatin enhanced diaphragm force and halved fibrosis, a major cause of functional decline in DMD. These improvements were accompanied by autophagy activation, a recent therapeutic target for DMD, and less oxidative stress. Together, our findings highlight that simvastatin substantially improves the overall health and function of dystrophic skeletal muscles and may provide an unexpected, novel therapy for DMD and related neuromuscular diseases. PMID:26417069

Role of nutritional status and intervention in oesophageal cancer treated with definitive chemoradiotherapy: outcomes from SCOPE1.

PubMed

Cox, S; Powell, C; Carter, B; Hurt, C; Mukherjee, Somnath; Crosby, Thomas David Lewis

2016-07-12

Malnutrition is common in oesophageal cancer. We aimed to identify nutritional prognostic factors and survival outcomes associated with nutritional intervention in the SCOPE1 (Study of Chemoradiotherapy in OesoPhageal Cancer with or without Erbitux) trial. Two hundred and fifty eight patients were randomly allocated to definitive chemoradiotherapy (dCRT) +/- cetuximab. Nutritional Risk Index (NRI) scores were calculated; NRI<100 identified patients at risk of malnutrition. Nutritional intervention included dietary advice, oral supplementation or major intervention (enteral feeding/tube placement). Univariable and multivariable analyses using Cox proportional hazard modelling were conducted. At baseline NRI<100 strongly predicted for reduced overall survival (hazard ratio (HR) 12.45, 95% CI 5.24-29.57; P<0.001). Nutritional intervention improved survival if provided at baseline (dietary advice (HR 0.12, P=0.004), oral supplementation (HR 0.13, P<0.001) or major intervention (HR 0.13, P=0.003)), but not if provided later in the treatment course. Cetuximab patients receiving major nutritional intervention had worse outcomes compared with controls (13 vs 28 months, P=0.003). Pre-treatment assessment and correction of malnutrition may improve survival outcomes in oesophageal cancer patients treated with dCRT. Nutritional Risk Index is a simple and objective screening tool to identify patients at risk of malnutrition.

Oral methylphenidate normalizes cingulate activity in cocaine addiction during a salient cognitive task.

PubMed

Goldstein, Rita Z; Woicik, Patricia A; Maloney, Thomas; Tomasi, Dardo; Alia-Klein, Nelly; Shan, Juntian; Honorio, Jean; Samaras, Dimitris; Wang, Ruiliang; Telang, Frank; Wang, Gene-Jack; Volkow, Nora D

2010-09-21

Anterior cingulate cortex (ACC) hypoactivations during cognitive demand are a hallmark deficit in drug addiction. Methylphenidate (MPH) normalizes cortical function, enhancing task salience and improving associated cognitive abilities, in other frontal lobe pathologies; however, in clinical trials, MPH did not improve treatment outcome in cocaine addiction. We hypothesized that oral MPH will attenuate ACC hypoactivations and improve associated performance during a salient cognitive task in individuals with cocaine-use disorders (CUD). In the current functional MRI study, we used a rewarded drug cue-reactivity task previously shown to be associated with hypoactivations in both major ACC subdivisions (implicated in default brain function) in CUD compared with healthy controls. The task was performed by 13 CUD and 14 matched healthy controls on 2 d: after ingesting a single dose of oral MPH (20 mg) or placebo (lactose) in a counterbalanced fashion. Results show that oral MPH increased responses to this salient cognitive task in both major ACC subdivisions (including the caudal-dorsal ACC and rostroventromedial ACC extending to the medial orbitofrontal cortex) in the CUD. These functional MRI results were associated with reduced errors of commission (a common impulsivity measure) and improved task accuracy, especially during the drug (vs. neutral) cue-reactivity condition in all subjects. The clinical application of such MPH-induced brain-behavior enhancements remains to be tested.

Oral methylphenidate normalizes cingulate activity in cocaine addiction during a salient cognitive task

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

Goldstein, R.Z.; Goldstein, R.Z.; Woicik, P.A.

Anterior cingulate cortex (ACC) hypoactivations during cognitive demand are a hallmark deficit in drug addiction. Methylphenidate (MPH) normalizes cortical function, enhancing task salience and improving associated cognitive abilities, in other frontal lobe pathologies; however, in clinical trials, MPH did not improve treatment outcome in cocaine addiction. We hypothesized that oral MPH will attenuate ACC hypoactivations and improve associated performance during a salient cognitive task in individuals with cocaine-use disorders (CUD). In the current functional MRI study, we used a rewarded drug cue-reactivity task previously shown to be associated with hypoactivations in both major ACC subdivisions (implicated in default brain function)more » in CUD compared with healthy controls. The task was performed by 13 CUD and 14 matched healthy controls on 2 d: after ingesting a single dose of oral MPH (20 mg) or placebo (lactose) in a counterbalanced fashion. Results show that oral MPH increased responses to this salient cognitive task in both major ACC subdivisions (including the caudal-dorsal ACC and rostroventromedial ACC extending to the medial orbitofrontal cortex) in the CUD. These functional MRI results were associated with reduced errors of commission (a common impulsivity measure) and improved task accuracy, especially during the drug (vs. neutral) cue-reactivity condition in all subjects. The clinical application of such MPH-induced brain-behavior enhancements remains to be tested.« less

Single-molecule sequencing and optical mapping yields an improved genome of woodland strawberry (Fragaria vesca) with chromosome-scale contiguity.

PubMed

Edger, Patrick P; VanBuren, Robert; Colle, Marivi; Poorten, Thomas J; Wai, Ching Man; Niederhuth, Chad E; Alger, Elizabeth I; Ou, Shujun; Acharya, Charlotte B; Wang, Jie; Callow, Pete; McKain, Michael R; Shi, Jinghua; Collier, Chad; Xiong, Zhiyong; Mower, Jeffrey P; Slovin, Janet P; Hytönen, Timo; Jiang, Ning; Childs, Kevin L; Knapp, Steven J

2018-02-01

Although draft genomes are available for most agronomically important plant species, the majority are incomplete, highly fragmented, and often riddled with assembly and scaffolding errors. These assembly issues hinder advances in tool development for functional genomics and systems biology. Here we utilized a robust, cost-effective approach to produce high-quality reference genomes. We report a near-complete genome of diploid woodland strawberry (Fragaria vesca) using single-molecule real-time sequencing from Pacific Biosciences (PacBio). This assembly has a contig N50 length of ∼7.9 million base pairs (Mb), representing a ∼300-fold improvement of the previous version. The vast majority (>99.8%) of the assembly was anchored to 7 pseudomolecules using 2 sets of optical maps from Bionano Genomics. We obtained ∼24.96 Mb of sequence not present in the previous version of the F. vesca genome and produced an improved annotation that includes 1496 new genes. Comparative syntenic analyses uncovered numerous, large-scale scaffolding errors present in each chromosome in the previously published version of the F. vesca genome. Our results highlight the need to improve existing short-read based reference genomes. Furthermore, we demonstrate how genome quality impacts commonly used analyses for addressing both fundamental and applied biological questions. © The Authors 2017. Published by Oxford University Press.

Palmitoylethanolamide as adjunctive therapy in major depressive disorder: A double-blind, randomized and placebo-controlled trial.

PubMed

Ghazizadeh-Hashemi, Maryam; Ghajar, Alireza; Shalbafan, Mohammad-Reza; Ghazizadeh-Hashemi, Fatemeh; Afarideh, Mohsen; Malekpour, Farzaneh; Ghaleiha, Ali; Ardebili, Mehrdad Eftekhar; Akhondzadeh, Shahin

2018-05-01

Experimental studies provide evidence for antidepressant effects of Palmitoylethanolamide (PEA) in animal models of depression. We aimed to evaluate the efficacy and tolerability of PEA add-on therapy in treatment of patients with major depressive disorder (MDD). In a randomized double-blind, and placebo-controlled study, 58 patients with MDD (DSM-5) and Hamilton Depression Rating Scale (HAM-D) score ≥ 19 were randomized to receive either 600 mg twice daily Palmitoylethanolamide or placebo in addition to citalopram for six weeks. Patients were assessed using the HAM-D scale at baseline and weeks 2, 4, and 6. Fifty-four individuals completed the trial. At week 2, patients in the PEA group demonstrated significantly greater reduction in HAM-D scores compared to the placebo group (8.30 ± 2.41 vs. 5.81 ± 3.57, P = .004). The PEA group also demonstrated significantly greater improvement in depressive symptoms [F (3, 156) = 3.35, P = .021] compared to the placebo group throughout the trial period. The patients in the PEA group experienced more response rate (≥ 50% reduction in the HAM-D score) than the placebo group (100% vs. 74% respectively, P = .01) at the end of the trial. Baseline parameters and frequency of side effects were not significantly different between the two groups. The population size in this study was small and the follow-up period was relatively short. Palmitoylethanolamide adjunctive therapy to citalopram can effectively improve symptoms of patients (predominantly male gender) with major depressive disorder. PEA showed rapid-onset antidepressant effects which need further investigation. Copyright © 2018 Elsevier B.V. All rights reserved.

Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery.

PubMed

Adamina, Michel; Kehlet, Henrik; Tomlinson, George A; Senagore, Anthony J; Delaney, Conor P

2011-06-01

Health care systems provide care to increasingly complex and elderly patients. Colorectal surgery is a prime example, with high volumes of major procedures, significant morbidity, prolonged hospital stays, and unplanned readmissions. This situation is exacerbated by an exponential rise in costs that threatens the stability of health care systems. Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity and improve effectiveness of care. We have reviewed the evidence supporting the implementation of ERP in clinical practice. Medline, Embase, and the Cochrane library were searched for randomized, controlled trials comparing ERP with traditional care in colorectal surgery. Systematic reviews and papers on ERP based on data published in major surgical and anesthesiology journals were critically reviewed by international contributors, experienced in the development and implementation of ERP. A random-effect Bayesian meta-analysis was performed, including 6 randomized, controlled trials totalizing 452 patients. For patients adhering to ERP, length of stay decreased by 2.5 days (95% credible interval [CrI] -3.92 to -1.11), whereas 30-day morbidity was halved (relative risk, 0.52; 95% CrI, 0.36-0.73) and readmission was not increased (relative risk, 0.59; 95% CrI, 0.14-1.43) when compared with patients undergoing traditional care. Adherence to ERP achieves a reproducible improvement in the quality of care by enabling standardization of health care processes. Thus, while accelerating recovery and safely reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can and should be routinely used in care after colorectal and other major gastrointestinal procedures. Copyright © 2011 Mosby, Inc. All rights reserved.

Quality of Life, Functioning, and Depressive Symptom Severity in Older Adults With Major Depressive Disorder Treated With Citalopram in the STAR*D Study.

PubMed

Steiner, Alexander J; Recacho, Jennifer; Vanle, Brigitte; Dang, Jonathan; Wright, Stephanie M; Miller, Justin S; Kauzor, Kaitlyn; Reid, Mark; Bashmi, Luma E; Mirocha, James; Danovitch, Itai; IsHak, Waguih William

2017-07-01

Major depressive disorder (MDD) can substantially worsen patient-reported quality of life (QOL) and functioning. Prior studies have examined the role of age in MDD by comparing depressive symptom severity or remission rates between younger and older adults. This study examines these outcomes before and after SSRI treatment. On the basis of prior research, we hypothesized that older adults would have worse treatment outcomes in QOL, functioning, and depressive symptom severity and that nonremitters would have worse outcomes. A retrospective secondary data analysis was conducted from the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (July 2001-September 2006). We analyzed data for 2,280 nonpsychotic adults with DSM-IV-TR-defined MDD who received citalopram monotherapy. Older adults were classified as adults aged 65 years and above. All subjects completed patient-reported QOL, functioning, and depressive symptom severity measures at entry and exit. Subjects included 106 older adults and 2,174 adults < 65. MDD remission status posttreatment was also determined. Both older adults and adults < 65 experienced significant improvements and medium to large treatment responses across QOL, functioning, and depressive symptom severity (P < .001). Older adults had smaller treatment effect sizes for all outcomes, particularly functioning. Conversely, mean change scores from entry to exit were equivalent across all outcomes. Remitters at exit had significantly better responses to treatment than nonremitters for the majority of outcomes. Findings suggest that older adults and younger adults have comparable treatment responses to citalopram monotherapy, with significant improvements in patient-reported depressive symptom severity, functioning, and QOL. ClinicalTrials.gov identifier: NCT00021528. © Copyright 2017 Physicians Postgraduate Press, Inc.

Benchmarking Outcomes in the Critically Injured Burn Patient

PubMed Central

Klein, Matthew B.; Goverman, Jeremy; Hayden, Douglas L.; Fagan, Shawn P.; McDonald-Smith, Grace P.; Alexander, Andrew K.; Gamelli, Richard L.; Gibran, Nicole S.; Finnerty, Celeste C.; Jeschke, Marc G.; Arnoldo, Brett; Wispelwey, Bram; Mindrinos, Michael N.; Xiao, Wenzhong; Honari, Shari E.; Mason, Philip H.; Schoenfeld, David A.; Herndon, David N.; Tompkins, Ronald G.

2014-01-01

Objective To determine and compare outcomes with accepted benchmarks in burn care at six academic burn centers. Background Since the 1960s, U.S. morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries. Methods We followed 300 adults and 241 children from 2003–2009 through hospitalization using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care. Results Study patients were critically injured as demonstrated by mean %TBSA (41.2±18.3 for adults and 57.8±18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those less than 55 years old and 38.5% for those age ≥55 years. Mortality in patients less than 17 years old was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and %TBSA, presence of inhalation injury was not significant. Conclusions This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared to previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients less than 55 years old with severe burn injuries and inhalation injury to survive these devastating conditions. PMID:24722222

A comparative life cycle assessment of material handling systems for sustainable mining.

PubMed

Erkayaoğlu, M; Demirel, N

2016-06-01

In this comprehensive LCA comparison study, main objectives are to investigate life cycle environmental impacts of off-highway mining trucks and belt conveyors in surface mining. The research methodology essentially entails determination of the functional unit as 20,000 tons/day coal production transported for 5 km distance. After the system boundary was selected as the entire life cycle of material handling systems including pre-manufacturing of steel parts and plastic components, manufacturing, transportation, and utilization data was compiled from equipment manufacturers and the Eco-invent database. Life cycle impact categories for both material-handling systems were identified and the developed model was implemented using SIMAPRO 7.3. Climate change and acidification were selected as major impact categories as they were considered to be major concerns in mining industry. Although manufacturing stage had a significant impact on all of the environmental parameters, utilization stage was the hotspot for the selected impact categories. The results of this study revealed that belt conveyors have a greater environmental burden in climate change impact category when compared to the trucks. On the other hand, trucks have a greater environmental burden in acidification impact category when compared to the belt conveyors. This study implied that technological improvement in fuel combustion and electricity generation is crucial for the improvement of environmental profiles of off-highway trucks and belt conveyors in the mining industry. The main novelty of this study is that it is the first initiative in applying LCA in the Turkish mining industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

Primary Self-EXPANDing Nitinol Stenting vs Balloon Angioplasty With Optional Bailout Stenting for the Treatment of Infrapopliteal Artery Disease in Patients With Severe Intermittent Claudication or Critical Limb Ischemia (EXPAND Study).

PubMed

Schulte, Karl-Ludwig; Pilger, Ernst; Schellong, Sebastian; Tan, Kong Ten; Baumann, Frederic; Langhoff, Ralf; Torsello, Giovanni; Zeller, Thomas; Amendt, Klaus; Brodmann, Marianne

2015-10-01

To compare primary placement of a self-expanding nitinol stent to percutaneous transluminal angioplasty (PTA) with bailout stenting in infrapopliteal arteries of patients with severe intermittent claudication or critical limb ischemia (CLI). In the EXPAND trial (ClinicalTrials.gov; identifier NCT00906022), 92 patients (mean age 72.9±9.5 years; 62 men) undergoing treatment for infrapopliteal stenosis in 11 European centers were randomized 1:1 to either self-expanding nitinol stenting with the Astron Pulsar/Pulsar-18 nitinol stent or PTA with bailout stenting. The primary endpoint was sustainable clinical improvement after 12 months, defined as a ≥1-category increase for Rutherford category 3 patients or a ≥2-category increase for CLI patients (Rutherford categories 4/5) compared with baseline. Furthermore, target lesion revascularization (TLR), mortality, and amputation were assessed after 12 months. Sustained clinical improvement at 1 year was observed in 74.3% of the patients treated with primary stenting and in 68.6% of the patients treated with PTA and bailout stenting (p>0.05). Kaplan-Meier estimates of freedom from TLR (76.6% and 77.6%), mortality (7.4% vs 2.1%), and amputation [8.9% (major 6.7%) vs 13.2% (major 8.7%)] at 1 year were not significantly different. Primary self-expanding nitinol stenting did not show statistically different clinical outcomes compared to angioplasty with bailout stenting for infrapopliteal lesions. © The Author(s) 2015.

Work shift duration: a review comparing eight hour and 12 hour shift systems.

PubMed

Smith, L; Folkard, S; Tucker, P; Macdonald, I

1998-04-01

Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. There can be considerable extension of the person's time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.

Characterization of a CT unit for the detection of low contrast structures

NASA Astrophysics Data System (ADS)

Viry, Anais; Racine, Damien; Ba, Alexandre; Becce, Fabio; Bochud, François O.; Verdun, Francis R.

2017-03-01

Major technological advances in CT enable the acquisition of high quality images while minimizing patient exposure. The goal of this study was to objectively compare two generations of iterative reconstruction (IR) algorithms for the detection of low contrast structures. An abdominal phantom (QRM, Germany), containing 8, 6 and 5mm-diameter spheres (with a nominal contrast of 20HU) was scanned using our standard clinical noise index settings on a GE CT: "Discovery 750 HD". Two additional rings (2.5 and 5 cm) were also added to the phantom. Images were reconstructed using FBP, ASIR-50%, and VEO (full statistical Model Based Iterative Reconstruction, MBIR). The reconstructed slice thickness was 2.5 mm except 0.625 mm for VEO reconstructions. NPS was calculated to highlight the potential noise reduction of each IR algorithm. To assess LCD (low Contrast Detectability), a Channelized Hotelling Observer (CHO) with 10 DDoG channels was used with the area under the curve (AUC) as a figure of merit. Spheres contrast was also measured. ASIR-50% allowed a noise reduction by a factor two when compared to FBP without an improvement of the LCD. VEO allowed an additional noise reduction with a thinner slice thickness compared to ASIR-50% but with a major improvement of the LCD especially for the large-sized phantom and small lesions. Contrast decreased up to 10% with the phantom size increase for FBP and ASIR-50% and remained constant with VEO. VEO is particularly interesting for LCD when dealing with large patients and small lesion sizes and when the detection task is difficult.

Trends in biotechnological production of fuel ethanol from different feedstocks.

PubMed

Sánchez, Oscar J; Cardona, Carlos A

2008-09-01

Present work deals with the biotechnological production of fuel ethanol from different raw materials. The different technologies for producing fuel ethanol from sucrose-containing feedstocks (mainly sugar cane), starchy materials and lignocellulosic biomass are described along with the major research trends for improving them. The complexity of the biomass processing is recognized through the analysis of the different stages involved in the conversion of lignocellulosic complex into fermentable sugars. The features of fermentation processes for the three groups of studied feedstocks are discussed. Comparative indexes for the three major types of feedstocks for fuel ethanol production are presented. Finally, some concluding considerations on current research and future tendencies in the production of fuel ethanol regarding the pretreatment and biological conversion of the feedstocks are presented.

Growth and characterization of crystals for room temperature I.R. detectors and second harmonic generation devices

NASA Technical Reports Server (NTRS)

Lal, R. B.

1995-01-01

One of the major objectives of this program was to modify the triglycine sulfate (TGS) crystals with suitable dopants and variants to achieve better pyroelectric properties and improved infrared detectivities (D(sup *)), and higher Curie transition temperature compared to undoped TGS crystals. Towards these objectives, many promising dopants, both inorganic and organic, were investigated in the last few years. These dopants gave significant improvement in the D(sup *) value of the infrared detectors fabricated from the grown crystals with no significant increase in the Curie temperature (49 C). The IR detectors were fabricated at EDO/Barnes Engineering Division, Shelton, CT. In the last one year many TGS crystals doped with urea were grown using the low temperature solution crystal growth facility. It is found that doping with urea, the normalized growth yield increased significantly compared to pure TGS crystals and there is an improvement in the pyroelectric and dielectric constant values of doped crystals. This gave a significant increase in the materials figure of merits. The Vicker's hardness of 10 wt percent urea doped crystals is found to be about three times higher in the (010) direction compared to undoped crystals. This report describes in detail the results of urea doped TGS crystals.

Pilot Study on the Impact of Biogas as a Fuel Source on Respiratory Health of Women on Rural Kenyan Smallholder Dairy Farms

PubMed Central

Dohoo, Carolyn; Guernsey, Judith Read; Critchley, Kimberley; VanLeeuwen, John

2012-01-01

Biomass burning in indoor environments has been highlighted as a major cause of respiratory morbidity for women and children in low-income countries. Inexpensive technological innovations which reduce such exposures are needed. This study evaluated the impact of low tech compost digesters, which generate biogas for cooking, versus traditional fuel sources on the respiratory health of nonsmoking Kenyan farmwomen. Women from 31 farms with biogas digesters were compared to age-matched women from 31 biomass-reliant farms, in June 2010. Only 43% of the biogas group reported any breathing problems, compared to 71% in the referent group (P = 0.03). Referent women self-reported higher rates of shortness of breath (52% versus 30%), difficulty breathing (42% versus 23%), and chest pain while breathing (35% versus 17%) during the last 6 months (P = 0.09 to 0.12) compared to biogas women. Biogas women demonstrated slightly better spirometry results but differences were not statistically significant, likely due to limited latency between biogas digester installation and spirometry testing. Most biogas women reported improved personal respiratory health (87%) and improved children's health (72%) since biogas digester installation. These findings suggest that using biogas in cookhouses improves respiratory symptoms but long-term impacts on lung function are unclear. PMID:22969815

HIV-Related Knowledge and Perceptions by Academic Major: Implications for University Interventions.

PubMed

Smith, Matthew Lee; La Place, Lisa L; Menn, Mindy; Wilson, Kelly L

2014-01-01

Most universities offer human sexuality courses, although they are not required for graduation. While students in health-related majors may receive sexuality education in formal settings, majority of college students never receive formal sexual health or HIV/AIDS-related education, which may lead to elevated engagement in high-risk sexual behaviors. This study examines perceived knowledge about HIV/AIDS, perceived risk, and perceived consequences among college students by two distinct classifications of academic majors. Data were collected from 510 college students. Binary and multinomial logistic regressions were performed to compare HIV-related covariates by academic major category. Limited differences were observed by science, technology, engineering, and mathematics categorization. Relative to health and kinesiology majors, those who self-reported being "completely knowledgeable" about HIV were less likely to be physical sciences, mathematics, engineering, and business (PMEB) (OR = 0.41, P = 0.047) or education, humanities, and social sciences majors (OR = 0.25, P = 0.004). PMEB majors were less likely to report behavioral factors as a risk for contracting HIV (OR = 0.86, P = 0.004) and perceived acquiring HIV would be more detrimental to their quality of life (OR = 2.14, P = 0.012), but less detrimental to their mental well-being (OR = 0.58, P = 0.042). Findings can inform college-wide campaigns and interventions to raise HIV/AIDS awareness and improve college health.

Upward appraisal as a means for improving supervisory performance and promoting process improvement, with long-term implications for organizational change

NASA Technical Reports Server (NTRS)

Siegfeldt, Denise V.

1994-01-01

This study represents the implementation phase of an organizational development project which was initiated last year in the Management Support Division (MSD) at Langley Research Center to diagnose organizational functioning. As a result of MSD survey data from last year's effort, a Quality Action Team was created to address the responses compiled from the MSD Organizational Assessment Questionnaire and Follow-Up Questionnaire. The team was officially named the MSD Employee Relations Improvement Team (MERIT). MERIT's goal was to analyze major concerns generated by the questionnaires and to present feasible solutions to management which would improve supervisory performance, promote process improvement; and ultimately, lead to a better organization. The team met weekly and was very disciplined in following guidelines needed to ensure a fully functioning team. Several TQM tools were used during the team process, including brainstorming and the cause and effect diagram. One of the products produced by MERIT was a 'report card', more formally known as an upward appraisal system, to evaluate supervisory performance in the division office, its three branches, and in teams. Major areas of emphasis on the 47 item report card were those identified by employees through the previously administered questionnaires as needing to be improved; specifically, training, recognition, teamwork, supervision and leadership, and communication. MERIT created an enlarged and modified version of the report card which enabled scores for each individual supervisor to be recorded on a separate form, along with summary results and employee comments. Report card results have been compiled and fed back to the Division Chief and Assistant Division Chief. These individuals will in turn, feed the results back to the remaining supervisors and the team leaders. Although results differ among supervisors, some similarities exist. Communication generally appears to be adequate, which represents an improvement over last year. In contrast, recognition and teamwork are the two major areas where improvement in supervisory performance seems to be most needed. The initial report card results will serve as a baseline against which future performance ratings will be compared. Once supervisors have been presented with their data and given an opportunity to analyze and discus the results, they will be assisted in developing an action plan for improving their performance and work processes. They will be provided with ongoing support from management in following through with the action plan.

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

PubMed Central

2011-01-01

Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Conclusions Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality. PMID:21592322

Real money: complications and hospital costs in trauma patients.

PubMed

Hemmila, Mark R; Jakubus, Jill L; Maggio, Paul M; Wahl, Wendy L; Dimick, Justin B; Campbell, Darrell A; Taheri, Paul A

2008-08-01

Major postoperative complications are associated with a substantial increase in hospital costs. Trauma patients are known to have a higher rate of complications than the general surgery population. We used the National Surgical Quality Improvement Program (NSQIP) methodology to evaluate hospital costs, duration of stay, and payment associated with complications in trauma patients. Using NSQIP principles, patient data were collected for 512 adult patients admitted to the trauma service for > 24 hours at a Level 1 trauma center (2004-2005). Patients were placed in 1 of 3 groups: no complications (none), >or=1 minor complication (minor, eg, urinary tract infection), or >or=1 major complication (major, eg, pneumonia). Total hospital charges, costs, payment, and duration of stay associated with each complication group were determined from a cost-accounting database. Multiple regression was used to determine the costs of each type of complication after adjusting for differences in age, sex, new injury severity score, Glasgow coma scale score, maximum head abbreviated injury scale, and first emergency department systolic blood pressure. A total of 330 (64%) patients had no complications, 53 (10%) had >or= 1 minor complication, and 129 (25%) had >or= 1 major complication. Median hospital charges increased from $33,833 (none) to $81,936 (minor) and $150,885 (major). The mean contribution to margin per day was similar for the no complication and minor complication groups ($994 vs $1,115, P = .7). Despite higher costs, the patients in the major complication group generated a higher mean contribution to margin per day compared to the no complication group ($2,168, P < .001). The attributable increase in median total hospital costs when adjusted for confounding variables was $19,915 for the minor complication group (P < .001), and $40,555 for the major complication group (P < .001). Understanding the costs associated with traumatic injury provides a window for assessing the potential cost reductions associated with improved quality care. To optimize system benefits, payers and providers should develop integrated reimbursement methodologies that align incentives to provide quality care.

Survey of Programs Designed to Improve Employee Morale in Seven Major American Shipyards

DTIC Science & Technology

1992-07-01

Accident Program A combined union/management/ employee program whereby departmental committees work to design health and safety initiatives to attempt to...STANDARDS DING ENGINEERING ATION Survey of Programs Designed To Improve Employee Morale In Seven Major American Shipyards UNITED STATES NAVY David Taylor...4. TITLE AND SUBTITLE Survey of Programs Designed to Improve Employee Morale in Seven Major American Shipyards 5a. CONTRACT NUMBER 5b. GRANT

Ulcerative colitis from patients' viewpoint: a review of two Internet surveys.

PubMed

Dudley-Brown, Sharon; Baker, Kathy

2012-01-01

Ulcerative colitis negatively impacts patients' quality of life, but little is known about which aspects of patients' lives are affected, how patients' perceptions compare with patients with other chronic conditions, and how these perceptions compare with those of gastroenterologists. This review discusses two recent Internet surveys: (1) the Ulcerative Colitis: New Observations on Remission Management And Lifestyle (UC:NORMAL) and (2) the Crohn's and Colitis Foundation of America studies. The surveys revealed that the major impact ulcerative colitis has on patients includes frequent disease manifestations, a substantial psychological burden, and disruption to daily activities. This was more evident in patients with ulcerative colitis than those with migraine, asthma, or rheumatoid arthritis. Physicians' perceptions were considerably different from those of patients, as physicians believed that the disease had a lesser impact on patient quality of life. Furthermore, patients and physicians also identified nonadherence to prescribed medication as a major concern in the treatment of ulcerative colitis. Improved communication and education is needed to address nonadherence and poor health related quality of life in patients living with ulcerative colitis. The influence of Advanced Practice Registered Nurses on physicians, nurses, and patients may help improve adherence and long-term disease outcomes, including patients' health related quality of life. The nurse practitioner, working with both patients who have ulcerative colitis and the physicians who care for these patients, is uniquely placed to address these needs.

Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial.

PubMed

Lieverse, Ritsaert; Van Someren, Eus J W; Nielen, Marjan M A; Uitdehaag, Bernard M J; Smit, Jan H; Hoogendijk, Witte J G

2011-01-01

Major depressive disorder (MDD) in elderly individuals is prevalent and debilitating. It is accompanied by circadian rhythm disturbances associated with impaired functioning of the suprachiasmatic nucleus, the biological clock of the brain. Circadian rhythm disturbances are common in the elderly. Suprachiasmatic nucleus stimulation using bright light treatment (BLT) may, therefore, improve mood, sleep, and hormonal rhythms in elderly patients with MDD. To determine the efficacy of BLT in elderly patients with MDD. Double-blind, placebo-controlled randomized clinical trial. Home-based treatment in patients recruited from outpatient clinics and from case-finding using general practitioners' offices in the Amsterdam region. Eighty-nine outpatients 60 years or older who had MDD underwent assessment at baseline (T0), after 3 weeks of treatment (T1), and 3 weeks after the end of treatment (T2). Intervention Three weeks of 1-hour early-morning BLT (pale blue, approximately 7500 lux) vs placebo (dim red light, approximately 50 lux). Mean improvement in Hamilton Scale for Depression scores at T1 and T2 using parameters of sleep and cortisol and melatonin levels. Intention-to-treat analysis showed Hamilton Scale for Depression scores to improve with BLT more than placebo from T0 to T1 (7%; 95% confidence interval, 4%-23%; P = .03) and from T0 to T2 (21%; 7%-31%; P = .001). At T1 relative to T0, get-up time after final awakening in the BLT group advanced by 7% (P < .001), sleep efficiency increased by 2% (P = .01), and the steepness of the rise in evening melatonin levels increased by 81% (P = .03) compared with the placebo group. At T2 relative to T0, get-up time was still advanced by 3% (P = .001) and the 24-hour urinary free cortisol level was 37% lower (P = .003) compared with the placebo group. The evening salivary cortisol level had decreased by 34% in the BLT group compared with an increase of 7% in the placebo group (P = .02). In elderly patients with MDD, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin level gradient. In addition, BLT produced continuing improvement in mood and an attenuation of cortisol hyperexcretion after discontinuation of treatment. clinicaltrials.gov Identifier NCT00332670.

Does Hip Arthroscopy Provide Meaningful Outcome Improvement for Adolescent Femoroacetabular Impingement

PubMed Central

Nwachukwu, Benedict Uchenna; Chang, Brenda; Kahlenberg, Cynthia A.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2017-01-01

Objectives: Arthroscopic treatment of femoroacetabular impingement (FAI) produces meaningful outcome improvement in adults. Hip arthroscopy for pediatric FAI is now established as a safe procedure however there is a paucity of evidence reporting on outcome improvement after arthroscopic treatment of FAI in this population. Methods: A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for pediatric FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) are routinely collected as part of the registry. Minimal clinically important difference (MCID) was calculated using a distribution based method and substantial clinical benefit (SCB) was calculated using the an anchor question. Receiver operating characteristic (ROC) analysis with area under the curve was used. AUC > 0.7 was considered significantly predictive. Results: Forty-seven children and adolescents were identified. The majority of patients were female (N=32, 68.1%) with a mean age of 16.5 (+ 1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%) and 10.7 (94%) respectively. MCID values on these outcome tools were comparable to adult patients within the registry however for each outcome measure pediatric patients were more likely to achieve MCID. In univariate analysis acetabular version was the only predictive variable for achieving MCID in pediatric FAI (p<0.05). The majority of children (91%) reported improved physical ability based on the anchor question and 53% (compared to 40% in adult registry patients) were classified as achieving SCB. The following one-year raw outcome scores were significantly predictive of SCB on the mHHS, HOS ADL, HOS Sport and mHHS respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), 85.9 (0.76). These pediatric SCB values were all higher than SCB values for adult registry patients (82.5, 93.3, 84.4, 63.5 respectively) Conclusion: Pediatric patients undergoing arthroscopic FAI treatment can achieve meaningful outcome improvement and compared to adults, a larger proportion of children achieve meaningful outcome improvement. Additionally, while MCID values are comparable in children and adults, children appear to require substantially higher overall post-operative scores to perceive SCB. These findings highlight that commonly administered adult FAI outcome tools may have a relative ceiling effect in capturing outcome after treatment of pediatric FAI.

A Veterinary Comparative Counseling Elective Featuring Web-based, Student-created, Client Information Sheets.

PubMed

Miller, Jennifer C; Sehgal, Inder

2016-02-25

To design and implement a course in Companion Animal Comparative Counseling that would expose students (N=38) to essential elements of veterinary therapeutics and provide them with the opportunity to apply their knowledge by writing and posting client information sheets (CIS) on an open web site. The elective course was limited to companion animals. Nine different topics were covered over the semester. Class sessions included a didactic component, trivia questions, and field trips. There were 4 major graded assessments: an examination on foundation knowledge, followed by two comparative counseling assessments and evaluation of group-composed CIS. Attendance and participation were also considered. The class learned comparative disease states, how to counsel on common pet prescriptions, where to access informatics about specific veterinary drugs, and how to create their own CIS. As pharmacists, these students may have improved their training in veterinary comparative pharmacy.

A Veterinary Comparative Counseling Elective Featuring Web-based, Student-created, Client Information Sheets

PubMed Central

Miller, Jennifer C.

2016-01-01

Objective. To design and implement a course in Companion Animal Comparative Counseling that would expose students (N=38) to essential elements of veterinary therapeutics and provide them with the opportunity to apply their knowledge by writing and posting client information sheets (CIS) on an open web site. Design. The elective course was limited to companion animals. Nine different topics were covered over the semester. Class sessions included a didactic component, trivia questions, and field trips. There were 4 major graded assessments: an examination on foundation knowledge, followed by two comparative counseling assessments and evaluation of group-composed CIS. Attendance and participation were also considered. Assessment. The class learned comparative disease states, how to counsel on common pet prescriptions, where to access informatics about specific veterinary drugs, and how to create their own CIS. Conclusion. As pharmacists, these students may have improved their training in veterinary comparative pharmacy. PMID:26941441

Using the weighted area under the net benefit curve for decision curve analysis.

PubMed

Talluri, Rajesh; Shete, Sanjay

2016-07-18

Risk prediction models have been proposed for various diseases and are being improved as new predictors are identified. A major challenge is to determine whether the newly discovered predictors improve risk prediction. Decision curve analysis has been proposed as an alternative to the area under the curve and net reclassification index to evaluate the performance of prediction models in clinical scenarios. The decision curve computed using the net benefit can evaluate the predictive performance of risk models at a given or range of threshold probabilities. However, when the decision curves for 2 competing models cross in the range of interest, it is difficult to identify the best model as there is no readily available summary measure for evaluating the predictive performance. The key deterrent for using simple measures such as the area under the net benefit curve is the assumption that the threshold probabilities are uniformly distributed among patients. We propose a novel measure for performing decision curve analysis. The approach estimates the distribution of threshold probabilities without the need of additional data. Using the estimated distribution of threshold probabilities, the weighted area under the net benefit curve serves as the summary measure to compare risk prediction models in a range of interest. We compared 3 different approaches, the standard method, the area under the net benefit curve, and the weighted area under the net benefit curve. Type 1 error and power comparisons demonstrate that the weighted area under the net benefit curve has higher power compared to the other methods. Several simulation studies are presented to demonstrate the improvement in model comparison using the weighted area under the net benefit curve compared to the standard method. The proposed measure improves decision curve analysis by using the weighted area under the curve and thereby improves the power of the decision curve analysis to compare risk prediction models in a clinical scenario.

Cycle training induces muscle hypertrophy and strength gain: strategies and mechanisms.

PubMed

Ozaki, Hayao; Loenneke, J P; Thiebaud, R S; Abe, T

2015-03-01

Cycle training is widely performed as a major part of any exercise program seeking to improve aerobic capacity and cardiovascular health. However, the effect of cycle training on muscle size and strength gain still requires further insight, even though it is known that professional cyclists display larger muscle size compared to controls. Therefore, the purpose of this review is to discuss the effects of cycle training on muscle size and strength of the lower extremity and the possible mechanisms for increasing muscle size with cycle training. It is plausible that cycle training requires a longer period to significantly increase muscle size compared to typical resistance training due to a much slower hypertrophy rate. Cycle training induces muscle hypertrophy similarly between young and older age groups, while strength gain seems to favor older adults, which suggests that the probability for improving in muscle quality appears to be higher in older adults compared to young adults. For young adults, higher-intensity intermittent cycling may be required to achieve strength gains. It also appears that muscle hypertrophy induced by cycle training results from the positive changes in muscle protein net balance.

Improving Student Achievement in Introductory Computer Science Courses Using Peer-Led Team Learning

ERIC Educational Resources Information Center

Dennis, Sonya Maria

2013-01-01

There has been a steady decline of majors in the disciplines of science, technology, engineering, and mathematics ("STEM majors"). In an effort to improve recruitment and retention in "STEM" majors, an active-learning methodology--"peer-led team learning" ("PLTL")--was implemented by the participating…

Improved outcomes for newly diagnosed AL amyloidosis between 2000 and 2014: cracking the glass ceiling of early death.

PubMed

Muchtar, Eli; Gertz, Morie A; Kumar, Shaji K; Lacy, Martha Q; Dingli, David; Buadi, Francis K; Grogan, Martha; Hayman, Suzanne R; Kapoor, Prashant; Leung, Nelson; Fonder, Amie; Hobbs, Miriam; Hwa, Yi Lisa; Gonsalves, Wilson; Warsame, Rahma; Kourelis, Taxiarchis V; Russell, Stephen; Lust, John A; Lin, Yi; Go, Ronald S; Zeldenrust, Steven; Kyle, Robert A; Rajkumar, S Vincent; Dispenzieri, Angela

2017-04-13

In light of major advances in immunoglobulin light chain (AL) amyloidosis, we evaluated the trends in presentation, management, and outcome among 1551 newly diagnosed AL amyloidosis patients seen in our institution from 2000 to 2014. As compared with the 2 intervals 2000-2004 and 2005-2009, patients diagnosed in 2010-2014 were less likely to have >2 involved organs. Utilization of autologous stem cell transplant (ASCT) was similar across all periods, about one-third of patients, but there was an increase in the use of pre-ASCT bortezomib induction and of unattenuated melphalan conditioning in 2010-2014 compared with earlier periods. Non-ASCT first-line regimen changed with 65% of patients in 2010-2014 received bortezomib-based therapy, 79% of patients in 2005-2009 received melphalan-dexamethasone, and 64% of patients in 2000-2004 received melphalan-prednisone. The rate of better than very good partial response (VGPR) was higher in more recent periods (66% vs 58% vs 51%; P = .001), a change largely driven by improved VGPR rates in the non-ASCT population. Overall survival (OS) has improved, with inflection points for improvement differing for the ASCT and non-ASCT groups. In the ASCT population, the greatest gains were after 2010 (4-year OS, 91% compared with 73% and 65%). In the non-ASCT group, greatest gains were after 2005 (4-year OS, 38%, 32%, and 16%). Fewer patients died within 6 months of diagnosis in the 2 later periods (24% vs 25% vs 37%; P < .001). Overall, outcomes among patients with AL amyloidosis have improved with earlier diagnosis, higher rates of VGPR, lower early mortality, and improved OS. © 2017 by The American Society of Hematology.

United States Army physical readiness training: rationale and evaluation of the physical training doctrine.

PubMed

Knapik, Joseph J; Rieger, William; Palkoska, Frank; Van Camp, Steven; Darakjy, Salima

2009-07-01

This paper reviews the rationale and evaluations of Physical Readiness Training (PRT), the new U.S. Army physical training doctrine designed to improve soldiers' physical capability for military operations. The purposes of PRT are to improve physical fitness, prevent injuries, progressively train soldiers, and develop soldiers' self-confidence and discipline. The PRT follows the principles of progressive overload, regularity, specificity, precision, variety, and balance. Specificity was achieved by examining the standard list of military (warrior) tasks and determining 1) the physical requirements, 2) the fitness components involved, and 3) the training activities that most likely could improve the military tasks. Injury-prevention features include reduced running mileage, exercise variety (cross-training), and gradual, progressive training. In 3 military field studies, the overall adjusted risk of injury was 1.5-1.8 times higher in groups of soldiers performing traditional military physical training programs when compared with groups using a PRT program. Scores on the Army Physical Fitness Test were similar or higher in groups using PRT programs. In an 8-week laboratory study comparing PRT with a weightlifting/running program, both programs resulted in major improvements in militarily relevant tasks (e.g., 3.2-km walk/run with 32-kg load, 400-m run with 18-kg load, 5- to 30-second rushes to and from prone position, 80-kg casualty drag, obstacle course). When compared with traditional military physical training programs, PRT consistently resulted in fewer injuries and in equal or greater improvements in fitness and military task performance.

Adherence to guidelines for cardiovascular screening in current high school preparticipation evaluation forms.

PubMed

Rausch, Christopher M; Phillips, George C

2009-10-01

We compared the content of the cardiac screening questions on US state high school athletic association preparticipation evaluation forms with current consensus recommendations. We reviewed the high school athletic association's approved, recommended, or required sports preparticipation form from each of the 50 US states and the District of Columbia, and compared the content of the personal and family history components with current recommendations for cardiac screening questions. We found that 85% of the preparticipation forms in current use contain all elements of the formerly recommended guidelines, but only 17% contain all elements of the new consensus guidelines. We conclude that although there appears to be some improvement in the content of the preparticipation forms in current use compared with previous studies, the vast majority of these forms are incomplete compared with current consensus guidelines.

The Effects of Group Play Therapy on Self-Concept Among 7 to 11 Year-Old Children Suffering From Thalassemia Major

PubMed Central

Tomaj, Ome Kolsoum; Estebsari, Fatemeh; Taghavi, Taraneh; Borim Nejad, Leili; Dastoorpoor, Maryam; Ghasemi, Afsaneh

2016-01-01

Background Children suffering from thalassemia have higher levels of depression and lower levels of self-concept. Objectives The aim of this study was to determine if group play therapy could significantly increase self-concept among children with thalassemia major ages 7 to 11 years old in teaching hospitals of Golestan province, Iran, in 2012. Patients and Methods In this randomized, controlled clinical trial, 60 children with thalassemia major were randomly assigned to intervention (30 children) and control (30 children) groups. The intervention included eight 45 to 60 minute sessions during four weeks, during which the intervention group received group play therapy. The control group received no interventions. Self-concept was measured three times using the Piers-Harris children’s self-concept scale: before, immediately after, and a month after the intervention. Results For the intervention group, results showed that the mean self-concept score was significantly higher at the second point in time compared to the baseline (P < 0.001), going from 60.539 to 69.908. Likewise, comparing the first and third time points, the mean score significantly increased and reached 70.611 (P < 0.001). Furthermore, changes in the mean score from the second to the third time point, though non-significant (P = 0.509), followed the trend, going from 69.908 to 70.611. For the control group, comparing the first, second, and third time points did not result in any significant change in the mean score (P > 0.05). Conclusions The results showed that group play therapy improves self-concept in children suffering from thalassemia major. PMID:27275402

A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program.

PubMed

Phan, T D; D'Souza, B; Rattray, M J; Johnston, M J; Cowie, B S

2014-11-01

There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m(2), P <0.001, in the latter group. Length-of-stay was similar, 6.5 (5 to 9) versus 6 (4 to 9) days, P=0.421. The number of patients with any complication (minor or major) was similar; 0% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.

Teaching Reform of Civil Engineering Materials Course Based on Project-Driven Pedagogy

NASA Astrophysics Data System (ADS)

Yidong, Xu; Wei, Chen; WeiguoJian, You; Jiansheng, Shen

2018-05-01

In view of the scattered experimental projects in practical courses of civil engineering materials, the poor practical ability of students and the disconnection between practical teaching and theoretical teaching, this paper proposes a practical teaching procedure. Firstly, the single experiment should be offered which emphasizes on improving the students’ basic experimental operating ability. Secondly, the compressive experiment is offered and the overall quality of students can be examined in the form of project team. In order to investigate the effect of teaching reform, the comparative analysis of the students of three grades (2014, 2015 and 2016) majored in civil engineering was conducted. The result shows that the students’ ability of experimental operation is obviously improved by using the project driven method-based teaching reform. Besides, the students’ ability to analyse and solve problems has also been improved.

A requirements engineering approach for improving the quality of diabetes education websites.

PubMed

Shabestari, Omid; Roudsari, Abdul

2011-01-01

Diabetes Mellitus is a major chronic disease with multi-organ involvement and high-cost complications. Although it has been proved that structured education can control the risk of developing these complications, there is big room for improvement in the educational services for these patients. e-learning can be a good solution to fill this gap. Most of the current e-learning solutions for diabetes were designed by computer experts and healthcare professionals but the patients, as end-users of these systems, haven't been deeply involved in the design process. Considering the expectations of the patients, this article investigates a requirement engineering process comparing the level of importance given to different attributes of the e-learning by patients and healthcare professionals. The results of this comparison can be used for improving the currently developed online diabetes education systems.

Runoff and initial erosion assessment in fruit tree crops and improved forage pastures in the slopes of the Irazu Volcano (Costa Rica)

NASA Astrophysics Data System (ADS)

Marchamalo, Miguel; González-Rodrigo, Beatriz

2017-04-01

Costa Rica is located in the Central American tropical isthmus. It presents high precipitations (ranging from 1400-8500 mm) and protection levels (27% of national territory). However, intensive land use and increasing population in headwaters are major threats for water resource management in this country. Birrís Basin is a 4800 hectares sub-watershed of the River Reventazón Basin, the major hydroelectric source in Costa Rica. Birrís Basin was selected for its high estimated erosion rates and its potential for demonstrative projects (ICE, 1999). Some pilot projects have been developed in this watershed starting from 1999, when major Costa Rican energy producer, Instituto Costarricense de Electricidad, began with a long term watershed management program for the Reventazón Basin. This study aims at measuring runoff and initial splash and sheet erosion to assess the hydrological response of two pilot land use projects. Erosion and runoff plots were established and monitored in a one year period for two pilot projects (fruit trees and forage pastures) and their respective traditional land uses (vegetable crops and extensive pastures). Improved forage pastures showed reduced runoff by 73% and split erosion by 55% compared to prior extensive pastures. Conversion of vegetable crop lands into fruit tree plantations (apricot and avocado) made possible a 97% reduction of soil initial erosion. Land use pilot projects have succeeded in runoff and soil erosion reduction. Now it is time for a wider technology transfer program to expand improved land uses within Birrís Basin.

High level expression, purification and physico- and immunochemical characterisation of recombinant Pen a 1: a major allergen of shrimp.

PubMed

Albrecht, Melanie; Alessandri, Stefano; Conti, Amedeo; Reuter, Andreas; Lauer, Iris; Vieths, Stefan; Reese, Gerald

2008-11-01

Well-characterised and immunologically active recombinant allergens are of eminent importance for improvement of diagnostic tools and immunotherapy of allergic diseases. The use of recombinant allergens has several advantages such as the more precise quantification of the active substance compared to allergen extracts and the reduced risk of contamination with other allergenic proteins compared to purified natural allergens. Optimised standard protocols for expression and purification and a detailed physico-chemical characterisation of such recombinant allergens are necessary to ensure consistent quality and comparability of results obtained with recombinant material. In this study the major allergen Pen a 1 of brown shrimp (Penaeus aztecus) was expressed in E. coli and purified in two steps by immobilised metal chelate-affinity chromatography (IMAC) and size-exclusion chromatography. Identity and purity were verified with N-terminal sequencing and peptide mass fingerprinting. Circular dichroism and NMR-spectroscopy indicated an alpha-helical flexible structure of rPen a 1 which is in accordance with the known structure of tropomyosins. Finally, the recombinant allergen proved to be immunologically reactive in IgE Western blot analysis and ELISA. This study provides a protocol for the preparation of recombinant shrimp tropomyosin in standardised quality.

AGPase: its role in crop productivity with emphasis on heat tolerance in cereals.

PubMed

Saripalli, Gautam; Gupta, Pushpendra Kumar

2015-10-01

AGPase, a key enzyme of starch biosynthetic pathway, has a significant role in crop productivity. Thermotolerant variants of AGPase in cereals may be used for developing cultivars, which may enhance productivity under heat stress. Improvement of crop productivity has always been the major goal of plant breeders to meet the global demand for food. However, crop productivity itself is influenced in a large measure by a number of abiotic stresses including heat, which causes major losses in crop productivity. In cereals, crop productivity in terms of grain yield mainly depends upon the seed starch content so that starch biosynthesis and the enzymes involved in this process have been a major area of investigation for plant physiologists and plant breeders alike. Considerable work has been done on AGPase and its role in crop productivity, particularly under heat stress, because this enzyme is one of the major enzymes, which catalyses the rate-limiting first committed key enzymatic step of starch biosynthesis. Keeping the above in view, this review focuses on the basic features of AGPase including its structure, regulatory mechanisms involving allosteric regulators, its sub-cellular localization and its genetics. Major emphasis, however, has been laid on the genetics of AGPases and its manipulation for developing high yielding cultivars that will have comparable productivity under heat stress. Some important thermotolerant variants of AGPase, which mainly involve specific amino acid substitutions, have been highlighted, and the prospects of using these thermotolerant variants of AGPase in developing cultivars for heat prone areas have been discussed. The review also includes a brief account on transgenics for AGPase, which have been developed for basic studies and crop improvement.

Impact of arterial access site on outcomes after primary percutaneous coronary intervention: prespecified subgroup analysis from the EUROMAX trial.

PubMed

Hamon, Martial; Coste, Pierre; Van't Hof, Arnoud; Ten Berg, Jurrien; Clemmensen, Peter; Tabone, Xavier; Benamer, Hakim; Kristensen, Steen D; Cavallini, Claudio; Marzocchi, Antonio; Hamm, Christian; Kanic, Vojko; Bernstein, Debra; Anthopoulos, Prodromos; Deliargyris, Efthymios N; Steg, Philippe Gabriel

2015-06-01

In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin. In EUROMAX, choice of arterial access was left to operator discretion. Overall, 47% of patients underwent radial and 53% femoral access. Baseline risk was higher in the femoral access group. Unadjusted proportions for the primary outcome (death or noncoronary artery bypass graft protocol major bleeding at 30 days) were lower with radial access, however, without differences in major or major plus minor bleeding proportions. After multivariable adjustment, ischemic outcomes were no longer different between access site groups, except for a lower risk of stroke in radial patients. Bivalirudin was associated with lower proportions of the primary outcome in both the radial (odds ratio, 0.58; 95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95% CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly lower in the bivalirudin group both in the radial- and femoral-treated patients but no significant difference was observed in ischemic outcomes. In multivariable analysis, bivalirudin emerged as the only independent predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74; P=0.002). In this prespecified analysis from EUROMAX, radial access was preferred in lower risk patients and did not improve clinical outcomes. Bivalirudin was associated with less bleeding irrespective of access site. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01087723. © 2015 American Heart Association, Inc.

Pharmacological prevention of suicide in patients with major mood disorders.

PubMed

Rihmer, Zoltan; Gonda, Xenia

2013-12-01

The risk of self-destructive behavior in mood disorders is an inherent phenomenon and suicidal behavior in patients with unipolar or bipolar major mood disorders strongly relates to the presence and severity of depressive episodes. Consequently, early recognition, and successful acute and long-term treatment of depressive disorders is essential for suicide prevention in such patients. Large-scale, retrospective and prospective naturalistic long-term clinical studies, including severely ill, frequently suicidal depressives show that appropriate pharmacotherapy markedly reduces suicide morbidity and mortality even in this high-risk population. Supplementary psycho-social interventions further improve the effect. The slightly elevated (but in absolute sense quite low) risk of suicidal behavior among patients taking antidepressants compared to those taking placebo in randomized controlled antidepressant trials on unipolar major depression might be the consequence of the depression-worsening potential of antidepressant monotherapy in subthreshold and mixed bipolar depressed patients included in these trials and falsely diagnosed as suffering from unipolar major depression. Concurrent depression-focused psychotherapies increase the effectiveness of pharmacotherapy and this way contribute to suicide prevention for patients with mood disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Robust Multi-Scale Modeling System for the Study of Cloud and Precipitation Processes

NASA Technical Reports Server (NTRS)

Tao, Wei-Kuo

2012-01-01

During the past decade, numerical weather and global non-hydrostatic models have started using more complex microphysical schemes originally developed for high resolution cloud resolving models (CRMs) with 1-2 km or less horizontal resolutions. These microphysical schemes affect the dynamic through the release of latent heat (buoyancy loading and pressure gradient) the radiation through the cloud coverage (vertical distribution of cloud species), and surface processes through rainfall (both amount and intensity). Recently, several major improvements of ice microphysical processes (or schemes) have been developed for cloud-resolving model (Goddard Cumulus Ensemble, GCE, model) and regional scale (Weather Research and Forecast, WRF) model. These improvements include an improved 3-ICE (cloud ice, snow and graupel) scheme (Lang et al. 2010); a 4-ICE (cloud ice, snow, graupel and hail) scheme and a spectral bin microphysics scheme and two different two-moment microphysics schemes. The performance of these schemes has been evaluated by using observational data from TRMM and other major field campaigns. In this talk, we will present the high-resolution (1 km) GeE and WRF model simulations and compared the simulated model results with observation from recent field campaigns [i.e., midlatitude continental spring season (MC3E; 2010), high latitude cold-season (C3VP, 2007; GCPEx, 2012), and tropical oceanic (TWP-ICE, 2006)].

How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme

PubMed Central

Baghaei, Abdolmehdi; Rabiei, Katayoun; Gharipour, Mojgan; Tavasoli, Ali Akbar; Shirani, Shahin; Bahonar, Ahamad; Davarpanah, Amir Hossein; Ramezani, Mohammad Arash; Kelishadi, Roya

2010-01-01

Introduction The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases. Material and methods Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention. Results Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved. Conclusions Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population. PMID:22371716

Extending the duration of hypothermia does not further improve white matter protection after ischemia in term-equivalent fetal sheep.

PubMed

Davidson, Joanne O; Yuill, Caroline A; Zhang, Frank G; Wassink, Guido; Bennet, Laura; Gunn, Alistair J

2016-04-28

A major challenge in modern neonatal care is to further improve outcomes after therapeutic hypothermia for hypoxic ischemic encephalopathy. In this study we tested whether extending the duration of cooling might reduce white matter damage. Term-equivalent fetal sheep (0.85 gestation) received either sham ischemia followed by normothermia (n = 8) or 30 minutes of bilateral carotid artery occlusion followed by three days of normothermia (n = 8), three days of hypothermia (n = 8) or five days of hypothermia (n = 8) started three hours after ischemia. Histology was assessed 7 days after ischemia. Ischemia was associated with loss of myelin basic protein (MBP) and Olig-2 positive oligodendrocytes and increased Iba-1-positive microglia compared to sham controls (p < 0.05). Three days and five days of hypothermia were associated with a similar, partial improvement in MBP and numbers of oligodendrocytes compared to ischemia-normothermia (p < 0.05). Both hypothermia groups had reduced microglial activation compared to ischemia-normothermia (p < 0.05). In the ischemia-five-day hypothermia group, but not ischemia-three-day, numbers of microglia remained higher than in sham controls (p < 0.05). In conclusion, delayed cerebral hypothermia partially protected white matter after global cerebral ischemia in fetal sheep. Extending cooling from 3 to 5 days did not further improve outcomes, and may be associated with greater numbers of residual microglia.

An evaluation of the cognitive and mood effects of an energy shot over a 6h period in volunteers: a randomized, double-blind, placebo controlled, cross-over study.

PubMed

Wesnes, Keith A; Barrett, Marilyn L; Udani, Jay K

2013-08-01

Energy drinks are widely available mostly containing glucose, and several have been demonstrated to improve alertness and cognitive function; these effects generally being identified 30-60min after administration. The present study assessed whether an energy shot without carbohydrates would affect major aspects of cognitive function and also mood in volunteers over a 6h time period. This randomized, double-blind, placebo-controlled,crossover study compared the acute effects of the energy shot with a matching placebo in 94 healthy volunteers. Cognitive function was assessed with a widely used set of automated tests of attention and memory. Mood was assessed with the Bond-Lader, Beck Anxiety Index, Beck Depression Index, Chalder Fatigue Scales (CFS), and the POMS. The volunteers were requested to limit their sleep to between 3 and 6h the night before each testing day. Compared to the placebo, the energy shot significantly improved 6 validated composite cognitive function measures from the CDR System as well as self-rated alertness; the benefits on 4 of the cognitive measures still remaining at 6h. The overall effect sizes of the performance improvements were in the small to medium range and thus notable in this field. In conclusion, an energy shot can significantly improve important aspects of cognitive function for up to 6h compared to placebo in partially sleep-deprived healthy volunteers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Feeling Better at This Age? Investigating Three Explanations for Self-Rated Health Improvements Among the Oldest-Old.

PubMed

Vogelsang, Eric M

2017-09-08

Although the majority of individuals in their 80s or 90s do not experience improving health, a significant portion of this age group either (a) subjectively assess their health as improving; or (b) demonstrate self-rated health improvements when comparing consecutive surveys. While there is a body of research that examines self-rated health declines in older ages, much less work has studied possible determinants of self-rated health improvements. This is important, since there is increasing evidence that oldest-old adults have unique health evaluative processes that are not yet well-understood. Using 21,155 observations from eight waves of the Asset and Health Dynamics survey (the oldest-old portion of the Health and Retirement Study), I use hierarchical linear models to test three explanations as to why the oldest-old may report or demonstrate self-rated health improvements: (a) normalized pre-existing chronic conditions, (b) positive lifestyle changes, and (c) recovery from recent prior health shocks. Health improvements calculated by comparing consecutive surveys were related to a recovery from four particular serious health diagnoses (cancer, stroke, heart disease, and lung disease). Conversely, explicitly reported health improvements were associated with normalizing pre-existing conditions. Lastly, starting a regular exercise routine was related to both types of health improvements; while the cessation of negative health behaviors (i.e., drinking and smoking) was not related to either type. These results suggest that while subjective health "improvements" among the oldest-old may be a sign of successful aging, they should be interpreted critically and cautiously. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.

PubMed

Moole, Harsha; Bechtold, Matthew; Puli, Srinivas R

2016-07-11

In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups. Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model). Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74). In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.

A PLAN FOR EVALUATING MAJOR ACTIVITIES IN GREAT CITIES SCHOOL IMPROVEMENT PROGRAM.

ERIC Educational Resources Information Center

MARBURGER, CARL L.; RASSCHAERT, WILLIAM M.

THE GUIDE IS INTENDED TO ASSIST PROJECT DIRECTORS IN THEIR EFFORTS TO DEVELOP MORE SYSTEMATIC AND THOROUGH EVALUATION DESIGNS FOR THE GREAT CITIES SCHOOL IMPROVEMENT PROGRAM. MAJOR DIMENSIONS OF TEACHING-LEARNING, SCHOOL-COMMUNITY, AND PUPIL-PARENT-TEACHER ACTIVITIES ARE LISTED. MAJOR EVALUATION AREAS ARE IN PUPIL ACHIEVEMENT, IMPLEMENTED BY GROUP…

Use of short-acting insulin aspart in managing older people with diabetes

PubMed Central

Marouf, Eltayeb; Sinclair, Alan J

2009-01-01

Type 2 diabetes mellitus affects 5.9% of the world adult population, with older people and some ethnic groups disproportionately affected. Treatment of older people with diabetes differs in many ways from that in younger adults since the majority have type 2 disease and are at particular risk of macrovascular rather than disabling microvascular disease. Insulin therapy, the most effective of diabetes medications, can reduce any level of elevated HBA1c if used in adequate doses. However, some clinicians are often reluctant to initiate insulin therapy in older people with diabetes mainly out of their concerns about adverse reactions to insulin, particularly hypoglycemia. There is evidence suggesting that insulin aspart appears to act similarly to regular human insulin in older people with type 2 diabetes mellitus. Insulin aspart can be used in the treatment of older people with diabetes, but this should be individualized. There is evidence that it improves postprandial glucose control, improves long-term metabolic control, reduces risk of major nocturnal hypoglycemia and increases patient satisfaction compared with soluble insulin. PMID:19503780

Hematopoietic stem cell transplantation in thalassemia major and sickle cell disease: indications and management recommendations from an international expert panel

PubMed Central

Angelucci, Emanuele; Matthes-Martin, Susanne; Baronciani, Donatella; Bernaudin, Françoise; Bonanomi, Sonia; Cappellini, Maria Domenica; Dalle, Jean-Hugues; Di Bartolomeo, Paolo; de Heredia, Cristina Díaz; Dickerhoff, Roswitha; Giardini, Claudio; Gluckman, Eliane; Hussein, Ayad Achmed; Kamani, Naynesh; Minkov, Milen; Locatelli, Franco; Rocha, Vanderson; Sedlacek, Petr; Smiers, Frans; Thuret, Isabelle; Yaniv, Isaac; Cavazzana, Marina; Peters, Christina

2014-01-01

Thalassemia major and sickle cell disease are the two most widely disseminated hereditary hemoglobinopathies in the world. The outlook for affected individuals has improved in recent years due to advances in medical management in the prevention and treatment of complications. However, hematopoietic stem cell transplantation is still the only available curative option. The use of hematopoietic stem cell transplantation has been increasing, and outcomes today have substantially improved compared with the past three decades. Current experience world-wide is that more than 90% of patients now survive hematopoietic stem cell transplantation and disease-free survival is around 80%. However, only a few controlled trials have been reported, and decisions on patient selection for hematopoietic stem cell transplantation and transplant management remain principally dependent on data from retrospective analyses and on the clinical experience of the transplant centers. This consensus document from the European Blood and Marrow Transplantation Inborn Error Working Party and the Paediatric Diseases Working Party aims to report new data and provide consensus-based recommendations on indications for hematopoietic stem cell transplantation and transplant management. PMID:24790059

Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial.

PubMed

Celano, C M; Beale, E E; Mastromauro, C A; Stewart, J G; Millstein, R A; Auerbach, R P; Bedoya, C A; Huffman, J C

2017-04-01

Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior. A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment. Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = -3.15, 95% confidence interval -6.18 to -0.12, effect size = -0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks. Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.

Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial

PubMed Central

Celano, C. M.; Beale, E. E.; Mastromauro, C. A.; Stewart, J. G.; Millstein, R. A.; Auerbach, R. P.; Bedoya, C. A.; Huffman, J. C.

2016-01-01

Background Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior. Method A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment. Results Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = −3.15, 95% confidence interval −6.18 to −0.12, effect size = −0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks. Conclusions Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk. PMID:27876105

Comparison of iron chelation effects of deferoxamine, deferasirox, and combination of deferoxamine and deferiprone on liver and cardiac T2* MRI in thalassemia maior.

PubMed

Ansari, Shahla; Azarkeivan, Azita; Miri-Aliabad, Ghasem; Yousefian, Saeed; Rostami, Tahereh

2017-01-01

Cardiac complications due to iron overload are the most common cause of death in patients with thalassemia major. The aim of this study was to compare iron chelation effects of deferoxamine, deferasirox, and combination of deferoxamine and deferiprone on cardiac and liver iron load measured by T2* MRI. In this study, 108 patients with thalassemia major aged over 10 years who had iron overload in cardiac T2* MRI were studied in terms of iron chelators efficacy on the reduction of myocardial siderosis. The first group received deferoxamine, the second group only deferasirox, and the third group, a combination of deferoxamine and deferiprone. Myocardial iron was measured at baseline and 12 months later through T2* MRI technique. The three groups were similar in terms of age, gender, ferritin level, and mean myocardial T2* at baseline. In the deferoxamine group, myocardial T2* was increased from 12.0±4.1 ms at baseline to 13.5±8.4 ms at 12 months (p=0.10). Significant improvement was observed in myocardial T2* of the deferasirox group (p<0.001). In the combined treatment group, myocardial T2* was significantly increased (p<0.001). These differences among the three groups were not significant at the 12 months. A significant improvement was observed in liver T2* at 12 months compared to baseline in the deferasirox and the combination group. In comparison to deferoxamine monotherapy, combination therapy and deferasirox monotherapy have a significant impact on reducing iron overload and improvement of myocardial and liver T2* MRI.

Conservation genomics of anadromous Atlantic salmon across its North American range: outlier loci identify the same patterns of population structure as neutral loci.

PubMed

Moore, Jean-Sébastien; Bourret, Vincent; Dionne, Mélanie; Bradbury, Ian; O'Reilly, Patrick; Kent, Matthew; Chaput, Gérald; Bernatchez, Louis

2014-12-01

Anadromous Atlantic salmon (Salmo salar) is a species of major conservation and management concern in North America, where population abundance has been declining over the past 30 years. Effective conservation actions require the delineation of conservation units to appropriately reflect the spatial scale of intraspecific variation and local adaptation. Towards this goal, we used the most comprehensive genetic and genomic database for Atlantic salmon to date, covering the entire North American range of the species. The database included microsatellite data from 9142 individuals from 149 sampling locations and data from a medium-density SNP array providing genotypes for >3000 SNPs for 50 sampling locations. We used neutral and putatively selected loci to integrate adaptive information in the definition of conservation units. Bayesian clustering with the microsatellite data set and with neutral SNPs identified regional groupings largely consistent with previously published regional assessments. The use of outlier SNPs did not result in major differences in the regional groupings, suggesting that neutral markers can reflect the geographic scale of local adaptation despite not being under selection. We also performed assignment tests to compare power obtained from microsatellites, neutral SNPs and outlier SNPs. Using SNP data substantially improved power compared to microsatellites, and an assignment success of 97% to the population of origin and of 100% to the region of origin was achieved when all SNP loci were used. Using outlier SNPs only resulted in minor improvements to assignment success to the population of origin but improved regional assignment. We discuss the implications of these new genetic resources for the conservation and management of Atlantic salmon in North America. © 2014 John Wiley & Sons Ltd.

Relapse Prevention in Major Depressive Disorder: Mindfulness-Based Cognitive Therapy Versus an Active Control Condition

PubMed Central

Shallcross, Amanda J.; Gross, James J.; Visvanathan, Pallavi D.; Kumar, Niketa; Palfrey, Amy; Ford, Brett Q.; Dimidjian, Sona; Shirk, Stephen; Holm-Denoma, Jill; Goode, Kari M.; Cox, Erica; Chaplin, William; Mauss, Iris B.

2015-01-01

Objective We evaluated the comparative effectiveness of Mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method Ninety-two participants in remission from Major Depressive Disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for non-specific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (group x time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction post-intervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions. PMID:26371618

Influenza immunizations in the elderly: a continuous quality improvement project.

PubMed

Juma, A; Evans, M F; Bloom, J

2000-08-01

As part of the continuous quality improvement program at The Toronto Hospital's Department of Family & Community Medicine (TTH-DFCM), it was considered necessary to examine the structures, processes and outcomes of influenza immunization for the elderly. The study sought to (a) document the current influenza immunization process; (b) quantify influenza immunization rates for elderly patients during two consecutive immunization seasons (1996 and 1997), and compare these rates across physician teams, attending staff vs. residents, patient gender, and patient age groups; (c) compare influenza immunization rates with other centers; and (d) identify barriers and propose solutions to improve influenza immunization rates in the elderly. Evaluation Formative Research. A computerized roster of 15,000 patients at The Toronto Hospital, Department of Family and Community Medicine, a University of Toronto academic teaching center. Active patients age 65 years and over. Influenza immunization. Physician Teams, Physician status, Patient gender, and Patient age group. Immunization rates of attendees increased from 75.4% to 78.7%; over 3% increase from 1996 to 1997. Major subgroups which benefited from increased immunization rates were patients in the Blue team, patients age 70-74 years, and female patients. This study presents a rigorous examination of the components of the influenza immunization program, and demonstrates improved immunization rates over a two-year period. Suggestions for future action have been identified. The study design can also serve as a model for future clinical quality improvement projects.

Boosted classification trees result in minor to modest improvement in the accuracy in classifying cardiovascular outcomes compared to conventional classification trees

PubMed Central

Austin, Peter C; Lee, Douglas S

2011-01-01

Purpose: Classification trees are increasingly being used to classifying patients according to the presence or absence of a disease or health outcome. A limitation of classification trees is their limited predictive accuracy. In the data-mining and machine learning literature, boosting has been developed to improve classification. Boosting with classification trees iteratively grows classification trees in a sequence of reweighted datasets. In a given iteration, subjects that were misclassified in the previous iteration are weighted more highly than subjects that were correctly classified. Classifications from each of the classification trees in the sequence are combined through a weighted majority vote to produce a final classification. The authors' objective was to examine whether boosting improved the accuracy of classification trees for predicting outcomes in cardiovascular patients. Methods: We examined the utility of boosting classification trees for classifying 30-day mortality outcomes in patients hospitalized with either acute myocardial infarction or congestive heart failure. Results: Improvements in the misclassification rate using boosted classification trees were at best minor compared to when conventional classification trees were used. Minor to modest improvements to sensitivity were observed, with only a negligible reduction in specificity. For predicting cardiovascular mortality, boosted classification trees had high specificity, but low sensitivity. Conclusions: Gains in predictive accuracy for predicting cardiovascular outcomes were less impressive than gains in performance observed in the data mining literature. PMID:22254181

Does Pharmacogenomic Testing Improve Clinical Outcomes for Major Depressive Disorder? A Systematic Review of Clinical Trials and Cost-Effectiveness Studies.

PubMed

Rosenblat, Joshua D; Lee, Yena; McIntyre, Roger S

2017-06-01

Pharmacogenomic testing has become scalable and available to the general public. Pharmacogenomics has shown promise for predicting antidepressant response and tolerability in the treatment of major depressive disorder (MDD). In theory, pharmacogenomics can improve clinical outcomes by guiding antidepressant selection and dosing. The current systematic review examines the extant literature to determine the impact of pharmacogenomic testing on clinical outcomes in MDD and assesses its cost-effectiveness. The MEDLINE/PubMed and Google Scholar databases were systematically searched for relevant articles published prior to October 2015. Search terms included various combinations of the following: major depressive disorder (MDD), depression, mental illness, mood disorder, antidepressant, response, remission, outcome, pharmacogenetic, pharmacogenomics, pharmacodynamics, pharmacokinetic, genetic testing, genome wide association study (GWAS), CYP450, personalized medicine, cost-effectiveness, and pharmacoeconomics. Of the 66 records identified from the initial search, relevant clinical studies, written in English, assessing the cost-effectiveness and/or efficacy of pharmacogenomic testing for MDD were included. Each publication was critically examined for relevant data. Two nonrandomized, open-label, 8-week, prospective studies reported overall greater improvement in depressive symptom severity in the group of MDD subjects receiving psychiatric care guided by results of combinatorial pharmacogenomic testing (GeneSight) when compared to the unguided group. One industry-sponsored, randomized, double-blind, 10-week prospective study reported a trend for improved outcomes for the GeneSight-guided group; however, the trend did not reach statistical significance. Another industry-sponsored, randomized, double-blind, 12-week prospective study reported a 2.5-fold increase in remission rates in the CNSDose-guided group (P < .0001). One naturalistic, unblinded, industry-sponsored study showed clinical improvement when pharmacogenomics testing guided prescribing; however, this study lacked a control group. A single cost-effectiveness study concluded that single gene testing was not cost-effective. Conversely, a separate study reported that combinatorial pharmacogenomic testing is cost-effective. A limited number of studies have shown promise for the clinical utility of pharmacogenomic testing; however, cost-effectiveness of pharmacogenomics, as well as demonstration of improved health outcomes, is not yet supported with replicated evidence. © Copyright 2017 Physicians Postgraduate Press, Inc.

Comparing safety climate in naval aviation and hospitals: implications for improving patient safety.

PubMed

Singer, Sara J; Rosen, Amy; Zhao, Shibei; Ciavarelli, Anthony P; Gaba, David M

2010-01-01

Evidence of variation in safety climate suggests the need for improvement among at least some hospitals. However, comparisons only among hospitals may underestimate the improvement required. Comparison of hospitals with analogous industries may provide a broader perspective on the safety status of our nation's hospitals. The purpose of this study was to compare safety climate among hospital workers with personnel from naval aviation, an organization that operates with high reliability despite intrinsically hazardous conditions. We surveyed a random sample of health care workers in 67 U.S. hospitals and, for generalizability, 30 veterans affairs hospitals using questions comparable with those posed at approximately the same time (2007) to a census of personnel from 35 squadrons of U.S. naval aviators. We received 13,841 (41%) completed surveys in U.S. hospitals, 5,511 (50%) in veterans affairs hospitals, and 14,854 (82%) among naval aviators. We examined differences in respondents' perceptions of safety climate at their institution overall and for 16 individual items. Safety climate was three times better on average among naval aviators than among hospital personnel. Naval aviators perceived a safer climate (up to seven times safer) than hospital personnel with respect to each of the 16 survey items. Compared with hospital managers, naval commanders perceived climate more like frontline personnel did. When contrasting naval aviators with hospital personnel working in comparably hazardous areas, safety climate discrepancies increased rather than decreased. One individual hospital performed as well as naval aviation on average, and at least one hospital outperformed the Navy benchmark for all but three individual survey items. Results suggest that hospitals have not sufficiently created a uniform priority of safety. However, if each hospital performed as well as the top-performing hospital in each area measured, hospitals could achieve safety climate levels comparable with naval aviation. Major interventions to bolster hospital safety climate continue to be required to improve patient safety.

AMATS FY 1997-2000 Transportation Improvement Program

DOT National Transportation Integrated Search

1996-06-26

Planning, design and construction of major transportation capital : investment projects, such as major highway relocations and transit service expansions, are costly and time-consuming. Even relatively minor improvements require substantial investmen...

Improving the quality of care for women with cardiovascular disease: report of a DCRI Think Tank, March 8 to 9, 2007.

PubMed

Berger, Jeffrey S; Bairey-Merz, C Noel; Redberg, Rita F; Douglas, Pamela S

2008-11-01

Differences in pathophysiology, diagnosis, and treatment of women with cardiovascular disease compared with men has become a major focus during the past decade. Nevertheless, little attention has focused on improving the quality of healthcare in women compared with other areas of cardiovascular medicine. To address this deficit, Duke University Medical Center convened a national Duke Clinical Research Institute (DCRI) Think Tank meeting, including basic science and clinical researchers, payers, legislators, clinical experts, government regulators, and members of the pharmaceutical and device industries. This report provides an overview of the discussions and proposed solutions. Discussion concentrated on the development of strategies to improve the quality of health care for women with heart disease. Key components to improve quality care include: (1) enhance the quantity and quality of evidence-based medicine to guide care in women through improvements in trial design, enrollment and retention of women subjects, results analysis and reporting, and better incentives to perform research in women; (2) provide incentives to develop better data in women through mandating changes in the drug and device development and approval processes; (3) incorporate specific recommendations for women into guidelines when data are sufficient; and (4) apply proven sex-based differences in risk stratification, diagnostic testing, and drug usage and dosing in clinical care. Examples of possible strategies are included. The above approach represents a necessary, but not sufficient, platform to improve the overall quality of healthcare in women with cardiovascular disease.

The Association Between Preoperative Symptoms of Obesity in Knee and Hip Joints and the Change in Quality of Life After Laparoscopic Roux-en-Y Gastric Bypass.

PubMed

Birn, Ida; Mechlenburg, Inger; Liljensøe, Anette; Soballe, Kjeld; Larsen, Jens Fromholt

2016-05-01

Weight loss after bariatric surgery is shown to reduce knee and hip pain in the majority of the severely obese. Studies indicate that with a reduction in musculoskeletal symptoms, quality of life (QoL) will improve. The group of severely obese with knee and hip symptoms might therefore have potential for a large improvement in QoL after a bariatric surgery. This study aimed therefore to assess the association between the degree of knee and hip symptoms before a laparoscopic Roux-en-Y gastric bypass (LRYGB) and the improvement of QoL, 1 year after the surgery, in severely obese. This study is a historical cohort study based on data collected consecutively at the private hospital Mølholm, Denmark. Before LRYGB surgery, 4548 severely obese completed a questionnaire on knee and hip symptoms of obesity and QoL. One year after surgery, 2862 (62.9 %) of the participants answered the same questionnaire again. Participants with moderate or severe knee or hip symptoms, before the surgery, experienced a statistically significantly larger improvement of their QoL, compared to participants without symptoms before the surgery. Furthermore, an association between the reduction of knee and hip symptoms and the improvement in QoL was found. Severely obese with moderate or severe preoperative knee and hip symptoms experienced a larger improvement of their QoL after a LRYGB compared to participants without symptoms before the operation.

Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care.

PubMed

Hedrick, Susan C; Chaney, Edmund F; Felker, Bradford; Liu, Chuan-Fen; Hasenberg, Nicole; Heagerty, Patrick; Buchanan, Jan; Bagala, Rocco; Greenberg, Diane; Paden, Grady; Fihn, Stephan D; Katon, Wayne

2003-01-01

To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. Patients were randomly assigned to treatment model by clinic firm. VA primary care clinic. One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale. Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months. Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings from the CO-MED Trial

PubMed Central

Jha, Manish K.; Minhajuddin, Abu; Greer, Tracy L.; Carmody, Thomas; Rush, A. John; Trivedi, Madhukar H.

2018-01-01

Objective Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression’s economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course. Method Work productivity was measured repeatedly by the Work Productivity and Activity Impairment (WPAI) self-report in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months. Results Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). As compared to other participants, those with robust improvement had 3–5 times higher remission rates at 3 months and 2–5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6. Conclusions In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment. PMID:27523501

Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial.

PubMed

Jha, Manish K; Minhajuddin, Abu; Greer, Tracy L; Carmody, Thomas; Rush, A John; Trivedi, Madhukar H

2016-12-01

Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression's economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course. Work productivity was measured repeatedly by the Work Productivity and Activity Impairment self-report questionnaire in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months. Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). Compared with other participants, those with robust improvement had 3-5 times higher remission rates at 3 months and 2-5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6. In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment.

Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.

PubMed

Roshanov, Pavel S; Misra, Shikha; Gerstein, Hertzel C; Garg, Amit X; Sebaldt, Rolf J; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.

Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

PubMed Central

2011-01-01

Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes. PMID:21824386

A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions.

PubMed

Werner, Gerald S; Martin-Yuste, Victoria; Hildick-Smith, David; Boudou, Nicolas; Sianos, Georgios; Gelev, Valery; Rumoroso, Jose Ramon; Erglis, Andrejs; Christiansen, Evald Høj; Escaned, Javier; di Mario, Carlo; Hovasse, Thomas; Teruel, Luis; Bufe, Alexander; Lauer, Bernward; Bogaerts, Kris; Goicolea, Javier; Spratt, James C; Gershlick, Anthony H; Galassi, Alfredo R; Louvard, Yves

2018-05-02

The clinical value of percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) is not established by randomized trials. This study should compare the benefit of PCI vs. optimal medical therapy (OMT) on the health status in patients with at least one CTO. Three hundred and ninety-six patients were enrolled in a prospective randomized, multicentre, open-label, and controlled clinical trial to compare the treatment by PCI with OMT with a 2:1 randomization ratio. The primary endpoint was the change in health status assessed by the Seattle angina questionnaire (SAQ) between baseline and 12 months follow-up. Fifty-two percent of patients have multi-vessel disease in whom all significant non-occlusive lesions were treated before randomization. An intention-to-treat analysis was performed including 13.4% failed procedures in the PCI group and 7.3% cross-overs in the OMT group. At 12 months, a greater improvement of SAQ subscales was observed with PCI as compared with OMT for angina frequency [5.23, 95% confidence interval (CI) 1.75; 8.71; P = 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P = 0.007), reaching the prespecified significance level of 0.01 for the primary endpoint. Physical limitation (P = 0.02) was also improved in the PCI group. Complete freedom from angina was more frequent with PCI 71.6% than OMT 57.8% (P = 0.008). There was no periprocedural death or myocardial infarction. At 12 months, major adverse cardiac events were comparable between the two groups. Percutaneous coronary intervention leads to a significant improvement of the health status in patients with stable angina and a CTO as compared with OMT alone. NCT01760083.

In-Hospital Outcomes of Dual Loading Antiplatelet Therapy in Patients 75 Years and Older With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Findings From the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) Project.

PubMed

Zhao, Guanqi; Zhou, Mengge; Ma, Changsheng; Huo, Yong; Smith, Sidney C; Fonarow, Gregg C; Ge, Junbo; Han, Yaling; Liu, Jing; Hao, Yongchen; Liu, Jun; Wang, Xiao; Taubert, Kathryn A; Morgan, Louise; Zhao, Dong; Nie, Shaoping

2018-03-30

Elderly patients with acute coronary syndrome (ACS) are at high risk for ischemic and bleeding events. This study aimed to evaluate the clinical effectiveness and safety of dual loading antiplatelet therapy for patients 75 years and older undergoing percutaneous coronary intervention for ACS. The Improving Care for Cardiovascular Disease in China-ACS project was a collaborative study of the American Heart Association and Chinese Society of Cardiology. A total of 5887 patients 75 years and older with ACS who had percutaneous coronary intervention and received dual antiplatelet therapy with aspirin and P2Y 12 inhibitors (clopidogrel or ticagrelor) between November 2014 and June 2017 were enrolled. The primary effectiveness and safety outcomes were in-hospital major adverse cardiovascular events and major bleeding. Hazard ratios (HRs) of in-hospital outcomes with different loading statuses of antiplatelet therapy were estimated using Cox proportional hazard models with multivariate adjustment. A propensity score-matched analysis was also conducted. Compared with patients receiving a dual nonloading dose, patients taking a dual loading dose had increased risks of both major adverse cardiovascular events (HR, 1.66, 95% confidence interval, 1.13-2.44; [ P =0.010]) and major bleeding (HR, 2.34, 95% confidence interval, 1.75-3.13; [ P <0.001]). Among 3284 propensity score-matched patients, a dual loading dose was associated with a 1.36-fold risk of major adverse cardiovascular events (HR, 1.36; 95% confidence interval, 0.88-2.11 [ P =0.168]) and a 2.08-fold risk of major bleeding (HR, 2.08; 95% confidence interval, 1.47-2.93 [ P <0.001]). A dual loading dose of antiplatelet therapy was associated with increased major bleeding risk but not with decreased major adverse cardiovascular events risk among patients 75 years and older undergoing percutaneous coronary intervention for ACS in China. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02306616. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

A Model for Pharmacological Research-Treatment of Cocaine Dependence

PubMed Central

Montoya, Ivan D.; Hess, Judith M.; Preston, Kenzie L.; Gorelick, David A.

2008-01-01

Major problems for research on pharmacological treatments for cocaine dependence are lack of comparability of results from different treatment research programs and poor validity and/or reliability of results. Double-blind, placebo-controlled, random assignment, experimental designs, using standard intake and assessment procedures help to reduce these problems. Cessation or reduction of drug use and/or craving, retention in treatment, and medical and psychosocial improvement are some of the outcome variables collected in treatment research programs. A model to be followed across different outpatient clinical trials for pharmacological treatment of cocaine dependence is presented here. This model represents an effort to standardize data collection to make results more valid and comparable. PMID:8749725

Cryopreservation of Fish Sperm

NASA Astrophysics Data System (ADS)

Kurokura, Hisashi

Present status of research activities in cryopreservation of fish gamete in aquaculture field was introduced. More than 59 fish species have been reported in the research histories and nearly half of them were studied during recent 10 years. This means that the research activities are increasing, though commercial profit have not obtained yet. Fish species of which sperm can successfully cryopreserved is still limited comparing to numerous species in telost. One of the major obstacle for improvement of the technique is existence of wide specie specific variance in the freezing tolerance of fish sperm. The varianc can possibly be explaind thorugh the informations obtained by the studies in comparative spermatology, which is recently activated field in fish biology.

Exercise may decrease further destruction in the adult haemophilic joint.

PubMed

Harris, S; Boggio, L N

2006-05-01

The effect of exercise on adult haemophilic joints was investigated. Forty-six subjects with existing joint disease were evaluated and range of motion (ROM) in joints was measured. The effect of exercise of large joint ROM in haemophilia was evaluated by comparing the ranges of motion in subjects who exercised at least three times weekly against those subjects who did not exercise. The exercise group showed improvement in the majority of joint ranges of motion compared with the non-exercise group (P = 0.003). Thus regular exercise may help reduce further destruction in haemophilic joints by strengthening muscle ligaments and tendons surrounding the joint thereby protecting them from damage caused by recurrent haemarthrotic events.

Liquid Chromatography-Tandem Mass Spectrometry: An Emerging Technology in the Toxicology Laboratory.

PubMed

Zhang, Yan Victoria; Wei, Bin; Zhu, Yu; Zhang, Yanhua; Bluth, Martin H

2016-12-01

In the last decade, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has seen enormous growth in routine toxicology laboratories. LC-MS/MS offers significant advantages over other traditional testing, such as immunoassay and gas chromatography-mass spectrometry methodologies. Major strengths of LC-MS/MS include improvement in specificity, flexibility, and sample throughput when compared with other technologies. Here, the basic principles of LC-MS/MS technology are reviewed, followed by advantages and disadvantages of this technology compared with other traditional techniques. In addition, toxicology applications of LC-MS/MS for simultaneous detection of large panels of analytes are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study.

PubMed

Brorsson, Anna Lena; Viklund, Gunnel; Örtqvist, Eva; Lindholm Olinder, Anna

2015-11-01

To investigate long-term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores (BMI-SDS) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion (CSII) compared with children and adolescents treated with multiple daily injections (MDI). This retrospective case-control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin (HbA1c), sex, and age during a 2-yr period. Variables collected were gender, age, HbA1c, insulin requirement, BMI, BMI-SDS, ketoacidosis, and serious hypoglycaemic events. In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person-yr). The incidences of severe hypoglycaemic episodes per 100 person-yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group. This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The body project 4 all: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program.

PubMed

Kilpela, Lisa Smith; Blomquist, Kerstin; Verzijl, Christina; Wilfred, Salomé; Beyl, Robbie; Becker, Carolyn Black

2016-06-01

The Body Project is a cognitive dissonance-based body image improvement program with ample research support among female samples. More recently, researchers have highlighted the extent of male body dissatisfaction and disordered eating behaviors; however, boys/men have not been included in the majority of body image improvement programs. This study aims to explore the efficacy of a mixed-gender Body Project compared with the historically female-only body image intervention program. Participants included male and female college students (N = 185) across two sites. We randomly assigned women to a mixed-gender modification of the two-session, peer-led Body Project (MG), the two-session, peer-led, female-only (FO) Body Project, or a waitlist control (WL), and men to either MG or WL. Participants completed self-report measures assessing negative affect, appearance-ideal internalization, body satisfaction, and eating disorder pathology at baseline, post-test, and at 2- and 6-month follow-up. Linear mixed effects modeling to estimate the change from baseline over time for each dependent variable across conditions were used. For women, results were mixed regarding post-intervention improvement compared with WL, and were largely non-significant compared with WL at 6-month follow-up. Alternatively, results indicated that men in MG consistently improved compared with WL through 6-month follow-up on all measures except negative affect and appearance-ideal internalization. Results differed markedly between female and male samples, and were more promising for men than for women. Various explanations are provided, and further research is warranted prior to drawing firm conclusions regarding mixed-gender programming of the Body Project. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:591-602). © 2016 Wiley Periodicals, Inc.

The Body Project 4 All: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program

PubMed Central

Kilpela, Lisa Smith; Blomquist, Kerstin; Verzijl, Christina; Wilfred, Salomé; Beyl, Robbie; Becker, Carolyn Black

2017-01-01

Objective The Body Project is a cognitive dissonance-based body image improvement program with ample research support among female samples. More recently, researchers have highlighted the extent of male body dissatisfaction and disordered eating behaviors; however, boys/men have not been included in the majority of body image improvement programs. This study aims to explore the efficacy of a mixed-gender Body Project compared to the historically female-only body image intervention program. Method Participants included male and female college students (N=185) across two sites. We randomly assigned women to a mixed-gender modification of the two-session, peer-led Body Project (MG), the two-session, peer-led, female-only (FO) Body Project, or a waitlist control (WL), and men to either MG or WL. Participants completed self-report measures assessing negative affect, appearance-ideal internalization, body satisfaction, and eating disorder pathology at baseline, post-test, and at two- and six-month follow-up. Results We used linear mixed effects modeling to estimate the change from baseline over time for each dependent variable across conditions. For women, results were mixed regarding post-intervention improvement compared to WL, and were largely non-significant compared to WL at 6-month follow-up. Alternatively, results indicated that men in MG consistently improved compared to WL through 6-month follow-up on all measures except negative affect and appearance-ideal internalization. Discussion Results differed markedly between female and male samples, and were more promising for men than for women. Various explanations are provided, and further research is warranted prior to drawing firm conclusions regarding mixed-gender programming of the Body Project. PMID:27188688

Generation-V dual-Purkinje-image eyetracker

NASA Technical Reports Server (NTRS)

Crane, H. D.; Steele, C. M.

1985-01-01

Major advances characterize the Generation-V dual-Purkinje-image eyetracker compared with the Generation-III version previously described. These advances include a large reduction in size, major improvements in frequency response and noise level, automatic alignment to a subject, and automatic adjustment for different separation between the visual and optic axes, which can vary considerably from subject to subject. In a number of applications described in the paper, the eyetracker is coupled with other highly specialized optical devices. These applications include accurately stabilizing an image on a subject's retina; accurately simulating a visually dead retinal region (i.e., a scotoma) of arbitrary shape, size, and position; and, for clinical purposes, stabilizing the position of a laser coagulator beam on a patient's retina so that the point of contact is unaffected by the patient's own eye movements.

Hypnosis in the Treatment of Major Depression: An Analysis of Heart Rate Variability.

PubMed

Chen, Xiuwen; Yang, Rongqian; Ge, Lulu; Luo, Jie; Lv, Ruixue

2017-01-01

Hypnosis is an adjuvant treatment of major depression (MD). Heart rate variability (HRV) can assess the autonomic nervous system, which is associated with MD, and HRV is decreased in MD patients. There is a lack of research on HRV changes before, during, and after the use of hypnosis in MD patients. A total of 21 MD patients participated in this study, and 5-minute electrocardiograms were recorded before, during, and after hypnosis. Compared with the prehypnotic condition, HRV parameters significantly (p < .01) increased in the hypnotic and posthypnotic conditions. The results suggest that hypnosis treatment should bring some functional improvement to the autonomic nervous system. HRV is potentially a useful tool that quantifies the physiological impact of hypnosis treatment in MD patients.

Are there advantages of the combined latissimus-dorsi transfer according to L'Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis.

PubMed

Lichtenberg, Sven; Magosch, Petra; Habermeyer, Peter

2012-11-01

The aim of the study was to evaluate differences of clinical results between the latissimus-dorsi transfer combined with teres-major transfer (G1) and the isolated latissimus-dorsi transfer (G2) for the treatment of massive irreparable postero-superior rotator cuff tears. We performed the combined latissimus-dorsi/teres-major transfer in 17 patients at a mean age of 57 years. Furthermore, 17 patients at a mean age of 61 years were treated using the isolated latissimus-dorsi transfer. Both groups were followed-up clinically, radiologically, and with surface electromyography using the same study protocol. The Constant score (CS) improved significantly from 48.3 points pre-op to 69.5 points post-op after a follow-up of 58 months in G1. The active range of motion improved in G1 sig. for flexion (124° pre-op, 166.5° post-op) and for abduction (117° pre-op, 163° post-op). The CS improved significantly from 45.1 points pre-op to 74.2 points post-op after a follow-up of 51 months in G2. The flexion and abduction increased significantly from 133.3° pre-op to 176° post-op, resp. from 113.3° pre-op to 173° post-op. The comparison of both surgical techniques showed a significant better active flexion and abduction for G2. Both techniques achieved good functional results but the isolated latissimus-dorsi transfer produced a better active abduction and flexion, whereas the combined latissmus-dorsi/teres-major transfer achieved an increase in abduction strength. In contrast to the combined latissimus-dorsi/teres-major transfer, a progression of cuff tear arthropathy was not observed with the isolated latissimus-dorsi transfer. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

PubMed

Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems often complicate medical management on board. Effective communication and knowledge of patient's medical history and risk profile is very important to reviewing physician. Effective diagnosis depends on accurate and objective description of symptoms and clinical condition.

Full-scale aircraft cabin flammability tests of improved fire-resistant materials

NASA Technical Reports Server (NTRS)

Stuckey, R. N.; Surpkis, D. E.; Price, L. J.

1974-01-01

Full-scale aircraft cabin flammability tests to evaluate the effectiveness of new fire-resistant materials by comparing their burning characteristics with those of older aircraft materials are described. Three tests were conducted and are detailed. Test 1, using pre-1968 materials, was run to correlate the procedures and to compare the results with previous tests by other organizations. Test 2 included newer, improved fire-resistant materials. Test 3 was essentially a duplicate of test 2, but a smokeless fuel was used. Test objectives, methods, materials, and results are presented and discussed. Results indicate that the pre-1968 materials ignited easily, allowed the fire to spread, produced large amounts of smoke and toxic combustion products, and resulted in a flash fire and major fire damage. The newer fire-resistant materials did not allow the fire to spread. Furthermore, they produced less, lower concentrations of toxic combustion products, and lower temperatures. The newer materials did not produce a flash fire.

Lithographic performance of recent DUV photoresists

NASA Astrophysics Data System (ADS)

Streefkerk, Bob; van Ingen Schenau, Koen; Buijk, Corine

1998-06-01

Commercially available photoresists from the major photoresist vendors are investigated using a PAS 5500/300 wafer stepper, a 31.1 mm diameter field size high throughput wafer stepper with variable NA capability up to 0.63. The critical dimension (CD) investigated is 0.25 micrometers and lower for dense and isolated lines and 0.25 micrometers for dense contact holes. The photoresist process performance is quantified by measuring exposure-defocus windows for a specific resolution using a CD SEM. Photoresists that are comparable with or better than APEX-E with RTC top coat, which is the current base line process for lines and spaces imaging performance, are Clariant AZ-DX1300 and Shin Etsu SEPR-4103PB50. Most recent photoresists have much improved delay performance when compared to APEX without top coat. Improvement, when an organic BARC is applied, depends on the actual photoresist characteristics. The optimal photoresist found for 0.25 micrometers contact holes is TOK DP015 C. This process operates at optimal conditions.

Mapping local variation in educational attainment across Africa

NASA Astrophysics Data System (ADS)

Graetz, Nicholas; Friedman, Joseph; Osgood-Zimmerman, Aaron; Burstein, Roy; Biehl, Molly H.; Shields, Chloe; Mosser, Jonathan F.; Casey, Daniel C.; Deshpande, Aniruddha; Earl, Lucas; Reiner, Robert C.; Ray, Sarah E.; Fullman, Nancy; Levine, Aubrey J.; Stubbs, Rebecca W.; Mayala, Benjamin K.; Longbottom, Joshua; Browne, Annie J.; Bhatt, Samir; Weiss, Daniel J.; Gething, Peter W.; Mokdad, Ali H.; Lim, Stephen S.; Murray, Christopher J. L.; Gakidou, Emmanuela; Hay, Simon I.

2018-03-01

Educational attainment for women of reproductive age is linked to reduced child and maternal mortality, lower fertility and improved reproductive health. Comparable analyses of attainment exist only at the national level, potentially obscuring patterns in subnational inequality. Evidence suggests that wide disparities between urban and rural populations exist, raising questions about where the majority of progress towards the education targets of the Sustainable Development Goals is occurring in African countries. Here we explore within-country inequalities by predicting years of schooling across five by five kilometre grids, generating estimates of average educational attainment by age and sex at subnational levels. Despite marked progress in attainment from 2000 to 2015 across Africa, substantial differences persist between locations and sexes. These differences have widened in many countries, particularly across the Sahel. These high-resolution, comparable estimates improve the ability of decision-makers to plan the precisely targeted interventions that will be necessary to deliver progress during the era of the Sustainable Development Goals.

Smart health monitoring systems: an overview of design and modeling.

PubMed

Baig, Mirza Mansoor; Gholamhosseini, Hamid

2013-04-01

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.

Coupling the snow thermodynamic model SNOWPACK with the microwave emission model of layered snowpacks for subarctic and arctic snow water equivalent retrievals

NASA Astrophysics Data System (ADS)

Langlois, A.; Royer, A.; Derksen, C.; Montpetit, B.; Dupont, F.; GoïTa, K.

2012-12-01

Satellite-passive microwave remote sensing has been extensively used to estimate snow water equivalent (SWE) in northern regions. Although passive microwave sensors operate independent of solar illumination and the lower frequencies are independent of atmospheric conditions, the coarse spatial resolution introduces uncertainties to SWE retrievals due to the surface heterogeneity within individual pixels. In this article, we investigate the coupling of a thermodynamic multilayered snow model with a passive microwave emission model. Results show that the snow model itself provides poor SWE simulations when compared to field measurements from two major field campaigns. Coupling the snow and microwave emission models with successive iterations to correct the influence of snow grain size and density significantly improves SWE simulations. This method was further validated using an additional independent data set, which also showed significant improvement using the two-step iteration method compared to standalone simulations with the snow model.

Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression.

PubMed

Doerig, Nadja; Krieger, Tobias; Altenstein, David; Schlumpf, Yolanda; Spinelli, Simona; Späti, Jakub; Brakowski, Janis; Quednow, Boris B; Seifritz, Erich; Holtforth, Martin Grosse

2016-02-01

Cognitive-behavioural therapy is efficacious in the treatment of major depressive disorder but response rates are still far from satisfactory. To better understand brain responses to individualised emotional stimuli and their association with outcome, to enhance treatment. Functional magnetic resonance imaging data were collected prior to individual psychotherapy. Differences in brain activity during passive viewing of individualised self-critical material in 23 unmedicated out-patients with depression and 28 healthy controls were assessed. The associations between brain activity, cognitive and emotional change, and outcome were analysed in 21 patients. Patients showed enhanced activity in the amygdala and ventral striatum compared with the control group. Non-response to therapy was associated with enhanced activity in the right amygdala compared with those who responded, and activity in this region was negatively associated with outcome. Emotional but not cognitive changes mediated this association. Amygdala hyperactivity may lessen symptom improvement in psychotherapy for depression through attenuating emotional skill acquisition. © The Royal College of Psychiatrists 2016.

Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review.

PubMed

Yan, James; Musahl, Volker; Kay, Jeffrey; Khan, Moin; Simunovic, Nicole; Ayeni, Olufemi R

2016-11-01

This systematic review evaluates radiographic and clinical outcome reporting following navigated high tibial osteotomy (HTO). Conventional HTO was used as a control to compare outcomes and furthermore investigate the quality of evidence in studies reporting outcomes for navigated HTO. It was hypothesized that navigated HTO will show superior clinical and radiographic outcomes compared to conventional HTO. Two independent reviewers searched PubMed, Ovid (MEDLINE), EMBASE, and Cochrane databases for studies reporting outcomes following navigated HTO. Titles, abstracts, and full-text were screened in duplicate using an a priori inclusion and exclusion criteria. Descriptive statistics were calculated using Minitab ® statistical software. Methodological Index for Nonrandomized Studies (MINORS) and Cochrane Risk of Bias Scores were used to evaluate methodological quality. Thirty-four studies which involved 2216 HTOs were analysed in this review, 1608 (72.6 %) navigated HTOs and 608 (27.4 %) conventional HTOs. The majority of studies were of level IV evidence (16). Clinical outcomes were reported in knee and function scores or range of motion comparisons. Postoperative clinical and functional scores were improved by navigated HTO although it is not demonstrated if there is significant improvement compared to conventional HTO. Most common clinical outcome score reported was Lysholm scores (6) which report postoperative scores of 87.8 (standard deviation 5.9) and 88.8 (standard deviation 5.9) for conventional and navigation-assisted HTO, respectively. Radiographic outcomes reported commonly were weight-bearing mechanical axis, coronal plane angle, and posterior tibial slope angle in the sagittal plane. Studies have shown HTO gives significant correction of mechanical alignment and navigated HTO produces significantly less change in posterior tibial slope postoperatively compared to conventional. The mean MINORS for the 17 non-comparative studies was 9/16, and 15/24 for the 14 non-randomized comparative studies. Navigation HTO results in improved mechanical axis alignment and demonstrates significantly better control over the tibial slope angle change postoperatively compared to conventional methods; however, these improvements have not yet been reflected in clinical outcome scores. Overall the studies report HTO does create significantly improved knee scores and functions compared to patients' preoperative ratings regardless of technique. Future studies on HTO outcomes need to focus on consistency of outcome reporting. IV.

Longitudinal assessment of neuropsychological function in major depression.

PubMed

Douglas, Katie M; Porter, Richard J

2009-12-01

Neuropsychological impairment is a core component of major depression, yet its relationship to clinical state is unclear. The aims of the present review were to determine which neuropsychological domains and tasks were most sensitive to improvement in clinical state in major depression and to highlight the methodological issues in such research. Studies that included a baseline and at least one follow-up neuropsychological testing session in adults with major depression were identified using MEDLINE, Web of Science and ScienceDirect databases. Thirty studies were included in the review. Findings in younger adult populations suggested that improvement in mood was most strongly related to improved verbal memory and verbal fluency, while measures of executive functioning and attention tended to remain impaired across treatment. In late-life major depression, improved psychomotor speed was most closely related to treatment response, but there was much inconsistency between study findings, which may be due to methodological issues. In major depression, particular neuropsychological domains are more strongly related to clinical state than others. The findings from the present review suggest that the domains most sensitive to clinical state are verbal learning and memory, verbal fluency and psychomotor speed. In contrast, measures of attention and executive functioning perhaps represent more trait-like markers of major depression. With further methodologically sound research, the changes in neuropsychological function associated with treatment response may provide a means of evaluating different treatment strategies in major depression.

HIV-Related Knowledge and Perceptions by Academic Major: Implications for University Interventions

PubMed Central

Smith, Matthew Lee; La Place, Lisa L.; Menn, Mindy; Wilson, Kelly L.

2014-01-01

Most universities offer human sexuality courses, although they are not required for graduation. While students in health-related majors may receive sexuality education in formal settings, majority of college students never receive formal sexual health or HIV/AIDS-related education, which may lead to elevated engagement in high-risk sexual behaviors. This study examines perceived knowledge about HIV/AIDS, perceived risk, and perceived consequences among college students by two distinct classifications of academic majors. Data were collected from 510 college students. Binary and multinomial logistic regressions were performed to compare HIV-related covariates by academic major category. Limited differences were observed by science, technology, engineering, and mathematics categorization. Relative to health and kinesiology majors, those who self-reported being “completely knowledgeable” about HIV were less likely to be physical sciences, mathematics, engineering, and business (PMEB) (OR = 0.41, P = 0.047) or education, humanities, and social sciences majors (OR = 0.25, P = 0.004). PMEB majors were less likely to report behavioral factors as a risk for contracting HIV (OR = 0.86, P = 0.004) and perceived acquiring HIV would be more detrimental to their quality of life (OR = 2.14, P = 0.012), but less detrimental to their mental well-being (OR = 0.58, P = 0.042). Findings can inform college-wide campaigns and interventions to raise HIV/AIDS awareness and improve college health. PMID:24660165

Beyond landraces: developing improved germplasm resources for underutilized species - a case for Bambara groundnut.

PubMed

Aliyu, Siise; Massawe, Festo; Mayes, Sean

2014-10-01

The potential for underutilized crops (also known as minor, neglected or orphan crops) to improve food and nutrition security has been gaining prominence within the research community in recent years. This is due to their significance for diversified agricultural systems which is a necessary component of future agriculture to address food and nutritional security concerns posed by changing climate and a growing world population. Developing workable value chain systems for underutilized crop species, coupled with comparative trait studies with major crops, potentially allows us to identify suitable agricultural modalities for such species. Bambara groundnut (Vigna subterranea L. Verdc.), an underutilized leguminous species, is of interest for its reported high levels of drought tolerance in particular, which contributes to environmental resilience in semi-arid environments. Here, we present a synopsis of suitable strategies for the genetic improvement of Bambara groundnut as a guide to other underutilized crop species. Underutilized crops have often been adapted over thousands of years in particular regions by farmers and largely still exist as landraces with little or no genetic knowledge of key phenotypic traits. Breeding in these species is fundamentally different to breeding in major crops, where significant pedigree structures and history allow highly directed improvement. In this regard, deploying new integrated germplasm development approaches for variety development and genetic analysis, such as multi-parent advance generation inter-crosses (MAGIC), within breeding programmes of underutilized species will be important to be able to fully utilize such crops.

Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials.

PubMed

Anastasiadis, Kyriakos; Antonitsis, Polychronis; Haidich, Anna-Bettina; Argiriadou, Helena; Deliopoulos, Apostolos; Papakonstantinou, Christos

2013-04-05

The question whether use of minimal extracorporeal circulation (MECC) influences patients' outcome remains unanswered. We performed a systemic review of the literature and a meta-analysis of randomized controlled trials to evaluate the impact of MECC compared to conventional extracorporeal circulation (CECC) on mortality and major adverse cardiovascular events in patients undergoing heart surgery. We independently conducted a systemic review of English and non-English articles using Medline, Embase and Cochrane database. Random allocation to treatment with a minimum of 40 patients in both groups was considered mandatory for inclusion in the meta-analysis. Primary outcomes were operative mortality and major adverse cardiac and cerebrovascular events comprising death before discharge, myocardial infarction and neurologic damage. We included 24 studies comparing MECC vs. CECC with a total of 2770 patients. Use of MECC was associated with a significant decrease in mortality (0.5% vs. 1.7%, P=0.02), in the risk of postoperative myocardial infarction (1.0% vs. 3.8%, P=0.03) and reduced rate of neurologic events (2.3% vs. 4.0%, P=0.08). Additionally, MECC was associated with reduced systemic inflammatory response as measured by polymorphonuclear elastase, hemodilution as calculated by hematocrit drop after procedure, need for red blood cell transfusion, reduced levels of peak troponin release, incidence of low cardiac output syndrome, need for inotropic support, peak creatinine level, occurrence of postoperative atrial fibrillation, duration of mechanical ventilation and intensive care unit stay. Use of MECC in heart surgery resulted in improved short-term outcome as reflected by reduced mortality and morbidity compared with conventional extracorporeal circulation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Comparable efficacy and safety of 8 weeks treatment with agomelatine 25-50mg or fluoxetine 20-40mg in Asian out-patients with major depressive disorder.

PubMed

Shu, L; Sulaiman, A H; Huang, Y S; Fones Soon Leng, C; Crutel, V Strijckmans; Kim, Y S

2014-04-01

This randomized, double-blind study evaluates the efficacy and tolerability of agomelatine, using fluoxetine as an active comparator, in Asian patients suffering from moderate to severe major depressive disorder (MDD). Patients were randomly assigned to receive either agomelatine (25-50mg/day, n=314) or fluoxetine (20-40mg/day, n=314) during an 8-week treatment period. The main outcome measure was the change in Hamilton Depression Rating Scale 17 items (HAM-D17) scores. Secondary efficacy criteria included scores on Clinical Global Impression Severity of illness (CGI-S) and Improvement of illness (CGI-I), patient sleeping improvement using the self-rating Leeds Sleep Evaluation Questionnaire (LSEQ) and anxiety using the Hamilton Anxiety Rating Scale (HAM-A) scores. Tolerability and safety evaluations were based on emergent adverse events. Agomelatine and fluoxetine exert a comparable antidepressant efficacy in the Asian population. Mean changes over 8 weeks were clinically relevant and similar in both groups (-14.8±7.3 and -15.0±8.1 on HAM-D17 scale in agomelatine and fluoxetine groups, respectively). The between-group difference reached statistical significance on non-inferiority test (p=0.015). Clinically relevant decreases in CGI-S and CGI-I scores were observed over the treatment period in both groups. The two treatments were equally effective on the symptoms of both anxiety and sleep. The good tolerability profile and safety of both doses of agomelatine was confirmed in the Asian population. Agomelatine and fluoxetine are equally effective in the treatment of MDD-associated symptoms in Asian depressed patients. Copyright © 2013 Elsevier B.V. All rights reserved.

Work shift duration: a review comparing eight hour and 12 hour shift systems

PubMed Central

Smith, L.; Folkard, S.; Tucker, P.; Macdonald, I.

1998-01-01

OBJECTIVES: Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. METHODS: Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. RESULTS: The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. CONCLUSIONS: There can be considerable extension of the person's time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.   PMID:9624275

Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis.

PubMed

Lin, Lin; Chen, Zhongchun; Cao, Yitan; Sun, Guangbin

2017-03-01

Upper airway inflammation is one of the most commonly identified causes of chronic cough, although the underlying mechanism is not clear. This study compared normal saline solution nasal-pharyngeal irrigation (NSNPI) and fluticasone propionate nasal spray (FPNS) treatment for chronic cough associated with allergic rhinitis (AR). Patients with suspected AR to house-dust mite were enrolled, and the symptom of cough was assessed by a cough symptom score and the Leicester Cough Questionnaire, and cough response to capsaicin was evaluated. AR was assessed by using the visual analog scale (VAS) and the Mini Juniper Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Mediators, including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein from nasal lavage fluid (NLF) were examined. The patients were treated with NSNPI (the NSNPI group) or FPNS (the FPNS group) for 30 days, after which they were reassessed. Forty-five of 50 patients completed this study. The scores of the cough symptom and the Leicester Cough Questionnaire, and the capsaicin cough threshold all improved statistically after NSNPI but did not change after FPNS. There were statistically significant changes in the evaluations of the MiniRQLQ and the mediators, including histamine and leukotriene C4, in the NLF in the NSNPI group. However, significant changes were found in the assessments of VAS, MiniRQLQ, and all above mediators including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein in the NLF of the FPNS group. Furthermore, the assessments of VAS and all the mediators were reduced more in the FPNS group compared with those in the NSNPI group. The patients with suspected AR to house-dust mite reported a better relief of the cough symptom after 30 days of treatment with NSNPI compared with that after nasal corticosteroid.

Cotton transformation via pollen tube pathway.

PubMed

Wang, Min; Zhang, Baohong; Wang, Qinglian

2013-01-01

Although many gene transfer methods have been employed for successfully obtaining transgenic cotton, the major constraint in cotton improvement is the limitation of genotype because the majority of transgenic methods require plant regeneration from a single transformed cell which is limited by cotton tissue culture. Comparing with other plant species, it is difficult to induce plant regeneration from cotton; currently, only a limited number of cotton cultivars can be cultured for obtaining regenerated plants. Thus, development of a simple and genotype-independent genetic transformation method is particularly important for cotton community. In this chapter, we present a simple, cost-efficient, and genotype-independent cotton transformation method-pollen tube pathway-mediated transformation. This method uses pollen tube pathway to deliver transgene into cotton embryo sacs and then insert foreign genes into cotton genome. There are three major steps for pollen tube pathway-mediated genetic transformation, which include injection of -foreign genes into pollen tube, integration of foreign genes into plant genome, and selection of transgenic plants.

Pathways to Depression Care: Help-Seeking Experiences of Low-Income Latinos with Diabetes and Depression

PubMed Central

Cabassa, Leopoldo J.

2013-01-01

This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression. PMID:22367667

Monitoring IACP samples and construction of a centralized data base

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

Walsh, D.B.; Ray, D.B.; Simonson, J.

1991-01-01

The Integrated Air Cancer Project (IACP) is a multiyear US EPA research program established to develop and evaluate methods required to identify the principal airborne carcinogens, determine emission sources, and improve the estimate of comparative human cancer risk. The first major field study designed to examine a residential wood combustion airshed was conducted in Boise, Idaho during the 1986-1987 winter heating season. The second major field study conducted in Roanoke, Virgina during the 1988-1989 was to study residential oil heating and wood combustion. Motor vehicle emissions were considered a major combustion product contributor in both airsheds. This paper describes twomore » critical components of the project. The first component is the sample custody and tracking of the samples before analysis. The second component describes the data management of the sample field data (eg. sample site, time, date, flow rate) as well as the analytical data (eg. mutagenicity, particle concentrations) for the environmental samples.« less

RNA major groove modifications improve siRNA stability and biological activity

PubMed Central

Terrazas, Montserrat; Kool, Eric T.

2009-01-01

RNA 5-methyl and 5-propynyl pyrimidine analogs were substituted into short interfering RNAs (siRNAs) to probe major groove steric effects in the active RNA-induced silencing complex (RISC). Synthetic RNA guide strands containing varied combinations of propynyl and methyl substitution revealed that all C-5 substitutions increased the thermal stability of siRNA duplexes containing them. Cellular gene suppression experiments using luciferase targets in HeLa cells showed that the bulky 5-propynyl modification was detrimental to RNA interference activity, despite its stabilization of the helix. Detrimental effects of this substitution were greatest at the 5′-half of the guide strand, suggesting close steric approach of proteins in the RISC complex with that end of the siRNA/mRNA duplex. However, substitutions with the smaller 5-methyl group resulted in gene silencing activities comparable to or better than that of wild-type siRNA. The major groove modifications also increased the serum stability of siRNAs. PMID:19042976

The New Zealand Major Trauma Registry: the foundation for a data-driven approach in a contemporary trauma system.

PubMed

Isles, Siobhan; Christey, Grant; Civil, Ian; Hicks, Peter

2017-10-06

To describe the development of the New Zealand Major Trauma Registry (NZ-MTR) and the initial experiences of its use. The background to the development of the NZ-MTR was reviewed and the processes undertaken to implement a single-instance of a web-based national registry described. A national minimum dataset was defined and utilised. Key structures to support the Registry such as a data governance group were established. The NZ-MTR was successfully implemented and is the foundation for a new, data-driven model of quality improvement. In its first year of operation over 1,300 patients were entered into the Registry although coverage is not yet universal. Overall incidence is 40.8 major trauma cases/100,000 population. The incidence in the Māori population was 69/100,000 compared with 31/100,000 in the non-Māori population. Case fatality rate was 9%. Three age peaks were observed at 20-24 years, 50-59 years and above 85 years. Road traffic crashes accounted for 50% of all caseload. A significant proportion of major trauma patients (21%) were transferred to one or more hospitals before reaching a definitive care facility. Despite the challenges working across multiple jurisdictions, initiation of a single-instance web-based registry has been achieved. The NZ-MTR enables New Zealand to have a national view of trauma treatment and outcomes for the first time. It will inform quality improvement and injury prevention initiatives and potentially decrease the burden of injury on all New Zealanders.

Slow sleep spindle and procedural memory consolidation in patients with major depressive disorder.

PubMed

Nishida, Masaki; Nakashima, Yusaku; Nishikawa, Toru

2016-01-01

Evidence has accumulated, which indicates that, in healthy individuals, sleep enhances procedural memory consolidation, and that sleep spindle activity modulates this process. However, whether sleep-dependent procedural memory consolidation occurs in patients medicated for major depressive disorder remains unclear, as are the pharmacological and physiological mechanisms that underlie this process. Healthy control participants (n=17) and patients medicated for major depressive disorder (n=11) were recruited and subjected to a finger-tapping motor sequence test (MST; nondominant hand) paradigm to compare the averaged scores of different learning phases (presleep, postsleep, and overnight improvement). Participants' brain activity was recorded during sleep with 16 electroencephalography channels (between MSTs). Sleep scoring and frequency analyses were performed on the electroencephalography data. Additionally, we evaluated sleep spindle activity, which divided the spindles into fast-frequency spindle activity (12.5-16 Hz) and slow-frequency spindle activity (10.5-12.5 Hz). Sleep-dependent motor memory consolidation in patients with depression was impaired in comparison with that in control participants. In patients with depression, age correlated negatively with overnight improvement. The duration of slow-wave sleep correlated with the magnitude of motor memory consolidation in patients with depression, but not in healthy controls. Slow-frequency spindle activity was associated with reduction in the magnitude of motor memory consolidation in both groups. Because the changes in slow-frequency spindle activity affected the thalamocortical network dysfunction in patients medicated for depression, dysregulated spindle generation may impair sleep-dependent memory consolidation. Our findings may help to elucidate the cognitive deficits that occur in patients with major depression both in the waking state and during sleep.

The impact of displacement on the expression of depressive disorder and social functioning among the war refugees.

PubMed

Radanović-Grgurić, Ljiljana; Barkić, Jelena; Filaković, Pavo; Koić, Oliver; Laufer, Davor; Petek, Anamarija; Mandić, Nikola

2009-12-01

Our research objective was to estimate the characteristics of major depressive disorder and social adaptation of women displaced during the war in Croatia in the early 1990s. We aimed to establish the relationship between major depressive disorder and displacement and study its impact on the outcome of depression in order to improve treatment and avoid possible complications. A group of 20 women, 35 to 55 years of age, displaced some time during the 199l.-1995. war in Croatia were compared to 27 women of the same age but with no experience of exile. All the patients suffered from major depressive disorder based upon DSM-IV diagnostic criteria. The Hamilton Rating Scale for Depression, the Zung Self Rating Depression Scale and the Social Adaptation Self-evaluation Scale were used. The objective intensity of depression of the displaced significantly decreased over time but not their personal experience of depression. All depressed patients manifested poor social adaptation. Many aspects of social functioning remained poor even after the improvement of depressive disorder. Displacement characteristics were: the length of time spent in exile, the place, and the circumstances of displacement regarding the members of the family accompanying the displaced women. These characteristics significantly influenced the expression of their major depressive disorder as well as social functioning. Displaced persons/refugees are at high risk of developing depressive disorder. Recognition of all risk factors and early diagnosis of depressive disorder followed by appropriate treatment could decrease the risk of chronic and complicated depression as well as the risk of poor social adaptation.

FRAX®: Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

PubMed Central

Briot, Karine; Paternotte, Simon; Kolta, Sami; Eastell, Richard; Felsenberg, Dieter; Reid, David M.; Glüer, Claus-C.; Roux, Christian

2013-01-01

Purposes The aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. Patients and methods The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). Results 85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®. Conclusions This study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population. PMID:24386199

Combining independent decisions increases diagnostic accuracy of reading lumbosacral radiographs and magnetic resonance imaging.

PubMed

Kurvers, Ralf H J M; de Zoete, Annemarie; Bachman, Shelby L; Algra, Paul R; Ostelo, Raymond

2018-01-01

Diagnosing the causes of low back pain is a challenging task, prone to errors. A novel approach to increase diagnostic accuracy in medical decision making is collective intelligence, which refers to the ability of groups to outperform individual decision makers in solving problems. We investigated whether combining the independent ratings of chiropractors, chiropractic radiologists and medical radiologists can improve diagnostic accuracy when interpreting diagnostic images of the lumbosacral spine. Evaluations were obtained from two previously published studies: study 1 consisted of 13 raters independently rating 300 lumbosacral radiographs; study 2 consisted of 14 raters independently rating 100 lumbosacral magnetic resonance images. In both studies, raters evaluated the presence of "abnormalities", which are indicators of a serious health risk and warrant immediate further examination. We combined independent decisions of raters using a majority rule which takes as final diagnosis the decision of the majority of the group. We compared the performance of the majority rule to the performance of single raters. Our results show that with increasing group size (i.e., increasing the number of independent decisions) both sensitivity and specificity increased in both data-sets, with groups consistently outperforming single raters. These results were found for radiographs and MR image reading alike. Our findings suggest that combining independent ratings can improve the accuracy of lumbosacral diagnostic image reading.

Performance after rotator cuff tear and operative treatment: a case-control study of major league baseball pitchers.

PubMed

Namdari, Surena; Baldwin, Keith; Ahn, Albert; Huffman, G Russell; Sennett, Brian J

2011-01-01

Little is known about pitching performance or lack of it among Major League Baseball (MLB) pitchers who undergo operative treatment of rotator cuff tears. To assess pitching performance outcomes in MLB players who needed operative treatment of rotator cuff tears and to compare performance in these athletes with that in a control group of MLB players. Case-control study. Publicly available player profiles, press releases, and team injury reports. Thirty-three MLB pitchers with documented surgery to treat rotator cuff tears and 117 control pitchers who did not have documented rotator cuff tears were identified. Major League Baseball pitching attrition and performance variables. Players who underwent rotator cuff surgery were no more likely not to play than control players. Performance variables of players who underwent surgery improved after surgery but never returned to baseline preoperative status. Players who needed rotator cuff surgery typically were more experienced and had better earned run averages than control players. Pitchers who had symptomatic rotator cuff tears that necessitated operative treatment tended to decline gradually in performance leading up to their operations and to improve gradually over the next 3 seasons. In contrast to what we expected, they did not have a greater attrition rate than their control counterparts; however, their performances did not return to preoperative levels over the course of the study.

The Unified Levelling Network of Sarawak and its Adjustment

NASA Astrophysics Data System (ADS)

Som, Z. A. M.; Yazid, A. M.; Ming, T. K.; Yazid, N. M.

2016-09-01

The height reference network of Sarawak has seen major improvement in over the past two decades. The most significant improvement was the establishment of extended precise leveling network of which is now able to connect all three major datum points at Pulau Lakei, Original and Bintulu. Datum by following the major accessible routes across Sarawak. This means the leveling network in Sarawak has now been inter-connected and unified. By having such a unified network leads to the possibility of having a common single least squares adjustment been performed for the first time. The least squares adjustment of this unified levelling network was attempted in order to compute the height of all Bench Marks established in the entire levelling network. The adjustment was done by using MoreFix levelling adjustment package developed at FGHT UTM. The computational procedure adopted is linear parametric adjustment by minimum constraint. Since Sarawak has three separate datums therefore three separate adjustments were implemented by utilizing datum at Pulau Lakei, Original Miri and Bintulu Datum respectively. Results of the MoreFix unified adjustment agreed very well with adjustment repeated using Starnet. Further the results were compared with solution given by Jupem and they are in good agreement as well. The difference in height analysed were within 10mm for the case of minimum constraint at Pulau Lakei datum and with much better agreement in the case of Original Miri Datum.

Delivery of health surveillance for hand-arm vibration in the West Midlands.

PubMed

Kinoulty, Mary

2006-01-01

Concerns about provider competence and quality of hand-arm vibrations (HAVs) health surveillance programmes were identified by Health & Safety Executive (HSE) inspectors. To evaluate health surveillance programmes and compare them with published HSE guidance. To identify deficiencies and areas for improvement in the health surveillance programmes. A proforma was developed for the study and used on a sample of 10 local occupational health providers. All 10 organizations were aware of current HSE guidance for health surveillance for HAVs but only a minority (30%) were following it. Occupational health provider training, written procedures and health surveillance delivery were all identified as areas requiring improvement. The majority of organizations were not following HSE guidance. Occupational health providers undertaking health surveillance for HAV require specific training.

Process for controlling morphology and improving thermal-mechanical performance of high performance interpenetrating and semi-interpenetrating polymer networks

NASA Technical Reports Server (NTRS)

Pater, Ruth H. (Inventor); Hansen, Marion G. (Inventor)

1997-01-01

In the process of the present invention, a non-polar, aprotic solvent is removed from an oligomer/polymer solution by freeze-drying in order to produce IPNs and semi-IPNs. By thermally quenching the solution to a solid in a short length of time, the size of the minor constituent-rich regions is greatly reduced as they are excluded along with the major constituent from the regions of crystallizing solvent. The use of this process sequence of controlling phase morphology provides IPNs and semi-IPNs with improved fracture toughness, microcracking resistance, and other physical-mechanical properties as compared to IPNs and semi-IPNs formed when the solvent is evaporated rather than sublimed.

Process for controlling morphology and improving thermal mechanical performance of high performance interpenetrating and semiinterpenetrating polymer networks

NASA Technical Reports Server (NTRS)

Pater, Ruth H. (Inventor); Hansen, Marion G. (Inventor)

1998-01-01

In the process of the present invention, a non-polar, aprotic solvent is removed from an oligomer/polymer solution by freeze-drying in order to produce IPNs and semi-IPNs. By thermally quenching the solution to a solid in a short length of time, the size of the minor constituent-rich regions is greatly reduced as they are excluded along with the major constituent from the regions of crystallizing solvent. The use of this process sequence of controlling phase morphology provides IPNs and semi-IPNs with improved fracture toughness, microcracking resistance, and other physical-mechanical properties as compared to IPNs and semi-IPNs formed when the solvent is evaporated rather than sublimed.

Swing arm profilometer: high accuracy testing for large reaction-bonded silicon carbide optics with a capacitive probe

NASA Astrophysics Data System (ADS)

Xiong, Ling; Luo, Xiao; Hu, Hai-xiang; Zhang, Zhi-yu; Zhang, Feng; Zheng, Li-gong; Zhang, Xue-jun

2017-08-01

A feasible way to improve the manufacturing efficiency of large reaction-bonded silicon carbide optics is to increase the processing accuracy in the ground stage before polishing, which requires high accuracy metrology. A swing arm profilometer (SAP) has been used to measure large optics during the ground stage. A method has been developed for improving the measurement accuracy of SAP using a capacitive probe and implementing calibrations. The experimental result compared with the interferometer test shows the accuracy of 0.068 μm in root-mean-square (RMS) and maps in 37 low-order Zernike terms show accuracy of 0.048 μm RMS, which shows a powerful capability to provide a major input in high-precision grinding.

The value of information as applied to the Landsat Follow-on benefit-cost analysis

NASA Technical Reports Server (NTRS)

Wood, D. B.

1978-01-01

An econometric model was run to compare the current forecasting system with a hypothetical (Landsat Follow-on) space-based system. The baseline current system was a hybrid of USDA SRS domestic forecasts and the best known foreign data. The space-based system improved upon the present Landsat by the higher spatial resolution capability of the thematic mapper. This satellite system is a major improvement for foreign forecasts but no better than SRS for domestic forecasts. The benefit analysis was concentrated on the use of Landsat Follow-on to forecast world wheat production. Results showed that it was possible to quantify the value of satellite information and that there are significant benefits in more timely and accurate crop condition information.

Psychological stress and its relationship with persistent allergic rhinitis.

PubMed

El Hennawi, Diaa El Din Mohamed; Ahmed, Mohamed Rifaat; Farid, Alaa Mohamed

2016-04-01

Allergic rhinitis is considered to be a major health problem that impairs quality of life. A possible relationship with psychological stress may exist. The aim of this study is to verify the relationship between persistent allergic rhinitis (PAR) and psychological stress aiming to improve treatment and thereby quality of life (QOL) of patients. Patients with PAR (166) were diagnosed then analyzed using the Kessler Psychological Distress Scale. Patients with allergic rhinitis and who were positive on the Kessler scale (122) were randomly divided equally into a control group which received levocetirizine and a study group which received levocetirizine and imipramine. Nasal symptom assessment and QOL assessment were performed in all patients after treatment. Of the 166 patients with PAR, 122 (73.5 %) were positive on the Kessler Psychological Distress Scale. There was a marked improvement in the study group compared with the control group as regards nasal symptoms with better QOL in the study group (6.93) compared with the control group (2.13). Psychological stress has a strong impact on persistent allergic rhinitis. When stress is controlled by a combined treatment of imipramine and levocetirizine, allergic rhinitis symptoms improved and a better QOL was obtained. 3b.

Botulinum toxin therapy for limb dystonias.

PubMed

Yoshimura, D M; Aminoff, M J; Olney, R K

1992-03-01

We investigated the effectiveness of botulinum toxin in 17 patients with limb dystonias (10 with occupational cramps, three with idiopathic dystonia unrelated to activity, and two each with post-stroke and parkinsonian dystonia) in a placebo-controlled, blinded study. We identified affected muscles clinically and by recording the EMG from implanted wire electrodes at rest and during performance of tasks that precipitated abnormal postures. There were three injections given with graded doses of toxin (average doses, 5 to 10, 10 to 20, and 20 to 40 units per muscle) and one with placebo, in random order. Subjective improvement occurred after 53% of injections of botulinum toxin, and this was substantial in 24%. Only one patient (7%) improved after placebo injection. Subjective improvement occurred in 82% of patients with at least one dose of toxin, lasting for 1 to 4 months. Response rates were similar between clinical groups. Objective evaluation failed to demonstrate significant improvement following treatment with toxin compared with placebo. The major side effect was transient focal weakness after 53% of injections of toxin.

Automotive Stirling engine development program

NASA Technical Reports Server (NTRS)

Ernst, W.; Richey, A.; Farrell, R.; Riecke, G.; Smith, G.; Howarth, R.; Cronin, M.; Simetkosky, M.; Meacher, J.

1986-01-01

The major accomplishments were the completion of the Basic Stirling Engine (BSE) and the Stirling Engine System (SES) designs on schedule, the approval and acceptance of those designs by NASA, and the initiation of manufacture of BSE components. The performance predictions indicate the Mod II engine design will meet or exceed the original program goals of 30% improvement in fuel economy over a conventional Internal Combustion (IC) powered vehicle, while providing acceptable emissions. This was accomplished while simultaneously reducing Mod II engine weight to a level comparable with IC engine power density, and packaging the Mod II in a 1985 Celebrity with no external sheet metal changes. The projected mileage of the Mod II Celebrity for the combined urban and highway CVS cycle is 40.9 mpg which is a 32% improvement over the IC Celebrity. If additional potential improvements are verified and incorporated in the Mod II, the mileage could increase to 42.7 mpg.

Use of customised pressure-guided elastic bandages to improve efficacy of compression bandaging for venous ulcers.

PubMed

Sermsathanasawadi, Nuttawut; Chatjaturapat, Choedpong; Pianchareonsin, Rattana; Puangpunngam, Nattawut; Wongwanit, Chumpol; Chinsakchai, Khamin; Ruangsetakit, Chanean; Mutirangura, Pramook

2017-08-01

Compression bandaging is a major treatment of chronic venous ulcers. Its efficacy depends on the applied pressure, which is dependent on the skill of the individual applying the bandage. To improve the quality of bandaging by reducing the variability in compression bandage interface pressures, we changed elastic bandages into a customised version by marking them with circular ink stamps, applied when the stretch achieves an interface pressure between 35 and 45 mmHg. Repeated applications by 20 residents of the customised bandage and non-marked bandage to one smaller and one larger leg were evaluated by measuring the sub-bandage pressure. The results demonstrated that the target pressure range is more often attained with the customised bandage compared with the non-marked bandage. The customised bandage improved the efficacy of compression bandaging for venous ulcers, with optimal sub-bandage pressure. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Vegetation projections for Wind Cave National Park with three future climate scenarios: Final report in completion of Task Agreement J8W07100052

USGS Publications Warehouse

King, David A.; Bachelet, Dominique M.; Symstad, Amy J.

2013-01-01

Since the initial application of MC1 to a small portion of WICA (Bachelet et al. 2000), the model has been altered to improve model performance with the inclusion of dynamic fire. Applying this improved version to WICA required substantial recalibration, during which we have made a number of improvements to MC1 that will be incorporated as permanent changes. In this report we document these changes and our calibration procedure following a brief overview of the model. We compare the projections of current vegetation to the current state of the park and present projections of vegetation dynamics under future climates downscaled from three GCMs selected to represent the existing range in available GCM projections. In doing so, we examine the consequences of different management options regarding fire and grazing, major aspects of biotic management at Wind Cave.

Treatment with protein synthesis inhibitors improves outcomes from secondary bacterial pneumonia following influenza

PubMed Central

Karlström, Åsa; Boyd, Kelli L.; English, B. Keith; McCullers, Jonathan A.

2008-01-01

Pneumonia as a secondary infection after influenza is a major cause of excess morbidity and mortality despite the availability and use of antibiotics active against Streptococcus pneumoniae. We hypothesized that use of a bacteriostatic protein synthesis inhibitor would improve outcomes by reducing the inflammatory response. BALB/c mice infected with influenza virus and super-infected with Streptococcus pneumoniae were treated with either the cell wall active antibiotic ampicillin or protein synthesis inhibitors clindamycin or azithromycin. Ampicillin therapy performed significantly worse (56% survival) in the model compared to clindamycin therapy either alone (82%) or in combination with ampicillin (80%) and to azithromycin (92%). Improved survival appeared to be mediated by decreased inflammation manifested as lower levels of inflammatory cells and pro-inflammatory cytokines in the lungs, and less severe histopathology. These data suggest that beta-lactam therapy may not be optimal as first line treatment of community acquired pneumonia when it follows influenza. PMID:19113989

Genomic prediction unifies animal and plant breeding programs to form platforms for biological discovery.

PubMed

Hickey, John M; Chiurugwi, Tinashe; Mackay, Ian; Powell, Wayne

2017-08-30

The rate of annual yield increases for major staple crops must more than double relative to current levels in order to feed a predicted global population of 9 billion by 2050. Controlled hybridization and selective breeding have been used for centuries to adapt plant and animal species for human use. However, achieving higher, sustainable rates of improvement in yields in various species will require renewed genetic interventions and dramatic improvement of agricultural practices. Genomic prediction of breeding values has the potential to improve selection, reduce costs and provide a platform that unifies breeding approaches, biological discovery, and tools and methods. Here we compare and contrast some animal and plant breeding approaches to make a case for bringing the two together through the application of genomic selection. We propose a strategy for the use of genomic selection as a unifying approach to deliver innovative 'step changes' in the rate of genetic gain at scale.

Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study.

PubMed

Hanselman, Andrew E; Tidwell, John E; Santrock, Robert D

2015-02-01

Treatment options for plantar fasciitis have resulted in varied patient outcomes. The aim of this study was to compare a novel treatment, cryopreserved human amniotic membrane (c-hAM), to a traditional treatment, corticosteroid. Our hypothesis was that c-hAM would be safe and comparable to corticosteroids for plantar fasciitis in regard to patient outcomes. A randomized, controlled, double-blind, single-center pilot study was completed. Patients were randomized into one of 2 treatment groups: c-hAM or corticosteroid. Patients received an injection at their initial baseline visit with an option for a second injection at their first 6-week follow-up. Total follow-up was obtained for 12 weeks after the most recent injection. The primary outcome measurement was the Foot Health Status Questionnaire (FHSQ). The secondary outcome measurements were the Visual Analog Scale (VAS) and verbally reported percentage improvement. Data were analyzed between groups for the 2 different cohorts (1 injection versus 2 injections). Twenty-three patients had complete follow-up. Fourteen were randomized to receive corticosteroid and 9 were randomized to receive c-hAM. Three patients in each group received second injections. With the numbers available, the majority of outcome measurements showed no statistical difference between groups. The corticosteroid did, however, have greater FHSQ shoe fit improvement (P = .0244) at 6 weeks, FHSQ general health improvement (P = .0132) at 6 weeks, and verbally reported improvement (P = .041) at 12 weeks in the one-injection cohort. Cryopreserved hAM had greater FHSQ foot pain improvement (P = .0113) at 18 weeks in the 2-injection cohort. Cryopreserved hAM injection may be safe and comparable to corticosteroid injection for treatment of plantar fasciitis. This is a pilot study and requires further investigation. Level I, prospective randomized trial. © The Author(s) 2014.

Use of a web-based educational intervention to improve knowledge of healthy diet and lifestyle in women with Gestational Diabetes Mellitus compared to standard clinic-based education.

PubMed

Sayakhot, Padaphet; Carolan-Olah, Mary; Steele, Cheryl

2016-08-05

This study introduced a web-based educational intervention for Australian women with gestational diabetes mellitus (GDM). The aim was to improve knowledge on healthy diet and lifestyle in GDM. Evaluation of the intervention explored women's knowledge and understanding of GDM, healthy diet, healthy food, and healthy lifestyle, after using the web-based program compared to women receiving standard clinic-based GDM education. A total of 116 women, aged 18-45 years old, newly diagnosed with GDM, participated (Intervention (n) = 56 and control (n) = 60). Women were randomly allocated to the intervention or control groups and both groups attended a standard GDM education class. Group 1(Intervention) additionally used an online touch screen/computer program. All women completed a questionnaire following the computer program and/or the education class. All questions evaluating levels of knowledge had more than one correct answer and scores were graded from 0 to 1, with each correct component receiving a score, eg. 0.25 per each correct answer in a 4 answer question. Chi-square test was performed to compare the two groups regarding knowledge of GDM. Findings indicated that the majority of women in the intervention group reported correct answers for "types of carbohydrate foods" for pregnant women with GDM, compared to the control group (62.5 % vs 58.3 %, respectively). Most women in both groups had an excellent understanding of "fruits and vegetables" (98.2 % vs 98.3 %), and the majority of women in the intervention group understood that they should exercise daily for 30 min, compared to the control group (92.9 % vs 91.7 %). Both groups had a good understanding across all categories, however, the majority of women in the intervention group scored all correct answers (score = 1) in term of foetal effects (17.9 % vs 13.3 %, respectively), maternal predictors (5.4 % vs 5 %), care requirements (39.3 % vs 23.3 %), GDM perceptions (48.2 % vs 46.7 %) and GDM treatment (67.9 % vs 61.7 %), compared to women in the control group. The study suggested that both approaches, standard education and standard education plus web-based program, resulted in excellent knowledge scores, but not statistically significant difference between groups. Multiple and immediate access to the web-based education program at home may prove useful as a source of reference for women with GDM. Future study comparing results pre and post intervention is needed. ACTRN12615000697583 ; Date registered: 03/07/2015; Retrospectively registered.

Rapid incorporation kinetics and improved fidelity of a novel class of 3'-OH unblocked reversible terminators.

PubMed

Gardner, Andrew F; Wang, Jinchun; Wu, Weidong; Karouby, Jennifer; Li, Hong; Stupi, Brian P; Jack, William E; Hersh, Megan N; Metzker, Michael L

2012-08-01

Recent developments of unique nucleotide probes have expanded our understanding of DNA polymerase function, providing many benefits to techniques involving next-generation sequencing (NGS) technologies. The cyclic reversible termination (CRT) method depends on efficient base-selective incorporation of reversible terminators by DNA polymerases. Most terminators are designed with 3'-O-blocking groups but are incorporated with low efficiency and fidelity. We have developed a novel class of 3'-OH unblocked nucleotides, called Lightning Terminators™, which have a terminating 2-nitrobenzyl moiety attached to hydroxymethylated nucleobases. A key structural feature of this photocleavable group displays a 'molecular tuning' effect with respect to single-base termination and improved nucleotide fidelity. Using Therminator DNA polymerase, we demonstrate that these 3'-OH unblocked terminators exhibit superior enzymatic performance compared to two other reversible terminators, 3'-O-amino-TTP and 3'-O-azidomethyl-TTP. Lightning Terminators show maximum incorporation rates (k(pol)) that range from 35 to 45 nt/s, comparable to the fastest NGS chemistries, yet with catalytic efficiencies (k(pol)/K(D)) comparable to natural nucleotides. Pre-steady-state kinetic studies of thymidine analogs revealed that the major determinant for improved nucleotide selectivity is a significant reduction in k(pol) by >1000-fold over TTP misincorporation. These studies highlight the importance of structure-function relationships of modified nucleotides in dictating polymerase performance.

Addressing "waste" in diagnostic imaging: some implications of comparative effectiveness research.

PubMed

Elshaug, Adam G; Bessen, Taryn; Moss, John R; Hiller, Janet E

2010-08-01

Comparative effectiveness research is intended to provide evidence to improve patient outcomes through the use of the most appropriate health technology affordable. The authors present 5 case studies, focusing on the use of plain radiography in common clinical scenarios, to illustrate the considerable scope for comparative effectiveness research within medical imaging and the different levels of evidence currently in existence to guide the improved use of medical imaging. These are blunt ankle injury, breast cancer follow-up, low back pain, routine daily chest x-rays in intensive care, and screening for breast cancer. Although there are established models for evaluating new technologies, especially pharmaceuticals, against the most commonly used current technology, the evaluation of technologies in current clinical practice is in an early phase of development. Because evaluation resources are limited, one major challenge is developing ways to identify established technologies for evaluation to refine the indications for their use. A set of criteria with which to identify established technologies that may not be delivering value for money is described, and their use is illustrated in relation to the 5 case studies. These criteria could be incorporated into literature search strategies, stakeholder consultations, and utilization scanning. Once identified, these technologies should be formally evaluated for their performance in improving patient health without restricting the availability of other effective interventions. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Shoulder tenotomies to improve passive motion and relieve pain in patients with spastic hemiplegia after upper motor neuron injury.

PubMed

Namdari, Surena; Alosh, Hassan; Baldwin, Keith; Mehta, Samir; Keenan, Mary Ann

2011-07-01

Shoulder adduction and internal rotation contractures commonly develop in patients with spastic hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function. A consecutive series of 36 adults (10 men, 26 women) with spastic hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively. Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P < .001). All patients with preoperative pain had improved pain relief at follow-up, with 18 (95%) being pain-free. Thirty-five (97%) were satisfied with the outcome of surgery, and all patients reported improved axillary hygiene and skin care. Age, gender, etiology, and chronicity of UMN injury were not associated with improvement in motion. We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy. Shoulder tenotomy to relieve spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

PubMed Central

Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

2012-01-01

Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Conclusion Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. PMID:22511688

Depression Care in the United States

PubMed Central

González, Hector M.; Vega, William A.; Williams, David R.; Tarraf, Wassim; West, Brady T.; Neighbors, Harold W.

2010-01-01

Objective: To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. Design: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. Setting: The 48 coterminous United States. Participants: Household residents 18 years and older (N=15 762) participated in the study. Main Outcome Measures: Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. Results: Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use. Conclusions: Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States. PMID:20048221

Morphometrics of the Southern Green Stink Bug [Nezara viridula (L.) (Hemiptera: Pentatomidae)] Stylet Bundle.

PubMed

Esquivel, J F; Droleskey, R E; Ward, L A; Harvey, R B

2018-03-29

The southern green stink bug, Nezara viridula (L.) (Hemiptera: Pentatomidae), is a cosmopolitan pest of high-value cash crops, including cotton (Gossypium hirsutum L.; Malvales: Malvaceae). The pest can ingest and transmit disease-causing bacterial and fungal pathogens of cotton. We hypothesized that the size of the food canal may contribute to selective transmission, as observed in previous reports. The objective of this study was to examine food canal size and other morphometric parameters of the southern green stink bug stylet bundle at two locations (labium and head) to improve our understanding of factors that may contribute to pathogen transmission. For the food canal, females possessed significantly larger canals than males, major axes were significantly longer than minor axes, and canal sizes were numerically higher at the labium compared with the head. For salivary canal, mean axes lengths were similar between sexes and the head and labium. For both food and salivary canals, axes lengths were longer and area was larger at the labium compared with the head. These findings indicate the presence of a "funnel effect" with canals becoming narrower proximally. Sex and location significantly affected the size of the intact stylet bundle. Results indicate the food canal size was not a factor affecting previously observed selective passive transmission. Major and minor axes measurements, coupled with morphological observations of canal shapes and observed "funnel effect" in the food and salivary canals, improve our understanding of the hemipteran stylet bundle and its relationship with the insect's internal morphology.

Experience and management of chronic pain among patients with other complex chronic conditions.

PubMed

Butchart, Amy; Kerr, Eve A; Heisler, Michele; Piette, John D; Krein, Sarah L

2009-05-01

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF). We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups. More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain. Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Beam Output Audit results within the EORTC Radiation Oncology Group network.

PubMed

Hurkmans, Coen W; Christiaens, Melissa; Collette, Sandra; Weber, Damien Charles

2016-12-15

Beam Output Auditing (BOA) is one key process of the EORTC radiation therapy quality assurance program. Here the results obtained between 2005 and 2014 are presented and compared to previous results.For all BOA reports the following parameters were scored: centre, country, date of audit, beam energies and treatment machines audited, auditing organisation, percentage of agreement between stated and measured dose.Four-hundred and sixty-one BOA reports were analyzed containing the results of 1790 photon and 1366 electron beams, delivered by 755 different treatment machines. The majority of beams (91.1%) were within the optimal limit of ≤ 3%. Only 13 beams (0.4%; n = 9 electrons; n = 4 photons), were out of the range of acceptance of ≤ 5%. Previous reviews reported a much higher percentage of 2.5% or more of the BOAs with >5% deviation.The majority of EORTC centres present beam output variations within the 3% tolerance cutoff value and only 0.4% of audited beams presented with variations of more than 5%. This is an important improvement compared to previous BOA results.

Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders.

PubMed

Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N; Crum, Rosa M

2014-02-01

Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 U.S. National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders. © 2013.

Serum lipid profile and inflammatory markers in the aorta of cholesterol-fed rats supplemented with extra virgin olive oil, sunflower oils and oil-products.

PubMed

Katsarou, Ageliki I; Kaliora, Andriana C; Papalois, Apostolos; Chiou, Antonia; Kalogeropoulos, Nick; Agrogiannis, George; Andrikopoulos, Nikolaos K

2015-01-01

Extra virgin olive oil (EVOO) major and minor component anti-inflammatory effect on aorta was evaluated; Wistar rats were fed (9 weeks) on either a high-cholesterol diet (HCD) or a HCD supplemented with oils, i.e. EVOO, sunflower oil (SO), high-oleic sunflower oil (HOSO), or oil-products modified to their phenolic content, i.e. phenolics deprived-EVOO [EVOO(-)], SO enriched with the EVOO phenolics [SO(+)], HOSO enriched with the EVOO phenolics [HOSO(+)]. HCD induced dyslipidemia and resulted in higher aorta adhesion molecules levels at euthanasia. Groups receiving EVOO, EVOO(-), HOSO, HOSO(+) presented higher serum TC and LDL-c levels compared to cholesterol-fed rats; attenuation of aorta E-selectin levels was also observed. In EVOO/EVOO(-) groups, aorta vascular endothelial adhesion molecule-1 (VCAM-1) was lower compared to HCD animals. SO/SO(+) diets had no effect on endothelial dysfunction amelioration. Overall, our results suggest that major and/or minor EVOO constituents improve aorta E-selectin and VCAM-1, while serum lipids do not benefit.

Improving Care for Depression in Obstetrics and Gynecology: A Randomized Controlled Trial

PubMed Central

Melville, Jennifer L.; Reed, Susan D.; Russo, Joan; Croicu, Carmen A.; Ludman, Evette; LaRocco-Cockburn, Anna; Katon, Wayne

2014-01-01

OBJECTIVE To evaluate an evidence-based collaborative depression care intervention adapted to obstetrics and gynecology clinics compared with usual care. METHODS Two-site randomized controlled trial included screen-positive women (Patient Health Questionnaire-9 of at least 10) who then met criteria for major depression, dysthymia or both (Mini-International Neuropsychiatric Interview). Women were randomized to 12-months of collaborative depression management or usual care; 6, 12 and 18-month outcomes were compared. The primary outcomes were change from baseline to 12-months on depression symptoms and functional status. Secondary outcomes included at least 50% decrease and remission in depressive symptoms, global improvement, treatment satisfaction, and quality of care. RESULTS Participants were on average 39 years old, 44% were non-white and 56% had posttraumatic stress disorder. Intervention (n= 102) compared to usual care (n=103) patients had greater improvement in depressive symptoms at 12 months (P< .001) and 18 months (P=.004). The intervention group compared with usual care had improved functioning over 18 months (P< .05), were more likely to have an at least 50% decrease in depressive symptoms at 12 months (relative risk [RR]=1.74, 95% confidence interval [CI] 1.11–2.73), greater likelihood of at least 4 specialty mental health visits (6 month RR=2.70, 95% CI1.73–4.20; 12 month RR=2.53, 95% CI 1.63–3.94), adequate dose of antidepressant (6-month RR=1.64, 95% CI 1.03–2.60; 12-month RR=1.71, 95%CI 1.08 2.73), and greater satisfaction with care (6-month RR=1.70, 95% CI 1.19–2.44; 12-month RR=2.26, 95% CI 1.52–3.36). CONCLUSION Collaborative depression care adapted to women’s health settings improved depressive and functional outcomes and quality of depression care. PMID:24807320

Duloxetine in the treatment of Major Depressive Disorder: a comparison of efficacy in patients with and without melancholic features.

PubMed

Mallinckrodt, Craig H; Watkin, John G; Liu, Chaofeng; Wohlreich, Madelaine M; Raskin, Joel

2005-01-04

The most prominent feature of melancholic depression is a near-total loss of the capacity to derive pleasure from activities or other positive stimuli. Additional symptoms can include psychomotor disturbances, anorexia, excessive guilt, and early awakening from sleep. Melancholic patients may exhibit treatment responses and outcomes that differ from those of non-melancholic patients. Pooled data from double-blind, placebo-controlled studies were utilized to compare the efficacy of duloxetine in depressed patients with and without melancholic features. Efficacy data were pooled from 8 double-blind, placebo-controlled clinical trials of duloxetine. The presence of melancholic features (DSM-IV criteria) was determined using results from the Mini International Neuropsychiatric Interview (MINI). Patients (aged >or= 18 years) meeting DSM-IV criteria for major depressive disorder (MDD) received duloxetine (40-120 mg/d; melancholic, N = 759; non-melancholic, N = 379) or placebo (melancholic, N = 519; non-melancholic, N = 256) for up to 9 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score, HAMD17 subscales (Maier, anxiety, retardation, sleep), the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain. In data from all 8 studies, duloxetine's advantage over placebo did not differ significantly between melancholic and non-melancholic patients (treatment-by-melancholic status interactions were not statistically significant). Duloxetine demonstrated significantly greater improvement in depressive symptom severity, compared with placebo, within both melancholic and non-melancholic cohorts (p

Open lung approach versus standard protective strategies: Effects on driving pressure and ventilatory efficiency during anesthesia - A pilot, randomized controlled trial.

PubMed

Ferrando, Carlos; Suarez-Sipmann, Fernando; Tusman, Gerardo; León, Irene; Romero, Esther; Gracia, Estefania; Mugarra, Ana; Arocas, Blanca; Pozo, Natividad; Soro, Marina; Belda, Francisco J

2017-01-01

Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia. Consecutive patients scheduled for major abdominal surgery were submitted to low-VT ventilation (6 ml·kg-1) and standard PEEP of 5 cmH2O (pre-RM, n = 36). After 30 min estabilization all patients received a RM and were randomly allocated to either continue with the same PEEP (RM-5 group, n = 18) or to an individualized open-lung PEEP (OL-PEEP) (Open Lung Approach, OLA group, n = 18) defined as the level resulting in maximal Cdyn during a decremental PEEP trial. We compared the effects on driving pressure and lung efficiency measured by volumetric capnography. OL-PEEP was found at 8±2 cmH2O. 36 patients were included in the final analysis. When compared with pre-RM, OLA resulted in a 22% increase in compliance and a 28% decrease in driving pressure when compared to pre-RM. These parameters did not improve in the RM-5. The trend of the DP was significantly different between the OLA and RM-5 groups (p = 0.002). VDalv/VTalv was significantly lower in the OLA group after the RM (p = 0.035). Lung recruitment applied during low-VT ventilation improves driving pressure and lung efficiency only when applied as an open-lung strategy with an individualized PEEP in patients without lung diseases undergoing major abdominal surgery. ClinicalTrials.gov NCT02798133.

Efficacy and safety of flexibly dosed brexpiprazole for the adjunctive treatment of major depressive disorder: a randomized, active-referenced, placebo-controlled study.

PubMed

Hobart, Mary; Skuban, Aleksandar; Zhang, Peter; Josiassen, Mette Krog; Hefting, Nanco; Augustine, Carole; Brewer, Claudette; Sanchez, Raymond; McQuade, Robert D

2018-04-01

To assess the efficacy, safety, and tolerability of brexpiprazole as adjunctive treatment in adults with major depressive disorder (MDD) and an inadequate response to prior antidepressant treatment (ADT). Patients with a current major depressive episode after prior treatment with 1-3 ADTs entered an 8- or 10-week prospective treatment phase in which they received double-blind placebo adjunct to open-label ADT. Inadequate responders were randomized (2:2:1) to brexpiprazole 2-3 mg/day, placebo, or quetiapine extended-release (XR) 150-300 mg/day, adjunct to the same ADT, for 6 weeks. The primary efficacy endpoint was the change from baseline (randomization) to week 6 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. The key secondary efficacy endpoint was the change in Sheehan Disability Scale (SDS) mean score. Adjunctive brexpiprazole showed a greater improvement in MADRS total score than adjunctive placebo (least squares mean difference [95% confidence interval] = -1.48 [-2.56, -0.39]; p = .0078), whereas adjunctive quetiapine XR did not separate from placebo (-0.30 [-1.63, 1.04]; p = .66). Adjunctive brexpiprazole failed to separate from placebo on the SDS mean score (-0.23 [-0.52, 0.07]; p = .13), but did improve functioning on two of the three SDS items (family life and social life). The most frequent treatment-emergent adverse events in patients receiving brexpiprazole were akathisia (6.1%), somnolence (5.6%), and headache (5.6%). Adjunctive brexpiprazole 2-3 mg/day improved symptoms of depression compared with adjunctive placebo in patients with MDD and an inadequate response to ADTs, and was well tolerated with no unexpected side effects.

Conformal and intensity modulated irradiation of head and neck cancer: the potential for improved target irradiation, salivary gland function, and quality of life.

PubMed

Eisbruch, A; Dawson, L A; Kim, H M; Bradford, C R; Terrell, J E; Chepeha, D B; Teknos, T N; Anzai, Y; Marsh, L H; Martel, M K; Ten Haken, R K; Wolf, G T; Ship, J A

1999-01-01

To develop techniques which facilitate sparing of the major salivary glands while adequately treating the targets in patients requiring comprehensive bilateral neck irradiation (RT). Conformal and static, multisegmental intensity modulated (IMRT) techniques have been developed. The salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands' dose volume histograms. Subjective xerostomia questionnaires have been developed and validated. The pattern of local-regional recurrences has been examined using CT scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans and regenerating the dose distributions at the recurrence sites. Target coverage and dose homogeneity in IMRT treatment plans were found to be significantly better than standard RT plans. Significant parotid gland sparing was achieved. The relationships among dose, irradiated volume and saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean dose of 26 Gy was found to be the threshold for stimulated saliva. Subjective xerostomia was significantly reduced in patients irradiated with parotid sparing techniques, compared to patients with similar tumors treated with standard RT. The large majority of recurrences occurred inside high-risk targets. Tangible gains in salivary gland sparing and target coverage are being achieved and an improvement in some measures of quality of life is suggested by our findings. A mean parotid gland dose of < or = 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to targets judged to be at highest risk may improve tumor control.

Exercise is medicine for patients with major depressive disorders: but only if the “pill” is taken!

PubMed Central

Gerber, Markus; Holsboer-Trachsler, Edith; Pühse, Uwe; Brand, Serge

2016-01-01

Major depressive disorders (MDDs) are a widespread and burdensome mental illness associated with a high comorbidity with other conditions and a significantly reduced life expectancy compared to the general population. Therefore, targeted actions are needed to improve physical health in people with MDDs, in addition to ongoing efforts to enhance psychological well-being. Meanwhile, the positive effects of exercise training on the treatment of MDDs are well documented, while compelling evidence exists that exercise interventions can improve cardiorespiratory fitness in clinically meaningful ways. On the flipside, the long-term effects of exercise therapy are still not well documented, and recent studies suggest that initial improvements in MDDs dissipate if regular exercise participation is discontinued after the end of interventions. A recent survey among Swiss psychiatric hospitals further shows that all institutions provide some form of physical activity and exercise program. However, only a limited number of patients participate in these programs, mainly because participation is voluntary and no particular efforts are undertaken to engage patients with the lowest physical activity levels. We argue that more systematic efforts are needed to fully exploit the potential of physical activity and exercise programs in psychiatric care. We also emphasize that initiating and maintaining regular physical activity among psychiatric patients is a major challenge because specific dysfunctional cognitive–emotional processes might interfere with their capacity to self-regulate health-related behaviors. Specifically, we claim that behavioral skill training should be used to support patients with MDDs in overcoming barriers to initiating and maintaining physical activity. Moreover, we suggest that the assessment of physical activity and cardiorespiratory fitness should become routine in psychiatric practice. PMID:27540294

The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia.

PubMed

Meltzer, Andrew J; Graham, Ashley; Connolly, Peter H; Meltzer, Ellen C; Karwowski, John K; Bush, Harry L; Schneider, Darren B

2013-05-01

Specific perioperative risk assessment models have been developed for bariatric, pancreatic, and colorectal surgery. A similar instrument, specific for patients with critical limb ischemia (CLI), could improve patient-centered clinical decision making. We describe a novel tool to predict 30-day major morbidity and mortality (M&M) after bypass surgery for CLI. Data for 4985 individuals from the 2007 to 2009 National Surgical Quality Improvement Program were used to develop and internally validate the model. Outcome measures included mortality, major morbidity, and a composite end point (M&M). M&M included mortality and the most severe postoperative morbidities that were highly associated with death (eg, sepsis and major cardiopulmonary complications). More than 30 preoperative factors were tested for association with 30-day mortality, major morbidity, and M&M. Significant predictors in multivariate models were assigned integer values (points), which were added to calculate a patient's Comprehensive Risk Assessment For Bypass (CRAB) score. Performance was assessed (C-index) across all outcome measures and compared with other general tools (American Society of Anesthesiologists class, Surgical Risk Scale) and existing CLI-specific survival prediction models (Finnvasc score, Edifoligide for the Prevention of Infrainguinal Vein Graft Failure [PREVENT III] score) on a distinct validation sample (n = 1620). In the derivation data set (n = 3275), the 30-day mortality rate was 2.9%. The rate of any major morbidity was 19.1%. The composite end point M&M occurred in 10.1%. Significant predictors of M&M by multivariate analysis included age >75 years, prior amputation or revascularization, tissue loss, dialysis dependence, severe cardiac disease, emergency operation, and functional dependence. Applied to a distinct validation sample of 1620 patients, higher CRAB scores were significantly associated with higher rates of mortality, all major morbidities, and M&M (P < .0001). Comparison with other models by assessment of area under the receiver-operating characteristic curve revealed the CRAB was a more accurate predictor of mortality, all major morbidity, and M&M. The CRAB is a CLI-specific, risk assessment instrument derived from multi-institutional American College of Surgeons-National Surgical Quality Improvement Program surgical outcomes data that out-performs existing prognostic risk indices in the prediction of clinically significant adverse events after bypass surgery. Use of the CRAB as a risk assessment tool provides an evidence basis for patient-centered clinical decision making and may have a role in identifying patients at higher risk for surgical revascularization in whom an endovascular approach is preferable. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Intending to stay: Positive images, attitudes, and classroom experiences as influences on students' intentions to persist in science and engineering majors

NASA Astrophysics Data System (ADS)

Wyer, Mary Beth

2000-10-01

Contemporary research on persistence in undergraduate education in science and engineering has focused primarily on identifying the structural, social, and psychological barriers to participation by students in underrepresented groups. As a result, there is a wealth of data to document why students leave their majors, but there is little direct empirical data to support prevailing presumptions about why students stay. Moreover, researchers have used widely differing definitions and measures of persistence, and they have seldom explored field differences. This study compared three ways of measuring persistence. These constituted three criterion variables: commitment to major, degree aspirations, and commitment to a science/engineering career. The study emphasized social factors that encourage students to persist, including four predictor variables---(1) positive images of scientists/engineers, (2) positive attitudes toward gender and racial equality, (3) positive classroom experiences, and (4) high levels of social integration. In addition, because researchers have repeatedly documented the degree to which women are more likely than men to drop out of science and engineering majors, the study examined the potential impact of gender in relation to these predictor variables. A survey was administered in the classroom to a total of 285 students enrolled in a required course for either a biological sciences and or an engineering major. Predictor variables were developed from standard scales, including the Images of Science/Scientists Scale, the Attitudes toward Women Scale, the Women in Science Scale, and the Perceptions of Prejudice Scale. Based on logistic regression models, results indicate that positive images of scientists and engineers was significantly related to improving the odds of students having a high commitment to major, high degree aspirations, and high commitment to career. There was also evidence that positive attitudes toward gender and racial equality as well as positive classroom experiences improved the odds of students' having high degree aspirations. There was limited evidence to suggest the significance of gender in interaction with the predictor variables. There was tentative evidence that field differences may play a critical role in persistence. The study concludes on two points. The first is that gender may be a more important factor in explaining why some students leave their science and engineering majors than in explaining why others stay. The second is that research directed at improving diversity in science would benefit from discussion about the measures of persistence.

Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

PubMed Central

Haidvogl, Max; Riley, David S; Heger, Marianne; Brien, Sara; Jong, Miek; Fischer, Michael; Lewith, George T; Jansen, Gerard; Thurneysen, André E

2007-01-01

Background The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting. Methods The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days) runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8), Germany (8), the Netherlands (7), Russia (6), Spain (6), Ukraine (4), United Kingdom (10) and the USA (8) and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy. Results Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720 conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the per-protocol set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40 (0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838). Conclusion In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment. PMID:17335565

Early improvement and response to antidepressant medications in adults with major depressive disorder. Meta-analysis and study of a sample with treatment-resistant depression.

PubMed

Olgiati, Paolo; Serretti, Alessandro; Souery, Daniel; Dold, Markus; Kasper, Siegfried; Montgomery, Stuart; Zohar, Joseph; Mendlewicz, Julien

2018-02-01

Initial improvement in the first weeks of antidepressant (AD) treatment is a useful early predictor of complete AD response. We performed a meta-analysis of AD studies to investigate whether a partial decrease in depressive symptoms by week 4 was associated with response and remission by weeks 6-14 in major depressive disorder (MDD). Finally, we focused on treatment-resistant depression (TRD: lack of response to prior AD) to test the impact of early improvement on a second AD treatment outcome and to compare different switching strategies. Meta-analysis was conducted on AD naturalistic studies published between 01.01.2000 and 06.30.2017. TRD was an exclusion criterion. TRD was analyzed in 407 MDD patients treated with venlafaxine for 6 weeks. The MADRS was used to define very early improvement (VEI: > 20% decrease at week 2), early improvement (EI: > 30% decrease at week 4) and remission (week 6 MADRS < 10). A theoretical model was used to simulate AD switch in TRD patients who failed to achieve remission (Algorithm A), VEI (Algorithm B) or EI (Algorithm C). Our meta-analysis (9 studies; N = 6185) showed significant associations between early improvement, response (OR: 3.28 95% C.I: 2.06-5.20) and remission (OR: 2.10 95% C.I: 1.53-2.87). 24.6% of TRD sample remitted. VEI was a poor outcome predictor: sensitivity = 0.52 (0.40-0.63); specificity = 0.82 (0.76-0.86); AUC = 0.67 (0.62-0.71). EI had a moderate predictive power: sensitivity = 0.87 (0.77-0.93); specificity = 0.71 (0.66-0.77); AUC = 0.76 (0.71-0.80). The best treatment scenario was Algorithm C (switch after 4 weeks) in which remission rate was marginally increased (35.1% vs 33.7% of Algorithm A). Algorithm B (switch after 2 weeks) led to a 4.3% decrease in remission compared to Algorithm A. Inclusion of a naturalistic sample without a control arm; simulation of treatments. Although literature data suggest a correlation between an initial improvement of depressive symptoms and later response and remission during AD treatment, our analysis shows that such an early improvement is not a reliable outcome predictor in TRD. The nature of TRD is complex and different biological mechanisms and treatments might be necessary for TRD patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Gynecologic oncology group strategies to improve timeliness of publication.

PubMed

Bialy, Sally; Blessing, John A; Stehman, Frederick B; Reardon, Anne M; Blaser, Kim M

2013-08-01

The Gynecologic Oncology Group (GOG) is a multi-institution cooperative group funded by the National Cancer Institute to conduct clinical trials encompassing clinical and basic scientific research in gynecologic malignancies. These results are disseminated via publication in peer-reviewed journals. This process requires collaboration of numerous investigators located in diverse cancer research centers. Coordination of manuscript development is positioned within the Statistical and Data Center (SDC), thus allowing the SDC personnel to manage the process and refine strategies to promote earlier dissemination of results. A major initiative to improve timeliness utilizing the assignment, monitoring, and enforcement of deadlines for each phase of manuscript development is the focus of this investigation. Document improvement in timeliness via comparison of deadline compliance and time to journal submission due to expanded administrative and technologic initiatives implemented in 2006. Major steps in the publication process include generation of first draft by the First Author and submission to SDC, Co-author review, editorial review by Publications Subcommittee, response to journal critique, and revision. Associated with each step are responsibilities of First Author to write or revise, collaborating Biostatistician to perform analysis and interpretation, and assigned SDC Clinical Trials Editorial Associate to format/revise according to journal requirements. Upon the initiation of each step, a deadline for completion is assigned. In order to improve efficiency, a publications database was developed to track potential steps in manuscript development that enables the SDC Director of Administration and the Publications Subcommittee Chair to assign, monitor, and enforce deadlines. They, in turn, report progress to Group Leadership through the Operations Committee. The success of the strategies utilized to improve the GOG publication process was assessed by comparing the timeliness of each potential step in the development of primary Phase II manuscripts during 2003-2006 versus 2007-2010. Improvement was noted in 10 of 11 identified steps resulting in a cumulative average improvement of 240 days from notification of data maturity to First Author through first submission to a journal. Moreover, the average time to journal acceptance has improved by an average of 346 days. The investigation is based on only Phase II trials to ensure comparability of manuscript complexity. Nonetheless, the procedures employed are applicable to the development of any clinical trials manuscript. The assignment, monitoring, and enforcement of deadlines for all stages of manuscript development have resulted in increased efficiency and timeliness. The positioning and support of manuscript development within the SDC provide a valuable resource to authors in meeting assigned deadlines, accomplishing peer review, and complying with journal requirements.

Surgical Mortality Audit-lessons Learned in a Developing Nation.

PubMed

Bindroo, Sandiya; Saraf, Rakesh

2015-06-01

Surgical audit is a systematic, critical analysis of the quality of surgical care that is reviewed by peers against explicit criteria or recognized standards. It is used to improve surgical practice with the ultimate goal of improving patient care. As the pattern of surgical care is different in the developing world, we analyzed mortalities in a referral medical institute of India to suggest interventions for improvement. An analysis of total admissions, different surgeries, and mortalities over 1 year in an urban referral medical institute of northern India was performed, followed by "peer review" of the mortalities. Mortality rates as outcomes and classification was done to provide comparative results. Of 10,005 surgical patients, 337 (male = 221, female = 116) deaths were reported over 1 year. The overall mortality rate was 3.36%, while mortality in operative cases was 1.76%. Total deaths were classified into (1) Viable: 153 (45%), (2) Nonviable: 174 (52%), and (3) Indeterminate: 10 (3%). Exclusion of the nonviable group reduced the mortality rate from 3.36% to 1.62%. Trauma was the major cause of mortality (n = 235; 70%) as compared to other surgical patients (n = 102; 30%). Increased mortality was also associated with emergency procedures (3.66%) as compared to elective surgeries (0.34%). In conclusion, audit of mortality and morbidity helps in initiating and implementing preventive strategies to improve surgical practice and patient care, and to reduce mortality rates. The mortality and morbidity forum is an important educational activity. It should be considered a mandatory activity in all postgraduate training programs.

CRISPR recognition tool (CRT): a tool for automatic detection of clustered regularly interspaced palindromic repeats.

PubMed

Bland, Charles; Ramsey, Teresa L; Sabree, Fareedah; Lowe, Micheal; Brown, Kyndall; Kyrpides, Nikos C; Hugenholtz, Philip

2007-06-18

Clustered Regularly Interspaced Palindromic Repeats (CRISPRs) are a novel type of direct repeat found in a wide range of bacteria and archaea. CRISPRs are beginning to attract attention because of their proposed mechanism; that is, defending their hosts against invading extrachromosomal elements such as viruses. Existing repeat detection tools do a poor job of identifying CRISPRs due to the presence of unique spacer sequences separating the repeats. In this study, a new tool, CRT, is introduced that rapidly and accurately identifies CRISPRs in large DNA strings, such as genomes and metagenomes. CRT was compared to CRISPR detection tools, Patscan and Pilercr. In terms of correctness, CRT was shown to be very reliable, demonstrating significant improvements over Patscan for measures precision, recall and quality. When compared to Pilercr, CRT showed improved performance for recall and quality. In terms of speed, CRT proved to be a huge improvement over Patscan. Both CRT and Pilercr were comparable in speed, however CRT was faster for genomes containing large numbers of repeats. In this paper a new tool was introduced for the automatic detection of CRISPR elements. This tool, CRT, showed some important improvements over current techniques for CRISPR identification. CRT's approach to detecting repetitive sequences is straightforward. It uses a simple sequential scan of a DNA sequence and detects repeats directly without any major conversion or preprocessing of the input. This leads to a program that is easy to describe and understand; yet it is very accurate, fast and memory efficient, being O(n) in space and O(nm/l) in time.

Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme.

PubMed

Hansson, L; Stjernswärd, S; Svensson, B

2016-08-01

Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010-2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009. Yearly population surveys were made between 2009 and 2014 including assessments of mental health literacy, attitudes, and intended future behaviour. Two surveys were made, one including a nationally representative sample and one including a representative sample from three original campaign regions. Multiple regression analyses, also including age, gender, education, and familiarity with mental illness were made to investigate yearly changes in public stigma compared to baseline. Mental health literacy improved significantly in the campaign regions between 2009 and 2014, as did intended future behaviour. Attitudes toward mental illness also improved significantly. Improvements were also shown in the national population surveys, but the time pattern of these compared to that of the original campaign regions indicated that these changes took place mainly after the campaign had been extended to a further five Swedish regions. The results of our surveys suggest that a campaign primarily based on social contact theory and involving people with lived experience of mental illness may, even in a rather short-term perspective, have a significant positive impact on mental health literacy, attitudes, and intentions of social contact with people with mental illness. © 2016 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.

Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies.

PubMed

Nieuwenhuijse, Marc J; Nelissen, R G H H; Schoones, J W; Sedrakyan, A

2014-09-09

To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations. PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration. The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible. After assessment of 10,557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15,384 implants in 13,164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200,000 of these implants. Reported comparative data with well established alternative devices (over 1,200,000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8). We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety. © Nieuwenhuijse et al 2014.

Improving Consensus Scoring of Crowdsourced Data Using the Rasch Model: Development and Refinement of a Diagnostic Instrument.

PubMed

Brady, Christopher John; Mudie, Lucy Iluka; Wang, Xueyang; Guallar, Eliseo; Friedman, David Steven

2017-06-20

Diabetic retinopathy (DR) is a leading cause of vision loss in working age individuals worldwide. While screening is effective and cost effective, it remains underutilized, and novel methods are needed to increase detection of DR. This clinical validation study compared diagnostic gradings of retinal fundus photographs provided by volunteers on the Amazon Mechanical Turk (AMT) crowdsourcing marketplace with expert-provided gold-standard grading and explored whether determination of the consensus of crowdsourced classifications could be improved beyond a simple majority vote (MV) using regression methods. The aim of our study was to determine whether regression methods could be used to improve the consensus grading of data collected by crowdsourcing. A total of 1200 retinal images of individuals with diabetes mellitus from the Messidor public dataset were posted to AMT. Eligible crowdsourcing workers had at least 500 previously approved tasks with an approval rating of 99% across their prior submitted work. A total of 10 workers were recruited to classify each image as normal or abnormal. If half or more workers judged the image to be abnormal, the MV consensus grade was recorded as abnormal. Rasch analysis was then used to calculate worker ability scores in a random 50% training set, which were then used as weights in a regression model in the remaining 50% test set to determine if a more accurate consensus could be devised. Outcomes of interest were the percent correctly classified images, sensitivity, specificity, and area under the receiver operating characteristic (AUROC) for the consensus grade as compared with the expert grading provided with the dataset. Using MV grading, the consensus was correct in 75.5% of images (906/1200), with 75.5% sensitivity, 75.5% specificity, and an AUROC of 0.75 (95% CI 0.73-0.78). A logistic regression model using Rasch-weighted individual scores generated an AUROC of 0.91 (95% CI 0.88-0.93) compared with 0.89 (95% CI 0.86-92) for a model using unweighted scores (chi-square P value<.001). Setting a diagnostic cut-point to optimize sensitivity at 90%, 77.5% (465/600) were graded correctly, with 90.3% sensitivity, 68.5% specificity, and an AUROC of 0.79 (95% CI 0.76-0.83). Crowdsourced interpretations of retinal images provide rapid and accurate results as compared with a gold-standard grading. Creating a logistic regression model using Rasch analysis to weight crowdsourced classifications by worker ability improves accuracy of aggregated grades as compared with simple majority vote. ©Christopher John Brady, Lucy Iluka Mudie, Xueyang Wang, Eliseo Guallar, David Steven Friedman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.06.2017.

Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies

PubMed Central

Nieuwenhuijse, Marc J; Nelissen, R G H H; Schoones, J W

2014-01-01

Objective To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. Design Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations. Data sources PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration. Study selection The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible. Results After assessment of 10 557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15 384 implants in 13 164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200 000 of these implants. Reported comparative data with well established alternative devices (over 1 200 000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8). Conclusion We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety. PMID:25208953

DoD Major Automated Information Systems: Improvements Can Be Made in Applying Leading Practices for Managing Risk and Testing

DTIC Science & Technology

2017-03-01

Government Accountability Office Highlights of GAO-17-322, a report to congressional committees March 2017 DOD MAJOR AUTOMATED INFORMATION ...DOD MAJOR AUTOMATED INFORMATION SYSTEMS Improvements Can Be Made in Applying Leading Practices for Managing Risk and...Testing Report to Congressional Committees March 2017 GAO-17-322 United States Government Accountability Office United States

Searching for a new ionomer for 3D printable ionic polymer-metal composites: Aquivion as a candidate

NASA Astrophysics Data System (ADS)

Trabia, Sarah; Olsen, Zakai; Kim, Kwang J.

2017-11-01

The work presented in this paper introduces Aquivion as a potential candidate for additive manufacturing of ionomeric polymers for the application of IPMCs. First, Aquivion was characterized and compared with Nafion to show that it has the similar qualities, with the major difference being the ionic conductivity. Ionic polymer-metal composites (IPMCs) were fabricated using off-the-shelf membranes of Nafion and Aquivion. The actuation tests showed improved performance for an IPMC with Aquivion as the base compared to an IPMC with a Nafion base. With these results in mind, additive manufacturing of unique shapes using Aquivion filament was studied. A 3D printer was modified to work with Aquivion filament and the polymer was printed into various shapes. Using the printed membranes, IPMCs were fabricated using an electroless plating process. Nafion-based and printed Aquivion-based IPMCs were tested for their performance in back relaxation, frequency driven actuation, blocking force, and mechano-electric sensing. The printed Aquivion-based IPMCs performed comparably to Nafion-based IPMC in back relaxation and showed significantly improved performance in frequency driven actuation, blocking force generation, and mechano-electric sensing.

Prevalence of abortion and adverse pregnancy outcomes among working women in Korea: A cross-sectional study

PubMed Central

Park, Chulyong; Kang, Mo-Yeol; Kim, Dohyung; Park, Jaechan; Eom, Huisu

2017-01-01

Objectives To investigate incidence and distribution of major adverse reproductive health problems related to various kinds of industries in Korea and to compare risks for major reproductive outcomes to assess maternal health in working and non-working women. Methods We requested claim data from the Korean National Health Insurance. We defined reference groups as (1) non-working women and (2) workers in the education field. Women working in each industry were compared with reference groups regarding rates of miscarriage, threatened abortion, preterm labor, and intrauterine growth restriction. Logistic regression was used for multivariate analysis, and age and income adjustment was performed. Results The percentages of all adverse obstetric outcomes were higher in working women than in non-working women. Working women had higher and statistically significant adjusted odds ratios (ORs) for miscarriage in 18 of the 21 industries. The age and income-adjusted OR for miscarriage for all working women was 1.26 (95% confidence interval, 1.23–1.28). Business facilities management and business support services, manufacturing, human health and social work activities, wholesale and retail trade, and professional, scientific, and technical activities were major industries with higher adjusted ORs for adverse obstetric outcomes. Conclusions We confirmed that compared to non-working women, working women have a higher risk for adverse pregnancy outcomes. Thus, adverse pregnancy outcomes such as threatened abortion, preterm labor, and intrauterine growth restriction may be associated with working status. This exploratory study identified several industries where in-depth studies are required in future to improve occupational safety in women of reproductive age. PMID:28850585

Prevalence of abortion and adverse pregnancy outcomes among working women in Korea: A cross-sectional study.

PubMed

Park, Chulyong; Kang, Mo-Yeol; Kim, Dohyung; Park, Jaechan; Eom, Huisu; Kim, Eun-A

2017-01-01

To investigate incidence and distribution of major adverse reproductive health problems related to various kinds of industries in Korea and to compare risks for major reproductive outcomes to assess maternal health in working and non-working women. We requested claim data from the Korean National Health Insurance. We defined reference groups as (1) non-working women and (2) workers in the education field. Women working in each industry were compared with reference groups regarding rates of miscarriage, threatened abortion, preterm labor, and intrauterine growth restriction. Logistic regression was used for multivariate analysis, and age and income adjustment was performed. The percentages of all adverse obstetric outcomes were higher in working women than in non-working women. Working women had higher and statistically significant adjusted odds ratios (ORs) for miscarriage in 18 of the 21 industries. The age and income-adjusted OR for miscarriage for all working women was 1.26 (95% confidence interval, 1.23-1.28). Business facilities management and business support services, manufacturing, human health and social work activities, wholesale and retail trade, and professional, scientific, and technical activities were major industries with higher adjusted ORs for adverse obstetric outcomes. We confirmed that compared to non-working women, working women have a higher risk for adverse pregnancy outcomes. Thus, adverse pregnancy outcomes such as threatened abortion, preterm labor, and intrauterine growth restriction may be associated with working status. This exploratory study identified several industries where in-depth studies are required in future to improve occupational safety in women of reproductive age.

Philanthropic Due Diligence: Exploratory Case Studies To Improve Investments in Urban Schools.

ERIC Educational Resources Information Center

Campbell, Christine; Harvey, James; DeArmond, Michael

This paper is designed to help funders avoid some of the pitfalls of embarking on major reform efforts in troubled urban districts, proposing exploratory case studies as a tool to improve philanthropic giving. The paper explains what is behind the two major flaws of philanthropic investment (not knowing how one thinks schools will improve and not…

Does epicatechin contribute to the acute vascular function effects of dark chocolate? A randomized, crossover study.

PubMed

Dower, James I; Geleijnse, Johanna M; Kroon, Paul A; Philo, Mark; Mensink, Marco; Kromhout, Daan; Hollman, Peter C H

2016-11-01

Cocoa, rich in flavan-3-ols, improves vascular function, but the contribution of specific flavan-3-ols is unknown. We compared the effects of pure epicatechin, a major cocoa flavan-3-ol, and chocolate. In a randomized crossover study, twenty healthy men (40-80 years) were supplemented with: (1) 70g dark chocolate (150 mg epicatechin) with placebo capsules; (2) pure epicatechin capsules (2 × 50 mg epicatechin) with 75g white chocolate; and (3) placebo capsules with 75 g white chocolate (0 mg epicatechin). Vascular function (flow-mediated dilation (FMD) and augmentation index (AIx)) were measured before and 2 hours after interventions. Epicatechin metabolites time-profiles were measured in blood to calculate the bioavailability. Pure epicatechin did not significantly improve FMD (+0.75%; p = 0.10) or AIx (-2.2%; p = 0.23) compared to placebo. Dark chocolate significantly improved FMD (+0.96%; p = 0.04) and AIx (-4.6%; p = 0.02). Differences in improvements in FMD (+ 0.21%; p = 0.65) or Aix (-2.4%; p = 0.20) between pure epicatechin and dark chocolate were not significant. The bioavailability of epicatechin did not differ between pure epicatechin and dark chocolate (p = 0.14). Despite differences in epicatechin dose, improvements in vascular function after pure epicatechin and chocolate were similar and the bioavailability did not differ, suggesting a role for epicatechin. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Protocol, and practical challenges, for a randomised controlled trial comparing the impact of high intensity interval training against standard care before major abdominal surgery: study protocol for a randomised controlled trial.

PubMed

Woodfield, John; Zacharias, Matthew; Wilson, Genevieve; Munro, Fran; Thomas, Kate; Gray, Andrew; Baldi, James

2018-06-25

Risk factors, such as the number of pre-existing co-morbidities, the extent of the underlying pathology and the magnitude of the required operation, cannot be changed before surgery. It may, however, be possible to improve the cardiopulmonary fitness of the patient with an individualised exercise program. We are performing a randomised controlled trial (RCT) assessing the impact of High Intensity Interval Training (HIIT) on preoperative cardiopulmonary fitness and postoperative outcomes in patients undergoing major abdominal surgery. Consecutive eligible patients undergoing elective abdominal surgery are being randomised to HIIT or standard care in a 1:1 ratio. Participants allocated to HIIT will perform 14 exercise sessions on a stationary cycle ergometer, over a period of 4-6 weeks before surgery. The sessions, which are individualised, aim to start with ten repeated 1-min blocks of intense exercise with a target of reaching a heart rate exceeding 90% of the age predicted maximum, followed by 1 min of lower intensity cycling. As endurance improves, the duration of exercise is increased to achieve five 2-min intervals of high intensity exercise followed by 2 min of lower intensity cycling. Each training session lasts approximately 30 min. The primary endpoint, change in peak oxygen consumption (Peak VO 2 ) measured during cardiopulmonary exercise testing, is assessed at baseline and before surgery. Secondary endpoints include postoperative complications, length of hospital stay and three clinically validated scores: the surgical recovery scale; the postoperative morbidity survey; and the SF-36 quality of life score. The standard deviation for changes in Peak VO 2 will be assessed after the first 30 patients and will be used to calculate the required sample size. We want to assess if 14 sessions of HIIT is sufficient to improve Peak VO 2 by 2 mL/kg/min in patients undergoing major abdominal surgery and to explore the best clinical endpoint for a subsequent RCT designed to assess if improving Peak VO 2 will translate into improving clinical outcomes after surgery. Australian New Zealand Clinical Trials Registry, ACTRN12617000587303 . Registered on 26 April 2017.

Perioperative outcomes of elective inflow revascularization for lower extremity claudication in the American College of Surgeons National Surgical Quality Improvement Program database.

PubMed

Madenci, Arin L; Ozaki, C Keith; Gupta, Naren; Raffetto, Joseph D; Belkin, Michael; McPhee, James T

2016-09-01

We compared the early postoperative morbidity and mortality rates of contemporary aortofemoral bypass (AFB) and other inflow procedures for claudication. We identified 1974 claudicants who underwent elective AFB (n = 566) or non-AFB (nonaortofemoral bypass [NAFB]; n = 1408) inflow reconstruction using the ACS-NSQIP database (2005 to 2012). Stent placement was not routinely captured. In propensity score-matched cohorts, we analyzed the association between type of inflow surgery and 30-day postoperative outcomes. Among 824 propensity score-matched patients (AFB, n = 412; NAFB, n = 412), the 30-day mortality rate was 2.7% for AFB and .0% for NAFB (P = .0008). NAFB conferred significantly lower rates of major cardiac (.2% vs 2.4%, P = .0063), respiratory (.7% vs 10.9%, P < .0001), renal (.2% vs 1.9%, P = .0380), and septic (.5% vs 3.6%, P = .0014) complications, and fewer returns to the operating room (4.6% vs 9.9%, P = .0032), compared with AFB. Rates of major venous thrombosis, wound complications, peripheral nerve injury, and graft failure were similar between the groups. This study reports a higher contemporary short-term complication rate with AFB compared to alternative inflow revascularization, against which future study of long-term durability may be weighed. Published by Elsevier Inc.

Ampicillin/sulbactam and cefoxitin in the treatment of cutaneous and other soft-tissue abscesses in patients with or without histories of injection drug abuse.

PubMed

Talan, D A; Summanen, P H; Finegold, S M

2000-08-01

A randomized, double-blind trial compared the clinical and bacteriologic efficacy of ampicillin/sulbactam (2 g/1 g) and cefoxitin (2 g) administered intravenously every 6 h to patients with (n=49) or without (n=47) histories of injection drug abuse who presented with cutaneous or other soft-tissue infections. Cure or improvement occurred in 89.8% of ampicillin/sulbactam-treated patients, compared with 93.6% of cefoxitin-treated patients. The median time to resolution of all symptoms was 10.5 days with ampicillin/sulbactam treatment and 15.5 days with cefoxitin treatment. Mixed aerobic-anaerobic infection was encountered frequently in both treatment groups. A significantly higher percentage of Streptococcus species was found in the major abscesses of the patients with histories of injection drug abuse, compared with those without such histories (37% vs. 19%, respectively; P=.0009). Overall, ampicillin/sulbactam eradicated pathogens from the major abscesses in 100% of patients, whereas the eradication rate with cefoxitin was 97.9%. The 2 drugs were well tolerated. Ampicillin/sulbactam and cefoxitin were equally effective for the empirical treatment of cutaneous or other soft-tissue infections in injection drug abusers and patients who did not inject drugs.

An On-Demand Emergency Packet Transmission Scheme for Wireless Body Area Networks.

PubMed

Al Ameen, Moshaddique; Hong, Choong Seon

2015-12-04

The rapid developments of sensor devices that can actively monitor human activities have given rise to a new field called wireless body area network (BAN). A BAN can manage devices in, on and around the human body. Major requirements of such a network are energy efficiency, long lifetime, low delay, security, etc. Traffic in a BAN can be scheduled (normal) or event-driven (emergency). Traditional media access control (MAC) protocols use duty cycling to improve performance. A sleep-wake up cycle is employed to save energy. However, this mechanism lacks features to handle emergency traffic in a prompt and immediate manner. To deliver an emergency packet, a node has to wait until the receiver is awake. It also suffers from overheads, such as idle listening, overhearing and control packet handshakes. An external radio-triggered wake up mechanism is proposed to handle prompt communication. It can reduce the overheads and improve the performance through an on-demand scheme. In this work, we present a simple-to-implement on-demand packet transmission scheme by taking into considerations the requirements of a BAN. The major concern is handling the event-based emergency traffic. The performance analysis of the proposed scheme is presented. The results showed significant improvements in the overall performance of a BAN compared to state-of-the-art protocols in terms of energy consumption, delay and lifetime.

New scoring methodology improves the sensitivity of the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) in clinical trials.

PubMed

Verma, Nishant; Beretvas, S Natasha; Pascual, Belen; Masdeu, Joseph C; Markey, Mia K

2015-11-12

As currently used, the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) has low sensitivity for measuring Alzheimer's disease progression in clinical trials. A major reason behind the low sensitivity is its sub-optimal scoring methodology, which can be improved to obtain better sensitivity. Using item response theory, we developed a new scoring methodology (ADAS-CogIRT) for the ADAS-Cog, which addresses several major limitations of the current scoring methodology. The sensitivity of the ADAS-CogIRT methodology was evaluated using clinical trial simulations as well as a negative clinical trial, which had shown an evidence of a treatment effect. The ADAS-Cog was found to measure impairment in three cognitive domains of memory, language, and praxis. The ADAS-CogIRT methodology required significantly fewer patients and shorter trial durations as compared to the current scoring methodology when both were evaluated in simulated clinical trials. When validated on data from a real clinical trial, the ADAS-CogIRT methodology had higher sensitivity than the current scoring methodology in detecting the treatment effect. The proposed scoring methodology significantly improves the sensitivity of the ADAS-Cog in measuring progression of cognitive impairment in clinical trials focused in the mild-to-moderate Alzheimer's disease stage. This provides a boost to the efficiency of clinical trials requiring fewer patients and shorter durations for investigating disease-modifying treatments.

An On-Demand Emergency Packet Transmission Scheme for Wireless Body Area Networks

PubMed Central

Al Ameen, Moshaddique; Hong, Choong Seon

2015-01-01

The rapid developments of sensor devices that can actively monitor human activities have given rise to a new field called wireless body area network (BAN). A BAN can manage devices in, on and around the human body. Major requirements of such a network are energy efficiency, long lifetime, low delay, security, etc. Traffic in a BAN can be scheduled (normal) or event-driven (emergency). Traditional media access control (MAC) protocols use duty cycling to improve performance. A sleep-wake up cycle is employed to save energy. However, this mechanism lacks features to handle emergency traffic in a prompt and immediate manner. To deliver an emergency packet, a node has to wait until the receiver is awake. It also suffers from overheads, such as idle listening, overhearing and control packet handshakes. An external radio-triggered wake up mechanism is proposed to handle prompt communication. It can reduce the overheads and improve the performance through an on-demand scheme. In this work, we present a simple-to-implement on-demand packet transmission scheme by taking into considerations the requirements of a BAN. The major concern is handling the event-based emergency traffic. The performance analysis of the proposed scheme is presented. The results showed significant improvements in the overall performance of a BAN compared to state-of-the-art protocols in terms of energy consumption, delay and lifetime. PMID:26690161

Food safety educational intervention positively influences college students' food safety attitudes, beliefs, knowledge, and self-reported practices.

PubMed

Yarrow, Linda; Remig, Valentina M; Higgins, Mary Meck

2009-01-01

In this study, the authors evaluated college students' food safety attitudes, beliefs, knowledge, and self-reported practices and explored whether these variables were positively influenced by educational intervention. Students (n=59), were mostly seniors, health or non-health majors, and responsible for meal preparation. Subjects completed a food safety questionnaire (FSQ) prior to educational intervention, which consisted of three interactive modules. Subjects completed module pre-, post-, and post-posttests. The FSQ was also administered after exposure to intervention and five weeks later to determine changes in food safety attitudes, beliefs, knowledge, and self-reported practices. Students' FSQ attitude scores increased from 114 to 122 (p < or = .001); FSQ belief and knowledge scores improved from 86 to 98 (p < or = .001) and from 11 to 13 (p < or = .001), respectively. Food safety knowledge was also measured by module pre- and posttests, and improved significantly after intervention for all students, with health majors having the greatest increase. Intervention resulted in improved food safety self-reported practices for health majors only. The educational intervention appeared effective in improving food safety beliefs and knowledge. For health majors, attitudes and some self-reported practices improved. For all areas, the strongest effects were seen in health majors.

Comparative Study of Professional vs Mass Market Topical Products for Treatment of Facial Photodamage.

PubMed

Reich, Hilary; Wallander, Irmina; Schulte, Lacie; Goodier, Molly; Zelickson, Brian

2016-01-01

Many over the counter topical products claim to reverse the signs of cutaneous photo-damage. To date, the two most studied ingredients for improving the texture, tone, and pigmentation of the skin are topical retinoids and hydroquinone. This split face study compares a mass market skincare regimen with a prescription skin care regimen for improvement in photo damaged skin. Twenty-seven subjects with moderate photo damaged facial skin were enrolled. Each subject was consented and assigned with the mass market anti-aging system (Treatment A) to one side of the face and the prescription anti-aging system (Treatment B or Treatment C) to the other side of the face. Treatment B contained 13 subjects whom did not use 0.025% Retinol cream. Treatment C contained 14 subjects who used a 0.025% Retinol Cream. Subjects had 4 visits over 12 weeks for digital photography and surveys. Photographs were evaluated by blinded physicians. Physician objective analysis showed all three systems to have a statistically significant clinical improvement in photoaged skin seen in as little as 4 weeks of use. Participant's surveys rated the mass market system higher than both of the professional systems for visible skin changes, ease of use, and likelihood to recommend to a friend. Twelve of twenty-seven subjects preferred the mass market system for overall improvement while twelve thought each system gave the same improvement. This study demonstrates that a mass marketed skin care system can give similar clinical improvements in photo-aged skin as a professionally dispensed prescription system and the majority of participants preferred the mass-marketed system.

Quality of life in treatment-seeking patients with obsessive-compulsive disorder with and without major depressive disorder.

PubMed

Cassin, Stephanie E; Richter, Margaret A; Zhang, K Anne; Rector, Neil A

2009-07-01

To compare the quality of life of patients with obsessive-compulsive disorder (OCD) with and without depression comorbidity. Treatment-seeking outpatients (n = 56) with OCD (n = 28) or comorbid OCD and major depressive disorder (MDD) (n = 28), matched by age, sex, and antidepressant medication use, completed a multidimensional measure of quality of life. Patients with comorbid OCD and MDD reported significantly greater decrements in their subjective feelings, social relations, and a composite measure of general activities (for example, overall well-being and life satisfaction) in comparison with patients with OCD without MDD. These differences were not owing to the presence of other Axis I comorbid disorders. Treatments addressing depression comorbidity in the context of primary OCD are required to improve the quality of life of this severely affected population of OCD sufferers.

Assessment of data quality of and staff satisfaction with an electronic health record system in a developing country (Uganda): a qualitative and quantitative comparative study.

PubMed

Ndira, S P; Rosenberger, K D; Wetter, T

2008-01-01

To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative. The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures. Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. pre-test 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic). While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.

Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care.

PubMed

Dogan, Kemal; Kraaij, Linda; Aarts, Edo O; Koehestanie, Parweez; Hammink, Edwin; van Laarhoven, Cees J H M; Aufenacker, Theo J; Janssen, Ignace M C; Berends, Frits J

2015-01-01

Due to the increased incidence of morbid obesity, the demand for bariatric surgery is increasing. Therefore, the methods for optimising perioperative care for the improvement of surgical outcome and to increase efficacy are necessary. The aim of this prospective matched cohort study is to objectify the effect of the fast-track surgery (FTS) programme in patients undergoing primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery compared to conventional perioperative care (CPC). This study compared the perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary LRYGB according to international guidelines in the periods January 2011-April 2011 (CPC group) and April 2012-June 2012 (FTS group). The two groups were matched for age and sex. Primary endpoints were surgery and hospitalisation time, while secondary endpoints were intraoperative medication use and complication rates. Baseline patient characteristics for age, sex, weight and ASA classification were similar (p > 0.05) for CPC and FTS patients. BMI and waist circumference were significantly lower (p < 0.05) in the FTS compared to CPC. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 min (p < 0.001). Surgery time was reduced from 80 to 56 min (p < 0.001); mean hospital stay was reduced from 65 to 43 h (p < 0.001). Major complications occurred in 3 versus 4 % in the FTS and CPC, respectively. The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources.

Integration of ethnic minorities during group-work for vocational teachers-in-training in health studies.

PubMed

Goth, Ursula Småland; Bergsli, Oddhild; Johanesen, Else Marie

2017-01-28

To determine how to enhance integration of minority students in health education, and thereby improve intercultural communication skills and cultural sensitivity in a sample of health teacher students in Norway. After a group-work intervention and for a period of six months afterwards we followed an "action research" approach and observed 47 health teachers-in-training in their first year at the Oslo and Akershus University College during classroom interactions. Data were qualitative and comprised student self-reports and survey results along with observations from three teachers, the authors of the study. Data were analyzed using a constant comparative approach with opinion categorization and an open coding procedure, with separate analyses performed on observations from minority students, majority students, and teachers. Both ethnic majority and minority students experienced an increase in intercultural knowledge and problem-solving ability after the experience of an early intervention in their first academic year of tertiary education. Students reacted favorably to the intervention and noted in class assessments both the challenges and rewards of overcoming cultural barriers. Teacher observation notes confirmed that early intervention led to an increase in interaction and cross-cultural engagement between minority and majority students compared to previous years' classes without the intervention. Early classroom intervention to promote intercultural engagement can prevent clique formation along majority/minority lines. The method used here, tailored group assignments in ethnically diverse working groups at the very beginning of students' tertiary academic career, can be an effective approach to cultivating attitudes and skills fostering intercultural awareness and sensitivity.

Family environment and pediatric major depressive disorder.

PubMed

Ogburn, Kelin M; Sanches, Marsal; Williamson, Douglas E; Caetano, Sheila C; Olvera, Rene L; Pliszka, Steven; Hatch, John P; Soares, Jair C

2010-01-01

The risks for depression broadly include biological and environmental factors. Furthermore, having a family member suffering from major depression is also likely to have consequences for the family environment. Further research aimed at understanding the effects of having a child with major depression on family interaction patterns is warranted. We studied 31 families with an 8- to 17-year-old child (mean age +/- SD = 12.9 +/- 2.7 years) who met the DSM-IV criteria for major depressive disorder (MDD) and 34 families with no mentally ill children (mean age +/- SD = 12.6 +/- 2.9 years) or parents. Children and their parents were assessed with the K-SADS-PL (Kiddie Schedule for Affective Disorders and Schizophrenia--Present and Lifetime Version) interview. Parents completed the Moos Family Environment Scale (FES) to assess their perceptions of current family functioning. Data were analyzed using the nonparametric Wilcoxon-Mann-Whitney test. Families of MDD children showed significantly different patterns of family functioning on FES subscales representing relationships and personal growth dimensions. The families with MDD children showed higher levels of conflict (p < 0.001) and lower levels of cohesion (p < 0.001), expressiveness (p = 0.003) and active-recreational orientation (p = 0.02) compared to the families without mentally ill children. Families with MDD children show a lower degree of commitment, provide less support to one another, provide less encouragement to express feelings and have more conflicts compared to families with no mentally ill children or parents. Interventions aimed at improving family dynamics may be beneficial to MDD children and their families. Copyright 2010 S. Karger AG, Basel.

Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial.

PubMed

Diaz-Borjon, Efrain; Torres-Gomez, Armando; Essex, Margaret Noyes; Salomon, Patricia; Li, Chunming; Cheung, Raymond; Parsons, Bruce

2017-06-01

Orthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery. This subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery. Pain scores were significantly lower in the parecoxib group (n = 142) compared with placebo (n = 139) on day 2 (-22%; p < 0.001) and day 3 (-17%; p = 0.004). Pain interference with function scores were also significantly lower in the parecoxib group on day 2 (-32%; p < 0.001) and day 3 (-27%; p = 0.003) relative to placebo. Additionally, significantly less supplemental morphine was required in the parecoxib group relative to placebo through 24 h (-28%; p = 0.008) and 48 h (-33%; p < 0.001). Patients in the parecoxib group had a reduced risk of experiencing opioid-related symptoms including fatigue, drowsiness, inability to concentrate, confusion, nausea, constipation, and confusion on day 2 and/or day 3. Finally, more patients receiving parecoxib (42%) rated treatment as "excellent" compared to those receiving placebo (21%). These findings support the use of parecoxib for the management of pain following major orthopedic surgery.

Integration of ethnic minorities during group-work for vocational teachers-in-training in health studies

PubMed Central

Bergsli, Oddhild; Johanesen, Else Marie

2017-01-01

Objectives To determine how to enhance integration of minority students in health education, and thereby improve intercultural communication skills and cultural sensitivity in a sample of health teacher students in Norway. Methods After a group-work intervention and for a period of six months afterwards we followed an “action research” approach and observed 47 health teachers-in-training in their first year at the Oslo and Akershus University College during classroom interactions. Data were qualitative and comprised student self-reports and survey results along with observations from three teachers, the authors of the study. Data were analyzed using a constant comparative approach with opinion categorization and an open coding procedure, with separate analyses performed on observations from minority students, majority students, and teachers. Results Both ethnic majority and minority students experienced an increase in intercultural knowledge and problem-solving ability after the experience of an early intervention in their first academic year of tertiary education. Students reacted favorably to the intervention and noted in class assessments both the challenges and rewards of overcoming cultural barriers. Teacher observation notes confirmed that early intervention led to an increase in interaction and cross-cultural engagement between minority and majority students compared to previous years’ classes without the intervention. Conclusions Early classroom intervention to promote intercultural engagement can prevent clique formation along majority/minority lines. The method used here, tailored group assignments in ethnically diverse working groups at the very beginning of students’ tertiary academic career, can be an effective approach to cultivating attitudes and skills fostering intercultural awareness and sensitivity. PMID:28132033

Radiation therapy oncology group gynecologic oncology working group: comprehensive results.

PubMed

Gaffney, David K; Jhingran, Anuja; Portelance, Lorraine; Viswanathan, Akila; Schefter, Tracey; Weidhaas, Joanne; Small, William

2014-06-01

The purpose of this report was to comprehensively describe the activities of the Gynecologic Oncology Working Group within the Radiation Therapy Oncology Group (RTOG). Clinical trials will be reviewed as well as translational science and ancillary activities. During the past 40 years, a myriad of clinical trials have been performed within the RTOG with the aim of improving overall survival (OS) and decreasing morbidity in women with cervical or endometrial cancer. Major study questions have included hyperbaric oxygen, neutron radiotherapy, altered fractionation, hypoxic cell sensitization, chemosensitization, and volume-directed radiotherapy.RTOG 7920 demonstrated improvement in OS in patients with stages IB through IIB cervical carcinoma receiving prophylactic para-aortic irradiation compared to pelvic radiation alone. RTOG 9001 demonstrated that cisplatin and 5-FU chemoradiotherapy to the pelvis for advanced cervix cancer markedly improved OS compared to extended field radiotherapy alone. More recent trials have used radioprotectors, molecular-targeted therapy, and intensity-modulated radiation therapy. Ancillary studies have developed clinical target volume atlases for research protocols and routine clinical use. Worldwide practice patterns have been investigated in cervix, endometrial, and vulvar cancer through the Gynecologic Cancer Intergroup. Translational studies have focused on immunohistochemical markers, changes in gene expression, and miRNA patterns impacting prognosis.The RTOG gynecologic working group has performed clinical trials that have defined the standard of care, improved survival, and added to our understanding of the biology of cervical and endometrial cancers.

Troposphere gradients from the ECMWF in VLBI analysis

NASA Astrophysics Data System (ADS)

Boehm, Johannes; Schuh, Harald

2007-06-01

Modeling path delays in the neutral atmosphere for the analysis of Very Long Baseline Interferometry (VLBI) observations has been improved significantly in recent years by the use of elevation-dependent mapping functions based on data from numerical weather models. In this paper, we present a fast way of extracting both, hydrostatic and wet, linear horizontal gradients for the troposphere from data of the European Centre for Medium-range Weather Forecasts (ECMWF) model, as it is realized at the Vienna University of Technology on a routine basis for all stations of the International GNSS (Global Navigation Satellite Systems) Service (IGS) and International VLBI Service for Geodesy and Astrometry (IVS) stations. This approach only uses information about the refractivity gradients at the site vertical, but no information from the line-of-sight. VLBI analysis of the CONT02 and CONT05 campaigns, as well as all IVS-R1 and IVS-R4 sessions in the first half of 2006, shows that fixing these a priori gradients improves the repeatability for 74% (40 out of 54) of the VLBI baseline lengths compared to fixing zero or constant a priori gradients, and improves the repeatability for the majority of baselines compared to estimating 24-h offsets for the gradients. Only if 6-h offsets are estimated, the baseline length repeatabilities significantly improve, no matter which a priori gradients are used.

Novel Automated Blood Separations Validate Whole Cell Biomarkers

PubMed Central

Burger, Douglas E.; Wang, Limei; Ban, Liqin; Okubo, Yoshiaki; Kühtreiber, Willem M.; Leichliter, Ashley K.; Faustman, Denise L.

2011-01-01

Background Progress in clinical trials in infectious disease, autoimmunity, and cancer is stymied by a dearth of successful whole cell biomarkers for peripheral blood lymphocytes (PBLs). Successful biomarkers could help to track drug effects at early time points in clinical trials to prevent costly trial failures late in development. One major obstacle is the inaccuracy of Ficoll density centrifugation, the decades-old method of separating PBLs from the abundant red blood cells (RBCs) of fresh blood samples. Methods and Findings To replace the Ficoll method, we developed and studied a novel blood-based magnetic separation method. The magnetic method strikingly surpassed Ficoll in viability, purity and yield of PBLs. To reduce labor, we developed an automated platform and compared two magnet configurations for cell separations. These more accurate and labor-saving magnet configurations allowed the lymphocytes to be tested in bioassays for rare antigen-specific T cells. The automated method succeeded at identifying 79% of patients with the rare PBLs of interest as compared with Ficoll's uniform failure. We validated improved upfront blood processing and show accurate detection of rare antigen-specific lymphocytes. Conclusions Improving, automating and standardizing lymphocyte detections from whole blood may facilitate development of new cell-based biomarkers for human diseases. Improved upfront blood processes may lead to broad improvements in monitoring early trial outcome measurements in human clinical trials. PMID:21799852

Levomilnacipran Extended-Release Treatment in Patients With Major Depressive Disorder: Improvements in Functional Impairment Categories

PubMed Central

Gommoll, Carl P.; Chen, Changzheng; Greenberg, William M.; Ruth, Adam

2015-01-01

Objective: In this post hoc analysis, improvement in functional impairment in patients with major depressive disorder (MDD) treated with levomilnacipran extended release (ER) was evaluated by assessing shifts from more severe to less severe functional impairment categories on individual Sheehan Disability Scale (SDS) subscales. Method: SDS data were pooled from 5 phase II/III studies conducted between December 2006 and March 2012 of levomilnacipran ER versus placebo in adult patients with MDD (DSM-IV-TR criteria). Proportions of patients shifting from moderate-extreme baseline impairment (score ≥ 4) to mild-no impairment (score ≤ 3) at end of treatment were assessed for each SDS subscale. Proportions of patients shifting from marked-extreme (score ≥ 7) baseline impairment to moderate-no (score ≤ 6) or mild-no impairment (score ≤ 3) at end of treatment, and shifts in which patients worsened from moderate-no to marked-extreme impairment, were also evaluated. Results: A significantly higher proportion of patients treated with levomilnacipran ER than placebo-treated patients improved from more severe categories of functional impairment at baseline to less severe impairment categories across all SDS subscales: work/school, social life, and family life/home responsibilities (P < .01). Depending on the SDS subscale, 48%–55% of levomilnacipran ER–treated patients with moderate-extreme impairment at baseline improved to mild or no impairment, compared with no more than 40% of placebo patients on any subscale. Almost half (42%–47%) of levomilnacipran ER–treated patients versus only about one-third (29%–34%) of placebo patients improved from marked-extreme to mild or no impairment across functional domains. Conclusions: These results suggest that functional improvement was observed across the SDS functional domains. To our knowledge, this is the first such categorical analysis of functional improvement, as measured by the SDS, for an antidepressant. Trial Registration: ClinicalTrials.gov identifiers: NCT00969709, NCT01377194, NCT00969150, and NCT01034462 and EudraCT identifier: 2006–002404-34 PMID:26644957

The diagnosis and management of pathological anxiety.

PubMed

Andrews, G

1990-06-18

The anxiety disorders are common reasons for patients approaching their doctors for help. While benzodiazepines used to be the treatments most commonly used, increasing concern about the wisdom of prescribing these drugs means that other treatments have to be considered. A differential diagnostic schema for patients who complain of anxiety is presented and an outline for counselling these patients is described. Treatment of the four major anxiety disorders is evaluated, and the efficacy of drug treatment compared to various levels of behaviour therapy. Cognitive behaviour therapy is recommended for all four disorders on the grounds of a short-term effectiveness comparable to drug therapy and evidence for stability of improvement after treatment has concluded, evidence that is lacking for the drug therapies.

New approaches to the representation and analysis of phenotype knowledge in human diseases and their animal models.

PubMed

Schofield, Paul N; Sundberg, John P; Hoehndorf, Robert; Gkoutos, Georgios V

2011-09-01

The systematic investigation of the phenotypes associated with genotypes in model organisms holds the promise of revealing genotype-phenotype relations directly and without additional, intermediate inferences. Large-scale projects are now underway to catalog the complete phenome of a species, notably the mouse. With the increasing amount of phenotype information becoming available, a major challenge that biology faces today is the systematic analysis of this information and the translation of research results across species and into an improved understanding of human disease. The challenge is to integrate and combine phenotype descriptions within a species and to systematically relate them to phenotype descriptions in other species, in order to form a comprehensive understanding of the relations between those phenotypes and the genotypes involved in human disease. We distinguish between two major approaches for comparative phenotype analyses: the first relies on evolutionary relations to bridge the species gap, while the other approach compares phenotypes directly. In particular, the direct comparison of phenotypes relies heavily on the quality and coherence of phenotype and disease databases. We discuss major achievements and future challenges for these databases in light of their potential to contribute to the understanding of the molecular mechanisms underlying human disease. In particular, we discuss how the use of ontologies and automated reasoning can significantly contribute to the analysis of phenotypes and demonstrate their potential for enabling translational research.

Are students' impressions of improved learning through active learning methods reflected by improved test scores?

PubMed

Everly, Marcee C

2013-02-01

To report the transformation from lecture to more active learning methods in a maternity nursing course and to evaluate whether student perception of improved learning through active-learning methods is supported by improved test scores. The process of transforming a course into an active-learning model of teaching is described. A voluntary mid-semester survey for student acceptance of the new teaching method was conducted. Course examination results, from both a standardized exam and a cumulative final exam, among students who received lecture in the classroom and students who had active learning activities in the classroom were compared. Active learning activities were very acceptable to students. The majority of students reported learning more from having active-learning activities in the classroom rather than lecture-only and this belief was supported by improved test scores. Students who had active learning activities in the classroom scored significantly higher on a standardized assessment test than students who received lecture only. The findings support the use of student reflection to evaluate the effectiveness of active-learning methods and help validate the use of student reflection of improved learning in other research projects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Reconstructed Image Spatial Resolution of Multiple Coincidences Compton Imager

NASA Astrophysics Data System (ADS)

Andreyev, Andriy; Sitek, Arkadiusz; Celler, Anna

2010-02-01

We study the multiple coincidences Compton imager (MCCI) which is based on a simultaneous acquisition of several photons emitted in cascade from a single nuclear decay. Theoretically, this technique should provide a major improvement in localization of a single radioactive source as compared to a standard Compton camera. In this work, we investigated the performance and limitations of MCCI using Monte Carlo computer simulations. Spatial resolutions of the reconstructed point source have been studied as a function of the MCCI parameters, including geometrical dimensions and detector characteristics such as materials, energy and spatial resolutions.

Materials for Advanced Turbine Engines. Volume 1; Power Metallurgy Rene 95 Rotating Turbine Engine Parts

NASA Technical Reports Server (NTRS)

Pfouts, W. R.; Shamblen, C. E.; Mosier, J. S.; Peebles, R. E.; Gorsler, R. W.

1979-01-01

An attempt was made to improve methods for producing powder metallurgy aircraft gas turbine engine parts from the nickel base superalloy known as Rene 95. The parts produced were the high pressure turbine aft shaft for the CF6-50 engine and the stages 5 through 9 compressor disk forgings for the CFM56/F101 engines. A 50% cost reduction was achieved as compared to conventional cast and wrought processing practices. An integrated effort involving several powder producers and a major forging source were included.

Aerosol Chemistry over a High Altitude Station at Northeastern Himalayas, India

PubMed Central

Chatterjee, Abhijit; Adak, Anandamay; Singh, Ajay K.; Srivastava, Manoj K.; Ghosh, Sanjay K.; Tiwari, Suresh; Devara, Panuganti C. S.; Raha, Sibaji

2010-01-01

Background There is an urgent need for an improved understanding of the sources, distributions and properties of atmospheric aerosol in order to control the atmospheric pollution over northeastern Himalayas where rising anthropogenic interferences from rapid urbanization and development is becoming an increasing concern. Methodology/Principal Findings An extensive aerosol sampling program was conducted in Darjeeling (altitude ∼2200 meter above sea level (masl), latitude 27°01′N and longitude 88°15′E), a high altitude station in northeastern Himalayas, during January–December 2005. Samples were collected using a respirable dust sampler and a fine dust sampler simultaneously. Ion chromatograph was used to analyze the water soluble ionic species of aerosol. The average concentrations of fine and coarse mode aerosol were found to be 29.5±20.8 µg m−3 and 19.6±11.1 µg m−3 respectively. Fine mode aerosol dominated during dry seasons and coarse mode aerosol dominated during monsoon. Nitrate existed as NH4NO3 in fine mode aerosol during winter and as NaNO3 in coarse mode aerosol during monsoon. Gas phase photochemical oxidation of SO2 during premonsoon and aqueous phase oxidation during winter and postmonsoon were the major pathways for the formation of SO4 2− in the atmosphere. Long range transport of dust aerosol from arid regions of western India was observed during premonsoon. The acidity of fine mode aerosol was higher in dry seasons compared to monsoon whereas the coarse mode acidity was higher in monsoon compared to dry seasons. Biomass burning, vehicular emissions and dust particles were the major types of aerosol from local and continental regions whereas sea salt particles were the major types of aerosol from marine source regions. Conclusions/Significance The year-long data presented in this paper provide substantial improvements to the heretofore poor knowledge regarding aerosol chemistry over northeastern Himalayas, and should be useful to policy makers in making control strategies. PMID:20585397

Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders.

PubMed

Fristad, Mary A; Verducci, Joseph S; Walters, Kimberly; Young, Matthew E

2009-09-01

Childhood mood disorders lack sufficient evidence-based treatments. While psychosocial treatments are recommended for both childhood depression and bipolar disorder, empirical support is scarce. To determine whether adjunctive multifamily psychoeducational psychotherapy would improve outcome for children aged 8 to 12 years with depression or bipolar disorder. One hundred sixty-five children were studied in a randomized controlled trial of multifamily psychoeducational psychotherapy plus treatment as usual (n = 78) compared with a wait-list control (WLC) condition plus treatment as usual (n = 87). Assessments occurred at baseline and at 6, 12, and 18 months. Intervention occurred between baseline and 6 months for the immediate treatment group and between 12 and 18 months for the WLC group. University medical center. Children were recruited from mental health and physical health care providers, media contacts, and word of mouth. All had a major mood disorder (major depressive disorder or dysthymic disorder, 30%; bipolar disorder type I, type II, or not otherwise specified, 70%). Intervention Children and 1 or more parents participated in eight 90-minute multifamily psychoeducational psychotherapy sessions. Parent and child groups met separately but began and ended sessions together. The Mood Severity Index (MSI) combines Mania Rating Scale and Children's Depression Rating Scale-Revised scores. Multifamily psychoeducational psychotherapy plus treatment as usual was associated with lower MSI scores at follow-up in intent-to-treat analyses compared with WLC plus treatment as usual (MSI: chi(2)(1) = 4.55; P = .03). The WLC group showed a similar decrease in MSI scores 1 year later, when also following their treatment (MSI decrease = 3.24 units per 6 months in the immediate treatment group and 3.50 units per 6 months in the WLC group). Brief, adjunctive psychoeducational group psychotherapy is associated with improved outcome for children aged 8 to 12 years with major mood disorders. Trial Registration clinicaltrials.gov Identifier: NCT00050557.

Aerosol chemistry over a high altitude station at northeastern Himalayas, India.

PubMed

Chatterjee, Abhijit; Adak, Anandamay; Singh, Ajay K; Srivastava, Manoj K; Ghosh, Sanjay K; Tiwari, Suresh; Devara, Panuganti C S; Raha, Sibaji

2010-06-16

There is an urgent need for an improved understanding of the sources, distributions and properties of atmospheric aerosol in order to control the atmospheric pollution over northeastern Himalayas where rising anthropogenic interferences from rapid urbanization and development is becoming an increasing concern. An extensive aerosol sampling program was conducted in Darjeeling (altitude approximately 2200 meter above sea level (masl), latitude 27 degrees 01'N and longitude 88 degrees 15'E), a high altitude station in northeastern Himalayas, during January-December 2005. Samples were collected using a respirable dust sampler and a fine dust sampler simultaneously. Ion chromatograph was used to analyze the water soluble ionic species of aerosol. The average concentrations of fine and coarse mode aerosol were found to be 29.5+/-20.8 microg m(-3) and 19.6+/-11.1 microg m(-3) respectively. Fine mode aerosol dominated during dry seasons and coarse mode aerosol dominated during monsoon. Nitrate existed as NH(4)NO(3) in fine mode aerosol during winter and as NaNO(3) in coarse mode aerosol during monsoon. Gas phase photochemical oxidation of SO(2) during premonsoon and aqueous phase oxidation during winter and postmonsoon were the major pathways for the formation of SO(4)(2-) in the atmosphere. Long range transport of dust aerosol from arid regions of western India was observed during premonsoon. The acidity of fine mode aerosol was higher in dry seasons compared to monsoon whereas the coarse mode acidity was higher in monsoon compared to dry seasons. Biomass burning, vehicular emissions and dust particles were the major types of aerosol from local and continental regions whereas sea salt particles were the major types of aerosol from marine source regions. The year-long data presented in this paper provide substantial improvements to the heretofore poor knowledge regarding aerosol chemistry over northeastern Himalayas, and should be useful to policy makers in making control strategies.

Improving the Efficiency of Free Energy Calculations in the Amber Molecular Dynamics Package.

PubMed

Kaus, Joseph W; Pierce, Levi T; Walker, Ross C; McCammont, J Andrew

2013-09-10

Alchemical transformations are widely used methods to calculate free energies. Amber has traditionally included support for alchemical transformations as part of the sander molecular dynamics (MD) engine. Here we describe the implementation of a more efficient approach to alchemical transformations in the Amber MD package. Specifically we have implemented this new approach within the more computational efficient and scalable pmemd MD engine that is included with the Amber MD package. The majority of the gain in efficiency comes from the improved design of the calculation, which includes better parallel scaling and reduction in the calculation of redundant terms. This new implementation is able to reproduce results from equivalent simulations run with the existing functionality, but at 2.5 times greater computational efficiency. This new implementation is also able to run softcore simulations at the λ end states making direct calculation of free energies more accurate, compared to the extrapolation required in the existing implementation. The updated alchemical transformation functionality will be included in the next major release of Amber (scheduled for release in Q1 2014) and will be available at http://ambermd.org, under the Amber license.

Chronic intermittent fasting improves cognitive functions and brain structures in mice.

PubMed

Li, Liaoliao; Wang, Zhi; Zuo, Zhiyi

2013-01-01

Obesity is a major health issue. Obesity started from teenagers has become a major health concern in recent years. Intermittent fasting increases the life span. However, it is not known whether obesity and intermittent fasting affect brain functions and structures before brain aging. Here, we subjected 7-week old CD-1 wild type male mice to intermittent (alternate-day) fasting or high fat diet (45% caloric supplied by fat) for 11 months. Mice on intermittent fasting had better learning and memory assessed by the Barnes maze and fear conditioning, thicker CA1 pyramidal cell layer, higher expression of drebrin, a dendritic protein, and lower oxidative stress than mice that had free access to regular diet (control mice). Mice fed with high fat diet was obese and with hyperlipidemia. They also had poorer exercise tolerance. However, these obese mice did not present significant learning and memory impairment or changes in brain structures or oxidative stress compared with control mice. These results suggest that intermittent fasting improves brain functions and structures and that high fat diet feeding started early in life does not cause significant changes in brain functions and structures in obese middle-aged animals.

Chronic Intermittent Fasting Improves Cognitive Functions and Brain Structures in Mice

PubMed Central

Li, Liaoliao; Wang, Zhi; Zuo, Zhiyi

2013-01-01

Obesity is a major health issue. Obesity started from teenagers has become a major health concern in recent years. Intermittent fasting increases the life span. However, it is not known whether obesity and intermittent fasting affect brain functions and structures before brain aging. Here, we subjected 7-week old CD-1 wild type male mice to intermittent (alternate-day) fasting or high fat diet (45% caloric supplied by fat) for 11 months. Mice on intermittent fasting had better learning and memory assessed by the Barnes maze and fear conditioning, thicker CA1 pyramidal cell layer, higher expression of drebrin, a dendritic protein, and lower oxidative stress than mice that had free access to regular diet (control mice). Mice fed with high fat diet was obese and with hyperlipidemia. They also had poorer exercise tolerance. However, these obese mice did not present significant learning and memory impairment or changes in brain structures or oxidative stress compared with control mice. These results suggest that intermittent fasting improves brain functions and structures and that high fat diet feeding started early in life does not cause significant changes in brain functions and structures in obese middle-aged animals. PMID:23755298

Radiation Dose Assessments of Solar Particle Events with Spectral Representation at High Energies for the Improvement of Radiation Protection

NASA Technical Reports Server (NTRS)

Kim, Myung-Hee; Atwell, William; Tylka, Allan J.; Dietrich, William F.; Cucinotta, Francis A.

2010-01-01

For radiation dose assessments of major solar particle events (SPEs), spectral functional forms of SPEs have been made by fitting available satellite measurements up to approx.100 MeV. However, very high-energy protons (above 500 MeV) have been observed with neutron monitors (NMs) in ground level enhancements (GLEs), which generally present the most severe radiation hazards to astronauts. Due to technical difficulties in converting NM data into absolutely normalized fluence measurements, those functional forms were made with little or no use of NM data. A new analysis of NM data has found that a double power law in rigidity (the so-called Band function) generally provides a satisfactory representation of the combined satellite and NM data from approx.10 MeV to approx.10 GeV in major SPEs (Tylka & Dietrich 2009). We use the Band function fits to re-assess human exposures from large SPEs. Using different spectral representations of large SPEs, variations of exposure levels were compared. The results can be applied to the development of approaches of improved radiation protection for astronauts, as well as the optimization of mission planning and shielding for future space missions.

Ceramic on ceramic arthroplasty of the hip: new materials confirm appropriate use in young patients.

PubMed

Sentuerk, U; von Roth, P; Perka, C

2016-01-01

The leading indication for revision total hip arthroplasty (THA) remains aseptic loosening owing to wear. The younger, more active patients currently undergoing THA present unprecedented demands on the bearings. Ceramic-on-ceramic (CoC) bearings have consistently shown the lowest rates of wear. The recent advances, especially involving alumina/zirconia composite ceramic, have led to substantial improvements and good results in vitro. Alumina/zirconia composite ceramics are extremely hard, scratch resistant and biocompatible. They offer a low co-efficient of friction and superior lubrication and lower rates of wear compared with other bearings. The major disadvantage is the risk of fracture of the ceramic. The new composite ceramic has reduced the risk of fracture of the femoral head to 0.002%. The risk of fracture of the liner is slightly higher (0.02%). Assuming that the components are introduced without impingement, CoC bearings have major advantages over other bearings. Owing to the superior hardness, they produce less third body wear and are less vulnerable to intra-operative damage. The improved tribology means that CoC bearings are an excellent choice for young, active patients requiring THA. ©2016 The British Editorial Society of Bone & Joint Surgery.

Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa.

PubMed

Dayyabu, Aliyu Labaran; Murtala, Yusuf; Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Levene, Malcolm I; Brent, Robert L; Monni, Giovanni; Sen, Cihat; Makatsariya, Alexander; Chervenak, Frank A

2018-05-29

Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.

Improving the Efficiency of Free Energy Calculations in the Amber Molecular Dynamics Package

PubMed Central

Pierce, Levi T.; Walker, Ross C.; McCammont, J. Andrew

2013-01-01

Alchemical transformations are widely used methods to calculate free energies. Amber has traditionally included support for alchemical transformations as part of the sander molecular dynamics (MD) engine. Here we describe the implementation of a more efficient approach to alchemical transformations in the Amber MD package. Specifically we have implemented this new approach within the more computational efficient and scalable pmemd MD engine that is included with the Amber MD package. The majority of the gain in efficiency comes from the improved design of the calculation, which includes better parallel scaling and reduction in the calculation of redundant terms. This new implementation is able to reproduce results from equivalent simulations run with the existing functionality, but at 2.5 times greater computational efficiency. This new implementation is also able to run softcore simulations at the λ end states making direct calculation of free energies more accurate, compared to the extrapolation required in the existing implementation. The updated alchemical transformation functionality will be included in the next major release of Amber (scheduled for release in Q1 2014) and will be available at http://ambermd.org, under the Amber license. PMID:24185531

Environmental Lessons from China: Finding Promising Policies 
in Unlikely Places

PubMed Central

Zhang, Junfeng

2011-01-01

Background: Alongside the major health risks posed by environmental pollution in China are recent achievements on several environmental issues that have affluent Western nations racing to catch up. The country has propelled itself to a position of leadership in clean energy and efficiency, for instance, with important consequences for public health. Objectives: We comment on China’s challenges and recent accomplishments in addressing environmental problems from domestic pollution to global climate change. We compare China’s commitment to clean energy technology with that of other leading nations and discuss key achievements in other areas, including vehicle efficiency standards and transportation policy. Discussion: We discuss policy directions that would secure much-needed improvements to environmental quality and health in China, along with actions that could motivate global action on issues of energy conservation and pollution reduction. Conclusions: A comprehensive regulatory and institutional framework for environmental policy is within reach in China but will require addressing major hurdles such as the lack of an independent monitoring mechanism and the need for greater transparency and enforcement in environmental matters. Meanwhile, China can continue to set important examples by investing in renewable energy, improving energy efficiency, and limiting greenhouse gas emissions. PMID:21402514

Cooperative Learning in Reservoir Simulation Classes: Overcoming Disparate Entry Skills

NASA Astrophysics Data System (ADS)

Awang, Mariyamni

2006-10-01

Reservoir simulation is one of the core courses in the petroleum engineering curriculum and it requires knowledge and skills in three major disciplines, namely programming, numerical methods and reservoir engineering. However, there were often gaps in the students' readiness to undertake the course, even after completing the necessary requirements. The disparate levels of competency of the good and poor students made it difficult to target a certain level. Cooperative learning in the form of projects and peer teaching was designed to address the major concern of disparate entry skills, and at the same time the method used should also succeed in keeping students interest in class, developing communication skills and improving self-learning. Slower and weaker students were expected to benefit from being taught by good students, who were better prepared, and good students would gain deeper comprehension of the subject matter. From evaluations, the approach was considered successful since the overall passing rate was greater than 95% compared to previous years of around 70-80%. It had also succeeded in improving the learning environment in class. Future simulation classes will continue to use the cooperative approach with minor adjustments.

Unilateral pedunculopontine stimulation improves falls in Parkinson's disease.

PubMed

Moro, Elena; Hamani, Clement; Poon, Yu-Yan; Al-Khairallah, Thamar; Dostrovsky, Jonathan O; Hutchison, William D; Lozano, Andres M

2010-01-01

Postural instability and falls are a major source of disability in patients with advanced Parkinson's disease. These problems are currently not well addressed by either pharmacotherapy nor by subthalamic nucleus deep-brain stimulation surgery. The neuroanatomical substrates of posture and gait are poorly understood but a number of important observations suggest a major role for the pedunculopontine nucleus and adjacent areas in the brainstem. We conducted a double-blinded evaluation of unilateral pedunculopontine nucleus deep-brain stimulation in a pilot study in six advanced Parkinson's disease patients with significant gait and postural abnormalities. There was no significant difference in the double-blinded on versus off stimulation Unified Parkinson's Disease Rating Scale motor scores after 3 or 12 months of continuous stimulation and no improvements in the Unified Parkinson's Disease Rating Scale part III scores compared to baseline. In contrast, patients reported a significant reduction in falls in the on and off medication states both at 3 and 12 months after pedunculopontine nucleus deep-brain stimulation as captured in the Unified Parkinson's Disease Rating Scale part II scores. Our results suggest that pedunculopontine nucleus deep-brain stimulation may be effective in preventing falls in patients with advanced Parkinson's disease but that further evaluation of this procedure is required.

Perspectives on engineering strategies for improving biofuel production from microalgae--a critical review.

PubMed

Ho, Shih-Hsin; Ye, Xiaoting; Hasunuma, Tomohisa; Chang, Jo-Shu; Kondo, Akihiko

2014-12-01

Although the potential for biofuel production from microalgae via photosynthesis has been intensively investigated, information on the selection of a suitable operation strategy for microalgae-based biofuel production is lacking. Many published reports describe competitive strains and optimal culture conditions for use in biofuel production; however, the major impediment to further improvements is the absence of effective engineering strategies for microalgae cultivation and biofuel production. This comprehensive review discusses recent advances in understanding the effects of major environmental stresses and the characteristics of various engineering operation strategies on the production of biofuels (mainly biodiesel and bioethanol) using microalgae. The performances of microalgae-based biofuel-producing systems under various environmental stresses (i.e., irradiance, temperature, pH, nitrogen depletion, and salinity) and cultivation strategies (i.e., fed-batch, semi-continuous, continuous, two-stage, and salinity-gradient) are compared. The reasons for variations in performance and the underlying theories of the various production strategies are also critically discussed. The aim of this review is to provide useful information to facilitate development of innovative and feasible operation technologies for effectively increasing the commercial viability of microalgae-based biofuel production. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents

PubMed Central

Gaidos, Jill KJ; Draganov, Peter V

2009-01-01

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases. PMID:19764086

Improving energy efficiency in handheld biometric applications

NASA Astrophysics Data System (ADS)

Hoyle, David C.; Gale, John W.; Schultz, Robert C.; Rakvic, Ryan N.; Ives, Robert W.

2012-06-01

With improved smartphone and tablet technology, it is becoming increasingly feasible to implement powerful biometric recognition algorithms on portable devices. Typical iris recognition algorithms, such as Ridge Energy Direction (RED), utilize two-dimensional convolution in their implementation. This paper explores the energy consumption implications of 12 different methods of implementing two-dimensional convolution on a portable device. Typically, convolution is implemented using floating point operations. If a given algorithm implemented integer convolution vice floating point convolution, it could drastically reduce the energy consumed by the processor. The 12 methods compared include 4 major categories: Integer C, Integer Java, Floating Point C, and Floating Point Java. Each major category is further divided into 3 implementations: variable size looped convolution, static size looped convolution, and unrolled looped convolution. All testing was performed using the HTC Thunderbolt with energy measured directly using a Tektronix TDS5104B Digital Phosphor oscilloscope. Results indicate that energy savings as high as 75% are possible by using Integer C versus Floating Point C. Considering the relative proportion of processing time that convolution is responsible for in a typical algorithm, the savings in energy would likely result in significantly greater time between battery charges.

DOD Major Automated Information Systems: Improvements Can Be Made in Reporting Critical Changes and Clarifying Leadership Responsibility

DTIC Science & Technology

2016-03-01

The program’s estimated program development cost increased by 45 percent over the original acquisition program baseline due to program scope changes ...DOD MAJOR AUTOMATED INFORMATION SYSTEMS Improvements Can Be Made in Reporting Critical Changes and Clarifying...INFORMATION SYSTEMS Improvements Can Be Made in Reporting Critical Changes and Clarifying Leadership Responsibility Why GAO Did This Study The National

Advanced Atmospheric Water Vapor DIAL Detection System

NASA Technical Reports Server (NTRS)

Refaat, Tamer F.; Elsayed-Ali, Hani E.; DeYoung, Russell J. (Technical Monitor)

2000-01-01

Measurement of atmospheric water vapor is very important for understanding the Earth's climate and water cycle. The remote sensing Differential Absorption Lidar (DIAL) technique is a powerful method to perform such measurement from aircraft and space. This thesis describes a new advanced detection system, which incorporates major improvements regarding sensitivity and size. These improvements include a low noise advanced avalanche photodiode detector, a custom analog circuit, a 14-bit digitizer, a microcontroller for on board averaging and finally a fast computer interface. This thesis describes the design and validation of this new water vapor DIAL detection system which was integrated onto a small Printed Circuit Board (PCB) with minimal weight and power consumption. Comparing its measurements to an existing DIAL system for aerosol and water vapor profiling validated the detection system.

Wet air co-oxidation of decabromodiphenyl ether (BDE209) and tetrahydrofuran.

PubMed

Zhao, Hongxia; Zhang, Feifang; Qu, Baocheng; Xue, Xingya; Liang, Xinmiao

2009-09-30

The wet air co-oxidation (WACO) of a major commercial polybrominated diphenyl ether flame retardant congener, decabromodiphenyl ether (BDE209), was investigated using tetrahydrofuran (THF) as an initiator in a stainless autoclave at temperature range of 120-170 degrees C and 0.5MPa oxygen pressure. Compared to the single oxidation of BDE209 under the same conditions, the addition of THF in the reaction system greatly improved the removal efficiency of BDE209. The effect of temperature on the reaction was studied. The removals of BDE209 and Br increased with increasing temperature. In addition, the effect of NaNO(2) as the catalyst on the WACO was also investigated and the results showed that the addition of NaNO(2) could improve the Br removal efficiency.

The practice of problem-based investigative teaching reform in semiconductor physics course

NASA Astrophysics Data System (ADS)

Chen, Aiping; Wu, Gaojian; Gu, Dawei; Jiang, Hongying; Wang, Lei

2017-08-01

Semiconductor physics is an important basic course for the students of the majors of applied physics, optoelectronics, and microelectronics. The authors have been carrying out investigative-teaching reform in semiconductor physics teaching. Firstly, the teaching content was re-structured based on scientific problems. Secondly, the students were placed in groups to discuss different scientific problems and to present a few short science-reports. Thirdly, micro-lesson videos were produced for the students to study and analyze before or after class. With comparative analysis, we find out that the semiconductor-physics curriculum content was greatly enriched. In addition, the students' learning motivation and scientific thinking ability increased, and their innovation ability was improved. Overall, the teaching quality of the semiconductor physics course could be significantly improved.

[Technology to improve adherence in community pharmacy: a literature review].

PubMed

Staessen, J

2015-03-01

Drug-related problems are very common and they need some specific attention. Improper use of medication as well as poor adherence leads to side effects, interaction, increased healthcare costs,... What technologies can be used in community pharmacies to improve drug adherence? Articles were found in scientific databases Pubmed, Embase and CINAHL using a fixed search strategy. In this review 21 studies were included. The different technologies were compared with each other. Reminders using sms or smartphone were the most effective. There are already plenty of reminder systems (SMS, Email, internet, smartphone) and practical tools (medication dispensers, MEMS) available in community pharmacies. A major hurdle is the lack of the infrastructure. There needs to be invested in systems were patients are confronted with their own drug use.

Desert Express: An Analysis on Improved Customer Service

DTIC Science & Technology

1991-09-01

Nt MARQ 3,199 Of. DESERT EXPRESS: AN ANALYSIS ON IMPROVED CUSTOMER SERVICE THESIS Thomas C Thaiheim, Majo-,r USAF AFTT/GLM/LSM,/91S-64 ?Z; W...Astq vt.: tyc a l AFIT/GLM/,LSM/91S-64 DESERT EXPRESS: AN ANALYSIS ON IMPROVED CUSTOMER SERVICE THESIS Thomas C. Thalheim, Major, USAF AFIT/GLM/LSM...91S-64 Approved for public release; distribution unlimited AFIT/GLM/LSM/91S-64 DESERT EXPRESS: AN ANALYSIS ON IMPROVED CUSTOMER SERVICE THESIS

Slow sleep spindle and procedural memory consolidation in patients with major depressive disorder

PubMed Central

Nishida, Masaki; Nakashima, Yusaku; Nishikawa, Toru

2016-01-01

Introduction Evidence has accumulated, which indicates that, in healthy individuals, sleep enhances procedural memory consolidation, and that sleep spindle activity modulates this process. However, whether sleep-dependent procedural memory consolidation occurs in patients medicated for major depressive disorder remains unclear, as are the pharmacological and physiological mechanisms that underlie this process. Methods Healthy control participants (n=17) and patients medicated for major depressive disorder (n=11) were recruited and subjected to a finger-tapping motor sequence test (MST; nondominant hand) paradigm to compare the averaged scores of different learning phases (presleep, postsleep, and overnight improvement). Participants’ brain activity was recorded during sleep with 16 electroencephalography channels (between MSTs). Sleep scoring and frequency analyses were performed on the electroencephalography data. Additionally, we evaluated sleep spindle activity, which divided the spindles into fast-frequency spindle activity (12.5–16 Hz) and slow-frequency spindle activity (10.5–12.5 Hz). Result Sleep-dependent motor memory consolidation in patients with depression was impaired in comparison with that in control participants. In patients with depression, age correlated negatively with overnight improvement. The duration of slow-wave sleep correlated with the magnitude of motor memory consolidation in patients with depression, but not in healthy controls. Slow-frequency spindle activity was associated with reduction in the magnitude of motor memory consolidation in both groups. Conclusion Because the changes in slow-frequency spindle activity affected the thalamocortical network dysfunction in patients medicated for depression, dysregulated spindle generation may impair sleep-dependent memory consolidation. Our findings may help to elucidate the cognitive deficits that occur in patients with major depression both in the waking state and during sleep. PMID:26869818

The predictive ability of the CHADS2 and CHA2DS2-VASc scores for bleeding risk in atrial fibrillation: the MAQI(2) experience.

PubMed

Barnes, Geoffrey D; Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Besley, Dennis; Krol, Gregory D; Froehlich, James B; Kaatz, Scott

2014-08-01

Guidelines recommend the assessment of stroke and bleeding risk before initiating warfarin anticoagulation in patients with atrial fibrillation. Many of the elements used to predict stroke also overlap with bleeding risk in atrial fibrillation patients and it is tempting to use stroke risk scores to efficiently estimate bleeding risk. Comparison of stroke risk scores to bleeding risk scores to predict bleeding has not been thoroughly assessed. 2600 patients followed at seven anticoagulation clinics were followed from October 2009-May 2013. Five risk models (CHADS2, CHA2DS2-VASc, HEMORR2HAGES, HAS-BLED and ATRIA) were retrospectively applied to each patient. The primary outcome was the first major bleeding event. Area under the ROC curves were compared with C statistic and net reclassification improvement (NRI) analysis was performed. 110 patients experienced a major bleeding event in 2581.6 patient-years (4.5%/year). Mean follow up was 1.0±0.8years. All of the formal bleeding risk scores had a modest predictive value for first major bleeding events (C statistic 0.66-0.69), performing better than CHADS2 and CHA2DS2-VASc scores (C statistic difference 0.10 - 0.16). NRI analysis demonstrated a 52-69% and 47-64% improvement of the formal bleeding risk scores over the CHADS2 score and CHA2DS2-VASc score, respectively. The CHADS2 and CHA2DS2-VASc scores did not perform as well as formal bleeding risk scores for prediction of major bleeding in non-valvular atrial fibrillation patients treated with warfarin. All three bleeding risk scores (HAS-BLED, ATRIA and HEMORR2HAGES) performed moderately well. Copyright © 2014 Elsevier Ltd. All rights reserved.

MRI guided iron assessment and oral chelator use improve iron status in thalassemia major patients

PubMed Central

Nichols-Vinueza, Diana X.; White, Matthew T.; Powell, Andrew J.; Banka, Puja; Neufeld, Ellis J.

2017-01-01

Oral iron chelators and magnetic resonance imaging (MRI) assessment of heart and liver iron burden have become widely available since the mid 2000s, allowing for improved patient compliance with chelation and noninvasive monitoring of iron levels for titration of therapy. We evaluated the impact of these changes in our center for patients with thalassemia major and transfusional iron overload. This single center, retrospective observational study covered the period from 2005 through 2012. Liver iron content (LIC) was estimated both by a T2* method and by R2 (Ferriscan®) technique. Cardiac iron was assessed as cT2*. Forty-two patients (55% male) with transfused thalassemia and at least two MRIs were included (median age at first MRI, 17.5 y). Over a mean follow-up period of 5.2 ± 1.9 y, 190 MRIs were performed (median 4.5 per patient). Comparing baseline to last MRI, 63% of patients remained within target ranges for cT2* and LIC, and 13% improved from high values to the target range. Both the median LIC and cT2* (cR2* = 1000/cT2*) status improved over time: LIC 7.3 to 4.5 mg/g dry weight, P = 0.0004; cR2* 33.4 to 28.3 Hz, P = 0.01. Individual responses varied widely. Two patients died of heart failure during the study period. Annual MRI iron assessments and availability of oral chelators both facilitate changes in chelation dose and strategies to optimize care. PMID:24652616

Importance of awareness in improving performance of emergency medical services (EMS) systems in enhancing traffic safety: A lesson from India.

PubMed

Vasudevan, Vinod; Singh, Preeti; Basu, Samyajit

2016-10-02

India has been slow in implementing a central emergency medical services (EMS) system across the country. "108 services" is one of the most popular services that is functional under the public-private partnership model. Limited available literature shows that despite access to services, many traffic crash victims are transported using private vehicles. The objective of this study is to understand the effectiveness of 108 services from a traffic safety perspective. A questionnaire survey is conducted to understand the awareness of EMS and their function. Using traffic-related fatalities as the dependent variable, a fixed effect panel data model is developed to analyze the effectiveness of the 108 services in improving the traffic safety. The results from the survey show that, in general, people are not aware of the 108 services. A majority of the population prefers taking victims to the hospital using their personal vehicles or any other vehicles available compared to calling an ambulance. Results from panel data analysis show that despite having an efficient system, these services failed to make significant improvement in the safety of road users in the states in which their services were subscribed. The lack of awareness of an important safety service is alarming. This could be a major reason for lower utilization of 108 services for transporting victims of traffic crashes. This article shows the importance of having efficient awareness campaigns to improve the efficiency of any similar programs that are aimed to enhance the safety of a region.

Dornase alfa for cystic fibrosis.

PubMed

Yang, Connie; Chilvers, Mark; Montgomery, Mark; Nolan, Sarah J

2016-04-04

Dornase alfa is currently used as a mucolytic to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. It reduces mucus viscosity in the lungs, promoting improved clearance of secretions. This is an update of a previously published review. To determine whether the use of dornase alfa in cystic fibrosis is associated with improved mortality and morbidity compared to placebo or other medications that improve airway clearance, and to identify any adverse events associated with its use. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstracts from conferences. Date of the most recent search of the Group's Cystic Fibrosis Register: 30 November 2015.Clinicaltrials.gov was also searched to identify unpublished or ongoing trials. Date of most recent search: 28 November 2015. All randomised and quasi-randomised controlled trials comparing dornase alfa to placebo, standard therapy or other medications that improve airway clearance. Authors independently assessed trials against the inclusion criteria; two authors carried out analysis of methodological quality and data extraction. The searches identified 54 trials, of which 19 (including a total of 2565 participants) met our inclusion criteria. Three additional papers examined the healthcare cost from one of the clinical trials. Fifteen trials compared dornase alfa to placebo or no dornase alfa treatment (2447 participants); two compared daily dornase to hypertonic saline (32 participants); one compared daily dornase alfa with hypertonic saline and alternate day dornase alfa (48 participants); one compared dornase alfa to mannitol and the combination of both drugs (38 participants). Trial duration varied from six days to three years.Compared to placebo, forced expiratory volume at one second improved in the intervention groups, with significant differences at one, three, six months and two years. There was also a significant improvement in lung clearance index at one month. There was a decrease in pulmonary exacerbations compared to placebo in trials of longer duration. The quality of the evidence from placebo-controlled trials was moderate to high for outcomes of lung function and pulmonary exacerbations. Limited, low quality evidence was available for changes in quality of life from baseline. One trial that examined the cost of care, including the cost of dornase alfa, found that the cost savings from dornase alfa offset 18% to 38% of the medication costs.The results for trials comparing dornase alfa to other medications that improve airway clearance (hypertonic saline or mannitol) were mixed, with one trial showing a greater improvement in forced expiratory volume at one second for dornase alfa compared to hypertonic saline, and three trials finding no difference between medications. In the only trial to assess the combination of dornase alfa with another medication compared to dornase alone, there was no benefit seen with the combination of dornase alfa and mannitol. Evidence of dornase alfa compared to other medications was limited and the open-label design of the trials may have induced bias, therefore the quality of the evidence was judged to be low.Dornase alfa did not cause significantly more adverse effects, except voice alteration and rash. There is evidence to show that, compared with placebo, therapy with dornase alfa improves lung function in people with cystic fibrosis in trials lasting one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to hyperosmolar agents in improving lung function.

Type and extent of trans-disciplinary co-operation to improve food security, health and household environment in low and middle income countries: systematic review.

PubMed

Gaihre, Santosh; Kyle, Janet; Semple, Sean; Smith, Jo; Subedi, Madhu; Marais, Debbi

2016-10-18

Although linkages have been found between agricultural interventions and nutritional health, and the development of clean fuels and improved solid fuel stoves in reducing household air pollution and adverse health effects, the extent of the potential of combined household interventions to improve health, nutrition and the environment has not been investigated. A systematic review was conducted to identify the extent and type of community-based agricultural and household interventions aimed at improving food security, health and the household environment in low and middle income countries. A systematic search of Ovid MEDLINE, PUBMED, EMBASE and SCOPUS databases was performed. Key search words were generated reflecting the "participants, interventions, comparators, outcomes and study design" approach and a comprehensive search strategy was developed following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" recommendations. Any community-based agricultural and/or household interventions were eligible for inclusion if the focus was to improve at least one of the outcome measures of interest. All relevant study designs employing any of these interventions (alone/in combination) were included if conducted in Low and middle income countries. Review articles, and clinical and occupational studies were excluded. A total of 123 studies were included and grouped into four intervention domains; agricultural (n = 27), air quality (n = 34), water quality (n = 32), and nutritional (n = 30). Most studies were conducted in Asia (39.2 %) or Africa (34.6 %) with the remaining 26.1 % in Latin America. Very few studies (n = 11) combined interventions across more than one domain. The majority of agricultural and nutritional studies were conducted in Africa and Asia, whereas the majority of interventions to improve household air quality were conducted in Latin America. It is clear that very little trans-disciplinary research has been done with the majority of studies still being discipline specific. It also appears that certain low and middle income countries seem to focus on domain-specific interventions. The review emphasizes the need to develop holistic, cross-domain intervention packages. Further investigation of the data is being conducted to determine the effectiveness of these interventions and whether interdisciplinary interventions provide greater benefit than those that address single health or community problems.

Energy and economic implications of magnetically-levitated vehicles

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

Johnson, L.R.; Rote, D.M.

1988-01-01

Maglev systems, if implemented as ''spokes'' around the nation's major hub airports, have the potential to significantly reduce air traffic congestion. Maglev systems could improve the capacity of existing airports, obviating the need to build major new airports at a time when there is widespread public opposition to both airport expansion and new construction. Because of maglev's high speed (250-300 mph), the maglev has a logical market niche of trips between 100 and 600 miles. These short distance flights are the most energy intensive for the airlines; consequently, maglevs provide the opportunity to save 10 to 15% of the energymore » used by the scheduled airlines, through substitution of more efficient transport and reduced delays. Integrated into airline service, rather than competing with airlines, the economics of maglev systems is substantially enhanced. Indeed, a substantial portion of a national maglev system (3000 miles) around several major hub airports could be built over the next twenty years with a portion of the costs that the Federal Aviation Administration calculates are incurred by the airlines and the passengers---nearly $5 billion in 1986. Further, maglevs are the most promising large-scale application for the new class of high temperature superconductors, because of the relatively low threshold design requirements of the magnets compared to other potential applications. In addition, the new superconductors will improve maglev system reliability and may reduce capital and operating costs by as much as 10%. 2 figs.« less

Mathematical Rigor vs. Conceptual Change: Some Early Results

NASA Astrophysics Data System (ADS)

Alexander, W. R.

2003-05-01

Results from two different pedagogical approaches to teaching introductory astronomy at the college level will be presented. The first of these approaches is a descriptive, conceptually based approach that emphasizes conceptual change. This descriptive class is typically an elective for non-science majors. The other approach is a mathematically rigorous treatment that emphasizes problem solving and is designed to prepare students for further study in astronomy. The mathematically rigorous class is typically taken by science majors. It also fulfills an elective science requirement for these science majors. The Astronomy Diagnostic Test version 2 (ADT 2.0) was used as an assessment instrument since the validity and reliability have been investigated by previous researchers. The ADT 2.0 was administered as both a pre-test and post-test to both groups. Initial results show no significant difference between the two groups in the post-test. However, there is a slightly greater improvement for the descriptive class between the pre and post testing compared to the mathematically rigorous course. There was great care to account for variables. These variables included: selection of text, class format as well as instructor differences. Results indicate that the mathematically rigorous model, doesn't improve conceptual understanding any better than the conceptual change model. Additional results indicate that there is a similar gender bias in favor of males that has been measured by previous investigators. This research has been funded by the College of Science and Mathematics at James Madison University.

Drought response of Mucuna pruriens (L.) DC. inoculated with ACC deaminase and IAA producing rhizobacteria.

PubMed

Saleem, Aansa Rukya; Brunetti, Cecilia; Khalid, Azeem; Della Rocca, Gianni; Raio, Aida; Emiliani, Giovanni; De Carlo, Anna; Mahmood, Tariq; Centritto, Mauro

2018-01-01

Drought is one of the major constraints limiting agricultural production worldwide and is expected to increase in the future. Limited water availability causes significant effects to plant growth and physiology. Plants have evolved different traits to mitigate the stress imposed by drought. The presence of plant growth-promoting rhizobacteria (PGPR) could play an important role in improving plant performances and productivity under drought. These beneficial microorganisms colonize the rhizosphere of plants and increase drought tolerance by lowering ethylene formation. In the present study, we demonstrate the potential to improve the growth of velvet bean under water deficit conditions of two different strains of PGPR with ACCd (1-Aminocyclopropane-1-Carboxylate deaminase) activity isolated from rainfed farming system. We compared uninoculated and inoculated plants with PGPR to assess: a) photosynthetic performance and biomass; b) ACC content and ethylene emission from leaves and roots; c) leaf isoprene emission. Our results provided evidence that under drought conditions inoculation with PGPR containing the ACCd enzyme could improve plant growth compared to untreated plants. Ethylene emission from roots and leaves of inoculated velvet bean plants was significantly lower than uninoculated plants. Moreover, isoprene emission increased with drought stress progression and was higher in inoculated plants compared to uninoculated counterparts. These findings clearly illustrate that selected PGPR strains isolated from rainfed areas could be highly effective in promoting plant growth under drought conditions by decreasing ACC and ethylene levels in plants.

Drought response of Mucuna pruriens (L.) DC. inoculated with ACC deaminase and IAA producing rhizobacteria

PubMed Central

Khalid, Azeem; Raio, Aida; Emiliani, Giovanni; De Carlo, Anna; Mahmood, Tariq

2018-01-01

Drought is one of the major constraints limiting agricultural production worldwide and is expected to increase in the future. Limited water availability causes significant effects to plant growth and physiology. Plants have evolved different traits to mitigate the stress imposed by drought. The presence of plant growth-promoting rhizobacteria (PGPR) could play an important role in improving plant performances and productivity under drought. These beneficial microorganisms colonize the rhizosphere of plants and increase drought tolerance by lowering ethylene formation. In the present study, we demonstrate the potential to improve the growth of velvet bean under water deficit conditions of two different strains of PGPR with ACCd (1-Aminocyclopropane-1-Carboxylate deaminase) activity isolated from rainfed farming system. We compared uninoculated and inoculated plants with PGPR to assess: a) photosynthetic performance and biomass; b) ACC content and ethylene emission from leaves and roots; c) leaf isoprene emission. Our results provided evidence that under drought conditions inoculation with PGPR containing the ACCd enzyme could improve plant growth compared to untreated plants. Ethylene emission from roots and leaves of inoculated velvet bean plants was significantly lower than uninoculated plants. Moreover, isoprene emission increased with drought stress progression and was higher in inoculated plants compared to uninoculated counterparts. These findings clearly illustrate that selected PGPR strains isolated from rainfed areas could be highly effective in promoting plant growth under drought conditions by decreasing ACC and ethylene levels in plants. PMID:29447189

Improving Work Outcomes of Dysthymia (Persistent Depressive Disorder) in an Employed Population

PubMed Central

Adler, David A.; Lerner, Debra; Visco, Zachary L.; Greenhill, Annabel; Chang, Hong; Cymerman, Elina; Azocar, Francisca; Rogers, William H.

2015-01-01

Objective To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia. Method This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age ≥ 45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-minute sessions) provided work coaching and modification, care coordination and cognitive-behavioral therapy (CBT). Adjusted mixed effects models compared the WFI versus UC group pre-intervention to four-month post-intervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (PHQ-9 scores). Results Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change P < 0.001). Absence days declined by 58.3% in WFI vs. 0.0% in UC (difference in change P = .09). Mean PHQ-9 depression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change P < 0.001). Conclusion At four months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population. PMID:25892151

Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population.

PubMed

Adler, David A; Lerner, Debra; Visco, Zachary L; Greenhill, Annabel; Chang, Hong; Cymerman, Elina; Azocar, Francisca; Rogers, William H

2015-01-01

To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia. This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age: ≥45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-min sessions) provided work coaching and modification, care coordination and cognitive behavioral therapy. Adjusted mixed effects models compared the WFI vs. UC group preintervention to 4-month postintervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (Patient Health Questionnaire PHQ-9 scores). Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change: P<.001). Absence days declined by 58.3% in WFI vs. 0.0% in UC (difference in change: P=.09). Mean PHQ-9 depression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change: P<.001). At 4 months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk assessment of brine contamination to aquatic resources from energy development in glacial drift deposits: Williston Basin, USA

USGS Publications Warehouse

Preston, Todd M.; Chesley-Preston, Tara

2015-01-01

Our goal was to improve the Sheridan County assessment (SCA) and evaluate the use of this new Williston Basin assessment (WBA) across 31 counties mantled by glacial drift in the Williston Basin. To determine if the WBA model improved the SCA model, results from both assessments were compared to CI values from 37 surface and groundwater samples collected to evaluate the SCA. The WBA (R2 = 0.65) outperformed the SCA (R2 = 0.52) indicating improved model performance. Applicability across the Williston Basin was evaluated by comparing WBA results to CI values from 123 surface water samples collected from 97 sections. Based on the WBA, the majority (83.5%) of sections lacked an oil well and had minimal risk. Sections with one or more oil wells comprised low (8.4%), moderate (6.5%), or high (1.7%) risk areas. The percentage of contaminated water samples, percentage of sections with at least one contaminated sample, and the average CI value of contaminated samples increased from low to high risk indicating applicability across the Williston Basin. Furthermore, the WBA performed better compared to only the contaminated samples (R2 = 0.62) versus all samples (R2 = 0.38). This demonstrates that the WBA was successful at identifying sections, but not individual aquatic resources, with an increased risk of contamination; therefore, WBA results can prioritize future sampling within areas of increased risk.

A comparative clinical study of Siravedha and Agnikarma in management of Gridhrasi (sciatica).

PubMed

Vaneet Kumar, J; Dudhamal, Tukaram S; Gupta, Sanjay Kumar; Mahanta, Vyasadev

2014-01-01

Lifetime incidence of low back pain is 50-70% and incidence of clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of the population. Low back pain and sciatica is major cause of morbidity throughout the world. There is only conservative treatment giving short-term relief in pain or surgical intervention with side-effect. There is need to find out quick relief from pain in today's era as it affects physical as well as mental and social life of patients. In Ayurveda, various modalities are given but Agnikarma and Siravedha are supposed to give instant relief from pain. To compare the efficacy of Agnikarma and Siravedha in the management of Griidhrasi. It's an open randomized parallel group trial. A total of 30 patients, divided randomly in two groups, were treated by Agnikarma in 19 patients and Siravedha in 11 patients. Agnikarama was done at lumbosacral spine and Achilles tendon region by Panchadhatu Shalaka. Siravedha was done from four Angulas below Janu Sandhi (Knee joint). Placebo starch capsules were given to all patients. Paired t-test applied for efficacy within the group and Chi-square test to compare the efficacy of two groups. Individually both groups had given relief in cardinal symptoms of Gridhrasi. 68.42% patients showed marked improvement and 21.05% had complete relief after Agnikarma. In Siravedha, 72.73% patients had moderate improvement whereas 27.27% patient had marked improvement. Agnikarma gives better effect than Siravedha in management of Gridhrasi.

Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved.

PubMed

Sassoon, Adam; Nam, Denis; Nunley, Ryan; Barrack, Robert

2015-01-01

Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions. We asked: (1) Do patient-specific cutting blocks achieve neutral mechanical alignment more reliably during TKA when compared with conventional methods? (2) Does patient-specific instrumentation (PSI) provide financial benefit through improved surgical efficiency? (3) Does the use of patient-specific cutting blocks translate to improved clinical results after TKA when compared with conventional instrumentation? We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE® and EMBASE® with respect to patient-specific cutting blocks and their effect on alignment, cost, operative time, clinical outcome scores, complications, and survivorship. Sixteen studies (Level I-III on the levels of evidence rubric) were identified and used in addressing the first question, 13 (Level I-III) for the second question, and two (Level III) for the third question. Qualitative assessment of the selected Level I studies was performed using the modified Jadad score; Level II and III studies were rated based on the Newcastle-Ottawa scoring system. The majority of studies did not show an improvement in overall limb alignment when PSI was compared with standard instrumentation. Mixed results were seen across studies with regard to the prevalence of alignment outliers when PSI was compared with conventional cutting blocks with some studies demonstrating no difference, some showing an improvement with PSI, and a single study showing worse results with PSI. The studies demonstrated mixed results regarding the influence of PSI on operative times. Decreased operative times were not uniformly observed, and when noted, they were found to be of minimal clinical or financial significance. PSI did reliably reduce the number of instrument trays required for processing perioperatively. The accuracy of the preoperative plan, generated by the PSI manufacturers, was found lacking, often leading to multiple intraoperative changes, thereby disrupting the flow of the operation and negatively impacting efficiency. Limited data exist with regard to the effect of PSI on postoperative function, improvement in pain, and patient satisfaction. Neither of the two studies we identified provided strong evidence to support an advantage favoring the use of PSI. No identified studies addressed survivorship of components placed with PSI compared with those placed with standard instrumentation. PSI for TKA has not reliably demonstrated improvement of postoperative limb or component alignment when compared with standard instrumentation. Although decisive evidence exists to support that PSI requires fewer surgical trays, PSI has not clearly been shown to improve overall surgical efficiency or the cost-effectiveness of TKA. Mid- and long-term data regarding PSI's effect on functional outcomes and component survivorship do not exist and short-term data are scarce. Limited available literature does not clearly support any improvement of postoperative pain, activity, function, or ROM when PSI is compared with traditional instrumentation.

Global analysis of the yeast lipidome by quantitative shotgun mass spectrometry.

PubMed

Ejsing, Christer S; Sampaio, Julio L; Surendranath, Vineeth; Duchoslav, Eva; Ekroos, Kim; Klemm, Robin W; Simons, Kai; Shevchenko, Andrej

2009-02-17

Although the transcriptome, proteome, and interactome of several eukaryotic model organisms have been described in detail, lipidomes remain relatively uncharacterized. Using Saccharomyces cerevisiae as an example, we demonstrate that automated shotgun lipidomics analysis enabled lipidome-wide absolute quantification of individual molecular lipid species by streamlined processing of a single sample of only 2 million yeast cells. By comparative lipidomics, we achieved the absolute quantification of 250 molecular lipid species covering 21 major lipid classes. This analysis provided approximately 95% coverage of the yeast lipidome achieved with 125-fold improvement in sensitivity compared with previous approaches. Comparative lipidomics demonstrated that growth temperature and defects in lipid biosynthesis induce ripple effects throughout the molecular composition of the yeast lipidome. This work serves as a resource for molecular characterization of eukaryotic lipidomes, and establishes shotgun lipidomics as a powerful platform for complementing biochemical studies and other systems-level approaches.

Global comparative healthcare effectiveness research: evaluating sustainable programmes in low & middle resource settings.

PubMed

Balkrishnan, Rajesh; Chang, Jongwha; Patel, Isha; Yang, Fang; Merajver, Sofia D

2013-03-01

The need to focus healthcare expenditures on innovative and sustainable health systems that efficiently use existing effective therapies are the major drivers stimulating Comparative Effectiveness Research (CER) across the globe. Lack of adequate access and high cost of essential medicines and technologies in many countries increases morbidity and mortality and cost of care that forces people and families into poverty due to disability and out-of-pocket expenses. This review illustrates the potential of value-added global health care comparative effectiveness research in shaping health systems and health care delivery paradigms in the "global south". Enabling the development of effective CER systems globally paves the way for tangible local and regional definitions of equity in health care because CER fosters the sharing of critical assets, resources, skills, and capabilities and the development of collaborative of multi-sectorial frameworks to improve health outcomes and metrics globally.

The efficacy of the Triple P-Positive Parenting Program in improving parenting and child behavior: a comparison with two other treatment conditions.

PubMed

Bodenmann, Guy; Cina, Annette; Ledermann, Thomas; Sanders, Matthew R

2008-04-01

The aim of this randomized controlled trial was to evaluate the efficacy of an evidence-based parenting program (the Triple P-Positive Parenting Program), intending to improve parenting skills and children's well-being. Parents participating in a Group Triple P program (n=50 couples) were compared with parents of a non-treated control group (n=50 couples) and parents participating in a marital distress prevention program (couples coping enhancement training (CCET)) (n=50 couples). The two major goals of this study were (a) to evaluate the efficacy of Triple P compared with the two other treatment conditions over a time-span of 1 year and (b) to answer the question whether this program that was developed in Australia is culturally accepted by Swiss parents. Results revealed that Triple P was effective with Swiss families. Mothers of the Triple P group showed significant improvements in parenting, parenting self-esteem, and a decrease in stressors related to parenting. Women trained in Triple P also reported significantly lower rates of child's misbehavior than women of the two other conditions. However, in men only a few significant results were found. Positive effects of the relationship training (CCET) were somewhat lower than those for the Triple P. These findings are further discussed.

Improved Environmental Life Cycle Assessment of Crop Production at the Catchment Scale via a Process-Based Nitrogen Simulation Model.

PubMed

Liao, Wenjie; van der Werf, Hayo M G; Salmon-Monviola, Jordy

2015-09-15

One of the major challenges in environmental life cycle assessment (LCA) of crop production is the nonlinearity between nitrogen (N) fertilizer inputs and on-site N emissions resulting from complex biogeochemical processes. A few studies have addressed this nonlinearity by combining process-based N simulation models with LCA, but none accounted for nitrate (NO3(-)) flows across fields. In this study, we present a new method, TNT2-LCA, that couples the topography-based simulation of nitrogen transfer and transformation (TNT2) model with LCA, and compare the new method with a current LCA method based on a French life cycle inventory database. Application of the two methods to a case study of crop production in a catchment in France showed that, compared to the current method, TNT2-LCA allows delineation of more appropriate temporal limits when developing data for on-site N emissions associated with specific crops in this catchment. It also improves estimates of NO3(-) emissions by better consideration of agricultural practices, soil-climatic conditions, and spatial interactions of NO3(-) flows across fields, and by providing predicted crop yield. The new method presented in this study provides improved LCA of crop production at the catchment scale.

Impact of Motivational Pharmacotherapy on Treatment Retention among Depressed Latinos

PubMed Central

Lewis-Fernández, Roberto; Balán, Iván C.; Patel, Sapana R.; Sánchez-Lacay, J. Arturo; Alfonso, César; Gorritz, Magdaliz; Blanco, Carlos; Schmidt, Andrew; Jiang, Huiping; Schneier, Franklin; Moyers, Theresa B.

2015-01-01

Compared to non-Latino Whites, US racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed Motivational Pharmacotherapy, a novel approach that combines Motivational Interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of Motivational Pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among N=50 first-generation Latino outpatients with Major Depressive Disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients’ symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational Pharmacotherapy appears to improve Latino retention in antidepressant therapy, and should be investigated further in controlled designs. PMID:23965261

Improved LCI profile of LAB based on latest technology advances

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

Berna, J.L.; Renta, C.

1995-12-31

The first technology used to produce LAB was introduced in the early 60`s and since then a continuous optimization process has taken place on this highly competitive product on which additional cost effectiveness improvements became highly challenging. The latest technology introduced in the market (CEPSA {minus} UOP DETAL) based on a fixed bed alkylation process, has already been proved on a commercial scale. The simplicity of the new technology as compared to current ones, namely HF, has proven to be very effective in reducing substantially the impact due to several major components of the Life Cycle Inventory (LCI) in particularmore » the emissions of the overall operation. Additional improvements in other aspects like energy consumption are extremely difficult to achieve today as this parameter has already been highly optimized during the last two decades making in fact LAB a highly effective chemical in terms of energy requirements as well as on raw material consumption. The results of the first LCI of the new LAB technology indicate a reduction of CO process emissions to nearly 1/2 as compared to standard HF process as well as reduction in solid waste to 1/3 of the corresponding HF process. Important reductions have also been noticed on NOx emissions with the new technology.« less

Clinical effects of the use of a bipolar vessel sealing device for soft palate resection and tonsillectomy in dogs, with histological assessment of resected tonsillar tissue.

PubMed

Cook, D A; Moses, P A; Mackie, J T

2015-12-01

To investigate whether soft palate resection and tonsillectomy with a bipolar vessel sealing device (BVSD) improves clinical respiratory score. To document histopathological changes to tonsillar tissue following removal with a BVSD. Case series of 22 dogs with clinical signs of upper respiratory obstruction related to brachycephalic airway syndrome. Soft palate and tonsils were removed using a BVSD. Alarplasty and saccullectomy were also performed if indicated. A clinical respiratory score was assigned preoperatively, 24-h postoperatively and 5 weeks postoperatively. Excised tonsillar samples were measured and then assessed histologically for depth of tissue damage deemed to be caused by the device. Depth of tissue damage was compared between two power settings of the device. Soft palate resection and tonsillectomy with a BVSD lead to a significant improvement in respiratory scores following surgery. Depth of tissue damage was significantly less for power setting 1 compared with power setting 2. Using power setting 1, median calculated depth of tonsillar tissue damage was 3.4 mm (range 1.2-8.0). One dog experienced major complications. Soft palate resection and tonsillectomy with a BVSD led to significant improvement in clinical respiratory score. © 2015 Australian Veterinary Association.

Soy Protein Alleviates Hypertension and Fish Oil Improves Diastolic Heart Function in the Han:SPRD-Cy Rat Model of Cystic Kidney Disease.

PubMed

Ibrahim, Naser H M; Thandapilly, Sijo J; Jia, Yong; Netticadan, Thomas; Aukema, Harold

2016-05-01

Abnormalities in cardiac structure and function are very common among people with chronic kidney disease, in whom cardiovascular disease is the major cause of death. Dietary soy protein and fish oil reduce kidney disease progression in the Han:SPRD-Cy model of cystic renal disease. However, the effects of these dietary interventions in preventing alterations in cardiac structure and function due to kidney disease (reno-cardiac syndrome) in a cystic kidney disease model are not known. Therefore, weanling Han:SPRD-Cy diseased (Cy/+) and normal (+/+) rats were given diets containing either casein or soy protein, and either soy or fish oil in a three-way design for 8 weeks. Diseased rats had larger hearts, augmented left ventricular mass, and higher systolic and mean arterial blood pressure compared to the normal rats. Assessment of cardiac function using two-dimensional guided M-mode and pulse-wave Doppler echocardiography revealed that isovolumic relaxation time was prolonged in the diseased compared to normal rats, reflecting a diastolic heart dysfunction, and fish oil prevented this elevation. Soy protein resulted in a small improvement in systolic and mean arterial pressure but did not improve diastolic heart function, while fish oil prevented diastolic heart dysfunction in this model of cystic kidney disease.

The Impact of Operative Approach on Postoperative Complications Following Colectomy for Colon Caner.

PubMed

Mungo, Benedetto; Papageorge, Christina M; Stem, Miloslawa; Molena, Daniela; Lidor, Anne O

2017-08-01

Colectomy is one of the most common major abdominal procedures performed in the USA. A better understanding of risk factors and the effect of operative approach on adverse postoperative outcomes may significantly improve quality of care. Adult patients with a primary diagnosis of colon cancer undergoing colectomy were selected from the National Surgical Quality Improvement Program 2013-2015 targeted colectomy database. Patients were stratified into five groups based on specific operative approach. Univariate and multivariate analyses were used to compare the five groups and identify risk factors for 30-day anastomotic leak, readmission, and mortality. In total, 25,097 patients were included in the study, with a 3.32% anastomotic leak rate, 1.20% mortality rate, and 9.57% readmission rate. After adjusting for other factors, open surgery and conversion to open significantly increased the odds for leak, mortality, and readmission compared to laparoscopy. Additionally, smoking and chemotherapy increased the risk for leak and readmission, while total resection was associated with increased mortality and leak. Operative approach and several other potentially modifiable perioperative factors have a significant impact on risk for adverse postoperative outcomes following colectomy. To improve quality of care for these patients, efforts should be made to identify and minimize the influence of such risk factors.

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India

PubMed Central

Dixit, Jyoti; Goel, Sonu; Sharma, Vijaylakshmi

2017-01-01

Introduction: Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Results: Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Conclusion: Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services. PMID:29302557

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India.

PubMed

Dixit, Jyoti; Goel, Sonu; Sharma, Vijaylakshmi

2017-01-01

Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. A cross-sectional quantitative study was conducted from January to June 2015 among health care workers ( n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services.

Comparison of clinical causes of death with autopsy diagnosis using discrepency classification.

PubMed

Ullah, Khalil; Alamgir, Wasim

2006-12-01

To determine the usefulness of autopsy findings in the quality improvement of patients care. An observational study. Departments of Pathology and Medicine, Combined Military Hospital (CMH) Kharian, a tertiary care hospital, from January 2001 to December 2003. The clinical and necropsy findings of all the cases, who died in hospital and had undergone autopsy examination at CMH, Kharian, from January 2001 to December 2003, were retrieved from record of clinical case sheet data and autopsy record of the hospital. The two were analyzed and compared according to the discrepancy classification. The exclusion and inclusion criteria, the international classification of disease (ICD) to code deaths, the global burden of disease (GBD) system to classify and group diseases, and the Goldman discrepancy classification to compare clinical and autopsy diagnosis and classify the discrepancies, were used as described. The death rate varied from 0.94% to 1.29% and autopsy rate from 4.69% to 10.10% annually between January 2001 and December 2003. The number of cases classified according to GBD system was 3 (5%) in Group 1, 26 (43.33 %) in Group 2 and 31 (51.66 %) in Group 3. The discrepancy classes included 9 (15 %) class I major discrepancies and 3 (5 %) class II major discrepancies. Non-discrepant diagnosis was seen in 37 cases (61.66 %) and 11 cases (18.32 %) were non-classifiable. This study showed the usefulness of autopsy findings in the quality improvement of the diagnosis and management of the disease by showing only a minority of cases with discrepant diagnosis of the cause of death.

Health insurance of rural/township schoolchildren in Pinggu, Beijing: coverage rate, determinants, disparities, and sustainability.

PubMed

Zhu, Jane M; Zhu, Yiliang; Liu, Rui

2008-11-03

As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and non-farmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. It also discusses barriers to sustainable enrollment and program growth. A survey of elementary school students was conducted in Pinggu, a rural/suburban district of Beijing. Statistical analyses of association and adjusted odds ratio via logistic regression were conducted to examine various aspects of health insurance. Children's health insurance coverage rose to 54% by 2005, the rates are comparable for farmers' and non-farmer's children. However, 76% of insured farmers' children were covered under a low-premium scheme protecting only major medical events, compared to 42% among insured non-farmers' children. The low-premium schemes improved parental perceptions of children's access to and affordability of healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care. Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term.

Dissociation in Rating Negative Facial Emotions between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder.

PubMed

Chiu, Isabelle; Piguet, Olivier; Diehl-Schmid, Janine; Riedl, Lina; Beck, Johannes; Leyhe, Thomas; Holsboer-Trachsler, Edith; Berres, Manfred; Monsch, Andreas U; Sollberger, Marc

2016-11-01

Features of behavioral variant frontotemporal dementia (bvFTD) such as executive dysfunction, apathy, and impaired empathic abilities are also observed in major depressive disorder (MDD). This may contribute to the reason why early stage bvFTD is often misdiagnosed as MDD. New assessment tools are thus needed to improve early diagnosis of bvFTD. Although emotion processing is affected in bvFTD and MDD, growing evidence indicates that the pattern of emotion processing deficits varies between the two disorders. As such, emotion processing paradigms have substantial potentials to distinguish bvFTD from MDD. The current study compared 25 patients with bvFTD, 21 patients with MDD, 21 patients with Alzheimer disease (AD) dementia, and 31 healthy participants on a novel facial emotion intensity rating task. Stimuli comprised morphed faces from the Ekman and Friesen stimulus set containing faces of each sex with two different degrees of emotion intensity for each of the six basic emotions. Analyses of covariance uncovered a significant dissociation between bvFTD and MDD patients in rating the intensity of negative emotions overall (i.e., bvFTD patients underrated negative emotions overall, whereas MDD patients overrated negative emotions overall compared with healthy participants). In contrast, AD dementia patients rated negative emotions similarly to healthy participants, suggesting no impact of cognitive deficits on rating facial emotions. By strongly differentiating bvFTD and MDDpatients through negative facial emotions, this sensitive and short rating task might help improve the early diagnosis of bvFTD. Copyright © 2016 American Association for Geriatric Psychiatry. All rights reserved.

MEDRank: using graph-based concept ranking to index biomedical texts

PubMed Central

Herskovic, Jorge R.; Cohen, Trevor; Subramanian, Devika; Iyengar, M. Sriram; Smith, Jack W.; Bernstam, Elmer V.

2011-01-01

BACKGROUND As the volume of biomedical text increases exponentially, automatic indexing becomes increasingly important. However, existing approaches do not distinguish central (or core) concepts from concepts that were mentioned in passing. We focus on the problem of indexing MEDLINE records, a process that is currently performed by highly-trained humans at the National Library of Medicine (NLM). NLM indexers are assisted by a system called the Medical Text Indexer (MTI) that suggests candidate indexing terms. OBJECTIVE To improve the ability of MTI to select the core terms in MEDLINE abstracts. These core concepts are deemed to be most important and are designated as “major headings” by MEDLINE indexers. We introduce and evaluate a graph-based indexing methodology called MEDRank that generates concept graphs from biomedical text and then ranks the concepts within these graphs to identify the most important ones. METHODS We insert a MEDRank step into the MTI and compare MTI’s output with and without MEDRank to the MEDLINE indexers’ selected terms for a sample of 11,803 PubMed Central articles. We also tested whether human raters prefer terms generated by the MEDLINE indexers, MTI without MEDRank, and MTI with MEDRank for a sample of 36 PubMed Central articles. RESULTS MEDRank improved recall of major headings designated by 30% over MTI without MEDRank (0.489 vs 0.376). Overall recall was only slightly (6.5%) higher (0.490 vs 0.460) as was F2 (3%, 0.408 vs 0.396). However, overall precision was 3.9% lower (0.268 vs 0.279). Human raters preferred terms generated by MTI with MEDRank over terms generated by MTI without MEDRank (by an average of 1.00 more term per article), and preferred terms generated by MTI with MEDRank and the MEDLINE indexers at the same rate. CONCLUSIONS The addition of MEDRank to MTI significantly improved the retrieval of core concepts in MEDLINE abstracts and more closely matched human expectations compared to MTI without MEDRank. In addition, MEDRank slightly improved overall recall and F2. PMID:21439897

MEDRank: using graph-based concept ranking to index biomedical texts.

PubMed

Herskovic, Jorge R; Cohen, Trevor; Subramanian, Devika; Iyengar, M Sriram; Smith, Jack W; Bernstam, Elmer V

2011-06-01

As the volume of biomedical text increases exponentially, automatic indexing becomes increasingly important. However, existing approaches do not distinguish central (or core) concepts from concepts that were mentioned in passing. We focus on the problem of indexing MEDLINE records, a process that is currently performed by highly trained humans at the National Library of Medicine (NLM). NLM indexers are assisted by a system called the Medical Text Indexer (MTI) that suggests candidate indexing terms. To improve the ability of MTI to select the core terms in MEDLINE abstracts. These core concepts are deemed to be most important and are designated as "major headings" by MEDLINE indexers. We introduce and evaluate a graph-based indexing methodology called MEDRank that generates concept graphs from biomedical text and then ranks the concepts within these graphs to identify the most important ones. We insert a MEDRank step into the MTI and compare MTI's output with and without MEDRank to the MEDLINE indexers' selected terms for a sample of 11,803 PubMed Central articles. We also tested whether human raters prefer terms generated by the MEDLINE indexers, MTI without MEDRank, and MTI with MEDRank for a sample of 36 PubMed Central articles. MEDRank improved recall of major headings designated by 30% over MTI without MEDRank (0.489 vs. 0.376). Overall recall was only slightly (6.5%) higher (0.490 vs. 0.460) as was F(2) (3%, 0.408 vs. 0.396). However, overall precision was 3.9% lower (0.268 vs. 0.279). Human raters preferred terms generated by MTI with MEDRank over terms generated by MTI without MEDRank (by an average of 1.00 more term per article), and preferred terms generated by MTI with MEDRank and the MEDLINE indexers at the same rate. The addition of MEDRank to MTI significantly improved the retrieval of core concepts in MEDLINE abstracts and more closely matched human expectations compared to MTI without MEDRank. In addition, MEDRank slightly improved overall recall and F(2). Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A Comparison of the Beneficial Effects of Live and Heat-Inactivated Baker's Yeast on Nile Tilapia: Suggestions on the Role and Function of the Secretory Metabolites Released from the Yeast.

PubMed

Ran, Chao; Huang, Lu; Liu, Zhi; Xu, Li; Yang, Yalin; Tacon, Philippe; Auclair, Eric; Zhou, Zhigang

2015-01-01

Yeast is frequently used as a probiotic in aquaculture with the potential to substitute for antibiotics. In this study, the involvement and extent to which the viability of yeast cells and thus the secretory metabolites released from the yeast contribute to effects of baker's yeast was investigated in Nile tilapia. No yeast, live yeast or heat-inactivated baker's yeast were added to basal diets high in fishmeal and low in soybean (diet A) or low in fishmeal and high in soybean (diet B), which were fed to fish for 8 weeks. Growth, feed utilization, gut microvilli morphology, and expressions of hsp70 and inflammation-related cytokines in the intestine and head kidney were assessed. Intestinal microbiota was investigated using 16S rRNA gene pyrosequencing. Gut alkaline phosphatase (AKP) activity was measured after challenging the fish with Aeromonas hydrophila. Results showed that live yeast significantly improved FBW and WG (P < 0.05), and tended to improve FCR (P = 0.06) of fish compared to the control (no yeast). No significant differences were observed between inactivated yeast and control. Live yeast improved gut microvilli length (P < 0.001) and density (P < 0.05) while inactivated yeast did not. The hsp70 expression level in both the intestine and head kidney of fish was significantly reduced by live yeast (P < 0.05) but not inactivated yeast. Live yeast but not inactivated yeast reduced intestinal expression of tnfα (P < 0.05), tgfβ (P < 0.05 under diet A) and il1β (P = 0.08). Intestinal Lactococcus spp. numbers were enriched by both live and inactivated yeast. Lastly, both live and inactivated yeast reduced the gut AKP activity compared to the control (P < 0.001), indicating protection of the host against infection by A. hydrophila. In conclusion, secretory metabolites did not play major roles in the growth promotion and disease protection effects of yeast. Nevertheless, secretory metabolites were the major contributing factor towards improved gut microvilli morphology, relieved stress status, and reduced intestinal inflammation of Nile tilapia fed diets supplemented with baker's yeast.

Effect of propofol versus sodium thiopental on electroconvulsive therapy in major depressive disorder: a randomized double-blind controlled clinical trial.

PubMed

Purtuloğlu, Tark; Özdemir, Barbaros; Erdem, Murat; Deniz, Süleyman; Balkç, Adem; Ünlü, Gazi; Öznur, Taner

2013-03-01

To compare propofol and sodium thiopental as anesthetic agents for electroconvulsive therapy (ECT) in major depression with respect to clinical effect. Participants were composed of 96 patients with depression who were administered either propofol or sodium thiopental as an anesthetic agent for bilateral ECT. The Hamilton Depression Rating Scale was administered at baseline and after 6 treatments. Algorithm-based charge dosing was used. There was a statistically significant difference between the groups regarding postintervention Hamilton Depression Rating Scale score. The preintervention mean (SD) scores in the propofol group and the sodium thiopental group were 37.3 (2.2) and 36.7 (1.2), respectively. The postintervention mean (SD) scores in the propofol group and the sodium thiopental group were 10.7 (1.8) and 13.4 (3.3), respectively. No correlation was found between clinical response and age, weight, and body mass index. There was no association between the groups' seizure time and duration of recovery. In conclusion, propofol may improve major depressive disorder more than sodium thiopental in patients who are receiving ECT.